A comparison of attitudes to laryngeal cancer treatment outcomes: a time trade-off study

Abstract

Design

Time trade-off choice experiment.

Setting

Two large head and neck cancer centres.

Participants

Patients who have received treatment for head and neck cancer and members of the head and neck cancer multidisciplinary team.

Main outcome measures

Participants were asked to rank the outcome scenarios, assign utility values using time trade-off and rate the importance of survival on treatment choice.

Results

49 head and neck cancer patients and 73 staff members were recruited. Chemoradiotherapy (CRT) optimal outcome was the most preferred health state (34/49, 69% patients and 50/73, 68% staff) and CRT with complications was least preferred (27/49 55% patients and 51/73 70% staff). Using time trade-off, mean utility values were calculated for CRT optimal outcome (0.73 for patients, 0.77 for staff), total laryngectomy (TL) optimal outcome (0.67 for patients, 0.69 for staff), TL outcome with complications (0.46 for patients, 0.51 for staff) and CRT with complications (0.36 for patients, 0.49 for staff). The average survival advantage required for a participant to change their preferred choice was 2.6 years.

Conclusions

We have demonstrated that a significant proportion of head and neck cancer patients and staff members would not choose CRT to manage locally advanced laryngeal cancer. Staff members rated the health states associated with laryngeal cancer treatment higher than patients who have experienced them, and this is particularly evident when considering the poorer outcomes. The head and neck cancer community should develop methods of practice and decision making which incorporate elicitation and reporting of patient values as a central principle.

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