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Risk tolerance and attitudes toward chemotherapy: Who chooses palliative treatment when cure is possible?

Publication ,  Conference
LeBlanc, TW; Scherr, K; Wang, A; Lemmon, M; Ubel, PA
Published in: Journal of Clinical Oncology
May 20, 2017

10054 Background: Many patients with acute myeloid leukemia (AML) face a difficult choice about whether to receive palliative chemotherapy or high-dose, potentially-curative chemotherapy that poses a risk of early death. How people weigh these factors in decision-making is unknown. We hypothesized that the possibility of cure primarily drives decision-making, regardless of treatment risk. Methods: We designed an electronic survey describing two treatment paths: (1) high-dose chemotherapy with possibility of cure but a 10% risk of early death, and (2) palliative chemotherapy with no chance of cure but no risk of early death. We recruited respondents via Amazon MTurk and presented 7 scenarios in random order, varying only the likelihood of cure associated with high-dose chemotherapy. Subjects rated their preferred treatment on a 4-point Likert scale. We assessed numeracy and attitudes toward chemotherapy using validated scales, and employed attention checks for quality assurance. Results: 100 subjects completed the survey (median age 30.5; 52 female, 85 Caucasian). 46 (46%) had at least a bachelor’s degree and numeracy was generally high (median 4.75 out of 6). Respondents’ preferences for intensive chemotherapy varied with likelihood of cure, however some displayed a fixed preference for either curative or palliative treatment throughout, regardless of benefit level. For example, given a 50% likelihood of cure 20 respondents (20%) still preferred palliative therapy; similarly, with only a 1% likelihood of cure 28 respondents (28%) still preferred high-dose chemotherapy. In a multivariable model, preference for palliative chemotherapy was significantly predicted by subjects’ scores on the attitudes toward chemotherapy scale (p < 0.001), controlling for age, education, and numeracy. Conclusions: Contrary to our hypothesis, a significant proportion of subjects preferred palliative chemotherapy, even in scenarios where high-dose chemotherapy confers a high likelihood of cure. Pre-existing attitudes toward chemotherapy appear to drive patients’ decision-making, even when treatments are potentially curative. This finding may have significant implications for risk communication in oncology.

Duke Scholars

Published In

Journal of Clinical Oncology

DOI

EISSN

1527-7755

ISSN

0732-183X

Publication Date

May 20, 2017

Volume

35

Issue

15_suppl

Start / End Page

10054 / 10054

Publisher

American Society of Clinical Oncology (ASCO)

Related Subject Headings

  • Oncology & Carcinogenesis
  • 3211 Oncology and carcinogenesis
  • 1112 Oncology and Carcinogenesis
  • 1103 Clinical Sciences
 

Citation

APA
Chicago
ICMJE
MLA
NLM
LeBlanc, T. W., Scherr, K., Wang, A., Lemmon, M., & Ubel, P. A. (2017). Risk tolerance and attitudes toward chemotherapy: Who chooses palliative treatment when cure is possible? In Journal of Clinical Oncology (Vol. 35, pp. 10054–10054). American Society of Clinical Oncology (ASCO). https://doi.org/10.1200/jco.2017.35.15_suppl.10054
LeBlanc, Thomas William, Karen Scherr, Annabel Wang, Monica Lemmon, and Peter A. Ubel. “Risk tolerance and attitudes toward chemotherapy: Who chooses palliative treatment when cure is possible?” In Journal of Clinical Oncology, 35:10054–10054. American Society of Clinical Oncology (ASCO), 2017. https://doi.org/10.1200/jco.2017.35.15_suppl.10054.
LeBlanc TW, Scherr K, Wang A, Lemmon M, Ubel PA. Risk tolerance and attitudes toward chemotherapy: Who chooses palliative treatment when cure is possible? In: Journal of Clinical Oncology. American Society of Clinical Oncology (ASCO); 2017. p. 10054–10054.
LeBlanc, Thomas William, et al. “Risk tolerance and attitudes toward chemotherapy: Who chooses palliative treatment when cure is possible?Journal of Clinical Oncology, vol. 35, no. 15_suppl, American Society of Clinical Oncology (ASCO), 2017, pp. 10054–10054. Crossref, doi:10.1200/jco.2017.35.15_suppl.10054.
LeBlanc TW, Scherr K, Wang A, Lemmon M, Ubel PA. Risk tolerance and attitudes toward chemotherapy: Who chooses palliative treatment when cure is possible? Journal of Clinical Oncology. American Society of Clinical Oncology (ASCO); 2017. p. 10054–10054.

Published In

Journal of Clinical Oncology

DOI

EISSN

1527-7755

ISSN

0732-183X

Publication Date

May 20, 2017

Volume

35

Issue

15_suppl

Start / End Page

10054 / 10054

Publisher

American Society of Clinical Oncology (ASCO)

Related Subject Headings

  • Oncology & Carcinogenesis
  • 3211 Oncology and carcinogenesis
  • 1112 Oncology and Carcinogenesis
  • 1103 Clinical Sciences