Quantity vs quality of life in laryngeal cancer: a time trade off study

Hamilton, David W., Bins, Janneke, McMeekin, Peter, Thomson, Richard G., Paleri, Vinidh and Wilson, Janet (2012) Quantity vs quality of life in laryngeal cancer: a time trade off study. Clinical Otolaryngology, 37 (S1). p. 108. ISSN 1749-4478

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Official URL: http://dx.doi.org/10.1111/j.1749-4486.2012.02512.x


Thirty years ago, McNeil concluded that patients with laryngeal cancer would trade life years to avoid total laryngectomy (TL) and maintain laryngeal speech. This influential study was never repeated, despite subsequent changes in management. We aimed to revisit her time trade off method using current treatment options.

Participants: 33 COPD patients and 39 demographically matched healthy volunteers recruited to date. Protocol: Participants ranked four model T3 laryngeal cancer treatment outcome scenarios: TL good outcome, TL with complications, chemoradiotherapy (CRT) good outcome, CRT with complications. They then assigned Utility Values to these health states using a time trade-off technique.

For 42/69 participants (61%), CRT with a good outcome was the preferred scenario. The average Utility values were ranked:
1 0.63 CRT good outcome
2 0.58 TL good outcome
3 0.34 TL with complications
4 0.31 CRT with complications
The average survival advantage required for a participant to change their preferred choice is 3.1 years.

Despite CRT being promoted near universally as the 'standard of care' for T3 laryngeal cancer, in our cohort, if given the choice, almost 40% may opt for TL with a good outcome. Conversely, CRT poor outcome is regarded as the worst health state. People's preferences are consistent - only a substantial putative survival advantage would change participants' primary treatment choice. Research is required on the relative risks of treatment to inform patient choice and participation in decision making. Meanwhile, clinicians should not assume all T3 laryngeal cancer patients want CRT.

Item Type: Article
Subjects: B900 Others in Subjects allied to Medicine
Department: Faculties > Health and Life Sciences > Nursing, Midwifery and Health
Depositing User: Becky Skoyles
Date Deposited: 13 Aug 2015 09:17
Last Modified: 12 Oct 2019 15:27
URI: http://nrl.northumbria.ac.uk/id/eprint/23562

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