Utility assessment for different clinical phases of breast cancer in Taiwan

Utility is an important index of health-related quality of life (HRQoL). The purpose of this study was to assess utility in different clinical phases of breast cancer in patients in Taiwan.

Based on a review of HRQoL literature pertaining to breast cancer and medical records of 979 breast cancer patients admitted to National Taiwan University Hospital from 1991 to 1995, a semi-open checklist describing the diagnosis and treatment activities and impacts of different clinical phases of breast cancer was constructed. The checklist was then reviewed and revised in consultation with surgeons, medical oncologists, radiation oncologists, nurses, and breast cancer patients. Thirty-one clinical and public health experts were invited to assess the utility of each phase with the visual analog scale (VAS), standard gamble (SG), and time trade-off (TTO) methods, according to the description of the average patient's life in the checklist. The Delphi technique was used to reach expert consensus.

The VAS utility scores were highest during screening phases (100 or 90), lower in phases of incidental finding of a tumor (75) and diagnosis (70), and lower still in the initial treatment phases, especially during adjuvant chemotherapy (50). The scores improved during the follow-up phases. There was a higher score for breast-conserving surgery (65) than modified radical mastectomy (60) only in the early follow-up phase. The scores for recurrence or metastasis (30) and terminal stage were considerably lower and reached the lowest level (10 in a general ward and 12.5 at home or in a hospice) among all phases. The utility scores assessed by SG and TTO were higher than those assessed by VAS.

In this study, we established a consensus among clinical and public health experts on the impact of different clinical phases of breast cancer on utility. The results of this study may be useful in cross-cultural comparisons and cost-utility analyses for breast cancer.