Patients' preferences for chemotherapy in non-small-cell lung cancer: a systematic review

Decisions about chemotherapy for NSCLC are complex and involve trade-offs between its benefits, harms and inconveniences. We sought to find, evaluate and summarise studies quantifying the survival benefits that cancer patients judged sufficient to make chemotherapy for NSCLC worthwhile.

A search of MEDLINE identified 5 papers reporting four studies including 270 patients. Two investigators independently extracted and tabulated relevant findings from each study.

Most cancer patients were male, aged over 65 years, had primary lung cancer (65%) and had experienced chemotherapy (62%). Preferences were determined for chemotherapy in metastatic NSCLC (3 papers) and in locally advanced NSCLC (2 papers), but no studies determined preferences for adjuvant chemotherapy. Most cancer patients (>50%) judged moderate survival benefits sufficient to make chemotherapy worthwhile, for example, absolute increases of 10% in survival rates or 6 months in life expectancies. Individual patients' preferences varied widely: benefits judged sufficient ranged from very small (e.g. survival rate of 1%) to very large (e.g. survival rate of 50%). Smaller benefits were judged sufficient to make chemotherapy worthwhile for metastatic rather than locally advanced disease, for less toxic rather than more toxic chemotherapy, and in North American rather than Japanese studies. Four baseline characteristics were weakly associated with judging smaller benefits sufficient: younger age, having dependents, tertiary education and worse quality of life.

The survival benefits patients judged sufficient to make chemotherapy for NSCLC worthwhile were moderate, widely variable, and difficult to predict. Doctors should encourage patients to express their preferences when facing decisions about chemotherapy for NSCLC.