Background. Studies have shown that utilities for a particular treatment, elicited by means of a hypothetical treatment scenario, may remain stable within the same patients when examined before, during, and after experiencing that treatment (within-group stability). However, other studies have found that utilities for a particular health state may differ between patient groups who are and who are not experiencing the particular health state (between-group differences). Objective. The authors evaluated this apparent contradiction in the case of adjuvant chemotherapy for breast cancer. A related purpose was to examine whether a chemotherapy scenario adequately reflects the patients’ own experiences with chemotherapy. Method. Forty-three patients with early-stage breast cancer evaluated their actually experienced health state and a chemotherapy scenario before, during, and after undergoing adjuvant chemotherapy (chemotherapy group). A control group of 51 patients for whom chemotherapy was not part of the treatment plan was interviewed at similar points in time. Utilities were elicited by means of a visual analog scale (VAS), a chained time trade-off (TTO), and a chained standard gamble (SG). Results. The utilities for the chemotherapy scenario remained relatively stable over time in the 2 patient groups. Furthermore, the chemotherapy scenario was evaluated more positively by patients in the chemotherapy group than by control patients (e.g., utilities before chemotherapy: VAS 0.69 vs. 0.50, TTO 0.88 vs.0.50, SG 0.92 vs. 0.58, all Ps < 0.01). Finally, patients in the chemotherapy group evaluated their actually experienced health states during chemotherapy higher than the chemotherapy scenario that was assessed at the same time (VAS 0.79 vs. 0.69, TTO 0.93 vs. 0.87, SG 0.97 vs. 0.96, all Ps < 0.05). Conclusions. Both within-group stability and between-group differences were found. A possible explanation for within-group stability may be that the chemotherapy scenario did not fully correspond to the patients’ actual experiences with chemotherapy (“noncorresponding description”). Therefore, preferences did not change even when the patients’ own clinical health status had changed. The between-group differences may be explained by “anticipated adaptation.” Both explanations may work together to explain why utilities remain stable within the same patients but differ between different patient groups.
Early Breast Cancer Trialists’ Collaborative Group. Polychemotherapy for early breast cancer: an overview of the randomised trials. Lancet. 1998;352:930-942.
2.
Dodwell DJ. Adjuvant cytotoxic chemotherapy for early breast cancer: doubts and decisions. Lancet. 1998;351: 1506-1507.
3.
Hillner BE, Smith TJ. Efficacy and cost effectiveness of adjuvant chemotherapy in women with node-negative breast cancer: a decision-analysis model. N Engl J Med. 1991;324:160-168.
4.
Van der Donk J, Levendag PC, Kuijper AJ, et al.Patient participation in clinical decision-making for treatment of T3 laryngeal cancer: a comparison of state and process utilities. J Clin Oncol. 1995;13:2369-2378.
5.
Grann VR, Panageas KR, Whang W, Antman KH, Neugut AI. Decision analysis of prophylactic mastectomy and oophorectomy in BRCA1-positive or BRCA2-positive patients. J Clin Oncol. 1998;16:979-985.
6.
Goldhirsch A, Gelber RD, Simes RJ, Glasziou P, Coates AS. Costs and benefits of adjuvant therapy in breast cancer: a quality-adjusted survival analysis. J Clin Oncol. 1989;7: 36-44.
7.
Gelber RD, Goldhirsch A, Cavalli F.Quality-of-life-adjusted evaluation of adjuvant therapies for operable breast cancer. Ann Intern Med. 1991;114:621-628.
8.
Feldstein ML. Quality-of-life-adjusted survival for comparing cancer treatments: a commentary on TWiST and Q-TWiST. Cancer. 1991;67:851-854.
9.
Gelber RD, Goldhirsch A, Cole BF. Evaluation of effectiveness: Q-TWiST. Cancer Treat Rev. 1993;19(Suppl. A):73-84.
10.
Gelber RD, Cole BF, Goldhirsch A, et al.Adjuvant chemotherapy plus tamoxifen compared with tamoxifen alone for postmenopausal breast cancer: meta-analysis of quality-adjusted survival. Lancet. 1996;347:1066-1071.
11.
Kaplan RM. Quality of life assessment for cost/utility studies in cancer. Cancer Treat Rev. 1993;19(Suppl. A):85-96.
Tsevat J, Dawson NV, Matchar DB. Assessing quality of life and preferences in the seriously ill using utility theory. J Clin Epidemiol. 1990;43:73S-77S.
14.
Bombardier C, Ware J, Russel IJ, Larson M, Chalmers A, Read JL. Auranofin therapy and quality of life in patients with rheumatoid arthritis: results of a multicenter trial. Am J Med. 1986;81:565-578.
15.
Kestle J, Levine M, Depauw S, Kelleher L.A time tradeoff method for measuring quality of life in stage 2 breast cancer patients. Clin Res. 1989;37:316(A).
16.
Llewellyn-Thomas HA, Thiel EC, McGreal MJ. Cancer patients’ evaluations of their current health states: the influences of expectations, comparisons, actual health status, and mood. Med Decis Making. 1992;12:115-122.
Llewellyn-Thomas HA, Sutherland HJ, Ciampi A, Etezadi-Amoli J, Boyd NF, Till JE. The assessment of values in laryngeal cancer: reliability of measurement methods. J Chronic Dis. 1984;37:283-291.
19.
Llewellyn-Thomas HA, Sutherland HJ, Thiel EC. Do patients’ evaluations of a future health state change when they actually enter that state?Med Care. 1993;31:1002-1012.
20.
O’Connor AMC, Boyd NF, Warde P, Stolbach L, Till JE. Eliciting preferences for alternative drug therapies in oncology: influence of treatment outcome description, elicitation technique and treatment experience on preferences. J Chronic Dis. 1987;40:811-818.
21.
Jansen SJT, Stiggelbout AM, Wakker PP, Nooij MA, Noordijk EM, Kievit J.Unstable preferences: a shift in valuation or an effect of the elicitation procedure?Med Decis Making. 2000;20:62-71.
22.
Lehmann HP, Fleisher LA, Lam J, Frink BA, Bass EB. Patient preferences for early discharge after laparoscopic cholecystectomy. Anesth Analg. 1999;88:1280-1285.
23.
Sackett DL, Torrance GW. The utility of different health states as perceived by the general public. J Chronic Dis. 1978;31:697-704.
24.
Ashby J, O’Hanlon M, Buxton MJ. The time trade-off technique: how do the valuations of breast cancer patients compare to those of other groups?Quality Life Res. 1994;3:257-265.
25.
de Wit GA, van Busschbach JJ, de Charro FT. Sensitivity and perspective in the valuation of health status: whose values count?Health Economics. 2000;9:109-126.
26.
Jansen SJT, Stiggelbout AM, Nooij MA, Kievit J.The effect of individually assessed preference weights on the relationship between holistic utilities and nonpreference-based assessment. Quality Life Res. 2000;9:541-557.
27.
Torrance GW. Measurement of health state utilities for economic appraisal: a review. J Health Economics. 1986;5: 1-30.
28.
Jansen SJT, Stiggelbout AM, Wakker PP, et al.Patients’ utilities for cancer treatments: a study of the chained procedure for the standard gamble and time tradeoff. Med Decis Making. 1998;18:391-399.
29.
Tsevat J, Goldman L, Soukup JR, et al.Stability of time tradeoff utilities in survivors of myocardial infarction. Med Decis Making. 1993;13:161-165.
30.
Revicki DA. Relationship between health utility and psychometric health status measures. Med Care. 1992;30:MS274-MS282.
31.
Kahneman D, Fredrickson BL, Schreiber CA, Redelmeier DA. When more pain is preferred to less: adding a better end. Psychol Sci. 1993;4:401-405.
32.
Redelmeier DA, Rozin P, Kahneman D.Understanding patients’ decisions: cognitive and emotional perspectives. JAMA. 1993;270:72-76.
33.
Redelmeier D, Kahneman D.Patients’ memories of painful medical treatments: real-time and retrospective evaluations of two minimally invasive procedures. Pain. 1996;66:3-8.
34.
Chapman GB, Elstein AS, Kuzel TM, et al.Prostate cancer patients’ utilities for health states: how it looks depends on where you stand. Med Decis Making. 1998;18:278-286.
35.
Shiell A, Seymour J, Hawe P, Cameron S.Are preferences over health states complete?Health Economics. 2000;9: 47-55.
36.
Stiggelbout AM, Jansen SJT, Nooij MA, Kievit J.Whose values in CEA? The impact of “anticipated adaptation.”Med Decis Making. 2000;20:499(A).
37.
Lindley C, Vasa S, Sawyer WT, Winer EP. Quality of life and preferences for treatment following systemic adjuvant therapy for early-stage breast cancer. J Clin Oncol. 1998;16:1380-1387.
38.
Berkowitz L.A Survey of Social Psychology. 3rd ed.New York: Holt, Rinehart & Winston, 1986.
39.
Hayman JA, Fairclough DL, Harris JR, Weeks JC. Patient preferences concerning the trade-off between the risks and benefits of routine radiation therapy after conservative surgery for early-stage breast cancer. J Clin Oncol. 1997;15:1252-1260.
40.
Torrance GW, Boyle MH, Horwood SP. Application of multiattribute utility theory to measure social preferences for health states. Oper Res. 1982;30:1043-1069.
41.
Lane DA. Utility, decision, and quality of life. J Chron Dis. 1987;40:585-591.
42.
Patrick DL, Starks HE, Cain KC, Uhlmann RF, Pearlman RA. Measuring preferences for health states worse than death. Med Decis Making. 1994;14:9-18.
43.
Rutten-van Mölken MP, Bakker CH, van Doorslaer EK, van der Linden S.Methodological issues of patient utility measurement: experience from two clinical trials. Med Care. 1995;33:922-937.
44.
Patrick DL, Pearlman RA, Starks HE, Cain KC, Cole WG, Uhlmann RF. Validation of preferences for life-sustaining treatment: implications for advance care planning. Ann Intern Med. 1997;127:509-517.
45.
Badia X, Monserrat S, Roset M, Herdman M.Feasibility, validity and test-retest reliability of scaling methods for health states: the visual analogue scale and the time trade-off. Quality Life Res. 1999;8:303-310.
46.
Saigal S, Stoskopf BL, Feeny D, et al.Differences in preferences for neonatal outcomes among health care professionals, parents, and adolescents. JAMA. 1999;281:1991-1997.
