Academic journal article Applied Health Economics and Health Policy

Oncologist Preferences for Health States Associated with the Treatment of Advanced Ovarian Cancer

Academic journal article Applied Health Economics and Health Policy

Oncologist Preferences for Health States Associated with the Treatment of Advanced Ovarian Cancer

Article excerpt


Epithelial ovarian cancer is the leading cause of gynaecological cancer death in the US.[1] Due to its nonspecific symptoms, epithelial ovarian cancer is generally not detected until it has become advanced, and, in the majority of cases, is likely to recur. Women with the disease will not only be faced with treatment decisions at the time of initial diagnosis, but are likely to experience disease recurrence and face a lifelong process of cancer treatment-related decisions. Knowledge of how oncologists and patients value the outcomes of care is important as a foundation to understanding and improving the communication process regarding treatment alternatives.

This study was developed as a follow-up project to a meta-analysis of intraperitoneal versus intravenous treatment for ovarian cancer.[2] In the meta-analysis, intraperitoneal therapy was associated with a statistically significant improvement in survival, but also with several significant increases in grade 3-4 toxicity. This highlighted that the incorporation of new options for the treatment of advanced ovarian cancer is rarely straightforward. Often, there are improvements in some aspects of care, while other aspects of the treatment may introduce risks. Alternatives for cancer care generally bring a set of trade-offs that physicians and patients must make while selecting among therapies.

This study was designed to explore how hypothetical outcomes of cancer are valued to understand the oncologist perspective of these trade-offs towards the care of women with advanced ovarian cancer. To explore these preferences, this study included the following specific aims: (i) to determine how physicians valued hypothetical ovarian cancer health states as measured by rating scale versus Standard Gamble (SG) elicitation strategies; (ii) to determine how physicians would trade-off the benefits with the adverse effects of cancer treatment as represented in the health state descriptions; and (iii) to determine if the valuation differed in the setting of newly diagnosed versus recurrent disease.


Eligible participants were oncologists who had clinical responsibilities that included prescribing chemotherapy to patients with ovarian cancer. Recruitment was conducted through emailed requests to select gynaecological oncologists in Arizona and New Mexico and within the Gynecologic Oncology Group. Face-to-face interviews were conducted at the oncologists' offices or at national meetings between May 2006 and January 2007. All study methods were granted exemption from review by the University of Arizona Institutional Review Board.

The health states were composed of varying levels of three domains: adverse events (toxicity); treatment efficacy (represented by changes in CA-125 level, which is a strong indicator of tumour response to therapy in the vast majority of advanced ovarian cancers); and patient emotional well-being (e.g. optimism, anxiety, depression) [table I]. Varying degrees of gastrointestinal toxicity and neurotoxicity were included as adverse events in the health states because prior work has demonstrated that these adverse events are among the most troublesome to patients.[3,4] To avoid introducing a time bias for survival benefits, the CA-125 level was used as an indicator of therapeutic benefit in the description of the hypothetical health states.

Table I. Hypothetical health state (HS) scenarios [Table omitted.]

The health states were worded and organized to be as clinically realistic as possible. The wording of the health states was obtained using a variety of open-access ovarian cancer survivorship internet chat rooms. The six health states proposed then underwent review of clinical and theoretical accuracy by an outcomes expert, a medical oncologist and a gynaecological oncologist. Language was minimized to bulleted lists of seven to nine items that could be contained on an index card at no less than 11-point font (see the Supplemental Digital Content 1, http://links. …

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