When to wait for more evidence?: real options analysis in proton therapy.

Purpose. Trends suggest that cancer spending growth will accelerate. One method for controlling costs is to examine whether the benefits of new technologies are worth the extra costs. However, especially new and emerging technologies are often more costly, while limited clinical evidence of superiority is available. In that situation it is often unclear whether to adopt the new technology now, with the risk of investing in a suboptimal therapy, or to wait for more evidence, with the risk of withholding patients their optimal treatment. This trade-off is especially difficult when it is costly to reverse the decision to adopt a technology, as is the case for proton therapy. Real options analysis, a technique originating from financial economics, assists in making this trade-off. Methods. We examined whether to adopt proton therapy, as compared to stereotactic body radiotherapy, in the treatment of inoperable stage I non-small cell lung cancer. Three options are available: adopt without further research; adopt and undertake a trial; or delay adoption and undertake a trial. The decision depends on the expected net gain of each option, calculated by subtracting its total costs from its expected benefits. Results. In The Netherlands, adopt and trial was found to be the preferred option, with an optimal sample size of 200 patients. Increase of treatment costs abroad and costs of reversal altered the preferred option. Conclusion. We have shown that real options analysis provides a transparent method of weighing the costs and benefits of adopting and/or further researching new and expensive technologies. The Oncologist 2011;16:1752-176

Health related quality of life assessment instruments: a prospective study on preference and acceptability among cancer patients referred for radiotherapy

The aim of this study was to determine the preferences for and acceptability of existing Quality of Life (QoL) questionnaires among cancer patients. Sixty-two patients completed a set of questionnaires. Criteria were the percentage of missing values, difficult items and the preferences for the answer options. Results indicated small proportions of missing values and difficult items for the EORTC QLQ-C30, the MFI, RSCL, and the MQ (0.0-1.0%). Considerably higher proportions of missing values and difficult items were found for the VAS and the PFS (2.5-3.4%). The answer option of the RSCL subscale 'activity level' was most preferred (29% of subjects), whereas the VAS and PFS were least preferred (19% and 21%, respectively). Our results indicate that patients prefer answer categories that have descriptors in words or a narrow range of answer options, rather than non-described answer options or a broad range of answer options per question

Impact of fatigue on overall quality of life in lung and breast cancer patients selected for high-dose radiotherapy

BACKGROUND: Although studies show that cancer patients consider fatigue as an important problem, few, if any, studies have quantified the impact of fatigue on overall quality of life (QoL) in cancer patients. In the present study, we evaluated the relative impact of different QoL domains/subscales, including fatigue, on overall QoL in cancer patients preceding radiotherapy. PATIENTS AND METHODS: Sixty-four patients with lung or breast cancer selected for high-dose radiotherapy on the primary tumour completed the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. Multivariate models were fitted to define the impact of QLQ-C30 subscales, including fatigue, on overall QoL. RESULTS: Of all QLQ-C30 subscales, fatigue showed by far the strongest univariate correlation with overall QoL (r = -0.76, P < 0.001); correlations for functioning subscales (r = 0.44-0.55) and symptom subscales (r = -0.31 to -0.45) were considerably lower. In multivariate analyses, adjusting for potential confounders, fatigue was the only subscale that independently contributed to overall QoL (standardized regression coefficient-0.57, P < 0.001). CONCLUSION: Our results indicate that, of all QoL domains/subscales, fatigue is by far the predominant contributor to patient-perceived overall QoL in both lung and breast cancer patients preceding high-dose radiotherapy

Psychometric properties of the revised Piper Fatigue Scale in Dutch cancer patients were satisfactory

OBJECTIVE: To examine the psychometric properties of the revised Piper Fatigue Scale (PFS) in Dutch cancer patients. STUDY DESIGN AND SETTING: Participants were 64 patients with lung (any stage, nonsurgery) and breast (any stage) cancer, selected for curative high-dose radiotherapy (>/=50 Gy). Prior to radiotherapy, patients completed the revised PFS (translated into Dutch), the Multidimensional Fatigue Inventory (MFI), and the Rotterdam Symptom Checklist (RSCL). Reliability and construct and criterion validity of the PFS were investigated. RESULTS: Overall, the structure of the Dutch revised PFS appeared appropriate, with corrected item-subscale correlations being higher than the correlations of the same item with the three other subscales; furthermore, internal consistency was excellent (Cronbach's alpha >/=0.90). Lung cancer patients were significantly more tired then breast cancer patients, supporting construct validity. Criterion validity was also satisfactory, with highest correlations of PFS total fatigue with the MFI subscale general fatigue (0.84) and RSCL overall quality of life score (0.74). Internal consistency was similar in Dutch and U.S. breast cancer patients; fatigue scores were lower on several PFS subscales in the Dutch study population. CONCLUSION: Psychometric properties of the Dutch version of the revised PFS, as tested in cancer patients prior to radiotherapy, were satisfactory. AD - Department of Epidemiology, NUTRIM, Maastricht University, P.O. Box 616, 6200 MD Maastricht, The Netherlands