Adjuvant Treatment Decision Making for Lung Cancer

Approximately 173,770 people are expected to be diagnosed with lung cancer in the United States in 2004, and another 160,440 are expected to die from the disease. Kentucky leads the nation in both lung cancer incidence andmortality, providing an unfortunate but unique laboratory to study this disease and its treatment. Chemotherapy has not historically played a role in adjuvant care for surgically resectable nonsmall cell lung cancer (NSCLC). However, recent data on platinum-based chemotherapy showed significantly increased 5-year survival from NSCLC, influencing the standard of care. While more individuals diagnosed with NSCLC will be offered adjuvant chemotherapy, experts caution that the modest benefits of chemotherapy should be weighed against the short and long-term treatment sequelae, and that the data should be used to help patients make informed choices based on their own values and preferences. Yet it is not clear that NSCLC patients have the capacity to interpret quantitative treatment benefit information. Among 120 individuals diagnosed with stages T-TTTA NSCLC, the proposed study will explore factors which may influence treatment decision-making regarding adjuvant chemotherapy. The primary aim is to examine the effects of different methods of communicating quantitative estimates of treatment benefit on adjuvant chemotherapy decisions among individuals diagnosed with NSCLC. Using an experimental design based on a hypothetical clinical scenario, this study will test the hypothesis that individuals diagnosed with NSCLC randomly assigned to receive relative risk reduction estimates will be more likely to choose adjuvant chemotherapy than individuals randomly assigned to receive absolute risk reduction information. This hypothesis is based on previous research which suggests that the method of describing treatment benefits plays an important role in treatment decisions regarding adjuvant chemotherapy. The secondary aim is to examine sociodemographic, psychological, social, and health factors which influence adjuvant chemotherapy decisions among individuals diagnosed with NSCLC. It is hypothesized that individuals who are older, more distressed, have less social support, and have poorer health status are more likely to decline adjuvant chemotherapy. With the expanding role of chemotherapy in NSCLC, it becomes even more important to understand the factors which influence treatment decisions and to identify the best methods of describing treatment benefits to patients. Only when patients understand the necessary information about the risks and benefits of each treatment option will they be able to make informed treatment decisions that are consident with their values.