Patient Preferences for Adjuvant Chemotherapy of Early Breast Cancer: How Much Benefit Is Needed?

Adjuvant chemotherapy for early-stage breast cancer has been shown to delay recurrence and improve survival. How-ever, the benefits are modest and must be balanced against the adverse treatment effects. We assessed the size of the survival benefit needed to justify the toxicity of chemo-therapy, based on the preferences of women who had pre-viously received adjuvant cyclophosphamide, methotrexate, and 5-fluorouracil (CMF). We also attempted to identify cir-cumstances in which larger survival gains would be needed. In semistructured interviews, 104 women who had received adjuvant CMF chemotherapy were asked to rate the sur-vival benefit that would justify 6 months of such treatment, using a series of hypothetical trade-offs between shorter sur-vival without treatment and longer survival with treatment. Similar preferences were sought for a greater probabilit