Justifying adjuvant chemotherapy in breast cancer: A survey of women and healthcare professionals

Aim The absolute survival gains required to make adjuvant chemotherapy acceptable to women are unknown. We questioned women and healthcare professionals on the absolute survival benefits required to make adjuvant chemotherapy acceptable. Methods A cohort of 1000 Irish women and 402 UK nurses and surgeons were invited to choose an absolute survival advantage sufficient to justify adjuvant cytotoxic chemotherapy. The non-physician cohort included women with a history of cancer, female medical healthcare professionals and women with no personal or professional experience of cancer. Results Eight hundred and thirty-five women completed the questionnaire; 769, 651 and 413 said they would accept chemotherapy for a 10%, 5% and 1% survival advantage, respectively. There was a significant difference in womenʹs preferences depending on their personal and professional experience of cancer. Eighty-nine women had personal experience of chemotherapy and these women were more likely to accept chemotherapy for any survival advantage (88, 87 and 66 for a 10%, 5% and 1% survival advantage, respectively; p = 0.0023; Chi2). Surgeons and nurses were less likely to accept chemotherapy for smaller absolute survival advantages. Conclusions This study confirms that women require modest absolute gains to choose adjuvant chemotherapy. The pattern of acceptance differs significantly between those with professional experience of cancer, a personal history of chemotherapy use and a history of cancer or not.