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Patient preference and decision-making for initiating metastatic colorectal cancer medical treatment



Some medical treatment for metastatic colorectal cancer (CRC) may have marginal survival benefit, but cause toxicities. The purpose of this study is to determine metastatic CRC patients’ tradeoffs in making a decision to undergo new medical treatment.


We conducted a survey of patients with a diagnosis of advanced CRC who were currently receiving or completed one chemotherapy regimen. First, patients were asked to rate the importance of 15 medical treatment-related adverse events that may arise as a consequence of chemotherapy or biological therapy in their treatment decision-making. Then, the patient identified his or her top five most important events and solicited preferences in hypothetical metastatic CRC treatment vignettes using the standard gamble technique.


A total of 107 patients responded to the survey. From the list of medical treatment-related adverse events, patients identified clinically serious ones such as stroke, heart attack, and gastrointestinal perforation as the most important in their medical treatment decision-making, yet placed lower willingness to tolerate symptom-related events such as pain, fatigue, and depression. Generally, patients who were older, stage III versus IV and who had prior radiotherapy, lower educational attainment, and lower household income (all p <0.05) were less willing to tolerate any medical treatment-related adverse events after adjusting for other demographic and clinical characteristics.


Variations in patients’ willingness to tolerate different treatment-related adverse events underscore the need for improved communications between physicians and patients about the risks and benefits of their medical treatment, which helps make a more personalized decision for metastatic CRC treatment.

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This study was supported by the Ruesch Center for the Cure of Gastrointestinal Cancers at Georgetown University, and Grant P30CA051008 from the National Cancer Institute. Dr Jensen was supported in part by Grant Number KL2TR000102 from the National Center for Research Resources (NCRR) and the National Center for Advancing Translational Sciences (NCATS), National Institutes of Health (NIH), through the Clinical and Translational Science Awards Program (CTSA).

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Correspondence to Alex Z. Fu.

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Conflict of interest

J. L. M. has received a speaker honorarium from Genentech, Bayer, Amgen, and Celgene. Other authors declared no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

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Fu, A.Z., Graves, K.D., Jensen, R.E. et al. Patient preference and decision-making for initiating metastatic colorectal cancer medical treatment. J Cancer Res Clin Oncol 142, 699–706 (2016).

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  • Patient preference
  • Treatment decision-making
  • Tradeoff
  • Metastatic colorectal cancer
  • Standard gamble