Surveillance versus adjuvant chemotherapy in stage I non-seminomatous testicular cancer: A decision analysis

In stage I non-seminomatous testicular cancer, the decision between surveillance and adjuvant chemotherapy rests heavily upon the valuation of quality of life. Decision analysis was used to assess at what relapse rate adjuvant chemotherapy is preferred when patients' and clinicians' valuations are considered. Probabilities were obtained from the literature and from experts. Valuations of the disease states were obtained from patients (n = 68) and clinicians (n = 50). Results from the model were compared with a treatment preference question, asking for the relapse rate directly. Adjuvant chemotherapy was preferred at relapse rates above 50% when patient valuations were used. The valuations of the disease states had a strong impact on the decision. Using clinician valuations, adjuvant chemotherapy was preferred at relapse rates above 73%. The relapse rates from the treatment preference question were lower: 46% for patients and 35% for clinicians. The results indicate that when patient preferences are accounted for, adjuvant chemotherapy should be considered more often. Copyright (C) 1996 Elsevier Science Ltd