Division of Hematology, Mayo Clinic, Rochester, MN, USA.
Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, NC, USA.
Value Health. 2022 Jul;25(7):1081-1086. doi: 10.1016/j.jval.2021.11.1368. Epub 2022 Jan 3.
Asking "Was it worth it?" (WIWI) potentially captures the patient perception of a treatment's benefit weighed against its harms. This exploratory analysis evaluates the WIWI questionnaire as a metric of patients' perspectives on the worthwhileness of cancer treatment.
A 3-item WIWI questionnaire was assessed at end of treatment in patients with cancer on the COMET-2 trial (NCT01522443). WIWI items were evaluated to determine their association with quality of life (QOL), treatment duration, end-of-treatment reason, patient-reported adverse events (AEs), and disease response.
A total of 65 patients completed the questionnaire; 40 (62%), 16 (25%), and 9 (14%) patients replied yes, uncertain, and no to "Was it worthwhile for you to receive the cancer treatment given in this study?" (item 1), respectively; 39 (60%), 12 (18%), and 14 (22%) to "If you had to do it over again, would you choose to have this cancer treatment?"; and 40 (62%), 14 (22%), and 11 (17%) to "Would you recommend this cancer treatment to others?" Patients responding yes to item 1 remained on treatment longer than those responding uncertain or no (mean 23.0 vs 11.3 weeks, P<.001). Patients responding uncertain/no to item 1 discontinued treatment because of AEs more frequently than those responding yes (36% vs 7.5%, P=.004) and demonstrated meaningful decline in QOL from baseline (-2.5 vs -0.2 mean change, P<.001). Associations between WIWI responses and most patient-reported AEs or treatment efficacy did not reach statistical significance.
Patients who responded affirmatively on WIWI items remained on therapy longer, were less likely to stop treatment because of AEs, and demonstrated superior QOL. The WIWI may inform clinical practice, oncology research, and value frameworks.
提出“治疗是否值得？”（WIWI）这一问题可能会反映出患者对治疗益处与危害的看法。本探索性分析旨在评估 WIWI 问卷作为评估患者对癌症治疗价值看法的指标。
在 COMET-2 试验（NCT01522443）中，对接受癌症治疗的患者在治疗结束时使用 3 项 WIWI 问卷进行评估。对 WIWI 各项进行评估，以确定它们与生活质量（QOL）、治疗持续时间、治疗结束原因、患者报告的不良事件（AE）和疾病反应的相关性。
共有 65 例患者完成了问卷；分别有 40 例（62%）、16 例（25%）和 9 例（14%）患者对“接受这项研究中的癌症治疗对您来说是否值得？”（项目 1）回答“是”“不确定”和“否”；分别有 39 例（60%）、12 例（18%）和 14 例（22%）患者对“如果您不得不再次选择，您会选择接受这种癌症治疗吗？”；分别有 40 例（62%）、14 例（22%）和 11 例（17%）患者对“您会向其他人推荐这种癌症治疗吗？”回答“是”的患者的治疗持续时间长于回答“不确定”或“否”的患者（平均 23.0 周与 11.3 周，P<.001）。对项目 1 回答“不确定/否”的患者因 AE 而停止治疗的频率高于回答“是”的患者（36%比 7.5%，P=.004），并且从基线开始 QOL 显著下降（-2.5 比-0.2 的平均变化，P<.001）。WIWI 应答与大多数患者报告的 AE 或治疗效果之间的关联未达到统计学意义。
对 WIWI 项目回答肯定的患者治疗持续时间更长，因 AE 而停止治疗的可能性更小，且 QOL 更高。WIWI 可能为临床实践、肿瘤学研究和价值框架提供信息。
