Methodology: A cross-sectional survey of female BCPs ages 36-80 at the University of Maryland Greenebaum Cancer Center, Baltimore, MD. Since “treatment” is considered a “short-term” health state, the chained procedure for the time trade-off was used to assess time trade-off values. Willingness to accept therapy was determined using “minimum years cancer-free to accept therapy” as the dependent variable. The number of years was calculated based upon BCPs time trade-off responses for mastectomy (MRM), breast-conserving therapy (BCT), chemotherapy (CTX) and tamoxifen (TAM). Independent variables included demographic factors and clinical data that were abstracted from the BCPs medical records. Tobit regression models were used to determine the association between the dependent and independent variables because the dependent variable, minimum cancer-free years (CFYs) to accept therapy, was right-skewed for all therapies.

Results: The mean age for the 77 respondents was 56.0 years (SD ± 9.43); 58.2% identified themselves as white; 75.6% had early stage cancer. BCPs required more cancer-free years (median of 4) to accept MRM than to accept BCT, CTX, or TAM (median 1 year for each). For all forms of therapy, the mode was 0, suggesting that BCPs were willing to accept therapy even if it provided no guaranteed survival benefit. Late stage patients require more CFYs to accept TAM (β=6.61, p=0.0489); similarly late stage patients in good physical health required more CFYs to have MRM (β=0.50, p=0.0322). BCPs who had experience with a particular therapy were more willing to accept that type of therapy than those who were treatment-naïve. Younger patients (versus those age 65+) required fewer CFYs to accept chemotherapy (age group 50-54, β=-4.77, p=0.0403, age group 55-59, β=-7.25, p=0.0019). Being non-white and having less education were associated with requiring fewer CFYs to accept to accept CTX (β=-3.86, p=0.0087; β=-5.10, p=0.0193, respectively)

Conclusions: BCPs require relatively few years of additional CFYs to accept treatment. Willingness to accept fewer CFYs for chemotherapy among those with less education and of younger age is consistent with treatment patterns previously-published. The fact that non-whites (primarily African Americans) required fewer CFYs to accept CTX appears in stark contrast to observed underutilization of chemotherapy among African American breast cancer patients.