Heather Jones, MD
University of Pennsylvania Cancer Center
Last Modified: November 5, 2001
Presenter: A. Konski
Presenter's Affiliation: Toledo Radiation Oncology, Hickman Cancer Center, Adrian, MI
Type of Session: Scientific
RTOG 90-03 a four-arm study that evaluated various fractionation schedules for the treatment of locally advanced head and neck cancer. This study attempts to determine the cost-effectiveness using cost-utility analysis of the four treatment regimens.
This analysis finds accelerated fractionated radiotherapy to be the most cost-effective treatment regimen for patients with locally advanced head and neck cancer. The results differ between gender because of the time spent in toxicity and in relapse. The results will differ based on the utility patient's place on time spent in toxicity and relapse. Patients placing a higher utility on any survival will favor the more aggressive regimens. Conversely, patients placing a low utility on time spent in toxicity and relapse and thus not wanting to spend time in these health states, would have lower QALY's and thus treatment which is less cost-effective than standard therapy.
As we attempt to be more aggressive in the treatment of locally advanced head and neck cancer, we must continue to monitor the cost in both dollars and cents and quality of life. To do so, we must develop stringent methodology to analyze data. This study is an excellent first step by the RTOG. I would hope in the next attempt to model quality adjusted survival that utility would be based on patient preferences and symptom distress scales and not on arbitrary values chosen by the physician.
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