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Preference-Based Utility Scores for Adverse Events Associated With the Treatment of Gynecologic Cancers
  1. Elizabeth L. Jewell, MD*,
  2. Michael Smrtka, MD,
  3. Gloria Broadwater, PhD,
  4. Fidel Valea, MD,§,
  5. Debra M. Davis, RN,§,
  6. Kimberly C. Nolte, PA,§,
  7. Renea Valea, MSW,§,
  8. Evan R. Myers, MD,,# and
  9. Laura J. Havrilesky, MD,§
  1. *Division of Gynecology, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, NY;
  2. Department of Obstetrics and Gynecology,
  3. Cancer Statistical Center,
  4. §Division of Gynecologic Oncology,
  5. Duke Comprehensive Cancer Center,
  6. Division of Clinical and Epidemiological Research, and
  7. #Duke Center for Clinical Health Policy Research, Duke University Medical Center, Durham, NC.
  1. Address correspondence and reprint requests to Elizabeth L. Jewell, MD, Gynecology Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Ave, New York, NY 10065. E-mail:


Objective Our goals were to (1) define a set of descriptive health states related to adverse events (AEs) associated with gynecologic cancer treatment with radical surgery and chemoradiation and (2) derive a set of quality of life–related utility scores corresponding to these health states.

Methods We developed a list of health states for grade 3/4 AEs related to gynecologic cancer treatment. Using the visual analog scale score and time trade-off (TTO) methods, valuation of each health state was obtained through interviews of 60 volunteers (15 cervical cancer survivors treated with surgery and/or chemoradiation and 45 women without a cancer diagnosis). Health states were ranked by mean/median TTO scores. Wilcoxon rank sum test was used to compare central tendencies related to patient and volunteer characteristics.

Results Patients and volunteers agreed on their preference rankings, with highest preference given to infection (median TTO = 1.0) and thrombosis (median TTO = 0.97). Lowest preference was assigned to radiation proctitis (median TTO = 0.87) and gastrointestinal fistula formation (median TTO = 0.83). Utility scores for the majority of health states were not significantly associated with age, race, parity, patient or volunteer status, history of abnormal Pap smear, stage of cervical cancer diagnosis, or personal experience of a serious treatment-related AE.

Conclusions This study helps establish preferences and quality-of-life utility scores for health states related to toxicities from surgery, radiation, and chemotherapy for gynecologic cancer treatment. Such information can be used to inform medical decision making/counseling and may be applied to future comparative effectiveness models in which radical surgery and/or chemoradiation are considered.

  • Utilities
  • Adverse events
  • Treatment
  • Gynecologic cancers

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  • This study was funded by the Charles Hammond Research Fund.

  • The authors declare no conflicts of interest.