Patient Preferences for the Chemoprevention of Esophageal Adenocarcinoma in Barrett's Esophagus

OBJECTIVES: Although evidence suggests that aspirin and celecoxib may reduce the risk of esophageal adenocarcinoma (EAC) in patients with Barrett's esophagus (BE), these drugs can also cause harmful side effects. Our aim was to determine and characterize preferences for these two drugs in patients with BE. METHODS: Preferences data were collected from recruited BE patients using a customized questionnaire, which incorporated standard risk communication techniques. Summary profiles outlined the benefits and harms of celecoxib and aspirin presented anonymously. Both drugs were portrayed as reducing the risk of EAC and increasing the risk of GI events. However, celecoxib increased the risk of myocardial infarction (MI) while aspirin reduced the risk. Factors influencing patient acceptance of each drug were analyzed. RESULTS: One hundred of 109 (92%) subjects completed the study. Under base case conditions, 15% stated that they would take celecoxib and 76% aspirin (P < 0.0001). Patients identified the greater risk of MI as the primary reason for their unwillingness to take celecoxib and the lower risk of EAC for aspirin. Even in scenarios in which the benefits of celecoxib were improved and the harms reduced, a majority continued to find it unacceptable. CONCLUSIONS: A majority of those surveyed stated that they would take aspirin but would not take celecoxib. Most patients are interested in EAC chemoprevention, but the amount of protection and the side effect profile of a drug determine its acceptability. These data can inform physicians regarding the tradeoffs patients are willing to consider for chemoprevention.