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Vaishampayan UN, Keessen M, Dreicer R, Heath EI, Buchler T, Árkosy PF, Csöszi T, Wiechno P, Kopyltsov E, Orlov SV, Plekhanov A, Smagina M, Varlamov S, Shore ND. A global phase II randomized trial comparing oral taxane ModraDoc006/r to intravenous docetaxel in metastatic castration resistant prostate cancer. Eur J Cancer 2024; 202:114007. [PMID: 38518534 DOI: 10.1016/j.ejca.2024.114007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/28/2024] [Accepted: 03/03/2024] [Indexed: 03/24/2024]
Abstract
STUDY AIM ModraDoc006, an oral formulation of docetaxel, is co-administered with the cytochrome P450-3A4 and P-glycoprotein inhibitor, ritonavir (r): ModraDoc006/r. The preliminary efficacy and safety of oral ModraDoc006/r was evaluated in a global randomized phase II trial and compared to the current standard chemotherapy regimen of intravenous (i.v.) docetaxel and prednisone. METHODS 103 mCRPC patients, chemotherapy-naïve with/without abiraterone and/or enzalutamide pretreated, with adequate organ function and evaluable disease per RECIST v1.1 and PCWG3 guidelines were randomized 1:1 into two cohorts. In Cohort 1, 49 patients received docetaxel 75 mg/m2 i.v. every 3 weeks (Q3W). In Cohort 2, 52 patients received ModraDoc006/r; 21 patients with a starting dose of ModraDoc006 30 mg with ritonavir 200 mg in the morning and ModraDoc006 20 mg with ritonavir 100 mg in the evening (30-20/200-100 mg) bi-daily-once-weekly (BIDW) on Days 1, 8, and 15 of a 21-day cycle. To alleviate tolerability, the starting dose was amended to ModraDoc006/r 20-20/200-100 mg in another 31 patients. All patients received prednisone 10 mg daily. Primary endpoint was rPFS. RESULTS There was no significant difference in rPFS between the 2 arms (p = 0.1465). Median rPFS was 9.5 months and 11.1 months (95% CI) for ModraDoc006/r and i.v. docetaxel, respectively. Partial response was noted in 44.1% and 38.7% measurable disease patients, and 50% decline of PSA was seen in 23 (50%) and 26 (56.5%) evaluable cases treated with ModraDoc006/r and i.v. docetaxel, respectively. The safety profile of ModraDoc006/r 20-20/200-100 mg dose was significantly better than i.v. docetaxel, with mild (mostly Grade 1) gastrointestinal toxicities, no hematologic adverse events, and neuropathy and alopecia incidence of 11.5% and 25%, respectively. CONCLUSIONS ModraDoc006/r potentially represents a widely applicable, convenient, effective, and better tolerated oral taxane therapy option for mCRPC. Further investigation of ModraDoc006/r in a large randomized trial is warranted.
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Affiliation(s)
| | | | | | | | - Tomas Buchler
- Department of Oncology, First Faculty of Medicine, Charles University and Thomayer University Hospital, Prague, Czech Republic
| | | | | | - Pawel Wiechno
- Klinika Nowotworów Układu Moczowego Centrum Onkologii, Warsaw, Poland
| | | | - Sergey V Orlov
- Pavlov First St. Petersburg State Medical University, Saint Petersburg, Russian Federation
| | | | - Maria Smagina
- Leningrad Regional Oncology Dispensary, Saint Petersburg, Russian Federation
| | | | - Neal D Shore
- Carolina Urologic Research Center, Myrtle Beach, SC, USA
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Gonzalez JM, Ganguli A, Morgans AK, Tombal BF, Hotte SJ, Suzuki H, Bhadauria H, Oh M, Scales CD, Wallace MJ, Yang JC, George DJ. Discrete-Choice Experiment to Understand the Preferences of Patients with Hormone-Sensitive Prostate Cancer in the USA, Canada, and the UK. THE PATIENT 2023; 16:607-623. [PMID: 37566214 PMCID: PMC10570152 DOI: 10.1007/s40271-023-00638-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/19/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Treatment options for patients with metastatic hormone-sensitive prostate cancer (mHSPC) have broadened, and treatment decisions can have a long-lasting impact on patients' quality of life. Data on patient preferences can improve therapeutic decision-making by helping physicians suggest treatments that align with patients' values and needs. OBJECTIVE This study aims to quantify patient preferences for attributes of chemohormonal therapies among patients with mHSPC in the USA, Canada, and the UK. METHODS A discrete-choice experiment survey instrument was developed and administered to patients with high- and very-high-risk localized prostate cancer and mHSPC. Patients chose between baseline androgen-deprivation therapy (ADT) alone and experimentally designed, hypothetical treatment alternatives representing chemohormonal therapies. Choices were analyzed using logit models to derive the relative importance of attributes for each country and to evaluate differences and similarities among patients across countries. RESULTS A total of 550 respondents completed the survey (USA, 200; Canada, 200; UK, 150); the mean age of respondents was 64.3 years. Treatment choices revealed that patients were most concerned with treatment efficacy. However, treatment-related convenience factors, such as route of drug administration and frequency of monitoring visits, were as important as some treatment-related side effects, such as skin rash, nausea, and fatigue. Patient preferences across countries were similar, although patients in Canada appeared to be more affected by concomitant steroid use. CONCLUSION Patients with mHSPC believe the use of ADT alone is insufficient when more effective treatments are available. Efficacy is the most significant driver of patient choices. Treatment-related convenience factors can be as important as safety concerns for patients.
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Affiliation(s)
- Juan Marcos Gonzalez
- Department of Population Health Sciences, Duke University School of Medicine, 300 W. Morgan Street, 27701, Durham, NC, USA.
- Department of Medicine, Duke University School of Medicine, Durham, NC, USA.
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA.
| | - Arijit Ganguli
- Medical Affairs, Astellas Pharma Inc., Northbrook, IL, USA
| | | | - Bertrand F Tombal
- Cliniques Universitaires Saint-Luc, Université Catholique de Louvain, Brussels, Belgium
| | - Sebastien J Hotte
- Department of Oncology, McMaster University and Juravinski Cancer Centre, Hamilton, ON, Canada
| | - Hiroyoshi Suzuki
- Department of Urology, Toho University Sakura Medical Center, Sakura City, Chiba, Japan
| | | | - Mok Oh
- Medical Affairs, Astellas Pharma Inc., Northbrook, IL, USA
| | - Charles D Scales
- Department of Population Health Sciences, Duke University School of Medicine, 300 W. Morgan Street, 27701, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
- Department of Urology, Duke University School of Medicine, Durham, NC, USA
| | - Matthew J Wallace
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Jui-Chen Yang
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Daniel J George
- Department of Population Health Sciences, Duke University School of Medicine, 300 W. Morgan Street, 27701, Durham, NC, USA
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Lee YS, Kim SH, Tae JH, Chang IH, Kim TH, Myung SC, Kim M, Nguyen TT, Choi J, Kim JH, Kim JW, Choi SY. Oral chemotherapeutic agents in metastatic hormone-sensitive prostate cancer: A network meta-analysis of randomized controlled trials. Prostate Int 2023; 11:159-166. [PMID: 37745904 PMCID: PMC10513908 DOI: 10.1016/j.prnil.2023.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 06/26/2023] [Accepted: 06/29/2023] [Indexed: 09/26/2023] Open
Abstract
Background Multiple oral chemotherapeutic agents for metastatic hormone-sensitive prostate cancer (mHSPC) have been developed for conjugated use with conventional androgen deprivation therapy (ADT). Several randomized controlled trials (RCTs) report significant benefits in mHSPC patients. Therefore, we compared overall survival (OS) and progression-free survival (PFS) benefits among considerable mHSPC oral chemotherapeutic agents. Materials and methods We investigated mHSPC treatment efficacy through a systematic RCT-trial literature review (PubMed, Embase, Web of Science, the Cochrane Library, and Scopus). Two reviewers independently screened, extracted data, and assessed bias risk in duplicate. Results We identified 18 RCTs (n = 13,509). Concerning OS, ADT + abiraterone, ADT + abiraterone + docetaxel, ADT + apalutamide, ADT + bicalutamide, ADT + darolutamide + docetaxel, ADT + enzalutamide, ADT + orteronel, and ADT + rezvilutamide were more effective than the standard of care (SOC). Comparing PFS, most treatments were more effective than SOC, excluding ADT + bicalutamide, nilutamide, flutamide, ADT + bicalutamide + palbociclib, and ADT + nilutamide. ADT + docetaxel with androgen receptor targeted agent (ARTA) triplet therapy was not among the top three treatments determined through ranking analysis. Conclusions Novel oral chemotherapeutic agent combination therapies must replace current ADT monotherapy and ADT + docetaxel SOC. Even so, ADT + docetaxel with ARTA triplet therapy still is not the best mHSPC treatment and requires further study.
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Affiliation(s)
- Yong Seong Lee
- Department of Urology, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gyeonggi-do, Korea
| | - Seong Hwan Kim
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Jong Hyun Tae
- Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - In Ho Chang
- Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Tae-Hyoung Kim
- Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Soon Chul Myung
- Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
| | - Myoungsuk Kim
- Healthcare Big-Data Center, Research Institute of Clinical Medicine, Kyung Hee University Hospital at Gang Dong, Seoul, Korea
| | - Tuan Thanh Nguyen
- Department of Urology, Cho Ray Hospital, University of Medicine and Pharmacy at Ho Chi Minh City, Viet Nam
| | - Joongwon Choi
- Department of Urology, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gyeonggi-do, Korea
| | - Jung Hoon Kim
- Department of Urology, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gyeonggi-do, Korea
| | - Jin Wook Kim
- Department of Urology, Chung-Ang University Gwangmyeong Hospital, Chung-Ang University College of Medicine, Gyeonggi-do, Korea
| | - Se Young Choi
- Department of Urology, Chung-Ang University Hospital, Chung-Ang University College of Medicine, Seoul, Korea
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Menges D, Piatti MC, Omlin A, Cathomas R, Benamran D, Fischer S, Iselin C, Küng M, Lorch A, Prause L, Rothermundt C, O'Meara Stern A, Zihler D, Lippuner M, Braun J, Cerny T, Puhan MA. Patient and General Population Preferences Regarding the Benefits and Harms of Treatment for Metastatic Prostate Cancer: A Discrete Choice Experiment. EUR UROL SUPPL 2023; 51:26-38. [PMID: 37187724 PMCID: PMC10175729 DOI: 10.1016/j.euros.2023.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/03/2023] [Indexed: 05/17/2023] Open
Abstract
Background Patient preferences for treatment outcomes are important to guide decision-making in clinical practice, but little is known about the preferences of patients with metastatic hormone-sensitive prostate cancer (mHSPC). Objective To evaluate patient preferences regarding the attributed benefits and harms of systemic treatments for mHSPC and preference heterogeneity between individuals and specific subgroups. Design setting and participants We conducted an online discrete choice experiment (DCE) preference survey among 77 patients with metastatic prostate cancer (mPC) and 311 men from the general population in Switzerland between November 2021 and August 2022. Outcome measurements and statistical analysis We evaluated preferences and preference heterogeneity related to survival benefits and treatment-related adverse effects using mixed multinomial logit models and estimated the maximum survival time participants were willing to trade to avert specific adverse effects. We further assessed characteristics associated with different preference patterns via subgroup and latent class analyses. Results and limitations Patients with mPC showed an overall stronger preference for survival benefits in comparison to men from the general population (p = 0.004), with substantial preference heterogeneity between individuals within the two samples (both p < 0.001). There was no evidence of differences in preferences for men aged 45-65 yr versus ≥65 yr, patients with mPC in different disease stages or with different adverse effect experiences, or general population participants with and without experiences with cancer. Latent class analyses suggested the presence of two groups strongly preferring either survival or the absence of adverse effects, with no specific characteristic clearly associated with belonging to either group. Potential biases due to participant selection, cognitive burden, and hypothetical choice scenarios may limit the study results. Conclusions Given the relevant heterogeneity in participant preferences regarding the benefits and harms of treatment for mHSPC, patient preferences should be explicitly discussed during decision-making in clinical practice and reflected in clinical practice guidelines and regulatory assessment regarding treatment for mHSPC. Patient summary We examined the preferences (values and perceptions) of patients and men from the general population regarding the benefits and harms of treatment for metastatic prostate cancer. There were large differences between men in how they balanced the expected survival benefits and potential adverse effects. While some men strongly valued survival, others more strongly valued the absence of adverse effects. Therefore, it is important to discuss patient preferences in clinical practice.
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Affiliation(s)
- Dominik Menges
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
- Corresponding author. Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001 Zurich, Switzerland. Tel. +41 44 6344615.
| | - Michela C. Piatti
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Aurelius Omlin
- Department of Medical Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen, Switzerland
- Onkozentrum Zürich, Zurich, Switzerland
| | - Richard Cathomas
- Division of Oncology/Hematology, Kantonsspital Graubünden, Chur, Switzerland
| | - Daniel Benamran
- Department of Urology, Hôpitaux Universitaires Genève, Geneva, Switzerland
| | - Stefanie Fischer
- Department of Medical Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Christophe Iselin
- Department of Urology, Hôpitaux Universitaires Genève, Geneva, Switzerland
| | - Marc Küng
- Department of Oncology, Hôpital Cantonal Fribourg, Fribourg, Switzerland
| | - Anja Lorch
- Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland
| | - Lukas Prause
- Department of Urology, Kantonsspital Aarau, Aarau, Switzerland
| | - Christian Rothermundt
- Department of Medical Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Alix O'Meara Stern
- Department of Oncology, Réseau Hospitalier Neuchâtelois, Neuchâtel, Switzerland
| | - Deborah Zihler
- Department of Oncology, Hematology and Transfusion Medicine, Kantonsspital Aarau, Aarau, Switzerland
| | - Max Lippuner
- Europa Uomo Switzerland, Ehrendingen, Switzerland
| | - Julia Braun
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Thomas Cerny
- Foundation Board, Cancer Research Switzerland, Bern, Switzerland
- Human Medicines Expert Committee, Swissmedic, Bern, Switzerland
| | - Milo A. Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
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Grivas P, Veeranki P, Chiu K, Pawar V, Chang J, Bharmal M. Preferences for first-line treatment of advanced urothelial carcinoma among US practicing oncologists and patients. Future Oncol 2023; 19:369-383. [PMID: 36876486 DOI: 10.2217/fon-2022-0767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
Aim: Investigate oncologist and patient preferences for the first-line treatment of advanced urothelial carcinoma. Materials & methods: A discrete-choice experiment was used to elicit treatment attribute preferences, including patient treatment experience (number and duration of treatments and grade 3/4 treatment-related adverse events), overall survival and treatment administration frequency. Results: The study included 151 eligible medical oncologists and 150 patients with urothelial carcinoma. Both physicians and patients appeared to prefer treatment attributes related to overall survival, treatment-related adverse events and the number and duration of the medications in a regimen over frequency of administration. Overall survival had the most influence in driving oncologists' treatment preferences, followed by the patient's treatment experience. Patients found the treatment experience the most important attribute when considering options, followed by overall survival. Conclusion: Patient preferences were based on treatment experience, while oncologists preferred treatments that prolong overall survival. These results help to direct clinical conversations, treatment recommendations and clinical guideline development.
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Affiliation(s)
- Petros Grivas
- Division of Medical Oncology, Department of Medicine, University of Washington, Seattle, WA 98109-1023, USA.,Clinical Research Division, Fred Hutchinson Cancer Center, Seattle, WA 98109-1023, USA
| | | | - Kevin Chiu
- PRECISIONheor, Los Angeles, CA 90025, USA
| | - Vivek Pawar
- EMD Serono, Inc., Rockland, MA 02370, USA, an affiliate of Merck KGaA
| | | | - Murtuza Bharmal
- EMD Serono, Inc., Rockland, MA 02370, USA, an affiliate of Merck KGaA
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George DJ, Mohamed AF, Tsai JH, Karimi M, Ning N, Jayade S, Botteman M. Understanding what matters to metastatic castration-resistant prostate cancer (mCRPC) patients when considering treatment options: A US patient preference survey. Cancer Med 2023; 12:6040-6055. [PMID: 36226867 PMCID: PMC10028042 DOI: 10.1002/cam4.5313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/02/2022] [Accepted: 09/20/2022] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Understanding how patients perceive the efficacy, safety, and administrative burden of treatments for metastatic castration-resistant prostate cancer (mCRPC) can facilitate shared-decision making for optimal management. This study sought to elicit patient preferences for mCRPC treatments in the US. METHODS We conducted a cross-sectional survey using the discrete-choice experiment method. Participants were asked to state their choices over successive sets of treatment alternatives, defined by varying levels of treatment attributes: overall survival (OS), months until patients develop a fracture or bone metastasis, likelihood of requiring radiation to control bone pain, fatigue, nausea, and administration (i.e., oral/IV injection/IV infusion). Using mixed logit models, we determined the value (i.e., preference weights) that respondents placed on each attribute. Relative attribute importance (RAI) and marginal rates of substitution (MRS) were calculated to understand patients' willingness to make tradeoffs among different attributes. RESULTS The final data set numbered 160 participants, with a mean age of 71.6 years old and a mean of 8.96 years since prostate cancer diagnosis. Participants' treatment preferences were as follows: OS (RAI: 31%), bone pain control (23%), nausea (16%), delaying fracture or bone metastasis (15%), fatigue (11%), and administration (3%). The MRS demonstrated that respondents were willing to trade 1.9 months of OS to eliminate moderate nausea and 3.3 months of OS for a reduction in fatigue from severe to mild. CONCLUSIONS Improving OS is the highest priority for patients with mCRPC, but they are willing to trade some survival to reduce the risk of requiring radiation to control bone pain, delay a fracture or bone metastasis, and experience less severe nausea and fatigue.
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Affiliation(s)
- Daniel J George
- Duke University School of Medicine, Durham, North Carolina, USA
| | | | - Jui-Hua Tsai
- Evidence and Access, OPEN Health, Parsippany, New Jersey, USA
| | - Milad Karimi
- Evidence and Access, OPEN Health, Rotterdam, The Netherlands
| | - Ning Ning
- Evidence and Access, OPEN Health, Parsippany, New Jersey, USA
| | - Sayeli Jayade
- Evidence and Access, OPEN Health, Parsippany, New Jersey, USA
| | - Marc Botteman
- Evidence and Access, OPEN Health, Parsippany, New Jersey, USA
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Jiang S, Ren R, Gu Y, Jeet V, Liu P, Li S. Patient Preferences in Targeted Pharmacotherapy for Cancers: A Systematic Review of Discrete Choice Experiments. PHARMACOECONOMICS 2023; 41:43-57. [PMID: 36372823 PMCID: PMC9813042 DOI: 10.1007/s40273-022-01198-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/18/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND Targeted pharmacotherapy has been increasingly applied in cancer treatment due to its breakthroughs. However, the unmet needs of cancer patients are still significant, highlighting the urgency to investigate patient preferences. It is unclear how patients deliberate their choices between different aspects of targeted therapy, including cost, efficacy, and adverse events. Since discrete choice experiments (DCEs) have been widely applied to patient preference elicitation, we reviewed DCEs on targeted therapy for different cancers. We also synthesized evidence on the factors influencing patients' choices and their willingness-to-pay (WTP) for survival when treated by targeted therapy. METHODS We searched databases, including PubMed, EMBASE and MEDLINE, up to August 16, 2022, supplemented by a reference screening. The attributes from the selected studies were categorized into three groups: outcomes, costs, and process. We also calculated the relative importance of attributes and WTP for survival whenever possible. The purpose, respondents, explanation, findings, significance (PREFS) checklist was used to evaluate the quality of the included DCE studies. RESULTS The review identified 34 eligible studies from 13 countries covering 14 cancers, such as breast, ovarian, kidney, prostate, and skin cancers. It also reveals a rising trend of DCEs on this topic, as most studies were published after 2018. We found that patients placed higher weights on the outcome (e.g., overall survival) and cost attributes than on process attributes. On average, patients were willing to pay $561 (95% confidence interval [CI]: $415-$758) and $716 (95% CI $524-$958) out-of-pocket for a 1-month increase in progression-free survival and overall survival, respectively. PREFS scores of the 34 studies ranged from 2 to 4, with a mean of 3.38 (SD: 0.65), suggesting a reasonable quality based on the checklist. However, most studies (n = 32, 94%) did not assess the impact of non-responses on the results. CONCLUSIONS This is the first systematic review focusing on patient preferences for targeted cancer therapy. We showcased novel approaches for evidence synthesis of DCE results, especially the attribute relative importance and WTP. The results may inform stakeholders about patient preferences toward targeted therapy and their WTP estimates. More studies with improved study design and quality are warranted to generate more robust evidence to assist decision making.
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Affiliation(s)
- Shan Jiang
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Ru Ren
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
- Center for Health Preference Research, Shandong University, Jinan, 250012, China
- Institute of Medical Sciences, The Second Hospital, Cheeloo College of Medicine, Shandong University, 247# Beiyuan Street, Jinan, 250033, China
| | - Yuanyuan Gu
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, 2109, Australia.
| | - Varinder Jeet
- Macquarie University Centre for the Health Economy, Macquarie Business School & Australian Institute of Health Innovation, Macquarie University, Sydney, NSW, 2109, Australia
| | - Ping Liu
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
- Center for Health Preference Research, Shandong University, Jinan, 250012, China
| | - Shunping Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research (Shandong University), Jinan, 250012, China
- Center for Health Preference Research, Shandong University, Jinan, 250012, China
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8
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Menges D, Piatti MC, Cerny T, Puhan MA. Patient Preference Studies for Advanced Prostate Cancer Treatment Along the Medical Product Life Cycle: Systematic Literature Review. Patient Prefer Adherence 2022; 16:1539-1557. [PMID: 35789822 PMCID: PMC9250329 DOI: 10.2147/ppa.s362802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2022] [Accepted: 06/16/2022] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Patient preference studies can inform decision-making across all stages of the medical product life cycle (MPLC). The treatment landscape for advanced prostate cancer (APC) treatment has substantially changed in recent years. However, the most patient-relevant aspects of APC treatment remain unclear. This systematic review of patient preference studies in APC aimed to summarize the evidence on patient preferences and patient-relevant aspects of APC treatments, and to evaluate the potential contribution of existing studies to decision-making within the respective stages of the MPLC. METHODS We searched MEDLINE and EMBASE for studies evaluating patient preferences related to APC treatment up to October 2020. Two reviewers independently performed screening, data extraction and quality assessment in duplicate. We descriptively summarized the findings and analyzed the studies regarding their contribution within the MPLC using an analytical framework. RESULTS Seven quantitative preference studies were included. One study each was conducted in the marketing approval and the health technology assessment (HTA) and reimbursement stage, and five were conducted in the post-marketing stage of the MPLC. While almost all stated to inform clinical practice, the specific contributions to clinical decision-making remained unclear for almost all studies. Evaluated attributes related to benefits, harms, and other treatment-related aspects and their relative importance varied relevantly between studies. All studies were judged of high quality overall, but some methodological issues regarding sample selection and the definition of patient-relevant treatment attributes were identified. CONCLUSION The most patient-relevant aspects regarding the benefits and harms of APC treatment are not yet established, and it remains unclear which APC treatments are preferred by patients. Findings from this study highlight the importance of transparent reporting and discussion of study findings according to their aims and with respect to their stage within the MPLC. Future research may benefit from using the MPLC framework for analyzing or determining the aims and design of patient preference studies.
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Affiliation(s)
- Dominik Menges
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
- Correspondence: Dominik Menges, Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Hirschengraben 84, Zurich, CH-8001, Switzerland, Tel +41 44 634 46 15, Email
| | - Michela C Piatti
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
| | - Thomas Cerny
- Foundation Board, Cancer Research Switzerland (Krebsforschung Schweiz KFS), Bern, Switzerland
- Human Medicines Expert Committee (HMEC), Swissmedic, Bern, Switzerland
| | - Milo A Puhan
- Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich (UZH), Zurich, Switzerland
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Kwon DH, Karthikeyan S, Chang A, Borno HT, Koshkin VS, Desai A, Bose R, Friedlander T, Rodvelt T, Li P, Small EJ, Aggarwal RR, Belkora J. Mobile Audio Recording Technology to Promote Informed Decision Making in Advanced Prostate Cancer. JCO Oncol Pract 2021; 18:e648-e658. [PMID: 34932386 DOI: 10.1200/op.21.00480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Men with metastatic castration-resistant prostate cancer increasingly encounter complex treatment decisions. Consultation audio recordings and summaries promote patient informed decision making but are underutilized. Mobile recording software applications may increase access. Little is known regarding the feasibility of implementation in clinical encounters. METHODS We conducted a mixed-methods pilot study in men with progressive metastatic castration-resistant prostate cancer. We instructed patients to use a mobile software application to record an oncology visit. Patients could share the recording with our patient scribing program to receive a written summary. We assessed feasibility and acceptability with postvisit surveys. We measured patient-reported helpfulness of the intervention in decision making and change in Decisional Conflict Scale-informed subscale. We conducted semistructured interviews to explore implementation and analyzed transcripts using thematic analysis. RESULTS Across 20 patients, 18 (90%) recorded their visits. Thirteen of 18 (72%) listened to the recording, and 14 of 18 (78%) received a summary. Eighteen of 20 (90%) visits were telehealth. Fourteen patients (70% of all 20; 78% of 18 question respondents) found the application easy to use. Nine patients (50% of 18 recording patients; 90% of 10 question respondents) reported that the recording helped treatment decision making. Decisional conflict decreased from baseline to 1-week postvisit (47.4-28.5, P < .001). Interviews revealed benefits, facilitators, contextual factors, and technology and patient-related barriers to recordings and summaries. CONCLUSION In this single-institution academic setting, a mobile application for patients to record consultations was a feasible, acceptable, and potentially valued intervention that improved decision making in the telehealth setting. Studies in larger, diverse populations are needed.
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Affiliation(s)
- Daniel H Kwon
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA
| | - Sneha Karthikeyan
- Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Alison Chang
- Department of Surgery, University of California, San Francisco, San Francisco, CA
| | - Hala T Borno
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | - Vadim S Koshkin
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | - Arpita Desai
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | - Rohit Bose
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | - Terence Friedlander
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | - Tammy Rodvelt
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | - Patricia Li
- Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | - Eric J Small
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | - Rahul R Aggarwal
- Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, San Francisco, CA.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA
| | - Jeffrey Belkora
- Department of Surgery, University of California, San Francisco, San Francisco, CA.,Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, San Francisco, CA.,Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA
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10
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Connor MJ, Genie MG, Burns D, Bass EJ, Gonzalez M, Sarwar N, Falconer A, Mangar S, Dudderidge T, Khoo V, Winkler M, Ahmed HU, Watson V. A Systematic Review of Patients' Values, Preferences, and Expectations for the Treatment of Metastatic Prostate Cancer. EUR UROL SUPPL 2021; 36:9-18. [PMID: 34977691 PMCID: PMC8703228 DOI: 10.1016/j.euros.2021.10.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 12/01/2022] Open
Abstract
CONTEXT Advances in systemic agents have increased overall survival for men diagnosed with metastatic prostate cancer. Additional cytoreductive prostate treatments and metastasis-directed therapies are under evaluation. These confer toxicity but may offer incremental survival benefits. Thus, an understanding of patients' values and treatment preferences is important for counselling, decision-making, and guideline development. OBJECTIVE To perform a systematic review of patients' values, preferences, and expectations regarding treatment of metastatic prostate cancer. EVIDENCE ACQUISITION The MEDLINE, Embase, and CINAHL databases were systematically searched for qualitative and preference elucidation studies reporting on patients' preferences for treatment of metastatic prostate cancer. Certainty of evidence was assessed using Grading of Recommendation, Assessment, Development and Evaluation (GRADE) or GRADE Confidence in the Evidence from Reviews of Qualitative Research (CERQual). The protocol was registered on PROSPERO as CRD42020201420. EVIDENCE SYNTHESIS A total of 1491 participants from 15 studies met the prespecified eligibility for inclusion. The study designs included were discrete choice experiments (n = 5), mixed methods (n = 3), and qualitative methods (n = 7). Disease states reported per study were: metastatic castration-resistant prostate cancer in nine studies (60.0%), metastatic hormone-sensitive prostate cancer in two studies (13.3%), and a mixed cohort in four studies (26.6%). In quantitative preference elicitation studies, patients consistently valued treatment effectiveness and delay in time to symptoms as the two top-ranked treatment attributes (low or very low certainty). Patients were willing to trade off treatment-related toxicity for potential oncological benefits (low certainty). In qualitative studies, thematic analysis revealed cancer progression and/or survival, pain, and fatigue as key components in treatment decisions (low or very low certainty). Patients continue to value oncological benefits in making decisions on treatments under qualitative assessment. CONCLUSIONS There is limited understanding of how patients make treatment and trade-off decisions following a diagnosis of metastatic prostate cancer. For appropriate investment in emerging cytoreductive local tumour and metastasis-directed therapies, we should seek to better understand how this cohort weighs the oncological benefits against the risks. PATIENT SUMMARY We looked at how men with advanced (metastatic) prostate cancer make treatment decisions. We found that little is known about patients' preferences for current and proposed new treatments. Further studies are required to understand how patients make decisions to help guide the integration of new treatments into the standard of care.
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Affiliation(s)
- Martin J. Connor
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK,Corresponding author at: Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Campus, Fulham Palace Road, London W6 8RF, UK.
| | - Mesfin G. Genie
- Health Economic Research Unit (HERU), Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - David Burns
- Health Economic Research Unit (HERU), Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
| | - Edward J. Bass
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Michael Gonzalez
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Naveed Sarwar
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Alison Falconer
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Stephen Mangar
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Vincent Khoo
- Department of Clinical Oncology, The Royal Marsden Hospital & Institute of Cancer Research, London, UK
| | - Mathias Winkler
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Hashim U. Ahmed
- Imperial Prostate, Division of Surgery, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK,Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Verity Watson
- Health Economic Research Unit (HERU), Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK
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11
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Connor MJ, Genie MG, Gonzalez M, Sarwar N, Thippu Jayaprakash K, Horan G, Hosking-Jervis F, Klimowska-Nassar N, Sukumar J, Pokrovska T, Basak D, Robinson A, Beresford M, Rai B, Mangar S, Khoo V, Dudderidge T, Falconer A, Winkler M, Watson V, Ahmed HU. Metastatic prostate cancer men's attitudes towards treatment of the local tumour and metastasis evaluative research (IP5-MATTER): protocol for a prospective, multicentre discrete choice experiment study. BMJ Open 2021; 11:e048996. [PMID: 34794989 PMCID: PMC8603288 DOI: 10.1136/bmjopen-2021-048996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
INTRODUCTION Systemic therapy with androgen deprivation therapy (ADT) and intensification with agents such as docetaxel, abiraterone acetate and enzalutamide has resulted in improved overall survival in men with de novo synchronous metastatic hormone-sensitive prostate cancer (mHSPC). Novel local cytoreductive treatments and metastasis-directed therapy are now being evaluated. Such interventions may provide added survival benefit or delay the requirement for further systemic agents and associated toxicity but can confer additional harm. Understanding men's preferences for treatment options in this disease state is crucial for patients, clinicians, carers and future healthcare service providers. METHODS Using a prospective, multicentre discrete choice experiment (DCE), we aim to determine the attributes associated with treatment that are most important to men with mHSPC. Furthermore, we plan to determine men's preferences for, and trade-offs between, the attributes (survival and side effects) of different treatment options including systemic therapy, local cytoreductive approaches (external beam radiotherapy, cytoreductive radical prostatectomy or minimally invasive ablative therapy) and metastases-directed therapies (metastasectomy or stereotactic ablative body radiotherapy). All men with newly diagnosed mHSPC within 4 months of commencing ADT and WHO performance status 0-2 are eligible. Men who have previously consented to a cytoreductive treatment or have developed castrate-resistant disease will be excluded. This study includes a qualitative analysis component, with patients (n=15) and healthcare professionals (n=5), to identify and define the key attributes associated with treatment options that would warrant trade-off evaluation in a DCE. The main phase component planned recruitment is 300 patients over 1 year, commencing in January 2021, with planned study completion in March 2022. ETHICS AND DISSEMINATION Ethical approval was obtained from the Health Research Authority East of England, Cambridgeshire and Hertfordshire Research Ethics Committee (Reference: 20/EE/0194). Project information will be reported on the publicly available Imperial College London website and the Heath Economics Research Unit (HERU website including the HERU Blog). We will use the social media accounts of IP5-MATTER, Imperial Prostate London, HERU and the individual researchers to disseminate key findings following publication. Findings from the study will be presented at national/international conferences and peer-reviewed journals. Authorship policy will follow the recommendations of the International Committee of Medical Journal Editors. TRIAL REGISTRATION NUMBER NCT04590976.
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Affiliation(s)
- Martin John Connor
- Imperial Prostate, Divison of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Mesfin G Genie
- Health Economics Research Unit (HERU), Faculty of Medicine, University of Aberdeen, Aberdeen, UK
- Economics, Ca' Foscari University of Venice, Venezia, Italy
| | - Michael Gonzalez
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Naveed Sarwar
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Kamalram Thippu Jayaprakash
- Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
- Department of Oncology, Queen Elizabeth Hospital King's Lynn NHS Foundation Trust, King's Lynn, UK
| | - Gail Horan
- Department of Oncology, Addenbrooke's Hospital, Cambridge, UK
| | - Feargus Hosking-Jervis
- Imperial Prostate, Divison of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
| | - Natalia Klimowska-Nassar
- Imperial Prostate, Divison of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial College Clinical Trials Unit (ICTU), Imperial College London, London, UK
| | - Johanna Sukumar
- Imperial Prostate, Divison of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial College Clinical Trials Unit (ICTU), Imperial College London, London, UK
| | - Tzveta Pokrovska
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Dolan Basak
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Angus Robinson
- Department of Oncology, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Mark Beresford
- Department of Oncology, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Bhavan Rai
- Department of Urology, Newcastle Upon Tyne Hospitals NHS Foundation Trust, Newcastle Upon Tyne, UK
| | - Stephen Mangar
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Vincent Khoo
- Department of Oncology, The Royal Marsden NHS Foundation Trust and Institute of Cancer Research, London, UK
| | - Tim Dudderidge
- Department of Urology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Alison Falconer
- Department of Oncology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Mathias Winkler
- Imperial Prostate, Divison of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Verity Watson
- Health Economics Research Unit (HERU), Faculty of Medicine, University of Aberdeen, Aberdeen, UK
| | - Hashim Uddin Ahmed
- Imperial Prostate, Divison of Surgery, Department of Surgery and Cancer, Imperial College London, London, UK
- Imperial Urology, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
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12
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Collacott H, Soekhai V, Thomas C, Brooks A, Brookes E, Lo R, Mulnick S, Heidenreich S. A Systematic Review of Discrete Choice Experiments in Oncology Treatments. THE PATIENT 2021; 14:775-790. [PMID: 33950476 DOI: 10.1007/s40271-021-00520-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND As the number and type of cancer treatments available rises and patients live with the consequences of their disease and treatments for longer, understanding preferences for cancer care can help inform decisions about optimal treatment development, access, and care provision. Discrete choice experiments (DCEs) are commonly used as a tool to elicit stakeholder preferences; however, their implementation in oncology may be challenging if burdensome trade-offs (e.g. length of life versus quality of life) are involved and/or target populations are small. OBJECTIVES The aim of this review was to characterise DCEs relating to cancer treatments that were conducted between 1990 and March 2020. DATA SOURCES EMBASE, MEDLINE, and the Cochrane Database of Systematic Reviews were searched for relevant studies. STUDY ELIGIBILITY CRITERIA Studies were included if they implemented a DCE and reported outcomes of interest (i.e. quantitative outputs on participants' preferences for cancer treatments), but were excluded if they were not focused on pharmacological, radiological or surgical treatments (e.g. cancer screening or counselling services), were non-English, or were a secondary analysis of an included study. ANALYSIS METHODS Analysis followed a narrative synthesis, and quantitative data were summarised using descriptive statistics, including rankings of attribute importance. RESULT Seventy-nine studies were included in the review. The number of published DCEs relating to oncology grew over the review period. Studies were conducted in a range of indications (n = 19), most commonly breast (n =10, 13%) and prostate (n = 9, 11%) cancer, and most studies elicited preferences of patients (n = 59, 75%). Across reviewed studies, survival attributes were commonly ranked as most important, with overall survival (OS) and progression-free survival (PFS) ranked most important in 58% and 28% of models, respectively. Preferences varied between stakeholder groups, with patients and clinicians placing greater importance on survival outcomes, and general population samples valuing health-related quality of life (HRQoL). Despite the emphasis of guidelines on the importance of using qualitative research to inform attribute selection and DCE designs, reporting on instrument development was mixed. LIMITATIONS No formal assessment of bias was conducted, with the scope of the paper instead providing a descriptive characterisation. The review only included DCEs relating to cancer treatments, and no insight is provided into other health technologies such as cancer screening. Only DCEs were included. CONCLUSIONS AND IMPLICATIONS Although there was variation in attribute importance between responder types, survival attributes were consistently ranked as important by both patients and clinicians. Observed challenges included the risk of attribute dominance for survival outcomes, limited sample sizes in some indications, and a lack of reporting about instrument development processes. PROTOCOL REGISTRATION PROSPERO 2020 CRD42020184232.
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Affiliation(s)
- Hannah Collacott
- Evidera, The Ark, 2nd Floor, 201 Talgarth Road, London, W6 8BJ, UK.
| | - Vikas Soekhai
- Erasmus University, Rotterdam, The Netherlands
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Caitlin Thomas
- Evidera, The Ark, 2nd Floor, 201 Talgarth Road, London, W6 8BJ, UK
| | - Anne Brooks
- Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, 20814, USA
| | - Ella Brookes
- Evidera, The Ark, 2nd Floor, 201 Talgarth Road, London, W6 8BJ, UK
| | - Rachel Lo
- Evidera, The Ark, 2nd Floor, 201 Talgarth Road, London, W6 8BJ, UK
| | - Sarah Mulnick
- Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, 20814, USA
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13
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Uemura H, Matsushima H, Yokomizo A, Kobayashi K, Arai G, Satoh T, Grillo V, Chen Y, Singh S, Ledesma DA. Unmet needs in non-metastatic castration-resistant prostate cancer from the Japanese patient perspective: a discrete choice experiment. BMJ Open 2021; 11:e052471. [PMID: 34400460 PMCID: PMC8370498 DOI: 10.1136/bmjopen-2021-052471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES With novel antiandrogen treatments of varying clinical benefits and risks becoming available, this study investigates how patients with castration-resistant prostate cancer (CRPC) value differences in treatment characteristics. DESIGN Cross-sectional observational study. SETTING A discrete choice experiment was conducted. Patients chose between two hypothetical non-metastatic CRPC (nmCRPC) treatments defined by six attributes: risk of fatigue, falls or fracture, cognitive impairment, hypertension, rashes as side effects to treatment and extension of time until cancer-related pain occurs. PARTICIPANTS A total of 137 adult male patients with CRPC with no prior experience with chemotherapy and with Eastern Cooperative Oncology Group status 0-1 were recruited. Patients were excluded if they participated in an investigational programme outside of routine clinical practice, had a clinically relevant medical or psychiatric condition, or diagnosis of visceral/other metastases not related to the prostate, or were otherwise deemed ineligible by the referring physician. PRIMARY OUTCOME MEASURES Relative preference weights and relative importance of the attributes was estimated by hierarchical Bayesian logistic regression. RESULTS Among the treatment attributes, 'risk of cognitive impairment as a side effect of treatment' was the most important attribute (relative importance (RI) (95% CI): 27.47% (24.80% to 30.14%)), followed by 'extension of time until cancer-related pain occurs' (RI (95% CI): 17.87% (15.49% to 20.25%)) and the 'risk of falls or fracture' (RI (95% CI): 15.99% (14.73% to 17.25%)). The 'risk of hypertension as a side effect of treatment' (RI (95% CI): 13.77% (12.73% to 14.81%)) had similar RI as 'risk of rashes as a side effect of treatment' (RI (95% CI): 13.17% (12.15% to 14.19%)), followed by the 'risk of fatigue as a side effect of treatment' (RI (95% CI): 11.74% (10.75% to 12.73%)). CONCLUSIONS Patients consider the risk of cognitive impairment as a side effect of treatment as the most important attribute in nmCRPC, followed by the extension of time until cancer-related pain occurs, and the risk of falls and fracture. These features should be considered in treatment decision making for nmCRPC in Japan.
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Affiliation(s)
- Hiroji Uemura
- Department of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | | | - Akira Yokomizo
- Department of Urology, Harasanshin Hospital, Fukuoka, Japan
| | - Kazuki Kobayashi
- Department of Urology, Yokosuka Kyosai Hospital, Yokosuka, Japan
| | - Gaku Arai
- Department of Urology, Dokkyo Medical University Saitama Medical Center, Koshigaya, Japan
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14
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Bahl A, Crabb S, Ford D, Jones R, Malik Z, Mazhar D, O'Sullivan J, Payne H. Management of newly diagnosed metastatic hormone-sensitive prostate cancer: A survey of UK Uro-oncologists. Int J Clin Pract 2021; 75:e13874. [PMID: 33258206 DOI: 10.1111/ijcp.13874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Revised: 11/17/2020] [Accepted: 11/25/2020] [Indexed: 11/30/2022] Open
Abstract
AIM To explore the practice and views of uro-oncologists in the United Kingdom regarding their use of chemotherapy and androgen receptor-targeted agents (ARTAs) in patients with newly diagnosed metastatic hormone-sensitive prostate cancer (mHSPC). METHODS An expert-devised paper or online questionnaire was completed by members of the British Uro-oncology Group. RESULTS All respondents stated that they would offer patients with newly diagnosed mHSPC docetaxel and androgen deprivation therapy (ADT) if they were sufficiently fit to receive chemotherapy (this was the only option available at the time of the survey); 64% would strongly recommend docetaxel for those with high-volume metastatic disease and 31% for those with low-volume disease. Hypothetically, if both docetaxel and ARTAs were available in the United Kingdom for mHSPC, almost 65% of respondents would recommend an ARTA with ADT to these patients in at least one-half of all cases, with the strongest recommendations to patients with high-risk disease. Imaging for the response was conducted according to suspicion of disease progression, regardless of treatment, with the minority of clinicians recommending routine imaging. If a choice of therapy was available, docetaxel would be more likely to be offered to patients with liver or lung metastases, and ARTAs to patients with bone or lymph node only metastases. Almost all respondents would offer local radiotherapy to the primary tumour in patients with low-volume disease. CONCLUSION All the UK uro-oncologists surveyed stated that they would offer docetaxel in combination with ADT to all newly diagnosed patients with mHSPC if fit enough for chemotherapy. ARTAs would be offered to many patients if available, especially those with high-risk disease or those unfit to receive chemotherapy. Scanning was typically conducted following treatment only at the suspicion of disease progression.
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Affiliation(s)
- Amit Bahl
- Bristol Haematology and Oncology Centre, University Hospitals Bristol NHS Foundation Trust, Bristol, United Kingdom
| | - Simon Crabb
- University of Southampton, Southampton, United Kingdom
| | - Dan Ford
- University Hospitals Birmingham, Birmingham, United Kingdom
| | - Rob Jones
- University of Glasgow and Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
| | - Zaf Malik
- The Clatterbridge Cancer Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Danish Mazhar
- Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
| | - Joe O'Sullivan
- Queen's University Belfast and The Northern Ireland Cancer Centre, Belfast, United Kingdom
| | - Heather Payne
- University College London Hospitals, London, United Kingdom
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15
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Connor MJ, Khoo V, Watson V, Ahmed HU. Radical Treatment Without Cure: Decision-making in Oligometastatic Prostate Cancer. Eur Urol 2021; 79:558-560. [PMID: 33549359 DOI: 10.1016/j.eururo.2021.01.029] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 01/19/2021] [Indexed: 11/25/2022]
Affiliation(s)
- Martin J Connor
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Campus, London, UK; Department of Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK.
| | - Vincent Khoo
- Department of Clinical Oncology, The Royal Marsden NHS Foundation and Institute of Cancer Research, London, UK
| | - Verity Watson
- Health Economics Research Unit, Faculty of Medicine, University of Aberdeen, Aberdeen, UK
| | - Hashim U Ahmed
- Division of Surgery, Department of Surgery and Cancer, Imperial College London, Charing Cross Campus, London, UK; Department of Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
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16
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Pearce A, Harrison M, Watson V, Street DJ, Howard K, Bansback N, Bryan S. Respondent Understanding in Discrete Choice Experiments: A Scoping Review. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2020; 14:17-53. [PMID: 33141359 PMCID: PMC7794102 DOI: 10.1007/s40271-020-00467-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 11/27/2022]
Abstract
Introduction Despite the recognised importance of participant understanding for valid and reliable discrete choice experiment (DCE) results, there has been limited assessment of whether, and how, people understand DCEs, and how ‘understanding’ is conceptualised in DCEs applied to a health context. Objectives Our aim was to identify how participant understanding is conceptualised in the DCE literature in a health context. Our research questions addressed how participant understanding is defined, measured, and used. Methods Searches were conducted (June 2019) in the MEDLINE, EMBASE, PsychINFO and Econlit databases, as well as hand searching. Search terms were based on previous DCE systematic reviews, with additional understanding keywords used in a proximity-based search strategy. Eligible studies were peer-reviewed journal articles in the field of health, related to DCE or best-worst scaling type 3 (BWS3) studies, and reporting some consideration or assessment of participant understanding. A descriptive analytical approach was used to chart relevant data from each study, including publication year, country, clinical area, subject group, sample size, study design, numbers of attributes, levels and choice sets, definition of understanding, how understanding was tested, results of the understanding tests, and how the information about understanding was used. Each study was categorised based on how understanding was conceptualised and used within the study. Results Of 306 potentially eligible articles identified, 31 were excluded based on titles and abstracts, and 200 were excluded on full-text review, resulting in 75 included studies. Three categories of study were identified: applied DCEs (n = 52), pretesting studies (n = 7) and studies of understanding (n = 16). Typically, understanding was defined in relation to either the choice context, such as attribute terminology, or the concept of choosing. Very few studies considered respondents’ engagement as a component of understanding. Understanding was measured primarily through qualitative pretesting, rationality or validity tests included in the survey, and participant self-report, however reporting and use of the results of these methods was inconsistent. Conclusions Those conducting or using health DCEs should carefully select, justify, and report the measurement and potential impact of participant understanding in their specific choice context. There remains scope for research into the different components of participant understanding, particularly related to engagement, the impact of participant understanding on DCE validity and reliability, the best measures of understanding, and methods to maximise participant understanding. Electronic supplementary material The online version of this article (10.1007/s40271-020-00467-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Alison Pearce
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
| | - Mark Harrison
- Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Verity Watson
- Health Economics Research Unit, University of Aberdeen, Aberdeen, Scotland
| | - Deborah J Street
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Kirsten Howard
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Nick Bansback
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Stirling Bryan
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
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Oswald LB, Schumacher FA, Gonzalez BD, Moses KA, Penson DF, Morgans AK. What Do Men with Metastatic Prostate Cancer Consider When Making Treatment Decisions? A Mixed-methods Study. Patient Prefer Adherence 2020; 14:1949-1959. [PMID: 33116438 PMCID: PMC7569052 DOI: 10.2147/ppa.s271620] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2020] [Accepted: 09/05/2020] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Metastatic prostate cancer (mPCa) patients often make complicated treatment decisions, yet decision aids to facilitate shared decision-making for mPCa are uncommon. To inform the development of patient-centered mPCa decision aids, we examined what mPCa survivors considered most important when making treatment decisions. METHODS Using an exploratory sequential approach, we conducted three focus groups with 14 advanced prostate cancer survivors (n=5, n=3, n=6 in each group) to identify considerations for making treatment decisions. Focus groups were audio-recorded and transcribed, and we identified qualitative themes. We then developed a quantitative survey to assess the importance of each theme and administered the survey to mPCa survivors (N=100). We used relative frequencies to determine the most strongly endorsed items and chi-squared and Fisher's exact tests to assess associations with participant characteristics. RESULTS Focus groups yielded 11 themes, and the resulting survey included 20 items. The most strongly endorsed mPCa treatment considerations were: relying on physician's treatment recommendations (79% strongly agree); wanting to feel well enough to spend quality time with loved ones (72% strongly agree); the importance of dying in a manner consistent with one's wishes (70% strongly agree); hoping to eliminate cancer completely (68% strongly agree); and optimizing treatment efficacy (65% strongly agree). Age, race, marital status, employment status, and self-reported health were related to how strongly men endorsed various considerations for mPCa treatment decision-making. CONCLUSION We identified multiple considerations that mPCa survivors appraised when making treatment decisions. These data may inform the development of patient-centered decision aids for mPCa.
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Affiliation(s)
- Laura B Oswald
- Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL, USA
| | - Frank A Schumacher
- Department of Medicine (Hematology and Oncology), Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Brian D Gonzalez
- Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, FL, USA
| | - Kelvin A Moses
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
| | - David F Penson
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
- Department of Urology, VA Tennessee Valley Geriatric Research, Education, and Clinical Center (GRECC), Nashville, TN, USA
| | - Alicia K Morgans
- Department of Medicine (Hematology and Oncology), Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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Srinivas S, Mohamed AF, Appukkuttan S, Botteman M, Ng X, Joshi N, Tsai JH, Fang J, Waldeck AR, Simmons SJ. Patient and caregiver benefit-risk preferences for nonmetastatic castration-resistant prostate cancer treatment. Cancer Med 2020; 9:6586-6596. [PMID: 32725755 PMCID: PMC7520320 DOI: 10.1002/cam4.3321] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 12/20/2022] Open
Abstract
Background Recently approved second‐generation androgen receptor inhibitors (SGARIs) for non‐metastatic castration‐resistant prostate cancer (nmCRPC) have similar efficacy but differ in safety profiles. We used a discrete choice experiment (DCE) to examine how nmCRPC patients and caregivers perceive the benefits versus risks of these new treatments. Methods An online DCE survey with 14 treatment choice questions was administered to nmCRPC patients and caregivers. Each choice question compared two hypothetical medication profiles varying in terms of 5 safety attributes (risk or severity of adverse events [AEs]: fatigue, skin rash, cognitive problems, serious fall, and serious fracture) and two efficacy attributes (duration of overall survival [OS] and time to pain progression). Random parameters logit models were used to estimate each attribute's relative importance. We also estimated the amounts of OS that respondents were willing to forego for a reduction in AEs. Results In total, 143 nmCRPC patients and 149 caregivers viewed the AEs in following order of importance (most to least): serious fracture, serious fall, cognitive problems, fatigue, and skin rash. On average, patients were willing to trade 5.8 and 4.0 months of OS to reduce the risk of serious fracture and fall, respectively, from 3% to 0%; caregivers were willing to trade 6.6 and 5.4 months of OS. Conclusions nmCRPC patients and caregivers preferred treatments with lower AE burdens and were willing to forego OS to reduce the risk and severity of AEs. Our results highlight the importance of carefully balancing risks and benefits when selecting treatments in this relatively asymptomatic population.
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Affiliation(s)
| | | | | | | | - Xinyi Ng
- Pharmerit International, LP, Bethesda, MD, USA
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Srinivas S, Mohamed AF, Appukkuttan S, Botteman M, Ng X, Joshi N, Horodniceanu E, Waldeck AR, Simmons SJ. Physician preferences for non-metastatic castration-resistant prostate cancer treatment. BMC Urol 2020; 20:73. [PMID: 32571276 PMCID: PMC7310549 DOI: 10.1186/s12894-020-00631-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 05/20/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Recent approvals of second-generation androgen receptor inhibitors (SGARIs) have changed the treatment landscape for non-metastatic castration-resistant prostate cancer (nmCRPC). These SGARIs have similar efficacy but differ in safety profiles. We used a discrete choice experiment to explore how United States physicians make treatment decisions between adverse events (AEs) and survival gains in nmCRPC, a largely asymptomatic disease. METHODS Treating physicians (n = 149) participated in an online survey that included 14 treatment choice questions, each comparing 2 hypothetical treatment profiles, which varied in terms of 5 safety and 2 efficacy attributes. We described safety attributes (fatigue, skin rash, cognitive problems, falls, and fractures) in terms of severity and frequency, and efficacy attributes (overall survival [OS] and time to pain progression) in terms of duration of effect. We used a random parameters logit model to estimate preference weights and importance scores for each attribute. We also estimated the amount of survival gain physicians were willing to trade for a reduction in specific AEs between treatment options. RESULTS Physicians placed more importance on survival than on time to pain progression, and viewed a reduction in cognitive problems from severe to none, a reduction in risk of a serious fracture from 8% to none, and a reduction in fatigue from severe to none as the most important safety attributes. Physicians were willing to forego 9.1 and 6.6 months of OS, respectively, to reduce cognitive problems and fatigue from severe to mild-to-moderate. To reduce the risk of a serious fracture from 8 to 5% and 5% to none, physicians were willing to trade 3.9 and 5.3 months of OS, respectively. CONCLUSIONS Physicians were willing to trade substantial amounts of survival to avoid AEs between hypothetical treatments. These results emphasize the importance of carefully balancing therapies' benefits and risks to ultimately optimize the overall quality of nmCRPC patients' survival. Nonetheless, it is noted that the results from the study sample of 149 physicans may not be representative of the viewpoints of all nmCRPC-treating physicians.
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Affiliation(s)
- Sandy Srinivas
- Stanford University Medical Center, Palo Alto, California USA
| | | | | | | | - Xinyi Ng
- Pharmerit International, Bethesda, MD USA
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