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Kowal M, Douglas F, Jayne D, Meads D. Patient choice in colorectal cancer treatment - A systematic review and narrative synthesis of attribute-based stated preference studies. Colorectal Dis 2022; 24:1295-1307. [PMID: 35776854 PMCID: PMC9796068 DOI: 10.1111/codi.16242] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 06/14/2022] [Accepted: 06/27/2022] [Indexed: 12/30/2022]
Abstract
AIM The global burden of colorectal cancer (CRC) is set to increase by 60% by 2030. An aging population and increasing treatment complexity add difficulties for patients and clinicians in CRC management. Patient preferences can be investigated using attribute-based stated preference (AbSP) techniques to explore trade-offs between different treatments. These techniques include discrete-choice experiments (DCEs), conjoint analysis and time-trade off (TTO) methods. This systematic review with a narrative synthesis aimed to determine the use and design of AbSP studies in CRC treatment and to identify patient choice themes. METHODS The searches were performed using MEDLINE, Embase, PsycInfo and Cochrane Library in March 2021. All manuscripts featuring the use of AbSP techniques in CRC treatment were included. Data synthesis was performed using a narrative approach. RESULTS The search strategy returned 271 articles. Eighteen AbSP studies were included featuring 1890 patients and 296 clinicians. AbSP techniques compromised DCE (38.9%, n = 7), TTO (38.9%, n = 7) and conjoint analysis (22.2%, n = 4). Eleven studies (61.1%) involved piloting of tasks and the average task completion rate was 75%. CRC treatments included chemotherapy (33%, n = 6), combined treatments (33%, n = 6), surgery (17%, n = 3), targeted therapy (11%, n = 2) and radiotherapy (6%, n = 1). The most examined domain was physical health, investigated with 49 (59.8%) attributes. CONCLUSIONS Life expectancy was the main attribute in chemotherapy treatment. With surgery, patients were willing to trade life-expectancy to avoid adverse outcomes or a permanent stoma. Communication skills, treatment cost, and clinicians' views were important attributes for patients in cancer services. Further research in the elderly population, and other quality of life domains, are needed to deliver patient-centred CRC care.
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Affiliation(s)
- Mikolaj Kowal
- The John Goligher Colorectal Surgery UnitSt. James's University HospitalLeedsUK,Leeds Institute of Medical Research, Faculty of Medicine and HealthUniversity of LeedsLeedsUK
| | - Francesca Douglas
- The John Goligher Colorectal Surgery UnitSt. James's University HospitalLeedsUK,Leeds Institute of Medical Research, Faculty of Medicine and HealthUniversity of LeedsLeedsUK
| | - David Jayne
- The John Goligher Colorectal Surgery UnitSt. James's University HospitalLeedsUK,Leeds Institute of Medical Research, Faculty of Medicine and HealthUniversity of LeedsLeedsUK
| | - David Meads
- Leeds Institute for Health SciencesUniversity of LeedsLeedsUK
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2
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Shariatifar H, Ranjbarian F, Hajiahmadi F, Farasat A. A comprehensive review on methotrexate containing nanoparticles; an appropriate tool for cancer treatment. Mol Biol Rep 2022; 49:11049-11060. [PMID: 36097117 DOI: 10.1007/s11033-022-07782-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Accepted: 07/07/2022] [Indexed: 11/30/2022]
Abstract
For more than seven decades, methotrexate has been used all over the world for treatment of different diseases such as: cancer, autoimmune diseases, and rheumatoid arthritis. Several studies have addressed its formula, efficacy, and delivery methods in recent years. These studies have been focused on the effectiveness of different nanoparticles on drug delivery, delivery of the drug to the target cells, and attenuation of harm to the host cell. Whereas, the main usages of methotrexate are in cancer treatment field, this review provided a brief perspective into using different nanoparticles and their role in the treatment of different cancers.
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Affiliation(s)
- Hanifeh Shariatifar
- Health Products Safety Research Center, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Fateme Ranjbarian
- Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
| | - Fahimeh Hajiahmadi
- Department of Medical Imaging Technology (Molecular Imaging), School of Advanced Technologies in Medicine, Iran University of Medical Sciences, Tehran, Iran
| | - Alireza Farasat
- Cellular and Molecular Research Center, Research Institute for Prevention of Non-Communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran.
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3
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Trapani D, Franzoi MA, Burstein HJ, Carey LA, Delaloge S, Harbeck N, Hayes DF, Kalinsky K, Pusztai L, Regan MM, Sestak I, Spanic T, Sparano J, Jezdic S, Cherny N, Curigliano G, Andre F. Risk-adapted modulation through de-intensification of cancer treatments: an ESMO classification. Ann Oncol 2022; 33:702-712. [PMID: 35550723 DOI: 10.1016/j.annonc.2022.03.273] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Revised: 03/14/2022] [Accepted: 03/28/2022] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND The landscape of clinical trials testing risk-adapted modulations of cancer treatments is complex. Multiple trial designs, endpoints, and thresholds for non-inferiority have been used; however, no consensus or convention has ever been agreed to categorise biomarkers useful to inform the treatment intensity modulation of cancer treatments. METHODS An expert subgroup under the European Society for Medical Oncology (ESMO) Precision Medicine Working Group shaped an international collaborative project to develop a classification system for biomarkers used in the cancer treatment de-intensification, based on a tiered approach. A group of disease-oriented clinical, translational, methodology and public health experts, and patients' representatives provided an analysis of the status quo, and scanned the horizon of ongoing clinical trials. The classification was developed through multiple rounds of expert revisions and inputs. RESULTS The working group agreed on a univocal definition of treatment de-intensification. Evidence of reduction in the dose-density, intensity, or cumulative dose, including intermittent schedules or shorter treatment duration or deletion of segment(s) of the standard regimens, compound(s), or treatment modality must be demonstrated, to define a treatment de-intensification. De-intensified regimens must also portend a positive impact on toxicity, quality of life, health system burden, or financial toxicity. ESMO classification categorises the biomarkers for treatment modulation in three tiers, based on the level of evidence. Tier A includes biomarkers validated in prospective, randomised, non-inferiority clinical trials. The working group agreed that in non-inferiority clinical trials, boundaries are highly dependent upon the disease scenario and endpoint being studied and that the absolute differences in the outcomes are the most relevant measures, rather than relative differences. Biomarkers tested in single-arm studies with a threshold of non-inferiority are classified as Tier B. Tier C is when the validation occurs in prospective-retrospective quality cohort investigations. CONCLUSIONS ESMO classification for the risk-guided intensity modulation of cancer treatments provides a set of evidence-based criteria to categorise biomarkers deemed to inform de-intensification of cancer treatments, in risk-defined patients. The classification aims at harmonising definitions on this matter, therefore offering a common language for all the relevant stakeholders, including clinicians, patients, decision-makers, and for clinical trials.
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Affiliation(s)
- D Trapani
- New Drugs Development for Innovative Therapies, European Institute of Oncology, IRCCS, Milan, Italy; Department of Medical Oncology, Dana-Farber Cancer Center, Boston, USA
| | - M A Franzoi
- INSERM Unit 981 - Molecular Predictors and New Targets in Oncology, PRISM Center for Precision Medicine, Gustave Roussy, Villejuif, France
| | - H J Burstein
- Department of Medical Oncology, Dana-Farber Cancer Center, Boston, USA
| | - L A Carey
- University of North Carolina at Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, USA
| | - S Delaloge
- Breast Cancer Unit, Department of Medical Oncology, Gustave Roussy, Villejuif, France
| | - N Harbeck
- Breast Center, Department of Obstetrics & Gynecology and Comprehensive Cancer Center Munich, LMU University Hospital, Munich, Germany
| | - D F Hayes
- University of Michigan Rogel Cancer Center, Ann Arbor, USA
| | - K Kalinsky
- Department of Hematology and Medical Oncology, Winship Cancer Institute at Emory University, Atlanta, USA
| | - L Pusztai
- Yale Cancer Center Genetics and Genomics Program, Yale Cancer Center, Yale School of Medicine, New Haven, USA
| | - M M Regan
- Division of Biostatistics, Dana-Farber Cancer Institute, Harvard Medical School, Boston, USA
| | - I Sestak
- Wolfson Institute of Preventive Medicine - Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - T Spanic
- ESMO Patient Advocates Working Group, Ljubljana, Slovenia
| | - J Sparano
- Division of Hematology/Oncology, Icahn School of Medicine at Mt. Sinai, Tisch Cancer Institute, New York, USA
| | - S Jezdic
- Scientific and Medical Division, European Society for Medical Oncology, Lugano, Switzerland
| | - N Cherny
- Department of Medical Oncology, Shaare Zedek Medical Center, Jerusalem, Israel
| | - G Curigliano
- Department of Oncology and Hemato-Oncology, University of Milan, European Institute of Oncology, IRCCS, Milan, Italy.
| | - F Andre
- INSERM Unit 981 - Molecular Predictors and New Targets in Oncology, PRISM Center for Precision Medicine, Gustave Roussy, Villejuif, France.
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4
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Sadahiro S, Sakamoto K, Tsuchiya T, Takahashi T, Ohge H, Sato T, Kondo K, Ogata Y, Baba H, Itabashi M, Ikeda M, Hamada M, Maeda K, Masuko H, Takahashi K, Sakamoto J, Kusano M, Hyodo I, Taguri M, Morita S. Prospective observational study of the efficacy of oral uracil and tegafur plus leucovorin for stage II colon cancer with risk factors for recurrence using propensity score matching (JFMC46-1201). BMC Cancer 2022; 22:170. [PMID: 35168560 PMCID: PMC8845390 DOI: 10.1186/s12885-022-09267-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/31/2022] [Indexed: 11/24/2022] Open
Abstract
Background The efficacy of adjuvant chemotherapy for high-risk stage II colon cancer (CC) has not been well established. We compared the effects of surgery with and without oral uracil and tegafur plus leucovorin (UFT/LV) in patients with high-risk stage II CC, adjusting for potential risk factors. Methods We enrolled patients with histologically confirmed stage II colon adenocarcinoma with at least one of the following conditions: T4 disease, perforation/penetration, poorly differentiated adenocarcinoma/mucinous carcinoma, or < 12 dissected lymph nodes. Patients chose to be non-randomized or randomized to undergo surgery alone (NR-Group S or R-Group S) or surgery followed by 6 months of UFT/LV (NR-Group U or R-Group U). The primary endpoint was disease-free survival (DFS) after adjusting for previously reported risk factors using propensity score matching (1:2) and inverse probability of treatment weighting (IPTW) in the non-randomized arm. Results Overall, 1,902 (98%) and 36 (2%) patients were enrolled in the non-randomized and randomized arms, respectively. There were too few patients in the randomized arm and these were therefore excluded from the analysis. Of the 1,902 patients, 402 in NR-Group S and 804 in NR-Group U were propensity score-matched. The 3-year DFS rate (95% confidence interval) was significantly higher in NR-Group U (80.9% [77.9%–83.4%]) than in NR-Group S (74.0% [69.3%–78.0%]) (hazard ratio, 0.64 [0.50–0.83]; P = 0.0006). The 3-year overall survival rate was not significantly different between NR-Group S and NR-Group U. Significantly higher 3-year DFS (P = 0.0013) and overall survival (P = 0.0315) rates were observed in NR-Group U compared with NR-Group S using IPTW. Conclusions Adjuvant chemotherapy with UFT/LV showed a significant survival benefit over surgery alone in patients with high-risk stage II CC characterized by at least one of the following conditions: T4 disease, perforation/penetration, poorly differentiated adenocarcinoma/mucinous carcinoma, or < 12 dissected lymph nodes. Trial registration Japan Registry of Clinical Trials: jRCTs031180155 (date of registration: 25/02/2019) (UMIN Clinical Trials Registry: UMIN000007783, date of registration: 18/04/2012). Supplementary Information The online version contains supplementary material available at 10.1186/s12885-022-09267-z.
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Affiliation(s)
- Sotaro Sadahiro
- Department of Surgery, Tokai University, 143 Shimokasuya, Isehara, Kanagawa, 259-1193, Japan.
| | - Kazuhiro Sakamoto
- Department of Coloproctological Surgery, Juntendo University, 2-1-1 Hongo, Bunkyo-ku, Tokyo, 113-8421, Japan
| | - Takashi Tsuchiya
- Department of Surgery, Sendai City Medical Center, 5-22-1 Tsurugaya, Miyagino-ku, Sendai, Miyagi, 983-0824, Japan
| | - Takao Takahashi
- Department of Digestive Surgery, Gifu University Hospital, 1-1 Yanagido, Gifu, 501-1194, Japan
| | - Hiroki Ohge
- Department of Infectious Diseases, Hiroshima University Hospital, 1-2-3 Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Toshihiko Sato
- Department of Surgery, Yamagata Prefectural Central Hospital, 1800 Aoyagi, Yamagata, 990-2292, Japan
| | - Ken Kondo
- Department of Surgery, Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, Aichi, 460-0001, Japan
| | - Yutaka Ogata
- Department of Surgery, Kurume University Hospital Cancer Center, 67 Asahi-machi, Kurume, Fukuoka, 830-0011, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan
| | - Michio Itabashi
- Department of Surgery, Division of Inflammatory Bowel Disease Surgery, Tokyo Women's Medical University, 8-1 Kawada-cho, Shinjuku-ku, Tokyo, 162-8666, Japan
| | - Masataka Ikeda
- Department of Gastroenterological Surgery, Hyogo College of Medicine, 1-1 Mukogawa-cho, Nishinomiya, Hyogo, 663-8501, Japan
| | - Madoka Hamada
- Division of Gastrointestinal Surgery, Kansai Medical University Hospital, 2-3-1 Shinmachi Hirakata, Osaka, 573-1191, Japan
| | - Kiyoshi Maeda
- Department of Gastroenterological Surgery, Osaka City General Hospital, 2-13-22 Miyakojimahondori, Miyakojima-ku, Osaka, 534-0021, Japan
| | - Hiroyuki Masuko
- Department of Surgery, Nikko Memorial Hospital, 1-5-13 Shintomi-cho, Muroran, Hokkaido, 051-8501, Japan
| | - Keiichi Takahashi
- Tokyo Metropolitan Health and Hospitals Corporation Ohkubo Hospital, 2-44-1 Kabuki-cho, Shinjuku-ku, Tokyo, 160-8488, Japan
| | - Junichi Sakamoto
- Tokai Central Hospital, 4-6-2 Sohara Higashijima-cho, Kakamigahara, Gifu, 504-8601, Japan
| | - Mitsuo Kusano
- Department of Physical Medicine, Yoichi Hospital, 19-1-1 Kurokawa-cho Yoichi, Hokkaido, 046-0003, Japan
| | - Ichinosuke Hyodo
- Department of Gastrointestinal Medical Oncology, National Hospital Organization Shikoku Cancer Center, 160 Kou, Minamiumemoto, Matsuyama, Ehime, 791-0280, Japan
| | - Masataka Taguri
- Department of Data Science, Yokohama City University, 22-2 Seto, Kanazawa-ku, Yokohama, Kanagawa, 236-0027, Japan
| | - Satoshi Morita
- Department of Biomedical Statistics and Bioinformatics, Kyoto University, 54 Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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5
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Blinman P, Martin A, Jefford M, Goldstein D, Boadle D, Morris M, Tebbutt N, Aiken C, Harkin A, Segelov E, Haydon A, Iveson T, Stockler MR. Patients' Preferences for 3 Months vs 6 Months of Adjuvant Chemotherapy for Colon Cancer. JNCI Cancer Spectr 2021; 5:pkaa107. [PMID: 34159294 PMCID: PMC7883552 DOI: 10.1093/jncics/pkaa107] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 08/24/2020] [Accepted: 09/21/2020] [Indexed: 11/17/2022] Open
Abstract
Background SCOT was an international, randomized phase 3 trial of 3 months vs 6 months of adjuvant chemotherapy with oxaliplatin and a fluoropyrimidine in patients with colorectal cancer. We sought patients' preferences for 3 months vs 6 months of adjuvant chemotherapy in the SCOT trial. Methods SCOT participants from Australia and New Zealand completed a validated questionnaire (at 3 and 18 months) to elicit the minimum survival benefits judged necessary to make an extra 3 months of adjuvant chemotherapy worthwhile, based on their experience. Standardized hypothetical scenarios used the following baseline survivals (with 3 months of chemotherapy): life expectancies (LE) of 5 years and 15 years and 5-year survival rates (5YS) of 65% and 85%. Results Of the 160 participants, 82 were assigned 3 months adjuvant chemotherapy, and 78 were assigned 6 months. Adjuvant chemotherapy was FOLFOX in 121 (75.6%) and XELOX in 39 (24.4%). Preferences varied substantially and did not differ according to treatment group. The median survival benefits judged necessary to make the extra 3 months of chemotherapy worthwhile were an extra 3 years beyond a LE of 5 years; 3 years beyond a LE of 15 years; 15% beyond a 5YS of 65%; and 5% beyond a 5YS of 85%. Preferences were similar at 3 months and 18 months. Preferences were not predicted by participants' baseline characteristics. Conclusion Preferences varied substantially, and the benefits many required to warrant an extra 3 months of adjuvant chemotherapy were larger than the benefits of an extra 3 months of chemotherapy calculated in the International Duration Evaluation of Adjuvant Chemotherapy (IDEA) meta-analysis.
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Affiliation(s)
- Prunella Blinman
- Concord Cancer Centre, Sydney, Australia
- Australasian Gastro-Intestinal Trials Group, Australia
- University of Sydney, Australia
| | - Andrew Martin
- Australasian Gastro-Intestinal Trials Group, Australia
- University of Sydney, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Australia
| | - Michael Jefford
- Australasian Gastro-Intestinal Trials Group, Australia
- Peter MacCallum Cancer Centre, Melbourne, Australia
- Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Victoria, Australia
| | - David Goldstein
- Australasian Gastro-Intestinal Trials Group, Australia
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Sydney, Australia
| | - David Boadle
- Australasian Gastro-Intestinal Trials Group, Australia
- Department of Medical Oncology, Royal Hobart Hospital, Hobart, Australia
| | - Michelle Morris
- Australasian Gastro-Intestinal Trials Group, Australia
- Sunshine Coast University Private Hospital, Birtinya, Australia
| | - Niall Tebbutt
- Australasian Gastro-Intestinal Trials Group, Australia
- Olivia Newton-John Cancer Wellness & Research Centre, Austin Health, Melbourne, Australia
| | - Christine Aiken
- Australasian Gastro-Intestinal Trials Group, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Australia
| | - Andrea Harkin
- Clinical Trials Unit Glasgow, Glasgow, United Kingdom
| | - Eva Segelov
- Australasian Gastro-Intestinal Trials Group, Australia
- Department of Oncology, Monash Health and Monash University, Melbourne, Australia
| | - Andrew Haydon
- Australasian Gastro-Intestinal Trials Group, Australia
- Department of Medical Oncology, Alfred Health, Melbourne, Australia
| | - Tim Iveson
- Medical Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
| | - Martin R Stockler
- Australasian Gastro-Intestinal Trials Group, Australia
- University of Sydney, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Australia
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6
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Leuthold N, Cattaneo M, Halter J, Hügli C, Kirsch M, Petropoulou A, Erlanger TE, Gerull S, Passweg J, O'Meara Stern A. Patient preferences for allogeneic haematopoietic stem cell transplantation: how much benefit is worthwhile from the patient's perspective? Support Care Cancer 2020; 29:3129-3135. [PMID: 33067766 PMCID: PMC8062338 DOI: 10.1007/s00520-020-05816-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 10/07/2020] [Indexed: 11/27/2022]
Abstract
Oncological studies have shown that patients consider small benefits sufficient to make adjuvant chemotherapy worthwhile. We sought to determine the minimal survival benefits that patients considered enough to legitimate allogeneic haematopoietic stem cell transplantation (HCT) and the factors associated with patient preferences. One hundred eighty-four patients having previously received allogeneic HCT at our centre were included and completed a questionnaire exploring patient expectations elicited by time trade-off scenarios as well as quality of life (QoL), symptoms of graft-versus host disease (GvHD) and sociodemographic characteristics. The majority of patients considered a minimal survival benefit of at least 5 (38.6%) or 10 years (41.9%) sufficient to justify HCT, with less than 5% considering survival < 1 year sufficient to warrant HCT. In terms of minimal cure rate, a cumulative 14.8% of patients accepted cure rates below 30% and 30.6% rates below 50%. Likelihood-ratio tests were significant for the effect of age at transplant on expected minimal survival (p = 0.007) and cure rates (p = 0.0001); that is, younger patients at HCT were more likely to accept smaller survival and cure rates. Pre-transplant risk score, QoL, GvHD score and sociological factors did not seem to influence patients' expectations. In conclusion, patient expectations of treatment were much higher than what had been reported in oncological studies. Patients who experienced HCT considered a survival superior to 1 year and cure rates above 50% sufficient to make it worthwhile. Younger patients were more likely to accept smaller benefits; no other predictors for preferences could be detected.
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Affiliation(s)
| | - Marco Cattaneo
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Jörg Halter
- Division of Haematology, University Hospital Basel, Basel, Switzerland
| | - Claudia Hügli
- Department of Pediatric Oncology, Haematology and Immunology, University of Heidelberg, Heidelberg, Germany
| | - Monika Kirsch
- Department of Anaesthesia, University Hospital Basel, Basel, Switzerland
| | - Anna Petropoulou
- Department of Oncology, Cantonal Hospital Neuchâtel, Neuchâtel, Switzerland
| | - Tobias E Erlanger
- Department of Clinical Research, University of Basel and University Hospital Basel, Basel, Switzerland
| | - Sabine Gerull
- Division of Haematology, University Hospital Basel, Basel, Switzerland
| | - Jakob Passweg
- Division of Haematology, University Hospital Basel, Basel, Switzerland
| | - Alix O'Meara Stern
- University of Basel, Basel, Switzerland. .,Department of Oncology, Cantonal Hospital Neuchâtel, Neuchâtel, Switzerland.
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7
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Wong XY, Lim AQJ, Shen Q, Chia JWK, Chew MH, Tan WS, Wee HL. Patient preferences and predicted relative uptake for targeted therapies in metastatic colorectal cancer: a discrete choice experiment. Curr Med Res Opin 2020; 36:1677-1686. [PMID: 32609014 DOI: 10.1080/03007995.2020.1790348] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Ras wild-type metastatic colorectal cancers (mCRC) may be treated with anti-vascular endothelial growth factor (VEGF) or anti-epidermal growth factor receptor (EGFR) agents. We aim to estimate patients' preferences for mCRC treatment and relative importance of cost, efficacy improvement, avoidance of side effects and therapy convenience, and relative uptake between profiles that resemble Bevacizumab (anti-VEGF) and Cetuximab (anti-EGFR), two commonly prescribed mCRC targeted therapies. METHODS Discrete choice experiment (DCE) was administered to English- or Chinese-speaking Stage 2 or 3 colon cancer patients at the National Cancer Centre Singapore. DCE attributes comprise progression-free survival (PFS), severity of acne-like skin rashes, severity of bleeding, out-of-pocket cost per month and frequency of drug administration. Mixed logit model was used to calculate preference weights for all attribute levels. Subgroup analyses were conducted by interacting attribute levels with selected respondent characteristics. Relative uptake rates for various medication scenarios were studied. RESULTS 169 respondents aged 61.5 ± 10.5 years completed the survey. They placed the greatest weight on cost, followed by bleeding and skin rashes, then PFS and finally frequency of drug administration. This was similarly observed in the subgroup analyses. A scenario with shorter PFS but less severe side effects has a slightly higher relative uptake at 55%. One quarter of respondents reported that they would not take the treatment they preferred in the choice task. CONCLUSION Patients were willing to trade off some degree of efficacy to avoid certain severity of side effects. It is therefore crucial for patients and physicians to discuss patients' preferences and circumstances to understand which attributes are more important, as well as patients' views on the trade-offs between treatment benefits and risks.
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Affiliation(s)
- Xin Yi Wong
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Republic of Singapore
| | - Andrew Qi Jun Lim
- NUS Science Research Programme, Hwa Chong Institution (College Section), Singapore, Republic of Singapore
| | - Qianyu Shen
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Republic of Singapore
| | - John Whay Kuang Chia
- Division of Medical Oncology, National Cancer Centre Singapore, Singapore, Republic of Singapore
| | - Min Hoe Chew
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Republic of Singapore
| | - Wah Siew Tan
- Department of Colorectal Surgery, Singapore General Hospital, Singapore, Republic of Singapore
| | - Hwee-Lin Wee
- Department of Pharmacy, Faculty of Science, National University of Singapore, Singapore, Republic of Singapore
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Republic of Singapore
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8
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Montagna E, Pagan E, Bagnardi V, Colleoni M, Cancello G, Munzone E, Dellapasqua S, Bianco N, Campennì G, Iorfida M, Mazza M, De Maio A, Veronesi P, Sangalli C, Scateni B, Pettini G, Pravettoni G, Mazzocco K, Galimberti V. Evaluation of endocrine therapy and patients preferences in early breast cancer: results of Elena study. Breast Cancer Res Treat 2020; 184:783-795. [PMID: 32929568 DOI: 10.1007/s10549-020-05900-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Accepted: 08/29/2020] [Indexed: 11/27/2022]
Abstract
PURPOSE The development of the adjuvant therapy requires that clinicians and patients should discuss the magnitude of benefit of treatment for individual patient, estimating the pros and cons and the personal preferences. The aim of the present study was to determine the preferences of women treated with adjuvant hormonal therapy (HT) for breast cancer. METHODS The analyses were conducted into three different groups of early breast cancer patients to evaluate the survival benefit needed to make treatment worthwhile before starting HT (A), after a few months from the beginning (B) and after several years of HT (C). The questionnaires, showing hypothetical scenarios based on potential survival times and rates without HT, were used to determine the lowest gains women judged necessary to make the treatment worthwhile. RESULTS A total of 452 patients were included in the study: 149 in group A, 150 in group B and 153 in group C. In group C, 65% of patients were receiving HT with aromatase inhibitors (with or without a LHRH analogue). In the groups A, B, C 8%, 20% and 26%, respectively, received adjuvant chemotherapy. Overall, 355 women (79%) had children. The responses were quite similar between the three groups. A median gain of 10 years was judged necessary to make adjuvant HT worthwhile based on the hypothetical scenario of untreated mean survival time of 5 and 15 years. Median gain of 20% more women surviving was judged necessary to make adjuvant HT worthwhile based on an untreated 5-year survival rate expectation of 60%. Cognitive dysfunction was considered the side effect least compatible with the continuation of treatment in all three groups. CONCLUSIONS This is a large study of patient preferences on HT. Compared with other studies with similar design, the patients included in the present study required larger benefits to make adjuvant therapy worthwhile.
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Affiliation(s)
- E Montagna
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy.
| | - E Pagan
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - V Bagnardi
- Department of Statistics and Quantitative Methods, University of Milan-Bicocca, Milan, Italy
| | - M Colleoni
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - G Cancello
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - E Munzone
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - S Dellapasqua
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - N Bianco
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - G Campennì
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - M Iorfida
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - M Mazza
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - A De Maio
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - P Veronesi
- Division of Senology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - C Sangalli
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - B Scateni
- Division of Medical Senology, IEO, European Institute of Oncology IRCCS, Via Ripamonti 435, 20141, Milan, Italy
| | - G Pettini
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Milan, Italy
| | - G Pravettoni
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - K Mazzocco
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology, IRCCS, Milan, Italy
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - V Galimberti
- Division of Senology, IEO, European Institute of Oncology IRCCS, Milan, Italy
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9
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Gunjur A, Chazan G, Newnham G, McLachlan SA. Pilot Study of Patients' Preferences for Immediate Resection Versus a Watch and Wait Approach After Neoadjuvant Chemoradiation for Locally Advanced Rectal Cancer. JCO Oncol Pract 2020; 17:e149-e157. [PMID: 32926663 DOI: 10.1200/op.20.00158] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE In patients with rectal cancer who achieve a clinical complete response to neoadjuvant chemoradiation, it may be reasonable to adopt a watch-and-wait (W&W) strategy rather than proceed to immediate resection of the rectum. Patient preferences for this strategy are unknown. The primary aim of the current study was to determine the feasibility of assessing hypothetical recurrence and survival differences that relevant patients would tolerate to avoid immediate resection of the rectum. A secondary aim included estimating patients' tolerance thresholds and the factors that might predict them. METHODS We developed a study-specific written questionnaire based on a previously validated instrument. Hypothetical time tradeoff tasks were used to determine the recurrence rate patients would accept to adopt a W&W strategy and the survival benefit that would be needed to justify choosing immediate resection over W&W. Feasibility was measured on the basis of response rate, the stated ease of completion and the satisfaction of task, and time used. RESULTS Twenty of 31 potentially eligible patients completed the study-specific questionnaire. The majority of respondents felt that questions were clear (70%) and not hard to understand (65%). The median acceptable recurrence risk to adopt a W&W strategy was 20% (interquartile range [IQR], 10%-35%). Patients required a median of 2.0 extra years of survival (IQR, 1.0-3.0 years) over a baseline 7.0 years, and they required a median extra 10% (IQR, 4%-19%) over baseline 70% survival rates to justify immediate resection. CONCLUSION Measuring the preferences of patients with rectal cancer using time tradeoff methods seemed to be feasible. Larger studies are needed to confirm how acceptable a W&W strategy would be for relevant patients.
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Affiliation(s)
- Ashray Gunjur
- Department of Medical Oncology, Austin Health, Melbourne, NSW, Australia
| | - Grace Chazan
- Peter MacCallum Cancer Centre, Melbourne, NSW, Australia
| | - Genni Newnham
- Oncology and Cancer Services, St Vincent's Hospital Melbourne, Melbourne, NSW, Australia
| | - Sue-Anne McLachlan
- Oncology and Cancer Services, St Vincent's Hospital Melbourne, Melbourne, NSW, Australia.,Department of Medicine, University of Melbourne, Melbourne, NSW, Australia
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10
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Hauber B, Coulter J. Using the Threshold Technique to Elicit Patient Preferences: An Introduction to the Method and an Overview of Existing Empirical Applications. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2020; 18:31-46. [PMID: 31541362 DOI: 10.1007/s40258-019-00521-3] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
Patient preference information (PPI) is a topic of interest to regulators and industry. One of many known methods for eliciting PPI is the threshold technique (TT). However, empirical studies of the TT differ from each other in many ways and no effort to date has been made to summarize them or the evidence regarding the performance of the method. We sought to describe the TT and summarize the empirical applications of the method. Forty-three studies were reviewed. Most studies estimated the minimum level of benefit required to make a treatment worthwhile, and over half estimated the maximum level of risk patients would accept to achieve a treatment benefit. The evidence demonstrates that the TT can be used to elicit multiple types of thresholds and can be used to explore preference heterogeneity and preference non-linearity. Some evidence suggests that the method may be sensitive to anchoring and shift-framing effects; however, no evidence suggests that the method is more or less sensitive to these potential biases than other stated-preference methods. The TT may be a viable method for eliciting PPI to support regulatory decision-making; however, additional understanding of the performance of this method may be needed. Future research should focus on TT performance compared with other stated-preference methods, the extent to which results predict patient choice, and the ability of the TT to inform individual treatment decisions at the point of healthcare delivery.
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Affiliation(s)
- Brett Hauber
- RTI Health Solutions, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA.
| | - Joshua Coulter
- RTI Health Solutions, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, USA
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11
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Chang DW, Bressel M, Hansen C, Blinman P, Schofield P, Chua BH. Axillary dissection in sentinel lymph node positive breast cancer: Is the staging information worthwhile for patients? Asia Pac J Clin Oncol 2019; 17:e27-e34. [PMID: 31461222 DOI: 10.1111/ajco.13238] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Accepted: 08/04/2019] [Indexed: 12/18/2022]
Abstract
AIMS The Z0011 randomized trial demonstrated no significant difference in axillary recurrence rate or survival with or without axillary dissection in patients with a positive sentinel node biopsy. However, there is continuing controversy regarding the generalizability of its results, and axillary dissection provides additional pathologic staging information that may guide adjuvant therapy. Thus, axillary dissection after positive sentinel node biopsy is being further investigated in an actively recruiting randomized trial. We elicited patients' preferences for axillary dissection versus no axillary dissection after positive sentinel node biopsy for early breast cancer. METHODS Patients who had undergone axillary dissection after positive sentinel node biopsy as part of breast conserving therapy were provided with a validated, self-rated questionnaire. The questionnaire comprised two trade-off questions to determine the maximum chance of developing arm side-effects from axillary dissection to justify the benefit of additional axillary staging information. Social, demographic, and clinical details were collected. RESULTS Ninety-nine of the 126 eligible patients returned the questionnaire and 76 completed the trade-off assessment. The median age of participants was 62 years. The median numbers of sentinel and axillary nodes removed were 2 and 12, respectively. Forty-seven percent of participants had arm swelling or tenderness of any severity. Seventy-five percent of participants would have axillary dissection even if the chance of arm side-effects like they had experienced was 100%. CONCLUSION Most patients with early breast cancer preferred axillary dissection after positive sentinel node biopsy for the additional staging information even though there was no survival benefit from axillary dissection.
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Affiliation(s)
- David W Chang
- Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Department of Radiation Oncology, Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia.,Children's Cancer Institute Australia, Lowy Cancer Research Centre, University of New South Wales, Kensington, New South Wales, Australia
| | - Mathias Bressel
- Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Carmen Hansen
- Mid North Coast Cancer Institute, Port Macquarie Base Hospital, Port Macquarie, New South Wales, Australia
| | - Prunella Blinman
- Concord Cancer Centre, Hospital Road, Concord, New South Wales, Australia
| | - Penelope Schofield
- Department of Psychology, and Iverson Health Innovation Research Institute Swinburne University, Melbourne, Victoria, Australia.,Behavioural Sciences Unit, Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, The University of Melbourne, Parkville, Victoria, Australia
| | - Boon H Chua
- Nelune Comprehensive Cancer Centre, Prince of Wales Hospital, Randwick, New South Wales, Australia.,University of New South Wales Medicine, University of New South Wales, Sydney, New South Wales, Australia
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12
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Vanderpuye V, Hammad N, Martei Y, Hopman WM, Fundytus A, Sullivan R, Seruga B, Lopes G, Sengar M, Brundage MD, Booth CM. Cancer care workforce in Africa: perspectives from a global survey. Infect Agent Cancer 2019; 14:11. [PMID: 31139248 PMCID: PMC6528232 DOI: 10.1186/s13027-019-0227-8] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2018] [Accepted: 04/10/2019] [Indexed: 12/26/2022] Open
Abstract
Background While the burden of cancer in Africa is rapidly rising, there is a lack of investment in healthcare professionals to deliver care. Here we report the results of a survey of systemic therapy workload of oncologists in Africa in comparison to oncologists in other countries. Methods An online survey was distributed through a snowball method via national oncology societies to chemotherapy-prescribing physicians in 65 countries. The survey was distributed within Africa through a network of physicians associated with the African Organisation for Research and Training in Cancer (AORTIC). Workload was measured as the annual number of new cancer patient consults seen per oncologist. Job satisfaction was ranked on a 10-point Likert scale; scores of 9–10 were considered to represent high job satisfaction. Results Thirty-six oncologists from 18 countries in Africa and 1079 oncologists from 47 other countries completed the survey. Compared to oncologists from other countries, African oncologists were older (median age 51 vs 44 years, p = 0.007), more likely to prescribe chemotherapy and radiation [61% (22/36) vs 10% (108/1079), p < 0.001], less likely to have completed training in their home country [50% (18/36) vs 91% (979/1079), p < 0.001], and more likely to work in the private sector [47% (17/36) vs 34% (364/1079), p = 0.037]. The median number of annual consults per oncologist was 325 in Africa compared to175 in other countries. The proportion of oncologists seeing > 500 consults/year was 31% (11/36) in Africa compared to 12% (129/1079) in other countries (p = 0.001). African oncologists were more likely than global colleagues to see all cancer sites [72% (26/26) vs 24% (261/1079), p < 0.001]. Oncologists in Africa were less likely than other oncologists to have high job satisfaction [17% (6/36) vs 30% (314/1079), p = 0.013]. Conclusion African oncologists within the AORTIC network have a substantially higher clinical workload and lower job satisfaction than oncologists elsewhere in the world. There is an urgent need for governments and health systems to improve the oncologist-to-patient ratio and develop new models of capacity building, retention and skills enhancement to strengthen the wide variety of cancer care systems across continental Africa.
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Affiliation(s)
- Verna Vanderpuye
- 1National Centre for Radiotherapy Oncology and Nuclear Medicine, Korle Bu Teaching Hospital, P.O Box KB369, Accra, Ghana
| | - Nazik Hammad
- 2Department of Oncology, Queen's University, Kingston, Canada
| | - Yehoda Martei
- 3Botswana University of Pennsylvania Partnership, Gaborone, Botswana
| | - Wilma M Hopman
- Kingston General Health Research Institute, Kingston, Canada.,5Department of Public Health Sciences, Queen's University, Kingston, Canada
| | - Adam Fundytus
- 6Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Canada
| | - Richard Sullivan
- 7Institute of Cancer Policy, King's College London, & King's Health Partners Comprehensive Cancer Centre, London, UK
| | - Bostjan Seruga
- 8Division of Medical Oncology, Institute of Oncology Ljubljana, Ljubljana, Slovenia
| | - Gilberto Lopes
- 9University of Miami and Sylvester Comprehensive Cancer Center, Miami, USA
| | - Manju Sengar
- 10Department of Medical Oncology, Tata Memorial Centre, Mumbai, India
| | - Michael D Brundage
- 2Department of Oncology, Queen's University, Kingston, Canada.,5Department of Public Health Sciences, Queen's University, Kingston, Canada.,6Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Canada
| | - Christopher M Booth
- 2Department of Oncology, Queen's University, Kingston, Canada.,5Department of Public Health Sciences, Queen's University, Kingston, Canada.,6Division of Cancer Care and Epidemiology, Queen's University Cancer Research Institute, Kingston, Canada
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13
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Corica T, Saunders CM, Bulsara MK, Taylor M, Joseph DJ, Nowak AK. Patient preferences for adjuvant radiotherapy in early breast cancer are strongly influenced by treatment received through random assignment. Eur J Cancer Care (Engl) 2019; 28:e12985. [PMID: 30637839 PMCID: PMC6590655 DOI: 10.1111/ecc.12985] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 10/23/2018] [Accepted: 12/07/2018] [Indexed: 11/30/2022]
Abstract
OBJECTIVE TARGIT-A randomised women with early breast cancer to receive external beam radiotherapy (EBRT) or intraoperative radiotherapy (TARGIT-IORT). This study aimed to identify what extra risk of recurrence patients would accept for perceived benefits and risks of different radiotherapy treatments. METHODS Patient preferences were determined by self-rated trade-off questionnaires in two studies: Stage (1) 209 TARGIT-A participants (TARGIT-IORTn = 108, EBRTn = 101); Stage (2) 123 non-trial patients yet to receive radiotherapy (pre-treatment group), with 85 also surveyed post-radiotherapy. Patients traded-off risks of local recurrence in preference selection between TARGIT-IORT and EBRT. RESULTS TARGIT-IORT patients were more accepting of IORT than EBRT patients with 60% accepting the highest increased risk presented (4%-6%) compared to 12% of EBRT patients, and 2% not accepting IORT at all compared to 43% of EBRT patients. Pre-treatment patients were more accepting of IORT than post-treatment patients with 23% accepting the highest increased risk presented compared to 15% of post-treatment patients, and 15% not accepting IORT at all compared to 41% of pre-treatment patients. CONCLUSIONS Breast cancer patients yet to receive radiotherapy accept a higher recurrence risk than the actual risk found in TARGIT-A. Measured patient preferences are highly influenced by experience of treatment received. This finding challenges the validity of post-treatment preference studies.
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Affiliation(s)
- Tammy Corica
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia.,Radiation Oncology Clinical Trials and Research Unit, Comprehensive Cancer Centre, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Christobel M Saunders
- School of Medicine, Division of Surgery, University of Western Australia, Perth, Western Australia, Australia
| | - Max K Bulsara
- Institute for Health Research, University of Notre Dame, Fremantle, Western Australia, Australia
| | - Mandy Taylor
- Radiation Oncology, Comprehensive Cancer Centre, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - David J Joseph
- School of Medicine, Division of Surgery, University of Western Australia, Perth, Western Australia, Australia.,Radiation Oncology, Comprehensive Cancer Centre, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
| | - Anna K Nowak
- Radiation Oncology Clinical Trials and Research Unit, Comprehensive Cancer Centre, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia
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14
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Lawrence NJ, Martin A, Davis ID, Troon S, Sengupta S, Hovey E, Coskinas X, Kaplan R, Smith B, Ritchie A, Meade A, Eisen T, Blinman P, Stockler MR. What Survival Benefits are Needed to Make Adjuvant Sorafenib Worthwhile After Resection of Intermediate- or High-Risk Renal Cell Carcinoma? Clinical Investigators' Preferences in the SORCE Trial. KIDNEY CANCER 2018; 2:123-131. [PMID: 30740581 PMCID: PMC6364092 DOI: 10.3233/kca-180038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Background Decisions about adjuvant therapy involve trade-offs between possible benefits and harms. Objective We sought to determine the survival benefits that clinical investigators would judge as sufficient to warrant treatment with adjuvant sorafenib in the SORCE trial after nephrectomy for apparently localised renal cell carcinoma (RCC). Methods A subset of clinical investigators in the SORCE trial completed a validated questionnaire that elicited the minimum survival benefits they judged sufficient to warrant one year of adjuvant sorafenib in scenarios with hypothetical baseline survival times of 5 years and 15 years, and baseline survival rates at 5 years of 65% and 85%. Results The 100 participating SORCE investigators had a median age of 42 years, and 74 were male. For one year of sorafenib versus no therapy, the median benefits in survival times the investigators judged sufficient to warrant treatment were an extra nine months beyond five years and an extra 12 months beyond 15 years; the median benefits in survival rates were an extra 5% beyond baseline survival rates of both 65% and 85% at five years. The patients recruited in the SORCE trial by these investigators judged smaller benefits sufficient to warrant adjuvant sorafenib for both survival rate scenarios (p≤0.0001). The survival benefits the investigators judged sufficient to warrant one year of adjuvant therapy with sorafenib for RCC were similar to those of other clinicians considering three months of adjuvant chemotherapy for lung cancer, but smaller than those of clinicians considering six months of adjuvant chemotherapy for breast cancer. Conclusion SORCE investigators judged larger benefits necessary to warrant adjuvant sorafenib than their patients. The benefits required by the investigators were similar or smaller than those other clinicians considered sufficient to warrant adjuvant chemotherapy for other cancers. Clinicians should recognise that their patients and colleagues may have preferences that differ from their own when considering the potential benefits and harms of adjuvant treatment.
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Affiliation(s)
- Nicola J Lawrence
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia.,Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, NSW, Australia
| | - Andrew Martin
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia.,Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, NSW, Australia
| | - Ian D Davis
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, NSW, Australia.,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Oncology, Eastern Health, Box Hill, VIC, Australia
| | - Simon Troon
- Fiona Stanley Hospital, Perth, WA, Australia
| | - Shomik Sengupta
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, NSW, Australia.,Eastern Health Clinical School, Monash University, Melbourne, VIC, Australia.,Department of Surgery, University of Melbourne, Melbourne, VIC, Australia
| | - Elizabeth Hovey
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, NSW, Australia.,Nelune Cancer Centre, Prince of Wales Hospital, Sydney, NSW, Australia.,University of New South Wales, Sydney, NSW, Australia
| | - Xanthi Coskinas
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia
| | - Richard Kaplan
- MRC Clinical Trials Unit, University College London, London, UK
| | - Benjamin Smith
- MRC Clinical Trials Unit, University College London, London, UK
| | | | - Angela Meade
- MRC Clinical Trials Unit, University College London, London, UK
| | - Tim Eisen
- Cambridge University Hospital NHS Foundation Trust, Cambridge, UK
| | - Prunella Blinman
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, NSW, Australia.,Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, NSW, Australia
| | - Martin R Stockler
- NHMRC Clinical Trials Centre, University of Sydney, Camperdown, NSW, Australia.,Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, NSW, Australia.,Concord Cancer Centre, Concord Repatriation General Hospital, Sydney, NSW, Australia.,Chris O'Brien Lifehouse, Sydney, NSW, Australia
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15
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Jayashree S, Nirekshana K, Guha G, Bhakta-Guha D. Cancer chemotherapeutics in rheumatoid arthritis: A convoluted connection. Biomed Pharmacother 2018; 102:894-911. [PMID: 29710545 DOI: 10.1016/j.biopha.2018.03.123] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2017] [Revised: 03/20/2018] [Accepted: 03/20/2018] [Indexed: 12/11/2022] Open
Abstract
Chemotherapy is one of the most popular therapeutic strategies to treat cancer. However, cancer chemotherapeutics have often been associated with impairment of the immune system, which might consequently lead to an augmented risk of autoimmune disorders, such as rheumatoid arthritis. Though the accurate mechanistic facets of rheumatoid arthritis induction have not been interpreted yet, a conglomeration of genetic and environmental factors might promote its etiology. What makes the scenario more challenging is that patients with rheumatoid arthritis are at a significantly elevated risk of developing various types of cancer. It is intriguing to note that diverse cancer chemotherapy drugs are also commonly used to treat symptoms of rheumatoid arthritis. However, a colossal multitude of such cancer therapeutics has demonstrated highly varied results in rheumatoid arthritis patients, including both beneficial and adverse effects. Herein, we attempt to present a holistic account of the variegated modalities of this complex tripartite cross-talk between cancer, rheumatoid arthritis and chemotherapy drugs in order to decode the sinuous correlation between these two appalling pathological conditions.
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Affiliation(s)
- S Jayashree
- Cellular Dyshomeostasis Laboratory (CDHL), Department of Biotechnology, School of Chemical and Bio Technology, SASTRA University, Thanjavur, 613 401, Tamil Nadu, India
| | - K Nirekshana
- Cellular Dyshomeostasis Laboratory (CDHL), Department of Biotechnology, School of Chemical and Bio Technology, SASTRA University, Thanjavur, 613 401, Tamil Nadu, India
| | - Gunjan Guha
- Cellular Dyshomeostasis Laboratory (CDHL), Department of Biotechnology, School of Chemical and Bio Technology, SASTRA University, Thanjavur, 613 401, Tamil Nadu, India.
| | - Dipita Bhakta-Guha
- Cellular Dyshomeostasis Laboratory (CDHL), Department of Biotechnology, School of Chemical and Bio Technology, SASTRA University, Thanjavur, 613 401, Tamil Nadu, India.
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16
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Blinman PL, Davis ID, Martin A, Troon S, Sengupta S, Hovey E, Coskinas X, Kaplan R, Ritchie A, Meade A, Eisen T, Stockler MR. Patients' preferences for adjuvant sorafenib after resection of renal cell carcinoma in the SORCE trial: what makes it worthwhile? Ann Oncol 2018; 29:370-376. [PMID: 29177440 DOI: 10.1093/annonc/mdx715] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background We sought to determine the survival benefits that patients judged sufficient to warrant adjuvant therapy with sorafenib for 1 year, or for 3 years after resection of renal cell carcinoma in the SORCE trial. Methods SORCE participants from all sites in Australia and New Zealand, and selected sites in the UK, completed a validated preferences questionnaire at months 0, 3, 15, and 42 to elicit the minimum survival benefits they judged sufficient to warrant adjuvant sorafenib for 1 year (versus observation), or for 3 years (versus 1 year). The questionnaires used reference survival times of 5 and 15 years; and reference survival rates at 5 years of 65% and 85%. Results The 233 participants had a median age of 57 years (range 29-78) and 71% were male. For 1 year of sorafenib versus no adjuvant therapy, the median benefits in survival times judged sufficient to warrant treatment were an extra 9 months beyond 5 years and an extra 1 year beyond 15 years; the median benefit in survival rates were an extra 4% beyond 65% and an extra 3% beyond 85% at 5 years. For 3 years of sorafenib versus 1 year of sorafenib, the median benefit in survival time judged sufficient to warrant extended treatment was an extra 1 year beyond both 5 and 15 years. Participants randomly allocated to treatment with sorafenib judged larger benefits necessary than those allocated to placebo. Participants' preferences were not associated with their baseline characteristics or the interval from randomisation. Conclusion Most participants judged an extra year of survival necessary to warrant 1 year of adjuvant sorafenib worthwhile, and an additional year of survival to warrant extending the duration of sorafenib from 1 to 3 years. Patients' preferences are important in shared decision making. SORCE trial clinical trials number NCT00492258.
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Affiliation(s)
- P L Blinman
- Concord Cancer Centre, Concord Repatriation General Hospital, Concord, Australia; ANZUP Cancer Trials Group, Camperdown, Australia.
| | - I D Davis
- ANZUP Cancer Trials Group, Camperdown, Australia; Eastern Health Clinical School, Monash University, Box Hill, Australia; Eastern Health, Box Hill, Australia
| | - A Martin
- ANZUP Cancer Trials Group, Camperdown, Australia; Eastern Health Clinical School, Monash University, Box Hill, Australia; NHMRC Clinical Trials Centre, Camperdown, Australia
| | - S Troon
- ANZUP Cancer Trials Group, Camperdown, Australia; Department of Medical Oncology, Royal Perth Hospital, Perth, Australia
| | - S Sengupta
- ANZUP Cancer Trials Group, Camperdown, Australia; Austin Health, Heidelberg, Australia
| | - E Hovey
- ANZUP Cancer Trials Group, Camperdown, Australia; Nelune Cancer Centre, Prince of Wales Hospital, Randwick, Australia
| | - X Coskinas
- ANZUP Cancer Trials Group, Camperdown, Australia; NHMRC Clinical Trials Centre, Camperdown, Australia
| | - R Kaplan
- MRC Clinical Trials Unit at UCL, London, UK
| | - A Ritchie
- Gloucestershire Royal Hospital, Gloucester, UK
| | - A Meade
- MRC Clinical Trials Unit at UCL, London, UK
| | - T Eisen
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - M R Stockler
- Concord Cancer Centre, Concord Repatriation General Hospital, Concord, Australia; ANZUP Cancer Trials Group, Camperdown, Australia; NHMRC Clinical Trials Centre, Camperdown, Australia
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17
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González JM, Ogale S, Morlock R, Posner J, Hauber B, Sommer N, Grothey A. Patient and physician preferences for anticancer drugs for the treatment of metastatic colorectal cancer: a discrete-choice experiment. Cancer Manag Res 2017; 9:149-158. [PMID: 28490902 PMCID: PMC5414575 DOI: 10.2147/cmar.s125245] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective Many publications describe preferences for colorectal cancer (CRC) screening; however, few studies elicited preferences for anticancer-drug treatment for metastatic CRC (mCRC). This study was designed to elicit preferences and risk tolerance among patients and oncologists in the USA for anticancer drugs to treat mCRC. Materials and methods Patients aged 18 years or older with a self-reported diagnosis of mCRC and board-certified (or equivalent) oncologists who had treated patients with mCRC were recruited by two survey research companies from existing online patient panels in the USA. Additional oncologists were recruited from a list of US physicians. Patients and oncologists completed a discrete-choice experiment (DCE) survey. DCEs offer a systematic method of eliciting preferences and quantifying both the relative importance of treatment attributes and the tradeoffs respondents are willing to make among benefits and risks. Treatment attributes in the DCE were progression-free survival (PFS) and risks of severe papulopustular rash, serious hemorrhage, cardiopulmonary arrest, and gastrointestinal perforation. Patients’ and physicians’ maximum levels of acceptable treatment-related risks for two prespecified increases in efficacy were estimated. Results A total of 127 patients and 150 oncologists completed the survey. Relative preferences for the treatment attributes in the study were mostly consistent with the expectation that better clinical outcomes were preferred over worse clinical outcomes. Risk tolerance varied between patients and physicians. On average, physicians were willing to tolerate higher risks than patients, although these differences were mostly not statistically significant. Post hoc latent-class analyses revealed that some patients and physicians were unwilling to forgo any efficacy to avoid toxicities, while others were willing to make such tradeoffs. Conclusion Differences in preferences between patients and physicians suggest that there is the potential for improvement in patients’ well-being. Initiating or enhancing discussions about patient tolerance for toxicities, such as skin rash and gastrointestinal perforations, may help prescribe treatments that entail more appropriate benefit–risk tradeoffs.
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Affiliation(s)
- Juan Marcos González
- Health Preference Assessment Department, RTI Health Solutions, Research Triangle Park, NC
| | | | | | - Joshua Posner
- Health Preference Assessment Department, RTI Health Solutions, Research Triangle Park, NC
| | - Brett Hauber
- Health Preference Assessment Department, RTI Health Solutions, Research Triangle Park, NC
| | | | - Axel Grothey
- Division of Medical Oncology, Mayo Clinic, Rochester, MN, USA
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18
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Moth EB, Vardy J, Blinman P. Decision-making in geriatric oncology: systemic treatment considerations for older adults with colon cancer. Expert Rev Gastroenterol Hepatol 2016; 10:1321-1340. [PMID: 27718755 DOI: 10.1080/17474124.2016.1244003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Colon cancer is common and can be considered a disease of older adults with more than half of cases diagnosed in patients aged over 70 years. Decision-making about treatment with chemotherapy for older adults may be complicated by age-related physiological changes, impaired functional status, limited social supports, concerns regarding the occurrence of and ability to tolerate treatment toxicity, and the presence of comorbidities. This is compounded by a lack of high quality evidence guiding cancer treatment decisions for older adults. Areas covered: This narrative review evaluates the evidence for adjuvant and palliative systemic therapy in older adults with colon cancer. The value of an adequate assessment prior to making a treatment decision is addressed, with emphasis on the geriatric assessment. Guidance in making a treatment decision is provided. Expert commentary: Treatment decisions should consider goals of care, a patient's treatment preferences, and weigh up relative benefits and harms.
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Affiliation(s)
- Erin B Moth
- a Concord Cancer Centre , Concord Repatriation General Hospital , Sydney , Australia.,b Sydney Medical School , University of Sydney , Sydney , Australia
| | - Janette Vardy
- a Concord Cancer Centre , Concord Repatriation General Hospital , Sydney , Australia.,b Sydney Medical School , University of Sydney , Sydney , Australia
| | - Prunella Blinman
- a Concord Cancer Centre , Concord Repatriation General Hospital , Sydney , Australia.,b Sydney Medical School , University of Sydney , Sydney , Australia
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Patients' and clinicians' preferences for adjuvant chemotherapy in endometrial cancer: an ANZGOG substudy of the PORTEC-3 intergroup randomised trial. Br J Cancer 2016; 115:1179-1185. [PMID: 27764842 PMCID: PMC5104894 DOI: 10.1038/bjc.2016.323] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 08/18/2016] [Accepted: 09/10/2016] [Indexed: 12/02/2022] Open
Abstract
Background: To determine the minimum survival benefits that patients, and their clinicians, judged sufficient to make adjuvant chemotherapy (ACT) worthwhile, in addition to pelvic radiotherapy, for women with high risk and advanced stage endometrial cancer. Methods: Eighty-three participants in the PORTEC-3 trial completed a time trade-off questionnaire before and after adjuvant therapy; 44 of their clinicians completed it once only. The questionnaire used four hypothetical scenarios including baseline survival times without ACT of 5 and 8 years, and baseline survival rates at 5 years without ACT of 50 and 65%. Results: Over 50% of patients judged an extra 1 year of survival time or an extra 5% in survival rate sufficient to make ACT worthwhile. Over 50% of clinicians judged an extra 1 year of survival time, or an extra 10% in survival rate, sufficient to make ACT worthwhile. Compared with patients, clinicians required similar survival time benefits (medians both 1 year, P=0.4), but larger survival rate benefits (medians 8.5% vs 5%, P=0.03), and clinicians' preferences varied less (IQR 0.5–1.5 years vs 0.4–2 years, P=0.0007; 5–10% vs 1–13%, P=0.004). Patients' preferences changed over time for the survival rate scenarios depending on whether they had ACT or not (change in median benefit - 3 months vs 2.5 months respectively, P=0.028). There were no strong predictors of patients' or clinicians' preferences. Conclusions: Patients and clinicians judged moderate survival benefits sufficient to make ACT worthwhile after pelvic radiotherapy for endometrial cancer. These benefits are larger than those judged sufficient by patients with breast or colon cancers, but similar to those judged sufficient by patients with lung or ovarian cancers.
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Blinman P, Hughes B, Crombie C, Christmas T, Hudson M, Veillard AS, Muljadi N, Millward M, Wright G, Flynn P, Windsor M, Stockler M, McLachlan SA. Patients' and doctors' preferences for adjuvant chemotherapy in resected non-small-cell lung cancer: What makes it worthwhile? Eur J Cancer 2015; 51:1529-37. [PMID: 26059196 DOI: 10.1016/j.ejca.2015.05.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2015] [Revised: 05/07/2015] [Accepted: 05/08/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND Adjuvant chemotherapy (ACT) in non-small-cell lung cancer (NSCLC) improves overall survival, but the benefits must be weighed against its harms. We sought to determine the survival benefits that patients and their doctors judged sufficient to make ACT in NSCLC worthwhile. METHODS 122 patients completed a self-administered questionnaire at baseline and 6 months (before & after ACT, if they had it); 82 doctors completed the questionnaire once only. The time trade-off method was used to determine the minimum survival benefits judged sufficient in four hypothetical scenarios. Baseline survival times were 3 years & 5 years and baseline survival rates (at 5 years) were 50% & 65%. RESULTS At baseline, the median benefits judged sufficient by patients were an extra 9 months (Interquartile range (IQR) 1-12 months) beyond 3 years & 5 years and an extra 5% (IQR 0.1-10%) beyond 50% & 65%. At 6 months (n=91), patients' preferences had the same median benefit (9 months & 5%) but varied more (IQRs 0-18 months & 0-15%) than at baseline. Factors associated with judging smaller benefits sufficient were deciding to have ACT (P=0.01, 0.02) and better well-being (P=0.01, 0.006) during ACT. Doctors' preferences, compared with patients' preferences, had similar median benefits (9 months & 5%) but varied less (IQR 6-12 months versus 1-12 months, P<0.001; 5%-10% versus 0.1-10%, P<0.001). CONCLUSION Most patients and doctors judged moderate survival benefits sufficient to make ACT in NSCLC worthwhile, but the preferences of doctors varied less than those of patients. Doctors should endeavour to elicit patients' preferences during discussions about ACT in NSCLC.
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Affiliation(s)
| | - Brett Hughes
- The Prince Charles Hospital, Brisbane, Australia; University of Queensland, Brisbane, Australia
| | | | | | - Malcolm Hudson
- NHMRC Clinical Trials Centre, University of Sydney, Australia
| | | | - Nick Muljadi
- NHMRC Clinical Trials Centre, University of Sydney, Australia
| | | | | | | | | | - Martin Stockler
- Concord Repatriation General Hospital, Sydney, Australia; NHMRC Clinical Trials Centre, University of Sydney, Australia
| | - Sue-Anne McLachlan
- St Vincent's Hospital, Melbourne, Australia; University of Melbourne, Melbourne, Australia
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Currie A, Askari A, Nachiappan S, Sevdalis N, Faiz O, Kennedy R. A systematic review of patient preference elicitation methods in the treatment of colorectal cancer. Colorectal Dis 2015; 17:17-25. [PMID: 25155838 DOI: 10.1111/codi.12754] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 06/19/2014] [Accepted: 06/27/2014] [Indexed: 12/29/2022]
Abstract
AIM This systematic review aimed to assess the use of patient preference in colorectal cancer treatment. Eliciting patient preference is important for shared decision-making in colorectal cancer treatment. The introduction of newer treatments, which balance quality of life and overall survival, makes this an important future focus. METHOD A systematic search strategy of MEDLINE, Embase, PsycINFO, CINAHL and the Cochrane Database for Systematic Reviews was undertaken to obtain relevant articles. Information regarding the type of patients included, preference instruments, study settings, outcomes and limitations was extracted. RESULTS The eight articles comprising this review each described an empirical study using a validated instrument to define patient preference for an aspect of colorectal cancer treatment. The evidence suggests that patients are prepared to trade significant reductions in life expectancy to avoid certain complications of colorectal surgery, particularly stoma formation. In the adjuvant setting, patients are prepared to risk significant treatment side effects to gain small potential increases in life expectancy and chance of survival. Where neoadjuvant or adjuvant treatment risks worsening function, however, patients generally forgo any potential increase in survival to improve bowel function and therefore quality of life. The only predictors of preference were tertiary education and previous cancer treatment. CONCLUSION Most patients judge a moderate survival benefit to be sufficient to make adjuvant therapy for colorectal cancer worthwhile, but they are willing to trade a potential reduction in life expectancy and survival to avoid certain unwanted surgical sequelae.
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Affiliation(s)
- A Currie
- St Mark's Hospital and Academic Institute, Harrow, Middlesex, UK
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22
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Alberts SR, Yu TM, Behrens RJ, Renfro LA, Srivastava G, Soori GS, Dakhil SR, Mowat RB, Kuebler JP, Kim GP, Mazurczak MA, Hornberger J. Comparative economics of a 12-gene assay for predicting risk of recurrence in stage II colon cancer. PHARMACOECONOMICS 2014; 32:1231-43. [PMID: 25154747 PMCID: PMC4244576 DOI: 10.1007/s40273-014-0207-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
BACKGROUND Prior economic analysis that compared the 12-gene assay to published patterns of care predicted the assay would improve outcomes while lowering medical costs for stage II, T3, mismatch-repair-proficient (MMR-P) colon cancer patients. This study assessed the validity of those findings with real-world adjuvant chemotherapy (aCT) recommendations from the US third-party payer perspective. METHODS Costs and quality-adjusted life-years (QALYs) were estimated for stage II, T3, MMR-P colon cancer patients using guideline-compliant, state-transition probability estimation methods in a Markov model. A study of 141 patients from 17 sites in the Mayo Clinic Cancer Research Consortium provided aCT recommendations before and after knowledge of the 12-gene assay results. Progression and adverse events data with aCT regimens were based on published literature. Drug and administration costs for aCT were obtained from 2014 Medicare Fee Schedule. Sensitivity analyses evaluated the drivers and robustness of the primary outcomes. RESULTS After receiving the 12-gene assay results, physician recommendations in favor of aCT decreased 22 %; fluoropyrimidine monotherapy and FOLFOX recommendations each declined 11 %. Average per-patient drugs, administration, and adverse events costs decreased $US2,339, $US733, and $US3,211, respectively. Average total direct medical costs decreased $US991. Average patient well-being improved by 0.114 QALYs. Savings are expected to persist even if the cost of oxaliplatin drops by >75 % due to generic substitution. CONCLUSIONS This study provides evidence that real-world changes in aCT recommendations due to the 12-gene assay are likely to reduce direct medical costs and improve well-being for stage II, T3, MMR-P colon cancer patients.
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Affiliation(s)
| | - Tiffany M. Yu
- Cedar Associates LLC, 3715 Haven Avenue, Suite 100, Menlo Park, CA 94025 USA
| | - Robert J. Behrens
- Medical Oncology and Hematology Associates, 1221 Pleasant St, Des Moines, IA 50309 USA
| | | | | | - Gamini S. Soori
- Alegant Bergan Mercy Cancer Center, 7500 Mercy Rd, Omaha, NE 68124 USA
| | - Shaker R. Dakhil
- Cancer Center of Kansas, 818 N Emporia Ave, Wichita, KS 67214 USA
| | - Rex B. Mowat
- Toledo Clinic, 4235 Secor Rd, Toledo, OH 43623 USA
| | - John P. Kuebler
- Columbus Oncology Associates, 810 Jasonway Ave, Columbus, OH 43214 USA
| | - George P. Kim
- Mayo Clinic, 4500 San Pablo Rd S, Jacksonville, FL 32224 USA
| | | | - John Hornberger
- Cedar Associates LLC, 3715 Haven Avenue, Suite 100, Menlo Park, CA 94025 USA
- Stanford University School of Medicine, 291 Campus Dr, Stanford, CA 94305 USA
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Flis S, Gnyszka A, Flis K. DNA methyltransferase inhibitors improve the effect of chemotherapeutic agents in SW48 and HT-29 colorectal cancer cells. PLoS One 2014; 9:e92305. [PMID: 24676085 PMCID: PMC3967992 DOI: 10.1371/journal.pone.0092305] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2013] [Accepted: 02/20/2014] [Indexed: 11/29/2022] Open
Abstract
DNA methylation is an epigenetic phenomenon known to play an important role in the development and progression of human cancer. Enzyme responsible for this process is DNA methyltransferase 1 (DNMT1) that maintains an altered methylation pattern by copying it from parent to daughter DNA strands after replication. Aberrant methylation of the promoter regions of genes critical for normal cellular functions is potentially reversible. Therefore, inactivation of DNMT1 seems to be a valuable target for the development of cancer therapies. Currently, the most popular DNMT inhibitors (DNMTi) are cytidine analogues like 5-azacytidine, 5-aza-2′-deoxycytidine (decitabine) and pyrimidin-2-one ribonucleoside (zebularine). In colorectal cancer, epigenetic modifications play an essential role at each step of carcinogenesis. Therefore, we have addressed the hypothesis that DNA methyltransferase inhibitors may potentiate inhibitory effects of classical chemotherapeutic agents, such as oxaliplatin and 5-fluorouracil (5-FU), commonly used in colorectal cancer therapy. Here, our report shows that DNMTi can have positive interactions with standard chemotherapeutics in colorectal cancer treatment. Using pharmacological models for the drug-drug interaction analysis, we have revealed that the combination of decitabine with 5-FU or oxaliplatin shows the most attractive interaction (synergism), whereas the effect of zebularine in combinations with chemotherapeutics is moderate and may be depended on genetic/epigenetic background of a cell line or secondary drug used in combination. Our results suggest that DNMTi administered in combination with standard chemotherapeutics might improve the treatment of patients with colorectal cancers.
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Affiliation(s)
- Sylwia Flis
- Department of Pharmacology, National Medicines Institute, Warsaw, Poland
- * E-mail:
| | - Agnieszka Gnyszka
- Department of Pharmacology, National Medicines Institute, Warsaw, Poland
| | - Krzysztof Flis
- Department of Genetics, Institute of Biochemistry and Biophysics, Polish Academy of Sciences, Warsaw, Poland
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Corica T, Joseph D, Saunders C, Bulsara M, Nowak AK. Intraoperative radiotherapy for early breast cancer: do health professionals choose convenience or risk? Radiat Oncol 2014; 9:33. [PMID: 24461031 PMCID: PMC3907143 DOI: 10.1186/1748-717x-9-33] [Citation(s) in RCA: 15] [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: 11/12/2013] [Accepted: 01/20/2014] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND The randomized TARGIT trial comparing experimental intra-operative radiotherapy (IORT) to up to 7 weeks of daily conventional external beam radiotherapy (EBRT) recruited participants in Western Australia between 2003 and 2012. We aimed to understand preferences for this evolving radiotherapy treatment for early breast cancer (EBC) in health professionals, and how they changed over time and in response to emerging data. Preferences for single dose IORT or EBRT for EBC were elicited in 2004 and 2011, together with factors that may be associated with these preferences. METHODS Western Australian health professionals working with breast cancer patients were invited to complete a validated, self-administered questionnaire. The questionnaire used hypothetical scenarios and trade-off methodology to determine the maximum increase in risk of local recurrence health professionals were willing to accept in order to have a single dose of IORT in the place of EBRT if they were faced with this decision themselves. RESULTS Health professional characteristics were similar across the two time points although 2011 included a higher number of nurse (49% vs. 36%) and allied health (10% vs. 4%) participants and a lower number of radiation therapists (17% vs. 32% ) compared to 2004.Health professional preferences varied, with 7.5% and 3% judging IORT unacceptable at any risk, 18% and 21% judging IORT acceptable only if offering an equivalent risk, 56% and 59% judging IORT acceptable with a low maximum increase in risk (1-3%) and 19% and 17% judging a high maximum increase in risk acceptable (4-5%), in 2004 and 2011 respectively. A significantly greater number of nurses accepted IORT as a treatment option in 2011. CONCLUSIONS Most Western Australian health professionals working with breast cancer patients are willing to accept an increase in risk of local recurrence in order to replace EBRT with IORT in a hypothetical setting. This finding was consistent over two time points spanning 7 years despite the duration of clinical experience with IORT and the publication of the early clinical results of IORT in 2010. These results need to be compared with preferences elicited from patient groups, and further investigation into the impact of personal preferences on health professionals' advice to patients is warranted.
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Affiliation(s)
- Tammy Corica
- University of Western Australia PhD Candidate, School of Medicine and Pharmacology, Comprehensive Cancer Centre, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia
- Radiation Oncology Clinical Trials and Research Unit, Comprehensive Cancer Centre, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia
| | - David Joseph
- School of Surgery, University of Western Australia, Comprehensive Cancer Centre, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia
- Radiation Oncology, Comprehensive Cancer Centre, Sir Charles Gairdner Hospital, Nedlands, WA 6009, Australia
| | - Christobel Saunders
- School of Surgery, University of Western Australia, MBDP M507, Crawley, WA 6009, Australia
| | - Max Bulsara
- Institute of Health and Research, University of Notre Dame, 19 Mouat Street, P.O Box 1225, Fremantle, WA 6959, Australia
| | - Anna K Nowak
- School of Medicine and Pharmacology, University of Western Australia, MBDP M503, Crawley, WA 6009, Australia
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Long A, Ferraro D, Stockler M, Blinman P. Patient versus clinician preferences for chemotherapy in non-small-cell lung cancer. Lung Cancer Manag 2013. [DOI: 10.2217/lmt.13.60] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
SUMMARY Decisions about systemic treatment options for non-small-cell lung cancer are becoming increasingly complex for both patients and clinicians, and involve trade-offs between the benefits, harms and inconveniences of treatments. These trade-offs result in an individual’s (e.g., a patient or clinician) preference for a treatment. Optimal clinical decision-making about an individual’s cancer treatment is ideally shared between the patient and their clinician(s), but this requires clinicians to understand their patient’s preferences, as well as their own. Patients’ preferences for chemotherapy often differ from those of clinicians’, with patients generally needing smaller survival benefits, or accepting more toxicity, to make chemotherapy worthwhile. This review summarizes and compares recent studies of patients’ and clinicians’ preferences for chemotherapy in non-small-cell lung cancer, to help clinicians and their patients make more informed and patient-centered decisions about chemotherapy.
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Affiliation(s)
- Anne Long
- Australasian Lung Cancer Trials Group, Queensland, Australia
| | - Danielle Ferraro
- Australasian Lung Cancer Trials Group, Queensland, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Locked Bag 77, Camperdown, NSW 1450, Sydney, Australia
| | - Martin Stockler
- Australasian Lung Cancer Trials Group, Queensland, Australia
- NHMRC Clinical Trials Centre, University of Sydney, Locked Bag 77, Camperdown, NSW 1450, Sydney, Australia
- Royal Prince Alfred Hospital, Sydney, Australia
- Concord Repatriation General Hospital, Sydney, Australia
| | - Prunella Blinman
- Australasian Lung Cancer Trials Group, Queensland, Australia
- Concord Repatriation General Hospital, Sydney, Australia
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Blinman P, Gainford C, Donoghoe M, Martyn J, Blomfield P, Grant P, Kichenadasse G, Vaughan M, Brand A, Shannon C, Gebski V, Stockler M, Friedlander M. Feasibility, acceptability and preferences for intraperitoneal chemotherapy with paclitaxel and cisplatin after optimal debulking surgery for ovarian and related cancers: an ANZGOG study. J Gynecol Oncol 2013; 24:359-66. [PMID: 24167672 PMCID: PMC3805917 DOI: 10.3802/jgo.2013.24.4.359] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 06/09/2013] [Indexed: 11/30/2022] Open
Abstract
Objective Intraperitoneal (IP) chemotherapy in women with optimally debulked stage III ovarian cancer has been reported to prolong overall survival, but has not been widely adopted due to concerns about its toxicity, inconvenience and acceptability to patients. The purposes of this study were to determine the regimen's feasibility, adverse events, catheter-related complications, progression-free survival, health-related quality of life (HRQL), and patients' preferences for IP versus intravenous (IV) chemotherapy. Methods We conducted a single arm, multi-center study of IP chemotherapy with IV paclitaxel 135 mg/m2 (D1) over 3 hours, IP cisplatin 75 mg/m2 (D2), and IP paclitaxel 60 mg/m2 (D8) for 6 cycles in women with optimally debulked stage III ovarian or related cancers. Results Thirty-eight eligible patients were recruited from 12 sites between July 2007 and December 2009. Seventy-one percent (n=27) completed at least 4 cycles and 63% (n=24) completed all 6 cycles. Grade 3 or 4 adverse events included nausea (n=2), vomiting (n=2), abdominal pain (n=2), and diarrhea (n=1), but not febrile neutropenia, neurotoxicity, or nephropathy. There were no treatment-related deaths. Catheter-related complications were the most frequent cause of early discontinuation of treatment (16 patients, 21%). Apart from neurotoxicity HRQL which worsened over time, HRQL was stable or improved with time. Most patients (≥50%) judged moderate benefits (e.g., an extra 6 months survival time or a 5% improvement in survival rates) necessary to make IP chemotherapy worthwhile. Conclusion IP chemotherapy was feasible, tolerable, and most participants considered moderate survival benefits sufficient to warrant the adverse effects and inconvenience.
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Affiliation(s)
- Prunella Blinman
- Department of Medical Oncology, Concord Repatriation General Hospital, Sydney, Australia
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Jorgensen ML, Young JM, Solomon MJ. Adjuvant chemotherapy for colorectal cancer: age differences in factors influencing patients' treatment decisions. Patient Prefer Adherence 2013; 7:827-34. [PMID: 24003305 PMCID: PMC3755704 DOI: 10.2147/ppa.s50970] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
PURPOSE Older colorectal cancer patients are significantly less likely than younger patients to receive guideline-recommended adjuvant chemotherapy. Previous research has indicated that patient refusal of treatment is a contributing factor. This study aimed to identify potential barriers to adjuvant chemotherapy use in older patients by examining the associations between patient age, factors influencing chemotherapy treatment decisions, and preferences for information and decision-making involvement. PATIENTS AND METHODS Sixty-eight patients who underwent surgery for colorectal cancer in Sydney, Australia, within the previous 24 months completed a self-administered survey. RESULTS Fear of dying, health status, age, quality of life, and understanding treatment procedures and effects were significantly more important to older patients (aged ≥65 years) than younger patients in deciding whether to accept chemotherapy (all P < 0.05). Reducing the risk of cancer returning and physician trust were important factors for all patients. Practical barriers such as traveling for treatment and cost were rated lowest. Older patients preferred less information and involvement in treatment decision making than younger patients. However, 60% of the older group wanted detailed information about chemotherapy, and 83% wanted some involvement in decision making. Those preferring less information and involvement still rated many factors as important in their decision making, including understanding treatment procedures and effects. CONCLUSION A range of factors appears to influence patients' chemotherapy decision making, including, but not limited to, survival benefits and treatment toxicity. For older patients, balancing the risks and benefits of treatment may be made more complex by the impact of emotional motivators, greater health concerns, and conflicts between their need for understanding and their information and decision-making preferences. Through greater understanding of perceived barriers to treatment and unique motivators for treatment choice, physicians may be better able to support older patients to make informed decisions about their care.
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Affiliation(s)
- Mikaela L Jorgensen
- Surgical Outcomes Research Centre (SOuRCe), Sydney School of Public Health, University of Sydney and Sydney Local Health District, NSW, Australia
- Cancer Epidemiology and Services Research (CESR), Sydney School of Public Health, University of Sydney, NSW, Australia
- Correspondence: Mikaela L Jorgensen, Cancer Epidemiology and Services Research (CESR), Queen Elizabeth II Research Institute (D02), University of Sydney, NSW 2006, Australia, Tel +61 2 9036 5419, Fax +61 2 9515 3222, Email
| | - Jane M Young
- Surgical Outcomes Research Centre (SOuRCe), Sydney School of Public Health, University of Sydney and Sydney Local Health District, NSW, Australia
- Cancer Epidemiology and Services Research (CESR), Sydney School of Public Health, University of Sydney, NSW, Australia
| | - Michael J Solomon
- Surgical Outcomes Research Centre (SOuRCe), Sydney School of Public Health, University of Sydney and Sydney Local Health District, NSW, Australia
- Discipline of Surgery, University of Sydney, NSW, Australia
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Blinman P, King M, Norman R, Viney R, Stockler MR. Preferences for cancer treatments: an overview of methods and applications in oncology. Ann Oncol 2012; 23:1104-1110. [PMID: 22234737 DOI: 10.1093/annonc/mdr559] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
This review provides cancer clinicians and researchers with an overview of methods for assessing preferences, with examples and recommendations for their application in oncology. Decisions about cancer treatments involve trade-offs between their relative benefits and harms. An individual's preference for a cancer treatment reflects their evaluation of the relative benefits and harms in comparison with a given alternative or alternatives. Methods of preference assessment include the ranking or rating scale, standard gamble (SG), time trade-off (TTO), visual analogue scale, discrete choice experiment (DCE), and multi-attribute utility instrument (MAUI). The choice of method depends on the purpose of preference assessment; the ranking or rating scale, SG, TTO, and DCEs are best suited to clinical decisions, whereas MAUIs are best suited to health policy decisions. Knowledge of patients' preferences for cancer treatments can better inform clinical decisions about patient management by enabling the tailoring of decisions to individual patients' values, attitudes, and priorities and health policy decisions through economic evaluations of cancer treatments and their suitability for coverage by health payers.
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Affiliation(s)
- P Blinman
- NHMRC Clinical Trials Centre, University of Sydney, Sydney.
| | - M King
- Psycho-oncology Co-operative Research Group (PoCoG), School of Psychology, University of Sydney, Sydney
| | - R Norman
- Centre for Health Economics Research and Evaluation (CHERE), University of Technology Sydney (UTS), Sydney
| | - R Viney
- Centre for Health Economics Research and Evaluation (CHERE), University of Technology Sydney (UTS), Sydney
| | - M R Stockler
- NHMRC Clinical Trials Centre, University of Sydney, Sydney; Sydney Cancer Centre, Royal Prince Alfred and Concord Hospitals, Sydney, Australia
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de Gramont A, de Gramont A, Chibaudel B, Larsen AK, Tournigand C, André T. The evolution of adjuvant therapy in the treatment of early-stage colon cancer. Clin Colorectal Cancer 2012; 10:218-26. [PMID: 22122893 DOI: 10.1016/j.clcc.2011.10.001] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2011] [Accepted: 10/07/2011] [Indexed: 02/07/2023]
Abstract
Adjuvant treatment of colon cancer, one of the most common malignancies, is an important issue in oncology. This article describes the development of adjuvant therapy and how the 2 major evolution steps, the successes of fluoropyrimidines, and then of oxaliplatin, have been achieved, Problems and failures, such as those of targeted therapies, also are addressed to help us to overcome their limitations. Special situations, such as stage II disease and an elderly population in which adjuvant chemotherapy is still controversial, are reviewed from the clinician perspective. The synthesis of these data allows us to conceive a future development focused on translational research.
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Affiliation(s)
- Aimery de Gramont
- Service d'Oncologie médicale, Hôpital Saint-Antoine, Assistance Publique des Hôpitaux de Paris, Paris, France.
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Impact of oxaliplatin-induced neuropathy: a patient perspective. Support Care Cancer 2012; 20:2959-67. [PMID: 22426503 DOI: 10.1007/s00520-012-1428-5] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2011] [Accepted: 02/27/2012] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Dose-limiting neurotoxicity is a major side effect of oxaliplatin treatment, producing initial acute neurotoxicity and chronic neuropathy with increasing exposure. The improvement in survival for patients with early-stage colorectal cancer treated with oxaliplatin has highlighted the need for valid and reliable assessment of peripheral neuropathy. OBJECTIVES The objective of this paper was to explore neuropathic symptoms in oxaliplatin-treated patients as assessed using different methods. METHODS Consecutive symptomatic patients reporting peripheral neuropathy after oxaliplatin chemotherapy for colorectal cancer were interviewed using a semi-structured clinical interview. Neurotoxicity was also assessed using the National Cancer Institute Common Toxicity Criteria scale (clinician-rated), patient 'self-report' questionnaires (PNQ), nerve conduction and clinical assessment. RESULTS Twenty patients were assessed, 12.6 ± 2.8 months after treatment cessation (mean cumulative oxaliplatin dose, 789 mg/m(2)). In 40% of patients, neurotoxicity necessitated early cessation of treatment. Only 10% of patients were designated by clinicians with severe neurotoxicity, whilst, in contrast, patient interviews and self-report questionnaires described significant physical limitations due to neuropathic symptoms in 60% of patients. The majority (85%) of patients had objective evidence of sensory neuropathy with nerve conduction studies. Reports from clinical interviews were strongly correlated with patient self-assessment (Pearson coefficient = 0.790, p < 0.0005). CONCLUSION Given the discrepancies in symptom prevalence highlighted by these findings, the monitoring of oxaliplatin-induced neurotoxicity would benefit from more informative clinical assessment, with inclusion of patient-reported outcome measures. Such an approach would be beneficial in a clinical trial setting to monitor the efficacy of interventions and in prospective studies of survivorship to determine the true burden of peripheral neuropathy in oxaliplatin-treated patients.
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Lung cancer clinicians’ preferences for adjuvant chemotherapy in non-small-cell lung cancer: What makes it worthwhile? Lung Cancer 2011; 72:213-8. [DOI: 10.1016/j.lungcan.2010.08.007] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2010] [Revised: 07/30/2010] [Accepted: 08/08/2010] [Indexed: 10/19/2022]
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Blinman P, Alam M, Duric V, McLachlan SA, Stockler MR. Patients’ preferences for chemotherapy in non-small-cell lung cancer: A systematic review. Lung Cancer 2010; 69:141-7. [DOI: 10.1016/j.lungcan.2010.05.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2010] [Accepted: 05/02/2010] [Indexed: 12/15/2022]
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Grothey A. Adjuvant chemotherapy in colon cancer - is it worth it? Eur J Cancer 2010; 46:1768-9. [PMID: 20434902 DOI: 10.1016/j.ejca.2010.04.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2010] [Accepted: 04/06/2010] [Indexed: 11/19/2022]
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