1
|
Presley CJ, Dalal N, Davenport AP, Gounden A, Ramchandran K, Tonorezos E. Survivorship in Advanced Lung Cancer: Understanding a New Landscape and Opportunities. Am Soc Clin Oncol Educ Book 2024; 44:e433298. [PMID: 38768420 DOI: 10.1200/edbk_433298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/22/2024]
Abstract
People with advanced lung cancer represent a distinct group whose needs remain understudied, especially compared with people diagnosed with limited-stage disease. Fortunately, novel treatments such as tyrosine kinase inhibitors and immune checkpoint inhibitors are leading to significant advances in prognosis and survival, even among those with advanced disease at the time of diagnosis. However, there are known gaps in symptom management, psychosocial and nutritional support, complex care coordination, health behavior coaching, and health care delivery efforts among patients living with advanced lung cancer. Many of these patients would benefit from survivorship and palliative care approaches. In particular, survivorship care may include health care maintenance, treatment of immune-related adverse events and late- or long-term effects, frailty assessment and rehabilitation, and care coordination. Palliative care may be best suited to discuss ongoing symptom management, advanced care planning, and end-of-life considerations, as well as psychosocial well-being. To this end, we share a review of the current status of the palliative and survivorship care infrastructure for patients with advanced lung cancer and provide suggestions across the care continuum for this diverse group of patients and families.
Collapse
Affiliation(s)
- Carolyn J Presley
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | - Ashley P Davenport
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University Comprehensive Cancer Center, Columbus, OH
| | | | | | | |
Collapse
|
2
|
Bullen A, Ryan M, Ennis H, Gray E, Loría-Rebolledo LE, McIntyre M, Hall P. Trade-offs between overall survival and side effects in the treatment of metastatic breast cancer: eliciting preferences of patients with primary and metastatic breast cancer using a discrete choice experiment. BMJ Open 2024; 14:e076798. [PMID: 38684245 PMCID: PMC11057309 DOI: 10.1136/bmjopen-2023-076798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 03/01/2024] [Indexed: 05/02/2024] Open
Abstract
OBJECTIVES There has been a recent proliferation in treatment options for patients with metastatic breast cancer. Such treatments often involve trade-offs between overall survival and side effects. Our study aims to estimate the trade-offs that could be used to inform decision-making at the individual and policy level. DESIGN We designed a discrete choice experiment (DCE) to look at preferences for avoiding severity levels of side effects when choosing treatment for metastatic breast cancer. Treatment attributes were: fatigue, nausea, diarrhoea, other side effects (peripheral neuropathy, hand-foot syndrome and mucositis) and urgent hospital admission and overall survival. Responses were analysed using an error component logit model. We estimated the relative importance of attributes and minimum acceptable survival for improvements in side effects. SETTING The DCE was completed online by UK residents with self-reported diagnoses of breast cancer. PARTICIPANTS 105 respondents participated, of which 72 patients had metastatic breast cancer and 33 patients had primary breast cancer. RESULTS Overall survival had the largest relative importance, followed by other side effects, diarrhoea, nausea and fatigue. The risk of urgent hospital admission was not significant. While overall survival was the most important attribute, respondents were willing to forgo some absolute probability of overall survival for reductions in all Grade 2 side effects (12.02% for hand-foot syndrome, 11.01% for mucositis, 10.42% for peripheral neuropathy, 6.33% for diarrhoea and 3.62% for nausea). Grade 1 side effects were not significant, suggesting respondents have a general tolerance for them. CONCLUSIONS Patients are willing to forgo overall survival to avoid particular severity levels of side effects. Our results have implications for data collected in research studies and can help inform person-centred care and shared decision-making.
Collapse
Affiliation(s)
- Alistair Bullen
- Edinburgh Clinical Trials Unit, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
| | - Mandy Ryan
- Health Economics Research Unit, University of Aberdeen, Aberdeen, UK
| | | | - Ewan Gray
- The University of Edinburgh, Edinburgh, UK
| | | | | | - Peter Hall
- The University of Edinburgh, Edinburgh, UK
- Western General Hospital, Edinburgh, UK
| |
Collapse
|
3
|
Hata A, Fifer S, Hasegawa K, Ando E, Kasahara‐Kiritani M, Takahashi M, Ordman R, Toh L, Inoue A. Treatment preferences among Japanese patients and physicians for epidermal growth factor receptor-mutant non-small cell lung cancer. Cancer Med 2024; 13:e6777. [PMID: 38196301 PMCID: PMC10807555 DOI: 10.1002/cam4.6777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/30/2023] [Accepted: 11/21/2023] [Indexed: 01/11/2024] Open
Abstract
INTRODUCTION Evidence is limited on preferences of Japanese patients and physicians in treatment for epidermal growth factor receptor (EGFR)-mutant non-small cell lung cancer (NSCLC). Several oral or intravenous novel agents for EGFR exon 20 insertions are under development. The aim of our study was to investigate which attributes of novel treatments influenced selection of oral or intravenous agents among treated patients and treating physicians in Japan. METHODS The study was designed by board-certified oncologists, patient representatives, and analytics specialists. Eligible participants completed an online survey with a discrete choice experiment presenting two treatment profiles described by attributes: mode of administration (oral or intravenous); frequency of administration; overall response rate (ORR); average progression-free survival (PFS); chance of experiencing severe side effects (SEs); mild-moderate gastrointestinal SEs; mild-moderate skin-related SEs; and patient out-of-pocket costs. RESULTS Fifty-four patients (all self-reported EGFR-mutant) and 74 physicians participated from December 2021 to August 2022. All attributes being equal, there was greater preference for oral administration. However, there was greater preference for intravenous over oral, when ORR and PFS improved by 10% and 1 month, and severe SEs reduced by 10%. Physicians exhibited greater preference for PFS compared to patients (p < 0.01). Ranked order of attribute importance was as follows: (1) PFS; (2) ORR; (3) severe SEs, expressed by patients and physicians alike. CONCLUSIONS Our study revealed Japanese physician and patient preferences in treatment options for EGFR-mutant NSCLC. Compared to the strong preference for a more efficacious drug, the preference of oral versus intravenous revealed a smaller impact.
Collapse
Affiliation(s)
- Akito Hata
- Division of Thoracic OncologyKobe Minimally Invasive Cancer CenterKobeHyogoJapan
| | - Simon Fifer
- Community and Patient Preference Research (CaPPRe)SydneyAustralia
| | - Kazuo Hasegawa
- NPO Lung Cancer Patients Association One StepKanagawaJapan
| | - Emiko Ando
- NPO Lung Cancer Patients Association One StepKanagawaJapan
| | | | | | - Robyn Ordman
- Community and Patient Preference Research (CaPPRe)SydneyAustralia
| | - Lili Toh
- Community and Patient Preference Research (CaPPRe)SydneyAustralia
| | - Akira Inoue
- Department of Palliative MedicineTohoku University School of MedicineSendaiMiyagiJapan
| |
Collapse
|
4
|
Tankel J, Spicer J, Chu Q, Fiset PO, Kidane B, Leighl NB, Joubert P, Maziak D, Palma D, McGuire A, Melosky B, Snow S, Bahig H, Blais N. Canadian Consensus Recommendations for the Management of Operable Stage II/III Non-Small-Cell Lung Cancer: Results of a Modified Delphi Process. Curr Oncol 2023; 30:10363-10384. [PMID: 38132389 PMCID: PMC10742991 DOI: 10.3390/curroncol30120755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 11/22/2023] [Accepted: 11/24/2023] [Indexed: 12/23/2023] Open
Abstract
The treatment paradigm for patients with stage II/III non-small-cell lung cancer (NSCLC) is rapidly evolving. We performed a modified Delphi process culminating at the Early-stage Lung cancer International eXpert Retreat (ELIXR23) meeting held in Montreal, Canada, in June 2023. Participants included medical and radiation oncologists, thoracic surgeons and pathologists from across Quebec. Statements relating to diagnosis and treatment paradigms in the preoperative, operative and postoperative time periods were generated and modified until all held a high level of consensus. These statements are aimed to help guide clinicians involved in the treatment of patients with stage II/III NSCLC.
Collapse
Affiliation(s)
- James Tankel
- Department of Thoracic Surgery, McGill University Health Center, Montreal, QC H3G 1A4, Canada
| | - Jonathan Spicer
- Department of Thoracic Surgery, McGill University Health Center, Montreal, QC H3G 1A4, Canada
| | - Quincy Chu
- Department of Medical Oncology, Cross Cancer Institute, Edmonton, AB T6G 1Z2, Canada
| | - Pierre Olivier Fiset
- Department of Pathology, McGill University Health Center, Montreal, QC H3G 1A4, Canada
| | - Biniam Kidane
- Section of Thoracic Surgery, University of Manitoba & Cancer Care Manitoba, Winnipeg, MB R3A 1R9, Canada
| | - Natasha B. Leighl
- Division of Medical Oncology, Princess Margaret Cancer Center, Toronto, ON M5G 2C4, Canada
| | - Philippe Joubert
- Department of Pathology, Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université, Laval, QC G1V 4G5, Canada
| | - Donna Maziak
- Department of Thoracic Surgery, Ottawa Hospital, Ottawa, ON K1Y 4E9, Canada
| | - David Palma
- Department of Radiation Oncology, London Health Services Center, London, ON N6A 5A5, Canada
| | - Anna McGuire
- Department of Thoracic Surgery, Vancouver General Hospital, Vancouver, BC V5Z 1M9, Canada
| | - Barbara Melosky
- Department of Medical Oncology, BCCA, Vancouver, BC V5Z 4E6, Canada
| | - Stephanie Snow
- Department of Medical Oncology, Queen Elizabeth II Health Sciences Center, Halifax, NS B3H 3A7, Canada
| | - Houda Bahig
- Department of Radiation Oncology, Centre Hospitalier de l’Université de Montréal, Montreal, QC H2X 3E4, Canada
| | - Normand Blais
- Department of Medical Oncology, Centre Hospitalier de l’Université de Montréal, Montreal, QC H2X 3E4, Canada
| |
Collapse
|
5
|
Bebb DG, Murray C, Giannopoulou A, Felip E. Symptoms and Experiences with Small Cell Lung Cancer: A Mixed Methods Study of Patients and Caregivers. Pulm Ther 2023; 9:435-450. [PMID: 37310567 PMCID: PMC10262931 DOI: 10.1007/s41030-023-00229-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/15/2023] [Indexed: 06/14/2023] Open
Abstract
INTRODUCTION Understanding of the patient-perceived symptom burden of small cell lung cancer (SCLC) is limited. The objective of this study was to explore patients' experiences with SCLC, identify which treatment-/disease-related symptoms have the greatest impact on their well-being, and gain caregiver perspectives. METHODS A noninterventional, cross-sectional, multimodal, mixed methods study was conducted from April-June 2021. Adult patients with SCLC and unpaid caregivers were eligible to participate. Patients' experiences, captured via 5-day video diaries and follow-up interviews, were scored 1-10 on how bothersome the patients perceived each symptom/symptomatic adverse event. Patients indicated if they believed a symptom was disease or treatment related. Caregivers participated in an online community board. RESULTS The study included nine patients (five with extensive-stage [ES] disease, four with limited-stage [LS] disease) and nine caregivers. Except for one patient/caregiver pairing, patients and caregivers were unmatched. The most common impactful symptoms in patients with ES-SCLC were shortness of breath, fatigue, coughing, chest pain, and nausea/vomiting; in LS-SCLC, these were fatigue and shortness of breath. Among patients with ES disease, SCLC had a high impact on physical (leisure/hobbies, work, sleep, ability to do household chores and errands/responsibilities outside home), social (family dynamics, extrafamilial social interaction), and emotional (mental health) aspects. Patients with LS-SCLC faced the long-term physical effects of treatment, financial implications, and emotional toll of an uncertain prognosis. SCLC had a high personal and psychologic burden among caregivers, whose duties consumed much of their time. Caregivers observed similar symptoms and impacts of SCLC as those reported by patients. CONCLUSIONS This study provides valuable insight into patient- and caregiver-perceived burden of SCLC and can inform the design of prospective studies. Clinicians should seek to understand patients' opinions and priorities before making treatment decisions.
Collapse
Affiliation(s)
- D Gwyn Bebb
- Global Development, Amgen, One Amgen Centre Drive, Thousand Oaks, CA, 91320, USA.
- Cumming School of Medicine, University of Calgary, 3285 Hospital Drive, NW, Calgary, AB, T2N 4N1, Canada.
| | | | | | - Enriqueta Felip
- Vall d'Hebron University Hospital and Vall d'Hebron Institute of Oncology, Barcelona, Spain
| |
Collapse
|
6
|
Zubair HM, Khan MA, Gulzar F, Alkholief M, Malik A, Akhtar S, Sharif A, Akhtar MF, Abbas M. Patient Perspectives and Side-Effects Experience on Chemotherapy of Non-Small Cell Lung Cancer: A Qualitative Study. Cancer Manag Res 2023; 15:449-460. [PMID: 37255669 PMCID: PMC10226488 DOI: 10.2147/cmar.s396751] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 05/03/2023] [Indexed: 06/01/2023] Open
Abstract
Purpose This study aimed to explore patients' experiences of palliative chemotherapy for non-small cell lung cancer (NSCLC), how patients adapt to their new and challenging life after chemotherapy, their beliefs, and their quality of life. Patients and Methods The study used an exploratory descriptive qualitative approach that was designed to explore the experiences and side effects of NSCLC patients on chemotherapy in Pakistan. The study was designed to obtain a deeper understanding of 22 NSCLC patients' experiences, using a face-to-face approach and interviews were conducted. Patients who have completed chemotherapy agreed to participate in semi-structured interviews. Results The data were arranged into five themes: hospital facilities and environment, patient's beliefs in alternative treatments, presenting a positive/negative face, life is for living, and health insurance coverage. The major complaints related to bad experiences of chemotherapy-induced side effects, but these patients still managed to complete the full course of their respective chemotherapy. Additionally, the current study revealed the real experience of patients with NSCLC which had been less studied. The patient's experience was summarized into four themes and several subthemes. Conclusion This study aid healthcare providers when deciding on treatment options that will improve shared decision-making between clinicians and treatment outcomes.
Collapse
Affiliation(s)
| | - Muhammad Arslan Khan
- Department of Pharmacy Services, The University of Lahore Teaching Hospital, Lahore, Pakistan
| | - Faisal Gulzar
- Faculty of Pharmacy, The University of Lahore, Lahore, Pakistan
| | - Musaed Alkholief
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Abdul Malik
- Department of Pharmaceutics, College of Pharmacy, King Saud University, Riyadh, Saudi Arabia
| | - Suhail Akhtar
- Department of Biochemistry, A.T. Still University of Health Sciences, Kirksville, MO, USA
| | - Ali Sharif
- Department of Pharmacology, Institute of Pharmacy, Lahore College for Women University, Lahore, Pakistan
| | - Muhammad Furqan Akhtar
- Riphah Institute of Pharmaceutical Sciences, Riphah International University, Lahore Campus, Lahore, Pakistan
| | - Muhammad Abbas
- Riphah Institute of Pharmaceutical Sciences, Riphah International University, Islamabad, Pakistan
| |
Collapse
|
7
|
Tervonen T, Veldwijk J, Payne K, Ng X, Levitan B, Lackey LG, Marsh K, Thokala P, Pignatti F, Donnelly A, Ho M. Quantitative Benefit-Risk Assessment in Medical Product Decision Making: A Good Practices Report of an ISPOR Task Force. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:449-460. [PMID: 37005055 DOI: 10.1016/j.jval.2022.12.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 12/06/2022] [Indexed: 05/06/2023]
Abstract
Benefit-risk assessment is commonly conducted by drug and medical device developers and regulators, to evaluate and communicate issues around benefit-risk balance of medical products. Quantitative benefit-risk assessment (qBRA) is a set of techniques that incorporate explicit outcome weighting within a formal analysis to evaluate the benefit-risk balance. This report describes emerging good practices for the 5 main steps of developing qBRAs based on the multicriteria decision analysis process. First, research question formulation needs to identify the needs of decision makers and requirements for preference data and specify the role of external experts. Second, the formal analysis model should be developed by selecting benefit and safety endpoints while eliminating double counting and considering attribute value dependence. Third, preference elicitation method needs to be chosen, attributes framed appropriately within the elicitation instrument, and quality of the data should be evaluated. Fourth, analysis may need to normalize the preference weights, base-case and sensitivity analyses should be conducted, and the effect of preference heterogeneity analyzed. Finally, results should be communicated efficiently to decision makers and other stakeholders. In addition to detailed recommendations, we provide a checklist for reporting qBRAs developed through a Delphi process conducted with 34 experts.
Collapse
Affiliation(s)
| | - Jorien Veldwijk
- Erasmus School of Health Policy and Management & Erasmus Choice Modelling Center, Rotterdam, The Netherlands
| | - Katherine Payne
- Manchester Centre for Health Economics, School of Health Sciences, The University of Manchester, Manchester, England, UK
| | - Xinyi Ng
- Office of Biostatistics and Pharmacovigilance, Center for Biologics Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | | | - Leila G Lackey
- Decision Support and Analysis Staff, Office of Program and Strategic Analysis, Center for Drug Evaluation and Research, Food and Drug Administration, Silver Spring, MD, USA
| | | | - Praveen Thokala
- School of Health and Related Research, University of Sheffield, Sheffield, England, UK
| | | | - Anne Donnelly
- Patient Council of the Michael J. Fox Foundation for Parkinson's Research, New York, NY, USA
| | | |
Collapse
|
8
|
Campana LG, Quaglino P, de Terlizzi F, Mascherini M, Brizio M, Spina R, Bertino G, Kunte C, Odili J, Matteucci P, MacKenzie Ross A, Schepler H, Clover JAP, Kis E. Health-related quality of life trajectories in melanoma patients after electrochemotherapy: real-world insights from the InspECT register. J Eur Acad Dermatol Venereol 2022; 36:2352-2363. [PMID: 35870122 DOI: 10.1111/jdv.18456] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Accepted: 06/02/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Electrochemotherapy (ECT) effectively controls skin metastases from cutaneous melanoma. OBJECTIVES This study aimed to evaluate health-related quality of life (HRQoL) in melanoma patients pre-/post-ECT and its effect on treatment outcome. METHODS The analysis included prospective data from the International Network for Sharing Practices of ECT register. Following the Standard Operating Procedures, patients received intravenous or intratumoural bleomycin (15,000 IU/m2 ; 1000 IU mL/cm3 ) followed by 100-microsecond, 1000-V/cm electric pulses. Endpoints included response (RECIST v3.0), local progression-free survival (LPFS), toxicity (CTCAE v5.0), and patient-reported HRQoL at baseline, one, two, four and ten months (EuroQol [EQ-5D-3L], including 5-item utility score [EQ-5D] and visual analogue scale for self-reported health state [EQ-VAS]). Comparisons within/between subgroups were made for statistical and minimal important differences (MID). HRQoL scores and clinical covariates were analysed to identify predictors of response in multivariate analysis. RESULTS Median tumour size was 2 cm. Complete response rate, G3 toxicity and one-year LPFS in 378 patients (76% of the melanoma cohort) were 47%, 5%, and 78%. At baseline, age-paired HRQoL did not differ from the general European population. Following ECT, both EQ-5D and EQ-VAS scores remained within MID boundaries, particularly among complete responders. A subanalysis of the EQ-5D items revealed a statistically significant deterioration in pain/discomfort and mobility (restored within four months), and self-care and usual activities (throughout the follow-up) domains. Concomitant checkpoint inhibition correlated with better EQ-5D and EQ-VAS trajectories. Baseline EQ-5D was the exclusive independent predictor for complete response (RR 14.76, p=0.001). CONCLUSIONS HRQoL of ECT melanoma patients parallels the general population and is preserved in complete responders. Transient deterioration in pain/discomfort and mobility and persistent decline in self-care and usual activities may warrant targeted support interventions. Combination with checkpoint inhibitors is associated with better QoL outcomes. Baseline HRQoL provides predictive information which can help identify patients most likely to respond.
Collapse
Affiliation(s)
- L G Campana
- Department of Surgery, The Christie NHS Foundation Trust, Manchester, UK
- Department of Surgery, Manchester University NHS Foundation Trust, Manchester, UK
| | - P Quaglino
- Dermatologic Clinic, Department of Medical Sciences, University of Turin, Italy
| | - F de Terlizzi
- Biophysics Department, IGEA S.p.A., 41012 Carpi, Modena, Italy
| | - M Mascherini
- Department of Surgical Sciences, Polyclinic Hospital San Martino, Genoa, Italy
| | - M Brizio
- Dermatologic Clinic, Department of Medical Sciences, University of Turin, Italy
| | - R Spina
- Psychology Unit, University Hospital of Padua, Padua, Italy
| | - G Bertino
- Department of Otolaryngology-Head Neck Surgery, Policlinico San Matteo Foundation IRCCS, Pavia University, Pavia, Italy
| | - C Kunte
- Department of Dermatosurgery and Dermatology, Artemed Fachklinik, Munich, Germany
| | - J Odili
- Department of Plastic Surgery, St. Georges University Hospitals NHS Trust, London, UK
| | - P Matteucci
- Hull University Teaching Hospitals NHS Trust, Hull, UK
| | - A MacKenzie Ross
- Department of Plastic and Reconstructive Surgery, St Thomas' Hospital, UK
| | - H Schepler
- Department of Dermatology, University Medical Center, Johannes Gutenberg University KöR, Mainz, Germany
| | - J A P Clover
- Department of Plastic Surgery, Cork University Hospital, Cork, Ireland
- Cancer Research, University College Cork, Cork, Ireland
| | - E Kis
- Department of Dermatology and Allergology, University of Szeged, Hungary
| |
Collapse
|
9
|
Mimae T, Satouchi M, Okada M. Psychological states regarding adjuvant chemotherapy in patients with non-small cell lung cancer. Cancer Treat Res Commun 2022; 32:100591. [PMID: 35749949 DOI: 10.1016/j.ctarc.2022.100591] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 06/06/2022] [Accepted: 06/08/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Understanding the anxieties and emotions of patients with lung cancer before and after radical surgery is crucial in the decision to undergo postoperative adjuvant chemotherapy. However, the psychological states and changes associated with adjuvant chemotherapy during perioperative periods in patients with non-small cell lung cancer (NSCLC) remain unclear. PATIENTS AND METHODS Participants with a self-reported diagnosis of pathological stage II or III NSCLC who underwent complete surgical resection and received information on postoperative adjuvant chemotherapy (n = 101) were sampled from an online panel in Japan from October 9 to November 19, 2020. Eligible and consenting participants completed a self-administered online questionnaire survey about their disease, and their psychological states were assessed. RESULTS The majority of patients (39, 38.6%) were 60-69 years of age, and 87 (86.1%) were men. A total of 59 (58.4%) and 42 (41.6%) patients had pathological stages II and III, respectively. Regardless of the situation, more than 75% of the patients were anxious about the possibility of recurrence after complete surgical resection for lung cancer. Approximately 70% of respondents selected the option of "I will get adjuvant chemotherapy" on any precondition. Among them, almost all respondents selected the option "want to do everything I can do now to prevent recurrence." CONCLUSION In this small sample of respondents with NSCLC from Japan, it is important for surgeons and physicians to explain the condition and corresponding therapy for lung cancer, while considering the possibility of recurrence in any situation, even before surgery as a curative intent.
Collapse
Affiliation(s)
- Takahiro Mimae
- Department of Surgical Oncology, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan
| | - Miyako Satouchi
- Department of Thoracic Oncology, Hyogo Cancer Center, 13-70, Kitaouji-chou, Akashi, 673-0021, Japan
| | - Morihito Okada
- Department of Surgical Oncology, Hiroshima University, 1-2-3, Kasumi, Minami-ku, Hiroshima, 734-8551, Japan.
| |
Collapse
|
10
|
Transarterial Radioembolization Versus Atezolizumab-Bevacizumab in Unresectable Hepatocellular Carcinoma: A Matching-Adjusted Indirect Comparison of Time to Deterioration in Quality of Life. Adv Ther 2022; 39:2035-2051. [PMID: 35279814 PMCID: PMC9056454 DOI: 10.1007/s12325-022-02099-0] [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: 01/03/2022] [Accepted: 02/15/2022] [Indexed: 12/24/2022]
Abstract
Introduction Given the relatively short life expectancy of patients with hepatocellular carcinoma (HCC), quality of life (QOL) plays a significant role in treatment selection. This analysis aimed to compare time to deterioration (TTD) in QOL with transarterial radioembolization (TARE) and atezolizumab–bevacizumab, as well as sorafenib, in advanced and unresectable HCC. Methods Patient-level data from SARAH (TARE using SIR-Spheres® Y-90 resin microspheres [SIR-Spheres] versus sorafenib) and aggregate data from IMbrave150 (atezolizumab–bevacizumab versus sorafenib) randomized controlled trials were used to conduct an anchored matching-adjusted indirect comparison (MAIC). Patients with a Child–Pugh score B in SARAH were excluded to align with exclusion criteria in IMbrave150. To identify potential effect modifiers for adjustment, the literature was searched and multivariate Cox proportional hazards models were implemented using SARAH data. Patients from SARAH were then weighted to balance with baseline characteristics from IMbrave150. Median TTD in QOL and hazard ratios (HRs) were calculated. Results Four potential effect modifiers were identified and used for adjustment: cause of disease (viral/non-viral), macrovascular invasion, Eastern Cooperative Oncology Group performance score, and alpha-fetoprotein level. The MAIC included 217 patients from SARAH (TARE = 94; sorafenib = 123). Median TTD in QOL was 11.23 and 8.64 months for atezolizumab–bevacizumab and TARE, respectively (HR = 1.06; 95% confidence interval [CI] 0.75–1.50; p = 0.725). A sensitivity analysis was conducted adjusting for cause of disease defined as hepatitis B/hepatitis C/non-viral: median TTD in QOL was higher for TARE compared with atezolizumab–bevacizumab (19.88 vs 11.23 months; HR = 0.66; 95% CI 0.36–1.19; p = 0.163). Sorafenib resulted in the shortest TTD in QOL, with statistically significant differences in both base case and sensitivity analyses. Conclusion TARE using SIR-Spheres may achieve similar TTD in QOL compared with atezolizumab–bevacizumab, as the analyses found no statistically significant differences between these two interventions. Both TARE using SIR-Spheres and atezolizumab–bevacizumab seem to be more efficacious than sorafenib in maintaining QOL. Supplementary Information The online version contains supplementary material available at 10.1007/s12325-022-02099-0. For patients with hepatocellular carcinoma, as well as physicians treating hepatocellular carcinoma, the quality of life that different treatments can offer represents an increasingly important aspect to consider when choosing treatments. Transarterial radioembolization and atezolizumab–bevacizumab are two potential treatments for advanced and unresectable hepatocellular carcinoma, but no clinical trials have directly compared the outcomes of these two therapeutic options. With the data available (patient-level data from a clinical trial of transarterial radioembolization using SIR-Spheres® Y-90 resin microspheres [SIR-Spheres] versus sorafenib and data from a trial of atezolizumab–bevacizumab versus sorafenib from the literature), this study indirectly compared the time to deterioration of quality of life (i.e., how long quality of life is maintained) after treatment with transarterial radioembolization and atezolizumab–bevacizumab. The study showed that quality of life may be preserved over a similar time period with transarterial radioembolization using SIR-Spheres and atezolizumab–bevacizumab; also, both transarterial radioembolization using SIR-Spheres and atezolizumab–bevacizumab seem to maintain patients’ quality of life over a longer period of time compared with sorafenib. These results are expected to enrich the existing evidence on which patients and physicians can base their decisions, allowing them to choose the most appropriate treatment by assessing the treatments’ characteristics as a whole.
Collapse
|
11
|
Williams P, Burke T, Norquist JM, Daskalopoulou C, Speck RM, Samkari A, Eremenco S, Coons SJ. Non-Small Cell Lung Cancer Symptom Assessment Questionnaire (NSCLC-SAQ): Measurement Properties and Estimated Clinically Meaningful Thresholds from a Phase 3 Study. JTO Clin Res Rep 2022; 3:100298. [PMID: 35400081 PMCID: PMC8983345 DOI: 10.1016/j.jtocrr.2022.100298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 02/11/2022] [Accepted: 02/13/2022] [Indexed: 11/21/2022] Open
Abstract
Introduction The NSCLC Symptom Assessment Questionnaire (NSCLC-SAQ) was developed to assess NSCLC symptom severity in accordance with Food and Drug Administration evidentiary expectations leading to Food and Drug Administration qualification in 2018. This study evaluated the NSCLC-SAQ’s measurement properties within a clinical trial. Methods The KEYNOTE-598 phase 3 study of participants with stage IV metastatic NSCLC with programmed death-ligand 1 tumor proportion score greater than or equal to 50% was used to assess the NSCLC-SAQ’s reliability, construct validity, responsiveness, and estimate clinically meaningful within-person change. Other patient-reported outcome measures included patient global impression items of severity and change in lung cancer symptoms, and the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire core 30 and lung cancer module, LC13. Results Participants (N = 560) were mostly men (70%), had a mean age of 64 years, and had Eastern Cooperative Oncology Group performance status of 1 (64%) or 0 (36%). Internal consistency at baseline (Cronbach’s α = 0.74) and test-retest reliability after 3 weeks (intraclass correlation coefficient = 0.79) were satisfactory. NSCLC-SAQ items, domains, and total score correlated moderately to highly with patient-reported outcome measures capturing similar content, and the total score differentiated among patient global impression of severity groups (p < 0.001). The total score detected improvement over time and the estimated clinically meaningful within-person change threshold for improvement ranged from three to five points on the 0 to 20 scale. Few participants exhibited symptom worsening (n = 38), limiting inferences in this group. Conclusions The NSCLC-SAQ was found to be reliable, valid, responsive, and interpretable for assessing symptom improvement in NSCLC. Further evaluation is recommended in trial participants whose symptoms worsen over time.
Collapse
Affiliation(s)
- Paul Williams
- Patient-Centered Solutions, IQVIA, Paris, France
- Corresponding author. Address for correspondence: Paul Williams, MPH, Patient-Centered Solutions, IQVIA, Tour D2, 17 bis place des Reflets, TSA 64567, 92099 La Defense Cedex, France.
| | - Thomas Burke
- Center for Observational and Real World Evidence, Merck & Co., Inc., Kenilworth, New Jersey
| | | | | | - Rebecca M. Speck
- Clinical Outcome Assessment Program, Critical Path Institute, Tucson, Arizona
| | - Ayman Samkari
- Clinical Research, Merck & Co., Inc., Kenilworth, New Jersey
| | - Sonya Eremenco
- Clinical Outcome Assessment Program, Critical Path Institute, Tucson, Arizona
| | - Stephen Joel Coons
- Clinical Outcome Assessment Program, Critical Path Institute, Tucson, Arizona
| |
Collapse
|
12
|
Yong C, Cambron-Mellott MJ, Seal B, Will O, Maculaitis MC, Clapp K, Mulvihill E, Cotarla I, Mehra R. Patient and Caregiver Preferences for First-Line Treatments of Metastatic Non-Small Cell Lung Cancer: A Discrete Choice Experiment. Patient Prefer Adherence 2022; 16:123-135. [PMID: 35068928 PMCID: PMC8769053 DOI: 10.2147/ppa.s338840] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 12/15/2021] [Indexed: 12/30/2022] Open
Abstract
PURPOSE The approval of immune checkpoint inhibitors for metastatic non-small-cell lung carcinomas (mNSCLC) treatment has presented more care options. Therefore, it is important to identify the benefit-risk trade-offs patients and caregivers are willing to make among potential treatment options. This study quantified the preferences of patients and caregivers for attributes of mNSCLC treatment. METHODS Patients with mNSCLC and caregivers completed an online survey assessing preferences using a discrete choice experiment. Respondents chose between hypothetical treatment profiles, with varying levels for 7 attributes associated with first-line treatment, including overall survival (OS), progression-free survival, select adverse events (AEs), and regimen (caregivers). Hierarchical Bayesian modeling was used to estimate attribute-level preference weights. RESULTS Patients (n = 308) and caregivers (n = 166) most valued increasing OS from 11 to 30 months, followed by decreasing the risk of a serious AE (grade 3/4) that may lead to hospitalization from 70% to 18%. These attributes were over twice as important to both sets of respondents as the other attributes measured. Patients and caregivers would accept increases in the risks of a serious AE (grade 3/4) from 18% to 70% and all grades nausea from 10% to 69% if OS increased by 16.8 and 4.0 months, respectively. The least valued attributes were all grades of pneumonitis (patients) and all grades of skin rash (caregivers). CONCLUSION Patients and caregivers are willing to make trade-offs between efficacy and toxicity and may require up to 1.5 years of increased OS to accept a higher risk of AEs. These results can provide guidance to oncologists when engaging in shared-decision making discussions.
Collapse
Affiliation(s)
| | - M Janelle Cambron-Mellott
- Cerner Enviza, Malvern, PA, USA
- Correspondence: M Janelle Cambron-Mellott Cerner Enviza, 51 Valley Stream Pkwy, Malvern, PA, 19355, USATel +1 816 201 2190 Email
| | | | | | | | | | | | | | - Ranee Mehra
- University of Maryland Marlene and Stewart Greenebaum Cancer Center, Baltimore, MD, USA
| |
Collapse
|
13
|
Dhakal P, Wichman CS, Pozehl B, Weaver M, Fisher AL, Vose J, Bociek RG, Bhatt VR. Preferences of adults with cancer for systemic cancer treatment: do preferences differ based on age? Future Oncol 2022; 18:311-321. [PMID: 34761681 PMCID: PMC8819600 DOI: 10.2217/fon-2021-0260] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 10/04/2021] [Indexed: 02/07/2023] Open
Abstract
Background: We used the Therapy Preference Scale, a 30-item questionnaire, to determine cancer treatment preferences of adults with cancer. Methods: We used Wilcoxon's rank sum test and Fisher's exact test to compare the preferences of younger (<60 years) versus older adults (≥60 years). Results: While 56% of patients would accept treatment offering increased life expectancy at an expense of short-term side effects, 75% preferred maintenance of cognition, functional ability and quality of life to quantity of days. Oral instead of intravenous treatment (p = 0.003), shorter hospital stay (p = 0.03), preservation of cognitive function (p = 0.01) and avoidance of pain (p = 0.02) were more important to older patients compared with younger patients. Conclusion: Many patients prioritized maintenance of cognition, functional ability and quality of life; older patients valued oral treatment, shorter hospital stay, preservation of cognitive function and avoidance of pain.
Collapse
Affiliation(s)
- Prajwal Dhakal
- Department of Internal Medicine, Division of Hematology, Oncology, and Blood & Marrow Transplantation, University of Iowa Health Care, Iowa City, IA 52242, USA
| | - Christopher S Wichman
- Department of Biostatistics, University of Nebraska Medical Center, Omaha, NE 68198,USA
| | - Bunny Pozehl
- College of Nursing - Omaha Division, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Meaghann Weaver
- Division of Pediatric Palliative Care, Children's Hospital & Medical Center, Omaha, NE 68114, USA
- Department of Pediatrics, Division of Pediatric Hematology/Oncology, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Alfred L Fisher
- Division of Geriatrics, Gerontology and Palliative Medicine, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Julie Vose
- Department of Internal Medicine, Division of Hematology–Oncology, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - R Gregory Bociek
- Department of Internal Medicine, Division of Hematology–Oncology, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE 68198, USA
| | - Vijaya R Bhatt
- Department of Internal Medicine, Division of Hematology–Oncology, University of Nebraska Medical Center, Omaha, NE 68198, USA
- Fred and Pamela Buffett Cancer Center, University of Nebraska Medical Center, Omaha, NE 68198, USA
| |
Collapse
|
14
|
Richardson DR, Loh KP. Improving personalized treatment decision-making for older adults with cancer: The necessity of eliciting patient preferences. J Geriatr Oncol 2022; 13:1-3. [PMID: 34120848 PMCID: PMC8660947 DOI: 10.1016/j.jgo.2021.06.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/07/2021] [Indexed: 01/03/2023]
Abstract
We have a fundamental responsibility as oncologists to deliver personalized care tailored to each individual. In addition to an unprecedented expansion of treatment options for patients, recent advances in molecular profiling and functional assessments have greatly improved our ability to predict risks, benefits, and outcomes for older patients with cancer.1,2 Molecular profiling identifies genomic abnormalities and allows oncologists to predict response to cancer therapy. Functional assessment such as a geriatric assessment allows oncologists to predict risks of treatment-related morbidity and mortality. Ongoing efforts aim to further refine our ability to predict outcomes for individuals by identifying relevant clinically meaningful thresholds (e.g., cut-off values for variant allele frequency, fitness criteria for a specific disease). Complex risk prediction models are now routinely used to integrate these data and produce personalized estimates of survival and response to cancer therapies, helping oncologists to provide personalized, high-quality care. Assessments of the disease and function of the patient, however, are insufficient to guide personalized treatment recommendations—we must understand patient preferences for treatment outcomes in order to tailor treatment.
Collapse
Affiliation(s)
- Daniel R. Richardson
- Division of Hematology, Department of Medicine, Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Kah Poh Loh
- Division of Hematology/Oncology, Department of Medicine, James P. Wilmot Cancer Institute, University of Rochester Medical Center, Rochester, New York, USA
| |
Collapse
|
15
|
Auclair D, Mansfield C, Fiala MA, Chari A, Cole CE, Kaufman JL, Orloff GJ, Siegel DS, Zonder JA, Mange B, Yesil J, Dalal M, Mikhael JR. Preferences and Priorities for Relapsed Multiple Myeloma Treatments Among Patients and Caregivers in the United States. Patient Prefer Adherence 2022; 16:573-585. [PMID: 35256844 PMCID: PMC8898176 DOI: 10.2147/ppa.s345906] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 02/19/2022] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION/BACKGROUND This study aimed to describe patient and caregiver preferences for treatments of relapsed or refractory multiple myeloma (MM). MATERIALS AND METHODS A survey including discrete-choice experiment (DCE) and best-worst scaling (BWS) exercises was conducted among US patients with relapsed or refractory MM and their caregivers. The DCE included six attributes with varying levels including progression-free survival (PFS), toxicity, and mode and frequency of administration. In addition, the impact of treatment cost was assessed using a fixed-choice question. The BWS exercise included 18 items (modes and frequency of administration, additional treatment convenience, and toxicity items). The survey was administered online to patients recruited from the Multiple Myeloma Research Foundation CoMMpass study (NCT01454297). RESULTS The final samples consisted of 94 patients and 32 caregivers. Avoiding severe nerve damage was most important to patients, followed by longer PFS. Caregivers considered PFS to be the most important attribute. We estimate that a third or more of patients were cost-sensitive, meaning their treatment preference was altered based on cost implications. Caregivers were not cost-sensitive. The three most bothersome treatment features in the BWS exercise were risk of kidney failure, lowering white blood cell counts, and weakening the immune system. CONCLUSION Patients with relapsed or refractory MM and their caregivers consider many factors including efficacy, toxicity, mode/frequency of administration, and cost in their decisions regarding treatment options. The study provides a basis for future Research on patient and caregiver treatment preferences, which could be incorporated into shared decision-making with physicians.
Collapse
Affiliation(s)
- Daniel Auclair
- Department of Research, Multiple Myeloma Research Foundation, Norwalk, CT, USA
- Correspondence: Daniel Auclair, AstraZeneca Oncology R&D| Hematology, 35 Gatehouse Drive, Waltham, MA, 02451, USA, Email
| | | | - Mark A Fiala
- Division of Hematology & Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Ajai Chari
- Icahn School of Medicine, Mount Sinai Hospital, New York, NY, USA
| | - Craig E Cole
- Department of Medicine, MSU Breslin Cancer Center, Lansing, MI, USA
| | - Jonathan L Kaufman
- Winship Cancer Institute, Emory University School of Medicine, Atlanta, GA, USA
| | | | - David S Siegel
- John Theurer Cancer Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Jeffrey A Zonder
- Division of Clinical Hematology-Oncology, Barbara Ann Karmanos Cancer Institute, Detroit, MI, USA
| | - Brennan Mange
- RTI Health Solutions, Research Triangle Park, NC, USA
| | - Jennifer Yesil
- Department of Research, Multiple Myeloma Research Foundation, Norwalk, CT, USA
| | - Mehul Dalal
- Millennium Pharmaceuticals, Inc., a wholly owned subsidiary of Takeda Pharmaceutical, Company Ltd, Cambridge, MA, USA
| | - Joseph R Mikhael
- Translational Genomic Research Institute, City of Hope Cancer Center, Phoenix, AZ, USA
| |
Collapse
|
16
|
Zhao Z, Du L, Wang L, Wang Y, Yang Y, Dong H. Preferred Lung Cancer Screening Modalities in China: A Discrete Choice Experiment. Cancers (Basel) 2021; 13:6110. [PMID: 34885217 PMCID: PMC8656503 DOI: 10.3390/cancers13236110] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Revised: 11/22/2021] [Accepted: 11/29/2021] [Indexed: 11/17/2022] Open
Abstract
This study aimed to identify preferred lung cancer screening modalities in a Chinese population and predict uptake rates of different modalities. A discrete choice experiment questionnaire was administered to 392 Chinese individuals aged 50-74 years who were at high risk for lung cancer. Each choice set had two lung screening options and an option to opt-out, and respondents were asked to choose the most preferred one. Both mixed logit analysis and stepwise logistic analysis were conducted to explore whether preferences were related to respondent characteristics and identify which kinds of respondents were more likely to opt out of any screening. On mixed logit analysis, attributes that were predictive of choice at 1% level of statistical significance included the screening interval, screening venue, and out-of-pocket costs. The preferred screening modality seemed to be screening by low-dose computed tomography (LDCT) + blood test once a year in a general hospital at a cost of RMB 50; this could increase the uptake rate by 0.40 compared to the baseline setting. On stepwise logistic regression, those with no endowment insurance were more likely to opt out; those who were older and housewives/househusbands, and those with a health check habit and with commercial endowment insurance were less likely to opt out from a screening programme. There was considerable variance between real risk and self-perceived risk of lung cancer among respondents. Lung cancer screening uptake can be increased by offering various screening modalities, so as to help policymakers further design the screening modality.
Collapse
Affiliation(s)
- Zixuan Zhao
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China; (Z.Z.); (Y.Y.)
| | - Lingbin Du
- Department of Cancer Prevention, Institute of Cancer and Basic Medicine, Chinese Academy of Sciences, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou 310022, China; (L.D.); (L.W.); (Y.W.)
| | - Le Wang
- Department of Cancer Prevention, Institute of Cancer and Basic Medicine, Chinese Academy of Sciences, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou 310022, China; (L.D.); (L.W.); (Y.W.)
| | - Youqing Wang
- Department of Cancer Prevention, Institute of Cancer and Basic Medicine, Chinese Academy of Sciences, Cancer Hospital of the University of Chinese Academy of Sciences (Zhejiang Cancer Hospital), Hangzhou 310022, China; (L.D.); (L.W.); (Y.W.)
| | - Yi Yang
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China; (Z.Z.); (Y.Y.)
| | - Hengjin Dong
- Center for Health Policy Studies, School of Public Health, Zhejiang University School of Medicine, Hangzhou 310058, China; (Z.Z.); (Y.Y.)
- The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu 322000, China
| |
Collapse
|
17
|
Collacott H, Soekhai V, Thomas C, Brooks A, Brookes E, Lo R, Mulnick S, Heidenreich S. A Systematic Review of Discrete Choice Experiments in Oncology Treatments. THE PATIENT 2021; 14:775-790. [PMID: 33950476 DOI: 10.1007/s40271-021-00520-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/17/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND As the number and type of cancer treatments available rises and patients live with the consequences of their disease and treatments for longer, understanding preferences for cancer care can help inform decisions about optimal treatment development, access, and care provision. Discrete choice experiments (DCEs) are commonly used as a tool to elicit stakeholder preferences; however, their implementation in oncology may be challenging if burdensome trade-offs (e.g. length of life versus quality of life) are involved and/or target populations are small. OBJECTIVES The aim of this review was to characterise DCEs relating to cancer treatments that were conducted between 1990 and March 2020. DATA SOURCES EMBASE, MEDLINE, and the Cochrane Database of Systematic Reviews were searched for relevant studies. STUDY ELIGIBILITY CRITERIA Studies were included if they implemented a DCE and reported outcomes of interest (i.e. quantitative outputs on participants' preferences for cancer treatments), but were excluded if they were not focused on pharmacological, radiological or surgical treatments (e.g. cancer screening or counselling services), were non-English, or were a secondary analysis of an included study. ANALYSIS METHODS Analysis followed a narrative synthesis, and quantitative data were summarised using descriptive statistics, including rankings of attribute importance. RESULT Seventy-nine studies were included in the review. The number of published DCEs relating to oncology grew over the review period. Studies were conducted in a range of indications (n = 19), most commonly breast (n =10, 13%) and prostate (n = 9, 11%) cancer, and most studies elicited preferences of patients (n = 59, 75%). Across reviewed studies, survival attributes were commonly ranked as most important, with overall survival (OS) and progression-free survival (PFS) ranked most important in 58% and 28% of models, respectively. Preferences varied between stakeholder groups, with patients and clinicians placing greater importance on survival outcomes, and general population samples valuing health-related quality of life (HRQoL). Despite the emphasis of guidelines on the importance of using qualitative research to inform attribute selection and DCE designs, reporting on instrument development was mixed. LIMITATIONS No formal assessment of bias was conducted, with the scope of the paper instead providing a descriptive characterisation. The review only included DCEs relating to cancer treatments, and no insight is provided into other health technologies such as cancer screening. Only DCEs were included. CONCLUSIONS AND IMPLICATIONS Although there was variation in attribute importance between responder types, survival attributes were consistently ranked as important by both patients and clinicians. Observed challenges included the risk of attribute dominance for survival outcomes, limited sample sizes in some indications, and a lack of reporting about instrument development processes. PROTOCOL REGISTRATION PROSPERO 2020 CRD42020184232.
Collapse
Affiliation(s)
- Hannah Collacott
- Evidera, The Ark, 2nd Floor, 201 Talgarth Road, London, W6 8BJ, UK.
| | - Vikas Soekhai
- Erasmus University, Rotterdam, The Netherlands
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Caitlin Thomas
- Evidera, The Ark, 2nd Floor, 201 Talgarth Road, London, W6 8BJ, UK
| | - Anne Brooks
- Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, 20814, USA
| | - Ella Brookes
- Evidera, The Ark, 2nd Floor, 201 Talgarth Road, London, W6 8BJ, UK
| | - Rachel Lo
- Evidera, The Ark, 2nd Floor, 201 Talgarth Road, London, W6 8BJ, UK
| | - Sarah Mulnick
- Evidera, 7101 Wisconsin Avenue, Suite 1400, Bethesda, MD, 20814, USA
| | | |
Collapse
|
18
|
The Importance of Disease-Free Survival as a Clinical Trial Endpoint: A Qualitative Study Among Canadian Survivors of Lung Cancer. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 15:307-316. [PMID: 34643935 DOI: 10.1007/s40271-021-00552-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/19/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND In lung cancer trials, overall survival is a well-validated and widely used endpoint; yet, in the context of adjuvant or curative intent treatments, disease-free survival (DFS) may be a better indicator of transformative patient outcomes. Although use of DFS is growing, patient perceptions of its relevance have not been established. OBJECTIVE We aimed to understand the importance of DFS as a trial endpoint, from the perspective of survivors of lung cancer. METHODS Web-based qualitative interviews were conducted with Canadian survivors of stage Ib-IIIa lung cancer. Participants described their experiences of cancer diagnosis and treatment, including their treatment goals and priorities. Participants then provided their perspectives on DFS and overall survival, and how well each aligned with their treatment priorities. Thematic analysis was used to explore patterns in responses. RESULTS Among the 18 participants (mean age, 64 years), 83% were female, most (89%) had received surgery, and 56% received chemotherapy. Most participants viewed DFS as an intrinsically meaningful treatment outcome, for reasons such as alignment with treatment goals, and the perception that DFS would help maintain a high quality of life. One individual was interested in DFS only as a potential surrogate for overall survival. Participants desired access to new treatments that improve DFS and emphasized this within the context of promoting patient agency in treatment decision making. CONCLUSIONS These findings suggest DFS is a meaningful endpoint from the perspective of survivors of lung cancer; and may help inform decisions regarding regulatory approval and reimbursement of new treatments based on DFS data.
Collapse
|
19
|
Quantitative Preferences for Lung Cancer Treatment from the Patients' Perspective: A Systematic Review. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2021; 13:521-536. [PMID: 32686052 DOI: 10.1007/s40271-020-00434-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Regulatory agencies as well as private organizations pursue programs that advocate patient centricity and emphasize the importance of dialog with patients. Various methods are applied to elicit the preferences of patients regarding the aspects of treatment they lend more importance to. Decisions on treatment choices are critical to patients with lung cancer because of their poor prognosis and the serious trade-off between safety and efficacy in traditional cytotoxic chemotherapy. METHODS We conducted a systematic literature review of quantitative patient preference studies of patients with lung cancer. Our exhaustive search of MEDLINE, CINAHL, EMBASE, PLOS, and SpringerLink identified 15 relevant studies published from January 2000 to April 2020 that enabled us to assess the relative importance of treatment attributes according to lung cancer patients' perspective. RESULTS The literature review revealed that patients with lung cancer tend to place a higher weight on efficacy and quality of life (QoL) attributes than on other attributes. Overall survival was found to be the most important among the efficacy attributes. The consequences of adverse events seemed less important than the possible efficacy from therapies. The clinical utility of treatment, such as the route of administration, was generally not considered important. It remains inconclusive whether sociodemographic factors and/or medical history affect the relative importance of a patient's preference. CONCLUSION Our systematic review clarified that patients generally prefer a better efficacy profile to a better safety profile, which underscores the importance of improved benefits in anti-lung cancer drug development.
Collapse
|
20
|
Sugitani Y, Ito K, Ono S. Patient Preferences for Attributes of Chemotherapy for Lung Cancer: Discrete Choice Experiment Study in Japan. Front Pharmacol 2021; 12:697711. [PMID: 34354590 PMCID: PMC8329447 DOI: 10.3389/fphar.2021.697711] [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: 04/20/2021] [Accepted: 07/06/2021] [Indexed: 11/13/2022] Open
Abstract
Our study objective was to determine lung cancer chemotherapy attributes that are important to patients in Japan. A discrete choice experiment survey in an anonymous web-based questionnaire format with a reward was completed by 200 lung cancer patients in Japan from November 25, 2019, to November 27, 2019. The relative importance of patient preferences for each attribute was estimated using a conditional logit model. A hierarchical Bayesian logit model was also used to estimate the impact of each demographic characteristic on the relative importance of each attribute. Of the 200 respondents, 191 with consistent responses were included in the analysis. In their preference, overall survival was the most important, followed by diarrhea, nausea, rash, bone marrow suppression (BMS), progression-free survival, fatigue, interstitial lung disease, frequency of administration, and duration of administration. The preferences were influenced by demographic characteristics (e.g., gender and age) and disease background (e.g., cancer type and stage). Interestingly, the experience of cancer drug therapies and adverse events had a substantial impact on the hypothetical drug preferences. For the Japanese lung cancer patients, improved survival was the most important attribute that influenced their preference for chemotherapy, followed by adverse events, including diarrhea, nausea, rash, and BMS. The preferences varied depending on the patient’s demographic and experience. As drug attributes can affect patient preferences, pharmaceutical companies should be aware of the patient preferences and develop drugs that respond to segmented market needs.
Collapse
Affiliation(s)
- Yasuo Sugitani
- Biometrics Department, Chugai Pharmaceutical Co., Ltd., Tokyo, Japan.,Laboratory of Pharmaceutical Regulation and Sciences, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
| | - Kyoko Ito
- Sustainability Department, Chugai Pharmaceutical Co., Ltd., Tokyo, Japan
| | - Shunsuke Ono
- Laboratory of Pharmaceutical Regulation and Sciences, Graduate School of Pharmaceutical Sciences, The University of Tokyo, Tokyo, Japan
| |
Collapse
|
21
|
Sarikhani Y, Ostovar T, Rossi-Fedele G, Edirippulige S, Bastani P. A Protocol for Developing a Discrete Choice Experiment to Elicit Preferences of General Practitioners for the Choice of Specialty. Value Health Reg Issues 2021; 25:80-89. [PMID: 33845340 DOI: 10.1016/j.vhri.2020.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 12/16/2020] [Accepted: 12/23/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Discrete choice experiment (DCE) has been increasingly used in studies investigating preferences of the health workforce. This pilot study aimed to provide a comprehensive protocol for design and quality assessment of a DCE to elicit preferences of general practitioners for the choice of specialty. METHODS We conducted 3 rigorous qualitative studies, including a review of literature, qualitative interviews, and focus group discussion to develop attributes and levels of the DCE. Then a D-efficient fractional factorial design was applied to generate choice tasks and to block them into 4 equal versions using SAS software. Two hundred and forty general practitioners participated in a pilot study conducted to evaluate the quality of the instrument using 7 tests. RESULTS The qualitative studies resulted in the development of 8 attributes and 24 levels. Experimental design led to the generation of 36 choice tasks divided into 4 blocks. The pilot study revealed that the instrument has validity and reliability and also indicated that the design is comprehensible and feasible. CONCLUSIONS This study provided an integrated, comprehensive framework for development and quality assessment of a DCE that could be used in other studies. The pilot study indicated that the instrument is of sufficient quality because it was developed using rigorous qualitative studies and accurate experimental design method.
Collapse
Affiliation(s)
- Yaser Sarikhani
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Tahereh Ostovar
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
| | | | | | - Peivand Bastani
- Health Human Recourses Research Center, School of Management and Medical Informatics, Shiraz University of Medical Sciences, Shiraz, Iran.
| |
Collapse
|
22
|
Janse S, Janssen E, Huwig T, Basu Roy U, Ferris A, Presley CJ, Bridges JFP. Line of therapy and patient preferences regarding lung cancer treatment: a discrete-choice experiment. Curr Med Res Opin 2021; 37:643-653. [PMID: 33571024 DOI: 10.1080/03007995.2021.1888707] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVE A growing literature on patient preferences informs decisions in research, regulatory science, and value assessment, but few studies have explored how preferences vary across patients with differing treatment experience. We sought to quantify patient preferences for the benefits and risks of lung cancer treatment and test how preferences differed by line of therapy (LOT). METHODS Preferences were elicited using a discrete choice experiment (DCE) following rigorous patient and stakeholder engagement. The DCE spanned five attributes (each with three levels): progression-free survival (PFS), short-term side effects, long-term side effects, risk of developing late-onset side effects, and mode of administration (MOA) - each defined across 3 relevant levels. A D-efficient design was used to generate 3 survey blocks of 9 paired-profile choice tasks each and respondents were asked which profile they preferred and then if they preferred to have no treatment (opt-out). A mixed logit model, controlling for opt-out, was used to estimate preferences. Preferences and trade-offs between PFS and other attributes were compared across two groups: those receiving ≤1 LOT and those receiving ≥2 LOT. RESULTS Of the 466 participants, 42% received ≤1 LOT and 58% received ≥2 LOT. Stated preferences differed between the groups overall (p<.001) and specifically for 18 months of PFS (p<.001), moderate short-term side effects (p<.001), no long-term side effects (p=.03), and 30% chance of late-onset side effects (p=.02). Those receiving differing amounts of LOT were willing to trade different amounts of PFS to change from moderate to mild short-term side effects (p<.001), moderate to no (p<.001) and mild to no (p<.001) long-term side effects. There were also differing amounts of tradeoff acceptable between the groups for a 10% decrease in risk of late-onset side effects (p=.016), a decrease in MOA from infusion every 3 weeks to pills taken daily at any time (p=.005) and from pills taken daily without food to pills taken daily at any time (p<.001). CONCLUSION We demonstrate differences in preferences based on experience with LOT, suggesting that patient treatment experience may have an impact on their preferences. As patient preference data become an important component of treatment decision making, preference differences should be considered when recommending therapies at different stages in the treatment journey. Understanding patient preferences regarding treatment decisions is essential to informing shared decision-making and ensuring treatment plans are consistent with patients' goals.
Collapse
Affiliation(s)
- Sarah Janse
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Ellen Janssen
- Center for Medical Technology Policy (CMTP), Baltimore, MD, USA
| | - Tanya Huwig
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
| | | | | | - Carolyn J Presley
- Department of Internal Medicine, Division of Medical Oncology, Comprehensive Cancer Center, The Ohio State University College of Medicine, Columbus, OH, USA
| | - John F P Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
- Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| |
Collapse
|
23
|
Liu F, Hu H, Wang J, Chen Y, Hui S, Hu M. A Study of Patient Preferences for the Treatment of Non-small Cell Lung Cancer in Western China: A Discrete-Choice Experiment. Front Public Health 2021; 9:653450. [PMID: 33842426 PMCID: PMC8032943 DOI: 10.3389/fpubh.2021.653450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Accepted: 03/01/2021] [Indexed: 02/05/2023] Open
Abstract
Background: Non–small cell lung cancer (NSCLC) is the most common histologic type of lung cancer, accounting for 70–85% of all lung cancers. It has brought a heavy burden of disease and financial cost to families, society, and the nation of China. Patients have differing preferences for treatment because of their varying physical conditions and socioeconomic backgrounds, which ultimately affects the choice of treatment as well as treatment outcomes. For better and sustained health outcomes, it is vital to understand patients' preferences. We can then provide medical services to match these preferences and needs rather than basing treatment on our clinical viewpoints alone. Objectives: The aim of this study was to elicit patient preferences for treatment using a discrete-choice experiment and to explore the value/importance that patients place on the different attributes of treatment in order to provide a basis for clinical decision making and patient health management. Methods: The study was conducted with NSCLC patients from three typical hospitals in southwestern China. After identifying patient-relevant treatment attributes via literature review and qualitative semi structured interviews, a discrete-choice experiment (DCE) including seven patient-relevant attributes was conducted using a fractional factorial SAS design. The empiric data analyses of patients were performed using mixed logit models. Results: NSCLC patients (N = 202) completed a survey via a face-to-face interview. Among the seven attributes, the following were considered important: progression-free survival, disease control rate, cost, weakness/fatigue, and nausea/vomiting; mode of administration and rash were considered less important. A clear preference for an increase in progression-free survival and disease control rate was demonstrated. Compared with 5 months of progression-free survival, respondents were willing to pay more (19,860 RMB) for 11 months of progression-free survival (coef.: 0.687). Compared with a 60% rate of disease control, respondents were willing to pay more (19,940 RMB) for a 90% rate of disease control (coef.: 0.690). Conclusions: This study demonstrates the value of DCEs in determining patient preferences for the treatment of NSCLC. The results indicate that not only efficacy factors (such as progression-free survival and disease control rate) were considered but also other factors (such as side effects and treatment costs) and trade-offs between attributes were held to be important. These results are in accord with expectations and can provide evidence for more effective and efficient treatment results. Furthermore, the current results can increase benefits if the presented therapies can be designed, assessed, and chosen based on patient-oriented findings.
Collapse
Affiliation(s)
- Fei Liu
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Haiyao Hu
- West China School of Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Wang
- West China School of Pharmacy, Sichuan University, Chengdu, China
| | - Yingyao Chen
- School of Public Health, Fudan University, Shanghai, China
| | - Sun Hui
- School of Public Health, Fudan University, Shanghai, China
| | - Ming Hu
- West China School of Pharmacy, Sichuan University, Chengdu, China
| |
Collapse
|
24
|
Durosini I, Janssens R, Arnou R, Veldwijk J, Smith MY, Monzani D, Smith I, Galli G, Garassino M, Katz EG, Bailo L, Louis E, Vandevelde M, Nackaerts K, de Wit GA, Pravettoni G, Huys I. Patient Preferences for Lung Cancer Treatment: A Qualitative Study Protocol Among Advanced Lung Cancer Patients. Front Public Health 2021; 9:622154. [PMID: 33634069 PMCID: PMC7900128 DOI: 10.3389/fpubh.2021.622154] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 01/08/2021] [Indexed: 12/25/2022] Open
Abstract
Introduction: Lung cancer is the deadliest and most prevalent cancer worldwide. Lung cancer treatments have different characteristics and are associated with a range of benefits and side effects for patients. Such differences may raise uncertainty among drug developers, regulators, payers, and clinicians regarding the value of these treatment effects to patients. The value of conducting patient preference studies (using qualitative and/or quantitative methods) for benefits and side effects of different treatment options has been recognized by healthcare stakeholders, such as drug developers, regulators, health technology assessment bodies, and clinicians. However, evidence-based guidelines on how and when to conduct and use these studies in drug decision-making are lacking. As part of the Innovative Medicines Initiative PREFER project, we developed a protocol for a qualitative study that aims to understand which treatment characteristics are most important to lung cancer patients and to develop attributes and levels for inclusion in a subsequent quantitative preference survey. Methods: The study protocol specifies a four-phased approach: (i) a scoping literature review of published literature, (ii) four focus group discussions with stage III and IV Non-Small Cell Lung Cancer patients, (iii) two nominal group discussions with stage III and IV Non-Small Cell Lung Cancer patients, and (iv) multi-stakeholder discussions involving clinicians and preference experts. Discussion: This protocol outlines methodological and practical steps as to how qualitative research can be applied to identify and develop attributes and levels for inclusion in patient preference studies aiming to inform decisions across the drug life cycle. The results of this study are intended to inform a subsequent quantitative preference survey that assesses patient trade-offs regarding lung cancer treatment options. This protocol may assist researchers, drug developers, and decision-makers in designing qualitative studies to understand which treatment aspects are most valued by patients in drug development, regulation, and reimbursement.
Collapse
Affiliation(s)
- Ilaria Durosini
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Rosanne Janssens
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Reinhard Arnou
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| | - Jorien Veldwijk
- School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, Netherlands.,Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Meredith Y Smith
- Alexion Pharmaceuticals, Inc., University of Southern California School of Pharmacy, Los Angeles, CA, United States
| | - Dario Monzani
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Ian Smith
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Giulia Galli
- Unit of Thoracic Oncology, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Marina Garassino
- Unit of Thoracic Oncology, Medical Oncology Department, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Eva G Katz
- Janssen Research and Development, Raritan, NJ, United States
| | - Luca Bailo
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Evelyne Louis
- Department of Pneumology/Respiratory Oncology, University Hospital Leuven, KU Leuven, Leuven, Belgium
| | - Marie Vandevelde
- Department of Pneumology/Respiratory Oncology, University Hospital Leuven, KU Leuven, Leuven, Belgium
| | - Kristiaan Nackaerts
- Department of Pneumology/Respiratory Oncology, University Hospital Leuven, KU Leuven, Leuven, Belgium
| | - G Ardine de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, Netherlands
| | - Gabriella Pravettoni
- Applied Research Division for Cognitive and Psychological Science, IEO, European Institute of Oncology IRCCS, Milan, Italy.,Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Isabelle Huys
- Department of Pharmaceutical and Pharmacological Sciences, KU Leuven, Leuven, Belgium
| |
Collapse
|
25
|
Spradling K, Bhambhvani HP, Chang T, Pao AC, Liao J, Leppert JT, Welk B, Harris CR, Conti SL, Elliott CS. Evaluation of Patient Treatment Preferences for 15 to 20 mm Kidney Stones: A Conjoint Analysis. J Endourol 2021; 35:706-711. [PMID: 32867549 DOI: 10.1089/end.2020.0370] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
Introduction and Objective: Ureteroscopy (URS) and percutaneous nephrolithotomy (PCNL) are standard treatments for intermediate-size (15-20 mm) kidney stones but differ in their postoperative recovery, stone-free rates, and complication risks. We aimed to evaluate what affects patient treatment preferences. Methods: Patients with urinary stone disease completed a choice-based conjoint analysis exercise assessing four treatment attributes associated with URS and PCNL. A sensitivity analysis using a market simulator was performed, and the relative importance of each attribute was calculated. Differences in treatment preferences by demographic subgroup were assessed. Results: A total of 58 patients completed the conjoint analysis exercise. Stone-free rate was the most important treatment attribute, while the length of hospital stay and cosmesis were less important. Overall, sensitivity analysis based on market simulation scenarios predicted an almost equal preference for URS (52.4%) compared with PCNL (47.6%) for treatment of an intermediate-size stone. Older patients (>65 years old) expressed their stronger preferences for lower infection rates and shorter hospital stays, and were more likely to prefer URS (67.2%, 95% confidence interval [CI]: 52% to 82.5%) compared with younger patients (20-34 years old) (20.3%, 95% CI: 0% to 41.5%) who preferred higher procedure success rates and fewer repeat procedures. Conclusion: Conjoint analysis predicts nearly equal patient preference for URS or PCNL for the treatment of intermediate-size kidney stones. Older patients prefer the lower urinary tract infection risk and shorter hospital stay associated with URS, while younger patients prefer higher stone-free rates associated with PCNL. These results can help guide urologists in counseling patients and improve the shared decision-making process.
Collapse
Affiliation(s)
- Kyle Spradling
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| | - Hriday P Bhambhvani
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| | - Timothy Chang
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - Alan C Pao
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.,Department of Medicine (Nephrology), Stanford University School of Medicine, Stanford, California, USA
| | - Joseph Liao
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA
| | - John T Leppert
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA.,Veterans Affairs Palo Alto Health Care System, Palo Alto, California, USA.,Department of Medicine (Nephrology), Stanford University School of Medicine, Stanford, California, USA
| | - Blayne Welk
- Department of Surgery, Western University, London, Canada
| | - Catherine R Harris
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA.,Division of Urology, Santa Clara Valley Medical Center, San Jose, California, USA
| | - Simon L Conti
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA
| | - Christopher S Elliott
- Department of Urology, Stanford University School of Medicine, Stanford, California, USA.,Division of Urology, Santa Clara Valley Medical Center, San Jose, California, USA
| |
Collapse
|
26
|
Kim H, Lee SH, Kim DH, Lee JY, Hong SH, Ha US, Kim IH. Gemcitabine maintenance versus observation after first-line chemotherapy in patients with metastatic urothelial carcinoma: a retrospective study. Transl Androl Urol 2020; 9:2113-2121. [PMID: 33209674 PMCID: PMC7658126 DOI: 10.21037/tau-20-772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background Gemcitabine with platinum is one of the most important first-line treatments for metastatic urothelial cancer (mUC). However, continuation of platinum agents results in cumulative toxicities, such as nephrotoxicity, ototoxicity, and neurotoxicity, which lead to discontinuation of chemotherapy after 4–6 cycles despite a favorable response in the patients. The strategy of maintenance treatment can give clinical benefit to patients, but there is no consensus about maintenance treatment. The aim of this study was to investigate the clinical impact of the gemcitabine maintenance (GEM-m) in mUC patients who achieve disease control from first-line gemcitabine with platinum agents. Methods A total of 117 patients who showed response to 4–6 cycles of gemcitabine plus cisplatin or carboplatin as the first-line palliative chemotherapy were reviewed between 2014 to 2018. Patients who were treated with GEM-m received a 1,000 mg/m2 dose of gemcitabine on day 1 and 8 for 3 weeks until disease progression or development of unacceptable toxicity. The patients who are not treated with GEM-m were followed up with regular radiologic evaluation. Statistical analyses were performed using the log-rank test and Cox proportional hazards method. Results Fifty-eight patients (49.6%) received GEM-m. The median cycle of GEM-m was 4 (range, 1–12). Six patients (10.3%) in the GEM-m group showed an objective response. A median overall survival (OS) of 11.8 months and 9.6 months was observed for the GEM-m and non-GEM-m groups, respectively [HR 0.621; 95% CI, 0.39–0.97; P=0.026]. Additionally, median progression-free survival (PFS) was 4.6 months and 3.3 months in the GEM-m and non-GEM-m groups, respectively [HR 0.612; 95% CI, 0.41–0.91; P=0.009]. Grade 3 or higher neutropenia occurred in 17.2% of patients in the GEM-m and 1.7% in the non-GEM-m group. Conclusions Our results suggest that GEM-m can be considered in patients who respond to gemcitabine with platinum. Large-scale prospective study should be warranted.
Collapse
Affiliation(s)
- Hyunho Kim
- Division of Medical Oncology, Department of Internal Medicine, The Catholic University of Korea, St. Vincent's Hospital, Suwon, Republic of Korea
| | - Seung-Hwan Lee
- Division of Medical Oncology, Department of Internal Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | - Dong Hwan Kim
- Department of Radiology, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Republic of Korea
| | - Ji Youl Lee
- Department of Urology Cancer Center, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Republic of Korea.,Department of Genitourinary Cancer Centre, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Hoo Hong
- Department of Urology Cancer Center, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Republic of Korea.,Department of Genitourinary Cancer Centre, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - U-Syn Ha
- Department of Urology Cancer Center, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Republic of Korea.,Department of Genitourinary Cancer Centre, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - In-Ho Kim
- Division of Medical Oncology, Department of Internal Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, Seoul, Republic of Korea.,Department of Genitourinary Cancer Centre, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.,Cancer Research Institute, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| |
Collapse
|
27
|
Pearce A, Harrison M, Watson V, Street DJ, Howard K, Bansback N, Bryan S. Respondent Understanding in Discrete Choice Experiments: A Scoping Review. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2020; 14:17-53. [PMID: 33141359 PMCID: PMC7794102 DOI: 10.1007/s40271-020-00467-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/30/2020] [Indexed: 11/27/2022]
Abstract
Introduction Despite the recognised importance of participant understanding for valid and reliable discrete choice experiment (DCE) results, there has been limited assessment of whether, and how, people understand DCEs, and how ‘understanding’ is conceptualised in DCEs applied to a health context. Objectives Our aim was to identify how participant understanding is conceptualised in the DCE literature in a health context. Our research questions addressed how participant understanding is defined, measured, and used. Methods Searches were conducted (June 2019) in the MEDLINE, EMBASE, PsychINFO and Econlit databases, as well as hand searching. Search terms were based on previous DCE systematic reviews, with additional understanding keywords used in a proximity-based search strategy. Eligible studies were peer-reviewed journal articles in the field of health, related to DCE or best-worst scaling type 3 (BWS3) studies, and reporting some consideration or assessment of participant understanding. A descriptive analytical approach was used to chart relevant data from each study, including publication year, country, clinical area, subject group, sample size, study design, numbers of attributes, levels and choice sets, definition of understanding, how understanding was tested, results of the understanding tests, and how the information about understanding was used. Each study was categorised based on how understanding was conceptualised and used within the study. Results Of 306 potentially eligible articles identified, 31 were excluded based on titles and abstracts, and 200 were excluded on full-text review, resulting in 75 included studies. Three categories of study were identified: applied DCEs (n = 52), pretesting studies (n = 7) and studies of understanding (n = 16). Typically, understanding was defined in relation to either the choice context, such as attribute terminology, or the concept of choosing. Very few studies considered respondents’ engagement as a component of understanding. Understanding was measured primarily through qualitative pretesting, rationality or validity tests included in the survey, and participant self-report, however reporting and use of the results of these methods was inconsistent. Conclusions Those conducting or using health DCEs should carefully select, justify, and report the measurement and potential impact of participant understanding in their specific choice context. There remains scope for research into the different components of participant understanding, particularly related to engagement, the impact of participant understanding on DCE validity and reliability, the best measures of understanding, and methods to maximise participant understanding. Electronic supplementary material The online version of this article (10.1007/s40271-020-00467-y) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Alison Pearce
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia.
| | - Mark Harrison
- Centre for Health Evaluation and Outcome Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Verity Watson
- Health Economics Research Unit, University of Aberdeen, Aberdeen, Scotland
| | - Deborah J Street
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW, Australia
| | - Kirsten Howard
- Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - Nick Bansback
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Stirling Bryan
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| |
Collapse
|
28
|
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.
Collapse
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.
| |
Collapse
|
29
|
Boudewyns V, Southwell BG, DeFrank JT, Ferriola-Bruckenstein K, Halpern MT, O'Donoghue AC, Sullivan HW. Patients' understanding of oncology clinical endpoints: A literature review. PATIENT EDUCATION AND COUNSELING 2020; 103:1724-1735. [PMID: 32273145 PMCID: PMC7423743 DOI: 10.1016/j.pec.2020.03.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 02/13/2020] [Accepted: 03/18/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Oncology clinical trials use a variety of clinical endpoints. Patients' understanding of the differences between clinical endpoints is important because misperceptions of treatment efficacy may affect treatment decisions. The objective of this literature review is to find and synthesize available empirical publications assessing patients' understanding of common oncology clinical endpoints. METHODS We conducted a literature search of 5 databases and 3 conferences, limiting the search to articles and abstracts published in English through September 2018. We reviewed the titles and abstracts for inclusion, then reviewed full texts to determine if they reported empirical research studies focused on (1) clinical endpoints, (2) oncology, and (3) patient understanding. The original search identified 497publications, of which 13 met the inclusion criteria. RESULTS Available literature yields little information on this topic.The few publications that do exist suggest that healthcare professionals and cancer patients generally do not discuss clinical endpoint concepts and that patients can be confused about the purpose of a treatment based on misperceptions about endpoints. CONCLUSIONS Research is needed on how to discuss oncology clinical endpoints with patients. PRACTICE IMPLICATIONS Patient-friendly definitions of clinical endpoints may help healthcare providers communicate important information about treatments to patients.
Collapse
|
30
|
Cardoso F, Wilking N, Bernardini R, Biganzoli L, Espin J, Miikkulainen K, Schuurman S, Spence D, Spitz S, Ujupan S, Zernik N, Gordon J. A multi-stakeholder approach in optimising patients' needs in the benefit assessment process of new metastatic breast cancer treatments. Breast 2020; 52:78-87. [PMID: 32450470 PMCID: PMC7487948 DOI: 10.1016/j.breast.2020.04.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Revised: 04/24/2020] [Accepted: 04/24/2020] [Indexed: 11/25/2022] Open
Abstract
There is a growing understanding as science evolves that different cancer types require different approaches to treatment evaluation, especially in the metastatic stages. The introduction of new metastatic breast cancer (MBC) treatments may be hindered by several elements, including the availability of relevant evidence related to disease-specific outcomes, the benefit assessment process around the evaluation of the clinical benefit and the patients' need of new treatments. The Steering Committee (SC) found that not all issues relevant to MBC patients are consistently considered in the current benefit assessment process of new treatments. Among these are overall survival, time-to-event endpoints (e.g. progression-free survival), patients' priorities, burden of disease, MBC-specific quality of life, value in delaying chemotherapy, route of administration, side effects and toxicities, treatment adherence and the benefit of real-world evidence. This paper calls on decision makers to (1) Include MBC-specific patient priorities and outcomes in the overall benefit assessments of new MBC treatments; (2) Enhance multi-stakeholder collaboration in order to improve MBC patient outcomes.
Collapse
Affiliation(s)
- Fatima Cardoso
- Champalimaud Clinical Centre, Champalimaud Foundation and ABC Global Alliance, Lisbon, Portugal.
| | | | | | - Laura Biganzoli
- Hospital of Prato and European Society of Breast Cancer Specialists, Florence, Italy
| | - Jaime Espin
- Andalusian School of Public Health, Escuela Andaluza de Salud Pública (EASP), Granada, Spain; CIBER en Epidemiología y Salud Pública / CIBER of Epidemiology and Public Health (CIBERESP), Spain; Instituto de Investigación Biosanitaria ibs, Granada, Spain
| | | | | | | | - Sabine Spitz
- Europa Donna, Vienna, Austria and European Patients' Academy on Therapeutic Innovation (EUPATI)
| | | | | | - Jenn Gordon
- Canadian Breast Cancer Network, Ottawa, ON, Canada
| |
Collapse
|
31
|
Srinivas S, Mohamed AF, Appukkuttan S, Botteman M, Ng X, Joshi N, Tsai JH, Fang J, Waldeck AR, Simmons SJ. Patient and caregiver benefit-risk preferences for nonmetastatic castration-resistant prostate cancer treatment. Cancer Med 2020; 9:6586-6596. [PMID: 32725755 PMCID: PMC7520320 DOI: 10.1002/cam4.3321] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Revised: 06/25/2020] [Accepted: 06/26/2020] [Indexed: 12/20/2022] Open
Abstract
Background Recently approved second‐generation androgen receptor inhibitors (SGARIs) for non‐metastatic castration‐resistant prostate cancer (nmCRPC) have similar efficacy but differ in safety profiles. We used a discrete choice experiment (DCE) to examine how nmCRPC patients and caregivers perceive the benefits versus risks of these new treatments. Methods An online DCE survey with 14 treatment choice questions was administered to nmCRPC patients and caregivers. Each choice question compared two hypothetical medication profiles varying in terms of 5 safety attributes (risk or severity of adverse events [AEs]: fatigue, skin rash, cognitive problems, serious fall, and serious fracture) and two efficacy attributes (duration of overall survival [OS] and time to pain progression). Random parameters logit models were used to estimate each attribute's relative importance. We also estimated the amounts of OS that respondents were willing to forego for a reduction in AEs. Results In total, 143 nmCRPC patients and 149 caregivers viewed the AEs in following order of importance (most to least): serious fracture, serious fall, cognitive problems, fatigue, and skin rash. On average, patients were willing to trade 5.8 and 4.0 months of OS to reduce the risk of serious fracture and fall, respectively, from 3% to 0%; caregivers were willing to trade 6.6 and 5.4 months of OS. Conclusions nmCRPC patients and caregivers preferred treatments with lower AE burdens and were willing to forego OS to reduce the risk and severity of AEs. Our results highlight the importance of carefully balancing risks and benefits when selecting treatments in this relatively asymptomatic population.
Collapse
Affiliation(s)
| | | | | | | | - Xinyi Ng
- Pharmerit International, LP, Bethesda, MD, USA
| | | | | | | | | | | |
Collapse
|
32
|
Srinivas S, Mohamed AF, Appukkuttan S, Botteman M, Ng X, Joshi N, Horodniceanu E, Waldeck AR, Simmons SJ. Physician preferences for non-metastatic castration-resistant prostate cancer treatment. BMC Urol 2020; 20:73. [PMID: 32571276 PMCID: PMC7310549 DOI: 10.1186/s12894-020-00631-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 05/20/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Recent approvals of second-generation androgen receptor inhibitors (SGARIs) have changed the treatment landscape for non-metastatic castration-resistant prostate cancer (nmCRPC). These SGARIs have similar efficacy but differ in safety profiles. We used a discrete choice experiment to explore how United States physicians make treatment decisions between adverse events (AEs) and survival gains in nmCRPC, a largely asymptomatic disease. METHODS Treating physicians (n = 149) participated in an online survey that included 14 treatment choice questions, each comparing 2 hypothetical treatment profiles, which varied in terms of 5 safety and 2 efficacy attributes. We described safety attributes (fatigue, skin rash, cognitive problems, falls, and fractures) in terms of severity and frequency, and efficacy attributes (overall survival [OS] and time to pain progression) in terms of duration of effect. We used a random parameters logit model to estimate preference weights and importance scores for each attribute. We also estimated the amount of survival gain physicians were willing to trade for a reduction in specific AEs between treatment options. RESULTS Physicians placed more importance on survival than on time to pain progression, and viewed a reduction in cognitive problems from severe to none, a reduction in risk of a serious fracture from 8% to none, and a reduction in fatigue from severe to none as the most important safety attributes. Physicians were willing to forego 9.1 and 6.6 months of OS, respectively, to reduce cognitive problems and fatigue from severe to mild-to-moderate. To reduce the risk of a serious fracture from 8 to 5% and 5% to none, physicians were willing to trade 3.9 and 5.3 months of OS, respectively. CONCLUSIONS Physicians were willing to trade substantial amounts of survival to avoid AEs between hypothetical treatments. These results emphasize the importance of carefully balancing therapies' benefits and risks to ultimately optimize the overall quality of nmCRPC patients' survival. Nonetheless, it is noted that the results from the study sample of 149 physicans may not be representative of the viewpoints of all nmCRPC-treating physicians.
Collapse
Affiliation(s)
- Sandy Srinivas
- Stanford University Medical Center, Palo Alto, California USA
| | | | | | | | - Xinyi Ng
- Pharmerit International, Bethesda, MD USA
| | | | | | | | | |
Collapse
|
33
|
Eriksson J, Landfeldt E, Ireland S, Jackson C, Wyatt E, Gaudig M. Stated preferences for relapsed or refractory mantle cell lymphoma treatments in Sweden and Germany. Future Oncol 2020; 16:859-868. [PMID: 32292062 DOI: 10.2217/fon-2020-0018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Background: We aimed to elicit treatment preferences in relapsed/refractory mantle cell lymphoma (r/r MCL). Materials & methods: A discrete-choice experiment comprising six attributes ('overall survival', 'progression-free survival', 'fatigue', 'nausea', 'risk of serious infections' and 'treatment administration') was administered to r/r MCL patients, physicians and the general population (GP) in Sweden and Germany. Results: 18 patients, 68 physicians and 191 GP members participated. 'Overall survival' was the most important attribute, followed by 'risk of serious infection' and 'progression-free survival' among physicians and the GP. In contrast, 'treatment administration' was the second most important attribute to patients, followed by 'risk of serious infection.' Conclusion: Preferences for characteristics differentiating treatments of r/r MCL varies between patients, physicians and members of the GP.
Collapse
Affiliation(s)
| | - Erik Landfeldt
- ICON plc, Stockholm, Sweden.,Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden
| | - Steve Ireland
- Janssen EMEA Business Intelligence, High Wycombe, UK
| | | | | | - Maren Gaudig
- Janssen Health Economics & Market Access EMEA, Neuss, Germany
| |
Collapse
|
34
|
Norman R, Moorin R, Maxwell S, Robinson S, Brims F. Public Attitudes on Lung Cancer Screening and Radiation Risk: A Best-Worst Experiment. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2020; 23:495-505. [PMID: 32327167 DOI: 10.1016/j.jval.2019.11.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 10/30/2019] [Accepted: 11/23/2019] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To measure Australian population preferences for lung cancer screening and to explore whether these preferences are related to respondent characteristics and lung cancer risk. METHODS An online ranking task was administered to a sample of 521 Australians between the ages of 50 and 80 with a history of cigarette smoking. Choice sets contained 2 alternative lungs screens and an opt-out, and respondents were asked to rank the 3 options. Both conditional logit and mixed logit analyses were conducted exploring both the forced choice between the 2 screens and identifying the types of respondent most likely to opt out of any screening. For this, respondent 6-year lung cancer risk was estimated and used as a covariate. RESULTS Respondents valued tests that involved breath or blood tests in addition to computerized tomography (CT), locations that were close to home, receiving results quickly, and minimizing radiation from the CT scan. Willingness to pay differed between relatively higher and lower risk individuals; higher risk individuals placed greater emphasis on convenience, result timeliness, and radiation. Respondent characteristics that predicted opting out of any screening included being male, fewer years of smoking, and not having a previous cancer diagnosis. Lung cancer risk did not influence the likelihood of opting out. CONCLUSIONS Uptake of lung cancer screening is likely to be changeable if different modalities of screening are provided, with effects likely differing across population subgroups.
Collapse
Affiliation(s)
- Richard Norman
- School of Public Health, Curtin University, Perth, Australia.
| | - Rachael Moorin
- School of Public Health, Curtin University, Perth, Australia; School of Population and Global Health, University of Western Australia, Perth, Australia
| | - Suzy Maxwell
- School of Public Health, Curtin University, Perth, Australia
| | | | - Fraser Brims
- Curtin Medical School, Curtin University, Perth, Australia
| |
Collapse
|
35
|
Abstract
Background. Accurate diagnosis of patients' preferences is central to shared decision making. Missing from clinical practice is an approach that links pretreatment preferences and patient-reported outcomes. Objective. We propose a Bayesian collaborative filtering (CF) algorithm that combines pretreatment preferences and patient-reported outcomes to provide treatment recommendations. Design. We present the methodological details of a Bayesian CF algorithm designed to accomplish 3 tasks: 1) eliciting patient preferences using conjoint analysis surveys, 2) clustering patients into preference phenotypes, and 3) making treatment recommendations based on the posttreatment satisfaction of like-minded patients. We conduct a series of simulation studies to test the algorithm and to compare it to a 2-stage approach. Results. The Bayesian CF algorithm and 2-stage approaches performed similarly when there was extensive overlap between preference phenotypes. When the treatment was moderately associated with satisfaction, both methods made accurate recommendations. The kappa estimates measuring agreement between the true and predicted recommendations were 0.70 (95% confidence interval = 0.052-0.88) and 0.73 (0.56-0.90) under the Bayesian CF and 2-stage approaches, respectively. The 2-stage approach failed to converge in settings in which clusters were well separated, whereas the Bayesian CF algorithm produced acceptable results, with kappas of 0.73 (0.56-0.90) and 0.83 (0.69-0.97) for scenarios with moderate and large treatment effects, respectively. Limitations. Our approach assumes that the patient population is composed of distinct preference phenotypes, there is association between treatment and outcomes, and treatment effects vary across phenotypes. Findings are also limited to simulated data. Conclusion. The Bayesian CF algorithm is feasible, provides accurate cluster treatment recommendations, and outperforms 2-stage estimation when clusters are well separated. As such, the approach serves as a roadmap for incorporating predictive analytics into shared decision making.
Collapse
Affiliation(s)
- Azza Shaoibi
- Epidemiology Analytics, Janssen Research and Development, Titusville, NJ, USA
| | - Brian Neelon
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Leslie A Lenert
- Epidemiology Analytics, Janssen Research and Development, Titusville, NJ, USA
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA
| |
Collapse
|
36
|
Richardson DR, Crossnohere NL, Seo J, Estey E, O'Donoghue B, Smith BD, Bridges JFP. Age at Diagnosis and Patient Preferences for Treatment Outcomes in AML: A Discrete Choice Experiment to Explore Meaningful Benefits. Cancer Epidemiol Biomarkers Prev 2020; 29:942-948. [PMID: 32132149 DOI: 10.1158/1055-9965.epi-19-1277] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Revised: 12/17/2019] [Accepted: 02/25/2020] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The recent expansion of treatment options in acute myeloid leukemia (AML) has necessitated a greater understanding of patient preferences for treatment benefits, about which little is known. METHODS We sought to quantify and assess heterogeneity of the preferences of AML patients for treatment outcomes. An AML-specific discrete choice experiment (DCE) was developed involving multiple stakeholders. Attributes included in the DCE were event-free survival (EFS), complete remission (CR), time in the hospital, short-term side effects, and long-term side effects. Continuously coded conditional, stratified, and latent-class logistic regressions were used to model preferences of 294 patients with AML. RESULTS Most patients were white (89.4%) and in remission (95.0%). A 10% improvement in the chance of CR was the most meaningful offered benefit (P < 0.001). Patients were willing to trade up to 22 months of EFS or endure 8.7 months in the hospital or a two-step increase in long-term side effects to gain a 10% increase in chance of CR. Patients diagnosed at 60 years or older (21.6%) more strongly preferred to avoid short-term side effects (P = 0.03). Latent class analysis showed significant differences of preferences across gender and insurance status. CONCLUSIONS In this national sample of mostly AML survivors, patients preferred treatments that maximized chance at remission; however, significant preference heterogeneity for outcomes was identified. Age and gender may affect patients' preferences. IMPACT Survivor preferences for outcomes can inform patient-focused drug development and shared decision-making. Further studies are necessary to investigate the use of DCEs to guide treatment for individual patients.
Collapse
Affiliation(s)
- Daniel R Richardson
- UNC Lineberger Comprehensive Cancer Center, Division of Hematology/Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. .,The Cecil G. Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Norah L Crossnohere
- Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| | - Jaein Seo
- Patient-Centered Research, Evidera, Rockville, Maryland
| | - Elihu Estey
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington.,Division of Hematology, Department of Medicine, University of Washington, Seattle, Washington
| | | | - B Douglas Smith
- Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, Maryland
| | - John F P Bridges
- Department of Biomedical Informatics, The Ohio State University, Columbus, Ohio.,Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
| |
Collapse
|
37
|
Phillips CM, Deal K, Powis M, Singh S, Dharmakulaseelan L, Naik H, Dobriyal A, Alavi N, Krzyzanowska MK. Evaluating Patients' Perception of the Risk of Acute Care Visits During Systemic Therapy for Cancer. JCO Oncol Pract 2020; 16:e622-e629. [PMID: 32074009 DOI: 10.1200/jop.19.00551] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
PURPOSE Unplanned emergency department (ED) visits and hospitalizations are common during systemic cancer therapy. To determine how patients with cancer trade off treatment benefit with risk of experiencing an ED visit or hospitalization when deciding about systemic therapy, we undertook a discrete choice experiment. MATERIALS AND METHODS Patients with breast, colorectal, or head and neck cancer contemplating, receiving, or having previously received systemic therapy were presented with 10 choice tasks (5 in the curative and 5 in the palliative setting) that varied on 3 attributes: benefit, risk of ED visit, and risk of hospitalization. Preferences for attributes and levels were measured using part-worth utilities, estimated using hierarchical Bayes analysis. Segmentation analysis was conducted to identify subgroups with different preferences. RESULTS A total of 293 patients completed the survey; most were female (76%), had breast cancer (63%), and were currently receiving systemic therapy (72%) with curative intent (59%). Benefit was the most important decision attribute regardless of treatment intent, followed by risk of hospitalization, then risk of ED visit. Two segments were observed: one large cluster exhibiting logical and consistent choices, and a smaller segment exhibiting illogical and inconsistent choices. Patients in the latter segment were more likely to have metastatic head and neck cancer, be male, were older, and reported fewer prior ED visits. CONCLUSION Although the risk of ED visit or hospitalization contributes to patient treatment preferences, benefit was the most important attribute. Segmentation suggests that a subset of patients may lack cognitive abilities, engagement, or literacy to consistently evaluate treatment choices. Understanding this subset may provide insight into patients' decision making and understanding of treatment options.
Collapse
Affiliation(s)
- Cameron M Phillips
- University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Ken Deal
- McMaster University, Hamilton, Ontario, Canada
| | - Melanie Powis
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Simron Singh
- University of Toronto, Toronto, Ontario, Canada.,Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | | | - Harsh Naik
- Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Aditi Dobriyal
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Nasrin Alavi
- Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| | - Monika K Krzyzanowska
- University of Toronto, Toronto, Ontario, Canada.,Princess Margaret Cancer Centre, Toronto, Ontario, Canada
| |
Collapse
|
38
|
Sun H, Wang H, Shi L, Wang M, Li J, Shi J, Ni M, Hu X, Chen Y. Physician preferences for chemotherapy in the treatment of non-small cell lung cancer in China: evidence from multicentre discrete choice experiments. BMJ Open 2020; 10:e032336. [PMID: 32051302 PMCID: PMC7045216 DOI: 10.1136/bmjopen-2019-032336] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
OBJECTIVE To evaluate physician risk-benefit preferences and trade-offs when making chemotherapy decisions for patients with non-small cell lung cancer (NSCLC). DESIGN A discrete choice experiment (DCE). SETTINGS Tertiary hospitals in Beijing, Shanghai, Guangzhou and Chengdu of China. PARTICIPANTS The participants were 184 physicians (mean age of 37 years) with more than 1 year of NSCLC chemotherapy practice. OUTCOMES The DCE survey was constructed by six attributes: progression-free survival (PFS), disease control rate (DCR), risk of moderate side effects, risk of severe side effects, mode of administration and out-of-pocket costs. Physicians' relative preferences and trade-offs in patient out-of-pocket costs for each attribute level were estimated using a mixed logit model, and interaction terms were added to the model to assess preferences variation among physicians with different sociodemographic factors. RESULTS Physicians had the strongest preferences for improvements in PFS, followed by reducing the risk of severe side effects. The DCR, risk of moderate side effects and mode of administration were ranked in decreasing order of importance. There was little variation in preferences among physicians with different sociodemographic characteristics. Physicians were willing to trade $4814 (95% CI $4149 to $5480) of patient out-of-pocket costs per month for a chemotherapy that guaranteed 11 months of PFS, followed by $1908 (95% CI $1227 to $2539) for reducing the risk of severe side effects to 2%. CONCLUSIONS With regard to chemotherapy for patients with NSCLC, prolonging PFS, reducing severe and moderate side effects were primary considerations for physicians in China. The mode of administration and treatment costs significantly influenced physicians' therapeutic decision. The current findings could add some evidence to inform NSCLC chemotherapy implementation and promote shared decision-making.
Collapse
Affiliation(s)
- Hui Sun
- Key Lab of Health Technology Assessment, National Health Commission, School of Public Health, Fudan University, Shanghai, China
- Department of Health Technology Assessment Research, Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, China
| | - Huishan Wang
- The Second Clinical Medical School of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Lizheng Shi
- Health Systems Analytics Research Center, School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| | - Meifeng Wang
- Department of Health Technology Assessment Research, Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, China
| | - Junling Li
- Department of Oncology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Jufang Shi
- Department of Oncology, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Ming Ni
- Department of Oncology, Fudan University Shanghai Cancer Center, Shanghai, China
| | - Xianzhi Hu
- Department of Human Resource, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yingyao Chen
- Key Lab of Health Technology Assessment, National Health Commission, School of Public Health, Fudan University, Shanghai, China
| |
Collapse
|
39
|
MacEwan JP, Gupte-Singh K, Zhao LM, Reckamp KL. Non-Small Cell Lung Cancer Patient Preferences for First-Line Treatment: A Discrete Choice Experiment. MDM Policy Pract 2020; 5:2381468320922208. [PMID: 32548305 PMCID: PMC7249575 DOI: 10.1177/2381468320922208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 02/17/2020] [Indexed: 11/30/2022] Open
Abstract
Background. There has been much innovation in the treatment of non-small cell lung cancer (NSCLC) in recent years. In particular, use of immuno-oncology (IO) therapies has been growing. Methods. Patients with NSCLC in the United States were surveyed online using a discrete choice experiment to elicit first-line (1L) treatment preferences across six treatment attributes: survival, adverse events (AEs), mechanism of action (MOA), subsequent treatment options (STOs), genetic testing treatment delay, and out-of-pocket cost (OOPC). Preferences were estimated using a latent-class model. Preference shares were estimated for IO-IO, IO-chemo, and chemo-like regimens. Results. Of the 199 patients who completed the survey, 55% were male, 76% were white, 19% had not begun or were on 1L treatment, and the median age was 43 years. Based on a latent-class model with 3 preference classes, 53.0% of patients considered survival and OOPC alone and were less likely to choose an option with a higher OOPC and lower survival, 12.7% of patients were likely to choose the more expensive option, and for 34.3% of patients, survival, AE risk, and treatment delays all significantly influenced choices. MOA and STOs did not significantly influence treatment choices in any preference class. Approximately 53%, 27%, and 20% of patients preferred IO-IO-like, IO-chemo-like, and chemo-like regimens in 1L, respectively. Respondents were younger, more likely to be Caucasian, and more likely to speak English than the general NSCLC patient population. Conclusions. OOPC, effectiveness, treatment delays, and safety influenced NSCLC patients' 1L treatment decisions, and most patients preferred an IO-IO followed by IO-chemo-like regimen in 1L. Cancer treatment decisions are complex and patient preferences are unique; therefore, patients' treatment objectives should be discussed in shared treatment decision making.
Collapse
|
40
|
Janssen EM, Dy SM, Meara AS, Kneuertz PJ, Presley CJ, Bridges JFP. Analysis of Patient Preferences in Lung Cancer - Estimating Acceptable Tradeoffs Between Treatment Benefit and Side Effects. Patient Prefer Adherence 2020; 14:927-937. [PMID: 32581519 PMCID: PMC7276327 DOI: 10.2147/ppa.s235430] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Accepted: 04/28/2020] [Indexed: 02/02/2023] Open
Abstract
OBJECTIVE Increased treatment options and longer survival for lung cancer have generated increased interest in patient preferences. Previous studies of patient preferences in lung cancer have not fully explored preference heterogeneity. We demonstrate a method to explore preference heterogeneity in the willingness of patients with lung cancer and caregivers to trade progression-free survival (PFS) with side effects. PATIENTS AND METHODS Patients and caregivers attending a national lung cancer meeting completed a discrete-choice experiment (DCE) designed through a collaboration with patients. Participants answered 13 choice tasks described across PFS, short-term side effects, and four long-term side effects. Side effects were coded as a one-level change in severity (none-mild, mild-moderate, or moderate-severe). A mixed logit model in willingness-to-pay space estimated preference heterogeneity in acceptable tradeoffs (time equivalents) between PFS and side effects. The study was reported following quality indicators from the United States Food and Drug Administration's patient preference guidance. RESULTS A total of 87 patients and 24 caregivers participated in the DCE. Participants would trade 3.7 month PFS (95% CI (CI): 3.3-4.1) for less severe functional long-term treatment side effects, 2.3 months for less severe physical long-term effects (CI: 1.9-2.8) and cognitive long-term effects (CI: 1.8-2.8), 0.9 months (CI: 0.4-1.4) for less severe emotional long-term effects, and 1.8 months (CI: 1.4-2.3) for less severe short-term side effects. Most participants (90%) would accept treatment with more severe functional long-term effects for 8.4 additional month PFS. CONCLUSION Participants would trade PFS for changes in short-term side effects and long-term side effects, although preference heterogeneity existed. Lung cancer treatments that offer less PFS but also less severe side effects might be acceptable to some patients.
Collapse
Affiliation(s)
- Ellen M Janssen
- Center for Medical Technology Policy, Baltimore, MD, USA
- Correspondence: Ellen M Janssen Research Director,Center for Medical Technology Policy, 401 East Pratt Street, Suite 631, Baltimore, MD21202, USATel +1 443-222-8775 Email
| | - Sydney M Dy
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alexa S Meara
- Department of Internal Medicine Division Of Rheumatology, The Ohio State University, College of Medicine, Columbus, OH, USA
| | - Peter J Kneuertz
- Thoracic Surgery Division, Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Carolyn J Presley
- Division of Medical Oncology, Department of Internal Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - John F P Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH, USA
- Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| |
Collapse
|
41
|
Hauber B, Penrod JR, Gebben D, Musallam L. The Value of Hope: Patients' and Physicians' Preferences for Survival in Advanced Non-Small Cell Lung Cancer. Patient Prefer Adherence 2020; 14:2093-2104. [PMID: 33154633 PMCID: PMC7608144 DOI: 10.2147/ppa.s248295] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 09/19/2020] [Indexed: 11/23/2022] Open
Abstract
PURPOSE Immuno-oncology treatments offer patients with advanced non-small cell lung cancer (NSCLC) treatment options with greater probability of durable survival and a different toxicity profile compared with traditional chemotherapy. The objective of this study was to explore the importance of increases in the probability of long-term survival versus changes in expected (median) survival and treatment toxicities among patients with advanced NSCLC and physicians. PATIENTS AND METHODS In a discrete-choice experiment, oncologists and patients diagnosed with NSCLC chose between profiles of treatments for advanced NSCLC offering different combinations of benefits (expected, best-case, and worst-case survival) and risks. We analyzed preference data from each sample using a random-parameters logit model that controls for preference heterogeneity and the panel nature of the data. RESULTS Both patients and physicians expressed a strong preference for improving the probability of best-case survival; however, patients viewed increases in the probability of long-term survival as more important than increases in expected survival, while the opposite was true for physicians. Both patients and physicians weighted survival to be more important than toxicities. CONCLUSION This study identified a potentially important divergence between physician and patient perspectives on survival statistics. Physicians placed more importance on increases in expected survival than did patients with NSCLC. The importance patients placed on long-term survival reinforce previous research identifying the primacy of hope as a value among seriously ill patients. The findings underscore the importance of considering patients' priorities and in shared decision-making when choosing treatment.
Collapse
Affiliation(s)
- Brett Hauber
- RTI Health Solutions, Research Triangle Park, NC, USA
- Correspondence: Brett Hauber Email
| | | | - David Gebben
- RTI Health Solutions, Research Triangle Park, NC, USA
| | | |
Collapse
|
42
|
Poteet S, Craig BM. The Value Employees Place on Health Insurance Plans: A Discrete-Choice Experiment. APPLIED HEALTH ECONOMICS AND HEALTH POLICY 2019; 17:817-825. [PMID: 31423545 DOI: 10.1007/s40258-019-00507-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND The federally-facilitated Health Insurance Marketplace-also known as the Health Insurance Exchange-was designed as a tool to help people purchase insurance plans, yet many Americans remain uninsured, partially due to rising premiums. One possible strategy to stabilize its premiums is to encourage healthier people to purchase their plans through the Marketplace instead of through their employers. OBJECTIVE This study examined the values that single adults with employer-based coverage place on health insurance plan attributes using a discrete-choice experiment (DCE). METHODS As part of an online survey, each respondent completed 28 paired comparisons trading off four attributes: source of coverage, plan type, monthly out-of-pocket premium, and quality of coverage. RESULTS Based on our results (N = 2207), single employees slightly preferred their employer over the Marketplace as a source of coverage (0.726 odds ratio; p value < 0.01). Single employees would be willing to switch to the Marketplace for a US$25 reduction in monthly premiums. Preferred Provider Organization (PPO) plans were overwhelmingly preferred over all other plan types, especially compared to Fee-for-Service (FFS) plans (4.230 odds ratio; p value < 0.01). The predicted probability that a health insurance plan from the Marketplace would be chosen ranged from 42 to 43.7%. CONCLUSION This study demonstrated that a US$25 subsidy or providing slightly more generous coverage (Bronze-Silver) would motivate employees to purchase PPO plans through the Marketplace, potentially improving its risk pooling, reducing employers' administrative burden, and enhancing labor mobility.
Collapse
Affiliation(s)
- Stephen Poteet
- Department of Economics, University of South Florida, 4202 E. Fowler Avenue, CMC205, Tampa, FL, 33620, USA.
| | - Benjamin M Craig
- Department of Economics, University of South Florida, 4202 E. Fowler Avenue, CMC206, Tampa, FL, 33620, USA
| |
Collapse
|
43
|
Raphael MJ, Robinson A, Booth CM, O'Donnell J, Palmer M, Eisenhauer E, Brundage M. The Value of Progression-Free Survival as a Treatment End Point Among Patients With Advanced Cancer: A Systematic Review and Qualitative Assessment of the Literature. JAMA Oncol 2019; 5:1779-1789. [PMID: 31556921 DOI: 10.1001/jamaoncol.2019.3338] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
IMPORTANCE It is unclear whether patients with advanced cancer value surrogate end points, particularly progression-free survival (PFS). Despite this uncertainty, surrogate end points form the basis of regulatory approval for the majority of new cancer treatments. OBJECTIVE To summarize and qualitatively assess studies evaluating whether patients with advanced cancer understand and value PFS. EVIDENCE REVIEW MEDLINE, Embase, the Cochrane Database of Systematic Reviews, the Cochrane Central Register of Controlled Trials, and the Cumulative Index to Nursing and Allied Health Literature databases were searched from database inception to November 12, 2018. Articles eligible for inclusion investigated patient understanding, preference, or perceived value of disease progression or PFS in the setting of advanced cancer. Three authors independently reviewed and extracted data from all studies eligible for inclusion. FINDINGS In total, 17 studies representing 3646 patients were included. Of these studies, 15 specifically aimed to assess patients' values toward, and their willingness to trade off toxic effects for gains or losses in the end point of PFS. All studies examined used widely disparate definitions when attempting to describe the meaning of PFS to patients. Ten studies specifically presented patients with the term progression-free survival as an attribute choice. In the words used to define the attribute of PFS, 6 studies used the term survival. Five studies clarified that PFS may not translate into better overall survival, and 5 studies explained that improvements in PFS may not reflect how well the patient may feel. No study clarified that a PFS event could represent either progression or death, and no study defined for the patient what constituted progression. The studies assessed herein underrepresented ethnic and racial minorities (mean percentage of white patients, 88%; range, 77%-96%). Values and preferences may vary across cultural backgrounds given that different relative preferences were assigned to cost and efficacy outcomes in North American vs Asian studies, although only a few studies were evaluated. CONCLUSIONS AND RELEVANCE The existing literature evaluating patients' understanding, preferences, and values toward the end point of PFS was severely limited by the heterogeneity of methods, attribute selection, and descriptions used to define PFS to patients. High-quality studies are needed that clearly define PFS for patients and that systematically document their understanding of the term. Only then can it be assessed whether PFS is an end point of value to patients with advanced cancer.
Collapse
Affiliation(s)
- Michael J Raphael
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Ontario, Canada
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
| | - Andrew Robinson
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Ontario, Canada
| | - Christopher M Booth
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Ontario, Canada
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| | - Jennifer O'Donnell
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Ontario, Canada
| | - Michael Palmer
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Ontario, Canada
| | | | - Michael Brundage
- Division of Cancer Care and Epidemiology, Queen's Cancer Research Institute, Kingston, Ontario, Canada
- Department of Oncology, Queen's University, Kingston, Ontario, Canada
- Department of Public Health Sciences, Queen's University, Kingston, Ontario, Canada
| |
Collapse
|
44
|
Bridges JF, la Cruz MD, Pavilack M, Flood E, Janssen EM, Chehab N, Fernandes AW. Patient preferences for attributes of tyrosine kinase inhibitor treatments for EGFR mutation-positive non-small-cell lung cancer. Future Oncol 2019; 15:3895-3907. [PMID: 31621403 DOI: 10.2217/fon-2019-0396] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Aim: EGFR-tyrosine kinase inhibitors (TKIs) vary in efficacy, side effects (SEs) and dosing regimen. We explored EGFR-TKI treatment attribute preferences in EGFR mutation-positive metastatic non-small-cell lung cancer. Materials & methods: Patients completed a survey utilizing preference elicitation methods: direct elicitation of four EGFR-TKI profiles describing progression-free survival (PFS), severe SE risk, administration; discrete choice experiment involving 12 choice tasks. Results: 90 participated. The preferred profile (selected 89% of times) had the longest PFS (18 months) and the lowest severe SE risk (5%). Patients would need compensation with ≥three-times longer PFS for severe SEs. Patients would accept ≤7 months PFS reduction for oral treatments versus intravenous. Conclusion: Patients preferred longer PFS but were willing to accept reduced PFS for more favorable SEs and dosing convenience.
Collapse
Affiliation(s)
- John Fp Bridges
- Department of Biomedical Informatics, The Ohio State University College of Medicine, Columbus, OH 43210, USA
| | | | | | - Emuella Flood
- Patient Centered Outcomes, ICON, Gaithersburg, MD 20807, USA.,AstraZeneca, Gaithersburg, MD 20807, USA
| | - Ellen M Janssen
- Patient Centered Outcomes, ICON, Gaithersburg, MD 20807, USA
| | | | | |
Collapse
|
45
|
Trapero-Bertran M, Rodríguez-Martín B, López-Bastida J. What attributes should be included in a discrete choice experiment related to health technologies? A systematic literature review. PLoS One 2019; 14:e0219905. [PMID: 31318926 PMCID: PMC6639002 DOI: 10.1371/journal.pone.0219905] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Accepted: 07/04/2019] [Indexed: 01/12/2023] Open
Abstract
Discrete choice experiments (DCEs) are a way to assess priority-setting in health care provision. This approach allows for the evaluation of individuals’ preferences as a means of adding criteria to traditional quality-adjusted life year analysis. The aim of this systematic literature review was to identify attributes for designing a DCE in order to then develop and validate a framework that supports decision-making on health technologies. Our systematic literature review replicated the methods and search terms used by de Bekker-Grob et al. 2012 and Clark et al. 2014. The Medline database was searched for articles dated between 2008 and 2015. The search was limited to studies in English that reflected general preferences and were choice-based, published as full-text articles and related to health technologies. This study included 72 papers, 52% of which focused on DCEs on drug treatments. The average number of attributes used in all included DCE studies was 5.74 (SD 1.98). The most frequently used attributes in these DCEs were improvements in health (78%), side effects (57%) and cost of treatment (53%). Other, less frequently used attributes included waiting time for treatment or duration of treatment (25%), severity of disease (7%) and value for money (4%). The attributes identified might inform future DCE surveys designed to study societal preferences regarding health technologies in order to better inform decisions in health technology assessment.
Collapse
Affiliation(s)
- Marta Trapero-Bertran
- Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla La-Mancha (UCLM), Talavera de la Reina (Toledo), Spain
- Research Institute for Evaluation and Public Policies (IRAPP), Universitat Internacional de Catalunya (UIC), Barcelona, Spain
| | - Beatriz Rodríguez-Martín
- Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla La-Mancha (UCLM), Talavera de la Reina (Toledo), Spain
- Faculty of Health Sciences, University College Dublin, Dublin, Ireland
- * E-mail:
| | - Julio López-Bastida
- Department of Nursing, Physiotherapy and Occupational Therapy, University of Castilla La-Mancha (UCLM), Talavera de la Reina (Toledo), Spain
| |
Collapse
|
46
|
Sullivan DR, Eden KB, Dieckmann NF, Golden SE, Vranas KC, Nugent SM, Slatore CG. Understanding patients' values and preferences regarding early stage lung cancer treatment decision making. Lung Cancer 2019; 131:47-57. [PMID: 31027697 PMCID: PMC6512337 DOI: 10.1016/j.lungcan.2019.03.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 01/22/2019] [Accepted: 03/08/2019] [Indexed: 12/25/2022]
Abstract
INTRODUCTION With advances in treatments among patients with lung cancer, it is increasingly important to understand patients' values and preferences to facilitate shared decision making. METHODS Prospective, multicenter study of patients with treated stage I lung cancer. At the time of study participation, participants were 4-6 months posttreatment. Value clarification and discrete choice methods were used to elicit participants' values and treatment preferences regarding stereotactic body radiation therapy (SBRT) and surgical resection using only treatment attributes. RESULTS Among 114 participants, mean age was 70 years (Standard Deviation = 7.9), 65% were male, 68 (60%) received SBRT and 46 (40%) received surgery. More participants valued independence and quality of life (QOL) as "most important" compared to survival or cancer recurrence. Most participants (83%) were willing to accept lung cancer treatment with a 2% chance of periprocedural death for only one additional year of life. Participants also valued independence more than additional years of life as most (86%) were unwilling to accept either permanent placement in a nursing home or being limited to a bed/chair for four additional years of life. Surprisingly, treatment discordance was common as 49% of participants preferred the alternative lung cancer treatment than what they received. CONCLUSIONS Among participants with early stage lung cancer, maintaining independence and QOL were more highly valued than survival or cancer recurrence. Participants were willing to accept high periprocedural mortality, but not severe deficits affecting QOL when considering treatment. Treatment discordance was common among participants who received SBRT or surgery. Understanding patients' values and preferences regarding treatment decisions is essential to foster shared decision making and ensure treatment plans are consistent with patients' goals. Clinicians need more resources to engage in high quality communication during lung cancer treatment discussions.
Collapse
Affiliation(s)
- Donald R Sullivan
- Division of Pulmonary and Critical Care Medicine (PCCM), Oregon Health and Science University (OHSU), United States; Health Services Research & Development, Veterans Affairs Portland Health Care System (VAPHCS), United States; Cancer Prevention and Control Program, Knight Cancer Institute, OHSU, United States.
| | - Karen B Eden
- Department of Medical Informatics and Clinical Epidemiology, United States
| | - Nathan F Dieckmann
- School of Nursing, United States; Department of Psychiatry, OHSU Oregon Health & Science University, Portland, OR, United States
| | - Sara E Golden
- Health Services Research & Development, Veterans Affairs Portland Health Care System (VAPHCS), United States
| | - Kelly C Vranas
- Division of Pulmonary and Critical Care Medicine (PCCM), Oregon Health and Science University (OHSU), United States; Health Services Research & Development, Veterans Affairs Portland Health Care System (VAPHCS), United States
| | - Shannon M Nugent
- Health Services Research & Development, Veterans Affairs Portland Health Care System (VAPHCS), United States; Department of Psychiatry, OHSU Oregon Health & Science University, Portland, OR, United States
| | - Christopher G Slatore
- Division of Pulmonary and Critical Care Medicine (PCCM), Oregon Health and Science University (OHSU), United States; Health Services Research & Development, Veterans Affairs Portland Health Care System (VAPHCS), United States; Cancer Prevention and Control Program, Knight Cancer Institute, OHSU, United States; Section of PCCM, VAPORHCS, United States
| |
Collapse
|
47
|
de Freitas HM, Ito T, Hadi M, Al-Jassar G, Henry-Szatkowski M, Nafees B, Lloyd AJ. Patient Preferences for Metastatic Hormone-Sensitive Prostate Cancer Treatments: A Discrete Choice Experiment Among Men in Three European Countries. Adv Ther 2019; 36:318-332. [PMID: 30617763 PMCID: PMC6824341 DOI: 10.1007/s12325-018-0861-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Indexed: 12/31/2022]
Abstract
Introduction Various treatment options are available for metastatic hormone-sensitive prostate cancer. This study aimed to quantify how men with prostate cancer in the United Kingdom (UK), Germany, and Spain perceive the risks and benefits of hypothetical abiraterone acetate plus prednisone treatment and docetaxel-based chemotherapy treatment options. Methods A targeted literature review, exploratory interviews with prostate cancer patients and oncologists, and pre-test interviews were used to develop a discrete choice experiments (DCE). The final DCE included 32 choice sets, selected using a main-effects orthogonal design, divided into two survey blocks. Paired profiles presented hypothetical treatments for prostate cancer through six attributes that could be presented at two or four levels each. Preference estimates were estimated using a conditional logit regression model. Preference results were stratified by cancer stage. Results A total of 152 participants (mean age 69 years) completed the DCE in the UK, Germany, and Spain. Treatment effectiveness was the main concern for the patients (difference in preference estimates between 8 and 32 months 1.443). Participants wanted to avoid pain that was not well controlled (preference dummy coding estimate − 1.157). Participants valued a change from an oral medication to an intravenous treatment (change in preference estimate − 0.416) more negatively than a change from a 1% to a 5% risk of infection (change in preference estimate − 0.313). Conclusions This study shows that treatment effectiveness and pain control were the most important attributes for patients with prostate cancer. These two attributes influenced more than 50% of their decision-making in this study. The risk of fatigue and mode of administration were least prioritised by patients. This study highlights the relative importance that Spanish, German, and British patients place on various aspects of treatment options for prostate cancer. Understanding patient preference and taking them into consideration shall help physicians when developing their treatment strategies for their patients. Funding Janssen. Electronic supplementary material The online version of this article (10.1007/s12325-018-0861-3) contains supplementary material, which is available to authorized users.
Collapse
|
48
|
Preferences of women with epithelial ovarian cancer for aspects of genetic testing. GYNECOLOGIC ONCOLOGY RESEARCH AND PRACTICE 2019; 6:1. [PMID: 30693090 PMCID: PMC6341581 DOI: 10.1186/s40661-019-0066-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/14/2018] [Accepted: 01/14/2019] [Indexed: 01/13/2023]
Abstract
Background Although genetic testing is recommended for women with epithelial ovarian cancer (EOC), little is known about patient preferences for various testing options. We measured relative preferences for attributes of testing in women with EOC referred for genetic counseling. Methods Subjects were recruited to participate in a discrete-choice-experiment survey to elicit preferences for attributes of genetic testing: out-of-pocket cost ($0, $100, $250, or $1000), probability of a deleterious mutation (60, 80%, or 88%), probability of a variant of uncertain significance (VUS) result (5, 20%, or 40%), sample requirements (blood or saliva), and turn-around time (1, 2 or 4 weeks). Subjects viewed educational videos followed by a series of choices between pairs of constructed genetic tests with varying attribute levels. Random-parameters logit was used to estimate preference weights for attribute levels. Relative importance weights and money-equivalent values were calculated. Results Ninety-four patients were enrolled; 68 (76.4%) presented for genetic counseling. Test cost was the most important attribute to subjects (importance weight = 41 out of 100) followed by probability to detect deleterious mutations (36) and probability of a VUS result (20). Sample requirements and turnaround time did not drive test choices. Subjects were willing to pay an additional $155 and $70 for incremental 5% improvements in the probability to detect deleterious mutations and probability of a VUS result. At genetics consultation, 55/68 (80.9%) subjects chose multigene testing. Conclusions Low out-of-pocket cost, high probability of detecting deleterious mutations and high probability of a VUS result are preferred by patients with EOC considering genetic testing. Electronic supplementary material The online version of this article (10.1186/s40661-019-0066-8) contains supplementary material, which is available to authorized users.
Collapse
|
49
|
Sun H, Wang H, Xu N, Li J, Shi J, Zhou N, Ni M, Hu X, Chen Y. Patient Preferences For Chemotherapy In The Treatment Of Non-Small Cell Lung Cancer: A Multicenter Discrete Choice Experiment (DCE) Study In China. Patient Prefer Adherence 2019; 13:1701-1709. [PMID: 31631985 PMCID: PMC6790116 DOI: 10.2147/ppa.s224529] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 09/20/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE The study aims to quantify patients' risk-benefit preferences for chemotherapy in the treatment of non-small cell lung cancer (NSCLC), and to elicit their willingness to pay (WTP) for treatment outcomes. METHODS A face-to-face discrete choice experiment (DCE) was conducted on NSCLC patients in four tertiary hospitals each from Beijing, Shanghai, Guangzhou and Chengdu in China. Patients were invited to complete choice questions that constructed by seven attributes: progression-free survival (PFS), disease control rate (DCR), rash, nausea and vomiting, tiredness, mode of administration and out-of-pocket costs. A mixed logit model was used to evaluate the choice model. Estimates of relative preferences and marginal willingness to pay for each attribute were then explored. RESULTS A total of 361 patients completed the survey. Improvements in PFS (10, 95% CI: 8.4-11.6) were the most important attribute for patients, followed by increase in DCR (4.6, 95% CI: 3.4-5.8). Tiredness (3.9, 95% CI: 2.9-5.1) was judged to be the most important risk. While remaining attributes were ranked in decreasing order of importance: nausea and vomiting (1.9, 95% CI: 0.9-3.0), mode of administration (0.8, 95% CI: 0.2-1.4) and rash (0.5, 95% CI: -0.6-1.5). There was little variation in preferences among patients with different sociodemographic characteristics. Patients were monthly willing to pay $2304 (95% CI, $1916-$2754) that guaranteed 11 months of PFS, followed by $1465 (95% CI, $1163-$1767) per month to improve their disease control rate by 90%. CONCLUSION The results suggested that efficacy was the most important attribute for patients. Side effects, mode of administration and treatment cost significantly influenced patient preferences. Patient engagement in prioritizing their treatment preferences should be emphasized during the clinical decision-making process and regimen implementation.
Collapse
Affiliation(s)
- Hui Sun
- Key Lab of Health Technology Assessment, National Health Commission, School of Public Health, Fudan University, Shanghai, People’s Republic of China
- Department of Health Technology Assessment Research, Shanghai Health Development Research Center, Shanghai Medical Information Center, Shanghai, People’s Republic of China
| | - Huishan Wang
- The Second Clinical Medical School of Nanjing Medical University, Nanjing, People’s Republic of China
| | - Ningze Xu
- Key Lab of Health Technology Assessment, National Health Commission, School of Public Health, Fudan University, Shanghai, People’s Republic of China
| | - Junling Li
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Jufang Shi
- Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, People’s Republic of China
| | - Naitong Zhou
- West China School of Pharmacy, Sichuan University, Chengdu, People’s Republic of China
| | - Ming Ni
- Fudan University Shanghai Cancer Center, Shanghai, People’s Republic of China
| | - Xianzhi Hu
- Sun Yat-Sen University Cancer Center, Guangzhou, People’s Republic of China
| | - Yingyao Chen
- Key Lab of Health Technology Assessment, National Health Commission, School of Public Health, Fudan University, Shanghai, People’s Republic of China
- Correspondence: Yingyao Chen School of Public Health, Fudan University, Shanghai200032, People’s Republic of ChinaTel +86-21-33565183Fax +86-21-64169552 Email
| |
Collapse
|
50
|
Seo J, Smith BD, Estey E, Voyard E, O’ Donoghue B, Bridges JFP. Developing an instrument to assess patient preferences for benefits and risks of treating acute myeloid leukemia to promote patient-focused drug development. Curr Med Res Opin 2018; 34:2031-2039. [PMID: 29565196 PMCID: PMC8799376 DOI: 10.1080/03007995.2018.1456414] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Objective Acute myeloid leukemia (AML) is a progressive blood cancer with few effective treatment options. As part of a patient-focused drug development (PFDD) initiative led by the Leukemia and Lymphoma Society (LLS), this study sought to use a community-centered approach to develop and pilot an instrument to measure patient preferences for the benefits and risks of treating AML. Methods Instrument development was informed by a literature review, engagement with expert stakeholders (n = 12), engagement with community stakeholders, and pre-testing. A discrete-choice experiment (DCE), in which participants made choices between 16 pairs of hypothetical treatments, was developed with five attributes: event-free survival, complete remission, time in hospital, short-term side-effects, and long-term side-effects. A pilot test was conducted and analyzed using conditional logistic regression. Results are presented using relative attribute importance (RAI) scores. Results Patients with AML and caregivers were engaged in developing (n = 15), pre-testing (n = 13), and pilot testing (n = 26) the instrument. The pilot included patients with AML (n = 18) and caregivers of living or deceased patients with AML (n = 8). Participants had a mean age of 50 years (range =24-81), and were mostly college educated (n = 22), privately insured (n = 21), and employed (n = 13). Based on the DCE, complete remission was identified as the most important attribute (RAI =10), followed by event-free survival (3.7), time in hospital (2.8), long-term side-effects (2.3), and short-term side-effects (2.1). Conclusion The mixed-methods approach to PFDD was welcomed by all stakeholders and there was strong endorsement to implement this DCE as part of a national survey. Key points for decision makers The Leukemia and Lymphoma Society (LLS) initiated an independent effort to promote patient-focused drug development (PFDD). This study presents the development and piloting of a preference study as a first step in this initiative. Results of this pilot study were used to guide a PFDD meeting to discuss the lived experience of patients and caregivers affected by AML. Productive engagement by all patients, caregivers, and stakeholders throughout the process resulted in strong endorsement of the project's approach and recognition of the need to conduct a national study.
Collapse
Affiliation(s)
- Jaein Seo
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - B. Douglas Smith
- Johns Hopkins Sidney Kimmel Comprehensive Cancer Center, Baltimore, MD, USA
| | - Elihu Estey
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
- Department of Medical Oncology, University of Washington, Seattle, WA, USA
| | | | | | - John F. P. Bridges
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| |
Collapse
|