Patient Preference and Adherence (Sep 2023)
Patient Preferences for Adjuvant Treatment in Muscle-Invasive Urothelial Carcinoma: A Multi-Country Discrete Choice Experiment
Abstract
Kristen King-Concialdi,1 Kathleen Beusterien,1 Steven S Senglaub,1 Oliver Will,1 Dena H Jaffe,1 Miraj Y Patel,2 Michael R Harrison3 1Real-World Evidence, Cerner Enviza, an Oracle Company, North Kansas City, MO, USA; 2Health Economics and Outcomes Research, Bristol Myers Squibb, Princeton, NJ, USA; 3Duke Cancer Institute Center for Prostate and Urologic Cancers, Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, NC, USACorrespondence: Steven S Senglaub, Real-World Evidence, Cerner Enviza, an Oracle Company, 2800 Rock Creek Parkway, North Kansas City, MO, 64117, USA, Tel +1 816 201 1198, Email [email protected]: The evolving treatment landscape in muscle-invasive urothelial carcinoma creates challenges for clinicians and patients in selecting the most appropriate therapy. Here, we aimed to understand adjuvant treatment preferences among patients with muscle-invasive urothelial carcinoma who underwent radical resection, including tradeoffs between efficacy outcomes and toxicity risks.Patients and Methods: An observational, cross-sectional study utilizing a discrete choice experiment was conducted across the United States, United Kingdom, Canada, France, and Germany via a web-based survey. Patients ≥ 18 years of age who self-reported as having been diagnosed with muscle-invasive urothelial carcinoma were included. Patients indicated their preferences between hypothetical treatment profiles varying in eight attributes relating to efficacy, regimen, and side effects. Preference weights were estimated using hierarchical Bayesian logistic regression; relative attribute importance estimates were calculated.Results: Overall, 207 patients were included (age ≥ 56 years, 65.7%; male, 54.1%). Patients chose adjuvant treatment 91.2% of the time vs no treatment. Prolonging overall survival from 25 to 78 months was most important, followed by reducing serious side effect risks. Increasing disease-free survival from 12 to 24 months was more important than decreasing risks of fatigue from 54% to 15% and nausea from 53% to 7%. Treatment with the shortest dosing regimen was more important for patients who received neoadjuvant chemotherapy vs patients who did not receive neoadjuvant chemotherapy; prolonging overall survival was more important than reducing the risk of a serious side effect in non-US patients; the opposite was found in the United States.Conclusion: Patients with muscle-invasive urothelial carcinoma who underwent radical resection preferred adjuvant treatment over no treatment regardless of side effects. Patients prioritized overall survival improvements followed by a reduced side effect profile.Keywords: bladder cancer, discrete choice experiment, muscle-invasive urothelial carcinoma, patient treatment preferences
