Patient Preference and Adherence (Jan 2022)
Patient and Caregiver Preferences for First-Line Treatments of Metastatic Non-Small Cell Lung Cancer: A Discrete Choice Experiment
Abstract
Candice Yong,1 M Janelle Cambron-Mellott,2 Brian Seal,1 Oliver Will,2 Martine C Maculaitis,2 Kelly Clapp,2 Emily Mulvihill,2 Ion Cotarla,1 Ranee Mehra3 1AstraZeneca, Gaithersburg, MD, USA; 2Cerner Enviza, Malvern, PA, USA; 3University of Maryland Marlene and Stewart Greenebaum Cancer Center, Baltimore, MD, USACorrespondence: M Janelle Cambron-MellottCerner Enviza, 51 Valley Stream Pkwy, Malvern, PA, 19355, USATel +1 816 201 2190Email [email protected]: 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.Keywords: immune checkpoint inhibitors, metastases, non-small-cell lung carcinomas, overall survival, patient preference, toxicities
