Patients' preferences for treatment outcomes for advanced non-small cell lung cancer

A conjoint analysis

John F P Bridges, Ateesha F. Mohamed, Henrik W. Finnern, Anette Woehl, A. Brett Hauber

Research output: Contribution to journalArticle

Abstract

Background: Treatment decisions for advanced non-small cell lung cancer (NSCLC) are complex and require trade-offs between the benefits and risks experienced by patients. We evaluated the benefits that patients judged sufficient to compensate for the risks associated with therapy for NSCLC. Methods: Participants with a self-reported diagnosis of NSCLC (n= 100) were sampled from an online panel in the United Kingdom. Eligible and consenting participants then completed a self-administered online survey about their disease and their treatment preferences were assessed. This involved respondents choosing among systematically paired profiles that spanned eight attributes: progression-free survival [PFS], symptom severity, rash, diarrhoea, fatigue, nausea and vomiting, fever and infection, and mode of treatment administration (infusion and oral). A choice model was estimated using mixed-logit regression. Estimates of importance for each attribute level and attribute were then calculated and acceptable tradeoffs among attributes were explored. Results: A total of 89 respondents (73% male) completed all choice tasks appropriately. Increases in PFS together with improvements in symptom severity were judged most important and increased with PFS benefit - 4 months: 5.7; 95% CI: 3.5-7.9; 5 months: 7.1; 95% CI: 4.4-9.9; and 7 months: 10.0; 95% CI: 6.1-13.9. However, improvements in PFS were viewed as most beneficial when disease symptoms were mild and as detrimental when patients had severe symptoms. Fatigue (5.0; 95% CI: 2.7-7.3) was judged to be the most important risk, followed by diarrhoea (2.8; 95% CI: 0.7-4.9), nausea and vomiting (2.1; 95% CI: 0.1-4.1), fever and infection (2.1; 95% CI: 0.2-4.1), and rash (2.0; 95% CI: 0.2-3.9). Oral administration was preferred to infusion (1.8; 95% CI: 0.0-3.6). Patients with mild and moderate symptoms traded PFS for less risks or more convenience if the severe symptoms were not experienced. Conclusion: This study demonstrates the value of conjoint analysis in the study of patient preferences for cancer treatments. In this small sample of patients with NSCLC from the UK, we demonstrate that the value of improvements in PFS is conditional upon the severity of disease symptoms; and that risks are valued differently.

Original languageEnglish (US)
Pages (from-to)224-231
Number of pages8
JournalLung Cancer
Volume77
Issue number1
DOIs
StatePublished - Jul 2012

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Patient Preference
Non-Small Cell Lung Carcinoma
Disease-Free Survival
Exanthema
Nausea
Vomiting
Fatigue
Oral Administration
Diarrhea
Fever
Therapeutics
Infection
Surveys and Questionnaires
Neoplasms

Keywords

  • Benefit-risk assessment
  • Choice behaviour
  • Non-small cell lung cancer
  • Patient preferences
  • Progression-free survival

ASJC Scopus subject areas

  • Oncology
  • Pulmonary and Respiratory Medicine
  • Cancer Research

Cite this

Patients' preferences for treatment outcomes for advanced non-small cell lung cancer : A conjoint analysis. / Bridges, John F P; Mohamed, Ateesha F.; Finnern, Henrik W.; Woehl, Anette; Hauber, A. Brett.

In: Lung Cancer, Vol. 77, No. 1, 07.2012, p. 224-231.

Research output: Contribution to journalArticle

Bridges, John F P ; Mohamed, Ateesha F. ; Finnern, Henrik W. ; Woehl, Anette ; Hauber, A. Brett. / Patients' preferences for treatment outcomes for advanced non-small cell lung cancer : A conjoint analysis. In: Lung Cancer. 2012 ; Vol. 77, No. 1. pp. 224-231.
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abstract = "Background: Treatment decisions for advanced non-small cell lung cancer (NSCLC) are complex and require trade-offs between the benefits and risks experienced by patients. We evaluated the benefits that patients judged sufficient to compensate for the risks associated with therapy for NSCLC. Methods: Participants with a self-reported diagnosis of NSCLC (n= 100) were sampled from an online panel in the United Kingdom. Eligible and consenting participants then completed a self-administered online survey about their disease and their treatment preferences were assessed. This involved respondents choosing among systematically paired profiles that spanned eight attributes: progression-free survival [PFS], symptom severity, rash, diarrhoea, fatigue, nausea and vomiting, fever and infection, and mode of treatment administration (infusion and oral). A choice model was estimated using mixed-logit regression. Estimates of importance for each attribute level and attribute were then calculated and acceptable tradeoffs among attributes were explored. Results: A total of 89 respondents (73{\%} male) completed all choice tasks appropriately. Increases in PFS together with improvements in symptom severity were judged most important and increased with PFS benefit - 4 months: 5.7; 95{\%} CI: 3.5-7.9; 5 months: 7.1; 95{\%} CI: 4.4-9.9; and 7 months: 10.0; 95{\%} CI: 6.1-13.9. However, improvements in PFS were viewed as most beneficial when disease symptoms were mild and as detrimental when patients had severe symptoms. Fatigue (5.0; 95{\%} CI: 2.7-7.3) was judged to be the most important risk, followed by diarrhoea (2.8; 95{\%} CI: 0.7-4.9), nausea and vomiting (2.1; 95{\%} CI: 0.1-4.1), fever and infection (2.1; 95{\%} CI: 0.2-4.1), and rash (2.0; 95{\%} CI: 0.2-3.9). Oral administration was preferred to infusion (1.8; 95{\%} CI: 0.0-3.6). Patients with mild and moderate symptoms traded PFS for less risks or more convenience if the severe symptoms were not experienced. Conclusion: This study demonstrates the value of conjoint analysis in the study of patient preferences for cancer treatments. In this small sample of patients with NSCLC from the UK, we demonstrate that the value of improvements in PFS is conditional upon the severity of disease symptoms; and that risks are valued differently.",
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