BackgroundDecisions on palliative chemotherapy (CT) for locally advanced or metastatic gastric cancer (mGC) require trade-offs between potential benefits and risks for patients. Healthcare providers and payers agree that patient-preferences should be considered. We conducted a choice-based conjoint (CBC) analysis study in pre-treated patients from Germany with mGC or locally advanced or metastatic adenocarcinoma of the gastroesophageal junction (mGEJ-Ca), to evaluate their preferences when hypothetically selecting a CT regimen.MethodsGerman oncologists and gastroenterologists were contacted to identify patients with mGC or mGEJ-Ca who had completed ≥2 cycles of palliative CT in first or later lines of therapy (CT ongoing or complete). The primary objective was to quantify patient preferences for palliative CT by CBC analysis. Six in-depth qualitative interviews identified 3 attributes: treatment tolerability, quality of life in terms of ability of self-care, and additional survival benefit. The CBC matrix was constructed with 4 factor levels per attribute and each participant was presented with 15 different iterations of these levels. A minimum of 50 participants was needed. Consenting patients completed the CBC survey, choosing systematically among profiles. CBC models were estimated by multinomial logistic regression (MLR) and hierarchical Bayesian (HB) analysis. Estimates of importance for each attribute and factor-level were calculated.ResultsFifty-five patients participated in the CBC survey (78.2% male, median age 63 years, 81.8% currently receiving CT). Across this sample, low treatment toxicity was ranked highest (44.6% relative importance, MLR analysis), followed by ability to self-care (32.3%), and an additional survival benefit of up to 3 months (3 months 23.1%, 2 months 18.3%, 1 month 11.2%). The MLR analysis showed high validity (certainty 37.9%, chi square p < 0.01, root-likelihood 0.505). The HB analysis yielded similar results.ConclusionsPatients’ preferences related to a new hypothetical palliative CT of mGC or mGEJ-Ca can be assessed by CBCanalysis. Although in real-life, patients initially need to decide on CT before they have any experience, and patients’ varied experiences with CT will have impacted specific responses, low toxicity and self-care ability were considered as most important by this group of patients with mGC or mGEJ-Ca.
Decisions on palliative chemotherapy (CT) for advanced gastric cancer require trade-offs between potential benefits and risks for patients. Healthcare providers and payers agreed that patient preferences should be considered. We conducted a CBC study in patients with mGC or mGEJ-Ca from Germany to evaluate their preferences when trading-off between treatment tolerability, quality of life and survival benefit. METHODS: German oncologists were contacted to identify patients with mGC or mGEJ-Ca who had completed ≥ 2 cycles of palliative CT (ongoing or completed). The primary objective was the quantitative evaluation of patient preferences for palliative CT in this population by CBC analysis. The CBC matrix, developed based on 6 in-depth qualitative interviews, spanned the 3 attributes ability to self-care as a key component for quality of life, treatment toxicity and survival benefit (3-4 factor levels each, 15 iterations). A minimum of 50 participants was needed. Eligible consenting patients completed the 45min standardized CBC-survey, choosing systematically among profiles. CBC models were estimated by mixed-logit regression (MLR) and hierarchical Bayes analysis (HB). Estimates of importance for each attribute and factor-level were calculated. RESULTS: Overall, 55 patients participated in the survey (78% male, median age 63yrs, 82% currently receiving CT). Patients considered low treatment toxicity as most important (45% relative importance, MLR analysis), followed by ability to self-care (32%) and an additional survival benefit of up to 3 months (3 months 23%, 2 months 18%, 1 month 11%). The MLR analysis showed high validity (certainty 37.9%, chi square p< 0.01, root likelihood 0.505). The HB analysis yielded similar results. CONCLUSIONS: Patient preferences related to palliative CT of gastric cancer can appropriately be assessed by CBC analysis. Though patients' varied experiences with chemotherapy may have impacted specific responses, across the population of patients with mGC or mGEJ-Ca improved treatment tolerability and quality of life were ranked highest.
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