Patient Preferences for Minimally Invasive and Open Locoregional Treatment for Early-Stage Breast Cancer

Knuttel, Floortje M.; Bosch, Maurice A.A.J. van den; Young‐Afat, Danny A.; Emaus, Marleen J.; Bongard, H. J. G. D. van den; Witkamp, Arjen J.; Verkooijen, Helena M.

doi:10.1016/j.jval.2016.10.013

Cited by 11 publications

(15 citation statements)

References 27 publications

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“…Three studies used the 5L version of the EQ-5D. 18 – 20 Four studies (5.1%) compared direct and indirect methods, 21 – 24 6 studies (7.6%) compared 1 or more types of direct utility estimation methods, 20 , 21 , 25 – 28 and 3 studies (3.8%) compared 1 or more types of indirect utility elicitation methods. 9 , 13 , 29 Three studies (5.4%) compared country-specific algorithms.…”

Section: Resultsmentioning

confidence: 99%

“…Thirteen studies 17 , 20 , 26 , 27 , 46 , 55 , 64 , 73 , 77 , 81 , 82 , 87 , 97 used direct (SG, TTO, VAS) and indirect (EQ-5D, VR-6D) methods to obtain health utilities for breast cancer surgery ( Figure 2b ). Breast cancer surgery–related mean utilities were found to have large variation; utilities for breast-conserving surgery (range, 0.53 to 0.91) and mastectomy (range, 0.48 to 0.87) were found to be lower compared with utilities for mastectomy followed by breast-conserving surgery (range, 0.75 to 0.89) and bilateral mastectomy (range, 0.70 to 0.86).…”

Section: Resultsmentioning

confidence: 99%

“…Five studies 17 , 20 , 46 , 63 , 97 measured utilities related to breast cancer surgery and radiation combined. The values for mastectomy and radiation were lowest (range, 0.44 to 0.61), whereas the utilities for breast-conserving surgery (with or without mastectomy) and radiation or repeat breast-conserving surgery and radiation fell between 0.66 and 0.95.…”

Section: Resultsmentioning

confidence: 99%

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A Systematic Literature Review of Health Utility Values in Breast Cancer

et al. 2022

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Background Health utility values (HUVs) are important inputs to the cost-utility analysis of breast cancer interventions. Purpose Provide a catalog of breast cancer–related published HUVs across different stages of breast cancer and treatment interventions. Data Sources Systematic searches of MEDLINE, MEDLINE In-Process, EMBASE, Web of Science, CINAHL, PsycINFO, EconLit, and Cochrane databases (2005–2017). Study Selection Studies published in English that reported mean or median HUVs using direct or indirect methods of utility elicitation for breast cancer. Data Extraction Independent reviewers extracted data on a preestablished and piloted form; disagreements were resolved through discussion. Data Analysis Mixed-effects meta-regression using restricted maximum likelihood modeling was conducted for intervention type, stage of breast cancer, and typical clinical and treatment trajectory of breast cancer patients to assess the effect of study characteristics (i.e., sample size, utility elicitation method, and respondent type) on HUVs. Data Synthesis Seventy-nine studies were included in the review. Most articles ( n = 52, 66%) derived HUVs using the EQ-5D. Patients with advanced-stage breast cancer (range, 0.08 to 0.82) reported lower HUVs as compared with patients with early-stage breast cancer (range, 0.58 to 0.99). The meta-regression analysis found that undergoing chemotherapy and surgery and radiation, being diagnosed with an advanced stage of breast cancer, and recurrent cancer were associated with lower HUVs. The members of the general public reported lower HUVs as compared with patients. Limitations There was considerable heterogeneity in the study population, health states assessed, and utility elicitation methods. Conclusion This review provides a catalog of published HUVs related to breast cancer. The substantial heterogeneity in the health utility studies makes it challenging for researchers to choose which HUVs to use in cost-utility analyses for breast cancer interventions.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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A Systematic Literature Review of Health Utility Values in Breast Cancer

et al. 2022

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“…Within UMBRELLA, Knuttel et al assessed preferences of breast cancer patients and healthy women regarding new non- and minimally invasive breast cancer treatment options, compared to conventional surgical treatments. These results may be helpful to guide the development of innovative breast cancer therapies and randomized studies to evaluate these novel techniques [24]. …”

Section: Resultsmentioning

confidence: 99%

The Utrecht cohort for Multiple BREast cancer intervention studies and Long-term evaLuAtion (UMBRELLA): objectives, design, and baseline results

Young‐Afat

Gils

Bongard

et al. 2017

Breast Cancer Res Treat

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PurposeIn oncology, RCTs are often beset by slow recruitment, limited generalizability, and strong preferences for interventions by patients and physicians. The cohort multiple randomized controlled trial (cmRCT) is an innovative design with the potential to overcome those challenges. In cmRCT, a prospective cohort serves as an infrastructure for multiple RCTs. We implemented cmRCT in a clinical breast cancer setting by creating UMBRELLA—a large prospective cohort of breast cancer and DCIS patients/survivors.MethodsFor all participants, clinical data and patient-reported outcomes (PROs, i.e., quality of life, fatigue, anxiety and depression, physical activity, work ability, and cosmetic satisfaction) are being collected at regular time-intervals for a period of 10 years. These data are being used both for observational and randomized studies. For each intervention to be tested against standard care, a subcohort of eligible patients is identified within UMBRELLA. From this subcohort, a random sample of patients is offered the intervention. Their outcomes are compared to the outcomes of patients receiving standard care.ResultsSo far, between October 2013 and July 2016, we have recruited 1308 participants. In this period, 1308/1486 (88%) patients who were invited for participation in UMBRELLA consented to cohort participation. Of these patients, 1138 (87%) gave broad consent for randomization to future interventions. Return rate for PROs at baseline were 80%, and varied from 67 to 74% during follow-up. Several observational studies—and the first randomized intervention study—are currently ongoing.ConclusionsResults from UMBRELLA show that this novel study design is feasible and acceptable to patients in a clinical breast cancer setting. We invite researchers who are interested in conducting randomized or observational studies within the UMBRELLA cohort to contact the UMBRELLA scientific advisory board.

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“…The authors attributed this to previous experiences with specific treatment options when compared with healthy women. 32 Moreover, societal perspectives are, in general, favorable in terms of cost-effectiveness and directly advising decision makers. Institutions (eg, national health insurance, health systems agencies, and healthmaintenance organizations) place greater emphasis on the societal perspectives, continuously increasing the importance, and value of cost-effectiveness measures.…”

Section: Discussionmentioning

confidence: 99%

Analysis of Utility Assessment Scores to Objectify the Health Burden Caused by Breast Conservation Therapy

et al. 2020

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Background: Lumpectomy followed by radiation, known as breast conservation therapy (BCT), is a viable surgical treatment option for early-stage breast cancer. However, the current literature suggests that patients prefer mastectomy over BCT, likely due to the wide variety of postmastectomy reconstructive options. Our aim is to investigate the objective health burden of living with BCT to help surgeons gain a better understanding of patient treatment preferences. Methods: Three validated health state utility tools were used to objectify the burden of living with post-BCT results: visual analogue scale (VAS), time trade-off (TTO), and standard gamble (SG). A prospective sample of the general population and medical students were recruited, and their responses analyzed to attain these scores. Results: Utility scores for living with BCT are VAS 0.81 ± 0.19, TTO 0.93 ± 0.10, and SG 0.92 ± 0.14. The TTO and SG suggest a willingness to trade 2.5 years of life years and an 8% chance of death undergoing reconstructive procedures to correct a BCT defect, respectively. Age, gender, race, education, and income were not statistically significant independent predictors for higher or lower utility scores. Conclusion: The impact of the health burden of BCT was ascertained using validated objective numeric utility scores. These indices demonstrate a willingness to trade less life years to undergo correction of a BCT defect than reconstruction following unilateral mastectomy. They can provide surgeons with the best objective understanding of patient preferences for shared decision-making in the management of breast cancer.

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Patient Preferences for Minimally Invasive and Open Locoregional Treatment for Early-Stage Breast Cancer

Abstract: This study showed no significant preference for minimally invasive treatment for breast cancer. Using hypothetical scenarios, breast cancer survivors attributed the highest scores to BCT, whereas healthy volunteers showed a slight preference for minimally invasive treatments.

Cited by 11 publications

References 27 publications

A Systematic Literature Review of Health Utility Values in Breast Cancer

A Systematic Literature Review of Health Utility Values in Breast Cancer

The Utrecht cohort for Multiple BREast cancer intervention studies and Long-term evaLuAtion (UMBRELLA): objectives, design, and baseline results

Analysis of Utility Assessment Scores to Objectify the Health Burden Caused by Breast Conservation Therapy

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