Patient preferences for palliative treatment of locally advanced or metastatic gastric cancer and adenocarcinoma of the gastroesophageal junction: a choice-based conjoint analysis study from Germany

Abstract

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.

Exploring Patient Preferences for Adjunct-to-Insulin Therapy in Type 1 Diabetes

“…The core of conjoint analysis relies on the untangling of the complex tradeoffs patients unconsciously make when selecting one drug product over another, allowing for the objective qualification of patient preferences. Based on the reliability of this unbiased analysis methodology, its use to measure patient preferences has increased in health care research where health authorities such as the U.S. Food and Drug Administration (Center for Devices and Radiological Health) also value its utility (33)(34)(35)(36). Other strengths of the survey are the clinical applicability and relevance of the data generated, given the baseline clinical characteristics of the selected respondent population.…”

Patient Preferences Regarding Chemotherapy in Metastatic Breast Cancer—A Conjoint Analysis for Common Taxanes

“…Using conjoint analysis techniques may help in identification of trends in general patient preferences over time and detection of relevant shifts in culture. Interestingly, among other recent studies an excellent study by Ballinger et al found patients to tend to favor toxicity concerns over treatment benefit ( 11 , 13 ), while older studies often found survival benefit to be of supreme importance ( 16 , 28 – 30 ). Clinical trials on population level generally focus on survival benefit as the primary endpoint and most critical aspect of therapy.…”

“…Generally, the technique of conjoint analysis is widely used in the medical and non-medical field for assessment of preferences and has been demonstrated to offer a valuable tool to elicit patient preferences or utilities for specific treatments ( 11 – 14 ). In regard to medical treatment, conjoint analysis has proven to be useful for preference elicitation mainly in cancer therapy ( 11 , 13 , 15 , 16 ). By having participants evaluate alternatives and letting them choose between different combinations of attributes, the relative importance of each attribute can be deducted ( 17 ).…”

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“…It is commonly used both in scientific research and business analysis. Looking at the latest researches with conjoint usage, it can be noticed that the range of usage is very broad: from business and consumer preferences research [Meyerding 2016], across medicine and patient preferences [Hofheinz et al 2016], housing market [Rofè, Pashtan, Hornik 2017] and even hotels and restaurants [Lee 2016].…”