Preferences of Canadian Patients and Physicians for Adjuvant Treatments for Melanoma

Stellato, Daniel; Thabane, Marroon; Eichten, Caitlin; Delea, Thomas E.

doi:10.3747/co.26.5085

Cited by 8 publications

(8 citation statements)

References 20 publications

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“…Most studies (n = 70, 89%; e.g. [36,43,51,64,95]) were conducted in one country, with three studies (4% [50,84,97]) conducted in two countries and six (8% [39,41,58,75,110,111]) conducted in three countries. No study included more than three countries.…”

Section: Search Resultsmentioning

confidence: 99%

A Systematic Review of Discrete Choice Experiments in Oncology Treatments

Collacott

Soekhai

Thomas

et al. 2021

Patient

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Background As the number and type of cancer treatments available rises and patients live with the consequences of their disease and treatments for longer, understanding preferences for cancer care can help inform decisions about optimal treatment development, access, and care provision. Discrete choice experiments (DCEs) are commonly used as a tool to elicit stakeholder preferences; however, their implementation in oncology may be challenging if burdensome trade-offs (e.g. length of life versus quality of life) are involved and/or target populations are small. Objectives The aim of this review was to characterise DCEs relating to cancer treatments that were conducted between 1990 and March 2020. Data Sources EMBASE, MEDLINE, and the Cochrane Database of Systematic Reviews were searched for relevant studies. Study Eligibility Criteria Studies were included if they implemented a DCE and reported outcomes of interest (i.e. quantitative outputs on participants' preferences for cancer treatments), but were excluded if they were not focused on pharmacological, radiological or surgical treatments (e.g. cancer screening or counselling services), were non-English, or were a secondary analysis of an included study. Analysis Methods Analysis followed a narrative synthesis, and quantitative data were summarised using descriptive statistics, including rankings of attribute importance. Result Seventy-nine studies were included in the review. The number of published DCEs relating to oncology grew over the review period. Studies were conducted in a range of indications (n = 19), most commonly breast (n =10, 13%) and prostate (n = 9, 11%) cancer, and most studies elicited preferences of patients (n = 59, 75%). Across reviewed studies, survival attributes were commonly ranked as most important, with overall survival (OS) and progression-free survival (PFS) ranked most important in 58% and 28% of models, respectively. Preferences varied between stakeholder groups, with patients and clinicians placing greater importance on survival outcomes, and general population samples valuing health-related quality of life (HRQoL). Despite the emphasis of guidelines on the importance of using qualitative research to inform attribute selection and DCE designs, reporting on instrument development was mixed. Limitations No formal assessment of bias was conducted, with the scope of the paper instead providing a descriptive characterisation. The review only included DCEs relating to cancer treatments, and no insight is provided into other health technologies such as cancer screening. Only DCEs were included. Conclusions and Implications Although there was variation in attribute importance between responder types, survival attributes were consistently ranked as important by both patients and clinicians. Observed challenges included the risk of attribute dominance for survival outcomes, limited sample sizes in some indications, and a lack of reporting about instrument development processes. Protocol Registration PROSPERO 2020 CRD42020184232.

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Section: Search Resultsmentioning

confidence: 99%

A Systematic Review of Discrete Choice Experiments in Oncology Treatments

Collacott

Soekhai

Thomas

et al. 2021

Patient

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“…The improved RFS [ 9 , 10 , 18 ], as well as the experience in adverse-event management already gained in the advanced metastatic setting, might have been reasons for the rapid and high acceptance of adjuvant ICI and TT by physicians. A recent Canadian cross-sectional survey confirmed that patients considered RFS the most important and OS the second most important attribute of adjuvant treatment, and preferred active treatment to follow-up alone [ 25 ]. In our cohort, the tumor board decided against adjuvant treatment only in very few cases due to patients´ comorbidities or low sentinel tumor burden, reflecting physicians’ attitudes toward the safety and efficacy of current adjuvant therapy options.…”

Section: Discussionmentioning

confidence: 99%

Factors Influencing the Adjuvant Therapy Decision: Results of a Real-World Multicenter Data Analysis of 904 Melanoma Patients

Lodde

Forschner

Hassel

et al. 2021

Cancers

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Adjuvant treatment of melanoma patients with immune-checkpoint inhibition (ICI) and targeted therapy (TT) significantly improved recurrence-free survival. This study investigates the real-world situation of 904 patients from 13 German skin cancer centers with an indication for adjuvant treatment since the approval of adjuvant ICI and TT. From adjusted log-binomial regression models, we estimated relative risks for associations between various influence factors and treatment decisions (adjuvant therapy yes/no, TT vs. ICI in BRAF mutant patients). Of these patients, 76.9% (95% CI 74–80) opted for a systemic adjuvant treatment. The probability of starting an adjuvant treatment was 26% lower in patients >65 years (RR 0.74, 95% CI 68–80). The most common reasons against adjuvant treatment given by patients were age (29.4%, 95% CI 24–38), and fear of adverse events (21.1%, 95% CI 16–28) and impaired quality of life (11.9%, 95% CI 7–16). Of all BRAF-mutated patients who opted for adjuvant treatment, 52.9% (95% CI 47–59) decided for ICI. Treatment decision for TT or ICI was barely associated with age, gender and tumor stage, but with comorbidities and affiliated center. Shortly after their approval, adjuvant treatments have been well accepted by physicians and patients. Age plays a decisive role in the decision for adjuvant treatment, while pre-existing autoimmune disease and regional differences influence the choice between TT or ICI.

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“…When the total choice sets were beyond the cognitive capability of respondents, the blocking technique was used to reduce the number of choice tasks in one questionnaire [13]. Seven studies (21%) included opt-out or status quo options [43,44,53,[56][57][58][59].…”

Section: Methodsmentioning

confidence: 99%

Patient Preferences in Targeted Pharmacotherapy for Cancers: A Systematic Review of Discrete Choice Experiments

Jiang

Ren

et al. 2022

PharmacoEconomics

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Background Targeted pharmacotherapy has been increasingly applied in cancer treatment due to its breakthroughs. However, the unmet needs of cancer patients are still significant, highlighting the urgency to investigate patient preferences. It is unclear how patients deliberate their choices between different aspects of targeted therapy, including cost, efficacy, and adverse events. Since discrete choice experiments (DCEs) have been widely applied to patient preference elicitation, we reviewed DCEs on targeted therapy for different cancers. We also synthesized evidence on the factors influencing patients' choices and their willingness-to-pay (WTP) for survival when treated by targeted therapy. Methods We searched databases, including PubMed, EMBASE and MEDLINE, up to August 16, 2022, supplemented by a reference screening. The attributes from the selected studies were categorized into three groups: outcomes, costs, and process. We also calculated the relative importance of attributes and WTP for survival whenever possible. The purpose, respondents, explanation, findings, significance (PREFS) checklist was used to evaluate the quality of the included DCE studies. Results The review identified 34 eligible studies from 13 countries covering 14 cancers, such as breast, ovarian, kidney, prostate, and skin cancers. It also reveals a rising trend of DCEs on this topic, as most studies were published after 2018. We found that patients placed higher weights on the outcome (e.g., overall survival) and cost attributes than on process attributes.

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Preferences of Canadian Patients and Physicians for Adjuvant Treatments for Melanoma

Cited by 8 publications

References 20 publications

A Systematic Review of Discrete Choice Experiments in Oncology Treatments

A Systematic Review of Discrete Choice Experiments in Oncology Treatments

Factors Influencing the Adjuvant Therapy Decision: Results of a Real-World Multicenter Data Analysis of 904 Melanoma Patients

Patient Preferences in Targeted Pharmacotherapy for Cancers: A Systematic Review of Discrete Choice Experiments

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