Abstract
Purpose: This study aimed to evaluate Japanese patient preferences regarding features of intermediate or advanced (Progressed) hepatocellular carcinoma (HCC) treatments: transarterial chemoembolization (TACE), hepatic arterial infusion chemotherapy (HAIC), and oral anti-cancer therapy.
Methods: Patients with HCC, recruited from clinical sites and a patient panel in Japan, completed a cross-sectional web-based survey. Preferences were quantified using best–worst scaling, where patients identified the best and worst among 13 treatment features. Direct elicitation was used to identify preference for TACE, HAIC, or oral therapy, including the likelihood of trying each. Additional items asked for the willingness to try an oral medication that delays progression by six months but has an 8% or 21% risk of severe hand-foot skin reaction (HFSR).
Results: The sample (N=119; 29 early stage; 90 Progressed) most preferred “oral medication”, “artery branches plugged”, and “prevents formation of new blood vessels”, and least preferred “risk of liver damage” and “risk of catheter-related complications”. Overall, 51%, 40%, and 8% preferred oral therapy, TACE, and HAIC, respectively (p<0.05), and the mean likelihood of trying each were 59%, 52%, and 35%, respectively (p<0.001). Patients with sorafenib or TACE experience most preferred what they had received; however, both groups were equally willing to try the other treatment. Patients preferring oral therapy favored “oral medication” over “artery branches plugged”, “surgery is repeated as required when the cancer grows again”, and “risk of liver damage”, compared to those preferring TACE (p<0.05). Sixty-eight percent would probably try therapy with an 8% risk of severe HFSR, compared to 50% with a 21% risk.
Conclusion: Treatment type, mode of action, and risks may drive HCC patient preferences. Such features likely should be incorporated into physician–patient interactions regarding treatment decision-making.
Acknowledgments
The authors would like to acknowledge Masaaki Jitsu and Yuki Nishiyama for logistical support and Erika Tanaka for study concept support. All are employees of Bayer Yakuhin, Ltd. Conduct of this study and preparation of this paper were funded by Bayer Yakuhin, Ltd. Bayer approved the submission of the manuscript.
Ethics approval and informed consent
The study protocol was approved by the Ethical Review Committees of all the participating institutions: Chiba University, Ehime Prefectural Central Hospital, Kikkoman General Hospital, Numazu City Hospital, Osaka Red Cross Hospital, Kimitsu Chuo Hospital, and Mitsui Memorial Hospital, as well as the central IRB, Magil IRB (Rockville, MD). Patient recruitment was conducted from May to September 2016 (CT.gov: NCT02616692).
Data availability
The study data are available upon request from the corresponding author.
Author contributions
T. Chiba and O. Yokosuka contributed to the questionnaire clinical review, study design, data collection, data analysis and interpretation, and manuscript preparation. A. Hiraoka, S. Mikami, M. Shinozaki, Y. Osaki, M. Obu and T. Ohki contributed to the data collection, data analysis, and data interpretation. N. Mita, D. Ledesma, N. Yoshihara, K. Beusterien, K. Amos, and J. Bridges contributed to the study design, data analysis and interpretation, and manuscript preparation. All authors contributed to data analysis, drafting and revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.
Disclosure
T. Chiba reports commercial research funding from Bayer Yakuhin, Ltd. He also reports grants from Bayer Inc., during the conduct of the study and outside the submitted work. N. Mita, D. Ledesma, and N. Yoshihara are employees of Bayer Yakuhin, Ltd. K. Beusterien and K. Amos worked for ORS Health, which provided consulting services to Bayer Yakuhin, Ltd. during this study. J. Bridges has consulted for Bayer and has received travel support from Bayer. He also received personal fees from ORS Health, during the conduct of the study. T. Ohki reports personal fees from Bayer Yakuhin, personal fees from Eisai, outside the submitted work. O. Yokosuka reports personal fees from BMS, personal fees from Bayer, grants from Eisai, Takeda, Chugai, MSD, DS Pharma, Daiichi-Sankyo, Astellas, Asahi-kasei, Tanabe, and Nipponkayaku, outside the submitted work. The authors report no other conflicts of interest in this work.