https://orcid.org/0000-0003-0405-4252
Abstract
Objective
Increased treatment options and longer survival for lung cancer have generated increased interest in patient preferences. Previous studies of patient preferences in lung cancer have not fully explored preference heterogeneity. We demonstrate a method to explore preference heterogeneity in the willingness of patients with lung cancer and caregivers to trade progression-free survival (PFS) with side effects.
Patients and Methods
Patients and caregivers attending a national lung cancer meeting completed a discrete-choice experiment (DCE) designed through a collaboration with patients. Participants answered 13 choice tasks described across PFS, short-term side effects, and four long-term side effects. Side effects were coded as a one-level change in severity (none-mild, mild-moderate, or moderate-severe). A mixed logit model in willingness-to-pay space estimated preference heterogeneity in acceptable tradeoffs (time equivalents) between PFS and side effects. The study was reported following quality indicators from the United States Food and Drug Administration’s patient preference guidance.
Results
A total of 87 patients and 24 caregivers participated in the DCE. Participants would trade 3.7 month PFS (95% CI (CI): 3.3–4.1) for less severe functional long-term treatment side effects, 2.3 months for less severe physical long-term effects (CI: 1.9–2.8) and cognitive long-term effects (CI: 1.8–2.8), 0.9 months (CI: 0.4–1.4) for less severe emotional long-term effects, and 1.8 months (CI: 1.4–2.3) for less severe short-term side effects. Most participants (90%) would accept treatment with more severe functional long-term effects for 8.4 additional month PFS.
Conclusion
Participants would trade PFS for changes in short-term side effects and long-term side effects, although preference heterogeneity existed. Lung cancer treatments that offer less PFS but also less severe side effects might be acceptable to some patients.
Acknowledgments
The authors sincerely thank LUNGevity and the members of the Patient Action Committee (PAC) for their participation, engagement, and valuable contributions to Project Transform.
Compliance with Ethical Standards
This work was supported by LUNGevity (with funding from Celgene). Celgene had no influence on the design of the project, data collection, analysis, interpretation, or writing of the report. The authors report no potential conflicts of interest. This research was conducted in accordance with the Declaration of Helsinki, and the study protocol was reviewed by the Johns Hopkins Institutional Review Board (IRB 6404).
Disclosure
The abstract of this paper was presented at the IASLC 17th World Conference on Lung Cancer as a poster presentation/conference talk with interim findings. The poster’s abstract was published in the Journal of Thoracic Oncology: DOI: https://doi.10.1016/j.jtho.2016.11.2197.
Dr Carolyn J Presley reports other funding from Potential Metrics, outside the submitted work. Dr. Presley is a Paul Calabresi Scholars supported by the OSU K12 Training Grant for Clinical Faculty Investigators (5K12 CA133250-09). Dr John FP Bridges reports grants from LUNGevity, personal fees, non-financial support from AstraZeneca, during the conduct of the study. The authors have no other competing interests to declare.