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Published on: March 6, 2018
Physician preferences for non-metastatic castration-resistant prostate cancer treatment
Sandy Srinivas1, Ateesha F Mohamed2, Sreevalsa Appukkuttan2
1Stanford University Medical Center, Palo Alto, California, USA. sandysri@stanford.edu.
Background:
Recent approvals of second-generation androgen receptor inhibitors (SGARIs) have changed the treatment landscape for non-metastatic castration-resistant prostate cancer (nmCRPC). These SGARIs have similar efficacy but differ in safety profiles. We used a discrete choice experiment to explore how United States physicians make treatment decisions between adverse events (AEs) and survival gains in nmCRPC, a largely asymptomatic disease.
Methods:
Treating physicians (n = 149) participated in an online survey that included 14 treatment choice questions, each comparing 2 hypothetical treatment profiles, which varied in terms of 5 safety and 2 efficacy attributes. We described safety attributes (fatigue, skin rash, cognitive problems, falls, and fractures) in terms of severity and frequency, and efficacy attributes (overall survival [OS] and time to pain progression) in terms of duration of effect. We used a random parameters logit model to estimate preference weights and importance scores for each attribute. We also estimated the amount of survival gain physicians were willing to trade for a reduction in specific AEs between treatment options.
Results:
Physicians placed more importance on survival than on time to pain progression, and viewed a reduction in cognitive problems from severe to none, a reduction in risk of a serious fracture from 8% to none, and a reduction in fatigue from severe to none as the most important safety attributes. Physicians were willing to forego 9.1 and 6.6 months of OS, respectively, to reduce cognitive problems and fatigue from severe to mild-to-moderate. To reduce the risk of a serious fracture from 8 to 5% and 5% to none, physicians were willing to trade 3.9 and 5.3 months of OS, respectively.
Conclusions:
Physicians were willing to trade substantial amounts of survival to avoid AEs between hypothetical treatments. These results emphasize the importance of carefully balancing therapies' benefits and risks to ultimately optimize the overall quality of nmCRPC patients' survival. Nonetheless, it is noted that the results from the study sample of 149 physicans may not be representative of the viewpoints of all nmCRPC-treating physicians.
Insights
Physicians prioritize survival over pain progression in non-metastatic castration-resistant prostate cancer (nmCRPC) treatment decisions. They are willing to trade significant survival months to reduce adverse events like cognitive problems and fatigue.
Area of Science:
- Oncology
- Clinical Decision Making
- Patient-Reported Outcomes
Background:
- Second-generation androgen receptor inhibitors (SGARIs) have transformed nmCRPC treatment.
- SGARIs offer comparable efficacy but varied safety profiles.
- Understanding physician treatment preferences is crucial for optimizing patient care.
Purpose of the Study:
- To investigate how US physicians weigh adverse events against survival gains in nmCRPC treatment decisions.
- To quantify the trade-offs physicians are willing to make between specific side effects and overall survival.
- To inform clinical practice and treatment guidelines for nmCRPC.
Main Methods:
- A discrete choice experiment involving 149 US physicians.
- Physicians evaluated hypothetical treatment profiles varying in safety (fatigue, rash, cognitive, falls, fractures) and efficacy (overall survival, time to pain progression).
- A random parameters logit model analyzed attribute importance and willingness-to-trade survival for AE reduction.
Main Results:
- Physicians prioritized overall survival over time to pain progression.
- Reducing cognitive problems and fractures were highly valued safety attributes.
- Physicians were willing to trade substantial months of overall survival to mitigate severe adverse events like cognitive issues (9.1 months), fatigue (6.6 months), and fractures (up to 5.3 months).
Conclusions:
- Physicians are willing to sacrifice significant survival time to avoid severe adverse events in nmCRPC treatment.
- Balancing treatment benefits and risks is essential for optimizing patient quality of life.
- Study findings may not represent all nmCRPC-treating physicians due to sample size.
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