First-Line Treatment of Metastatic Lung Cancer: Patient and Caregiver Preferences
Posted: Wednesday, April 8, 2020
According to findings from two quantified surveys initially slated for presentation at the 2020 NCCN Annual Conference (Abstracts HSR20-106, 112) and published in JNCCN–Journal of the National Comprehensive Cancer Network (JNCCN), caregivers managing treatment for patients with metastatic non–small cell lung cancer are willing to accept higher toxicity risks in exchange for increased overall survival—and patients seemed to be willing to accept similar trade-offs between efficacy and toxicity. The study authors, Candice Yong, PhD, and Brian Seal, PhD, MBA, RPh, both of the University of Maryland, Baltimore, and colleague, stressed that these patient and caregiver considerations should be part of all treatment plans.
“These results can provide guidance to oncologists when counseling [patients] about selecting among available [first-line] treatments for metastatic NSCLC and underscore the need for [patient]-doctor discussions about the benefits and risks of treatment,” Dr. Seal and colleagues concluded in their study.
In both surveys, 308 patients and 166 caregivers completed cross-sectional surveys that assessed preferences using a discrete choice experiment based on qualitative research. Hypothetical treatment profiles were presented side by side, and subjects chose the ones they preferred. Additional questions about the economic burden of caregiving were asked for subjects in that pool.
For caregivers, increasing overall survival from 11 months to 30 months was considered the most important consideration, followed by decreasing the risk of serious adverse events that may lead to hospitalization. Both factors were more than twice as important as other listed attributes. Additionally, 72% of caregivers provided financial support, with 30% incurring out-of-pocket costs for travel to treatment, and 25% reporting unpaid leave from work.
For patients, increasing overall survival from 11 to 30 months was the most important factor, followed by decreasing the risk of grade 3 or 4 adverse events. These two factors were considered three times as important as other attributes. Patients were willing to accept an increase in the risk of grade 3 or 4 adverse events from 18% to 17% if overall survival increased by 17 months.
Disclosure: Drs. Seal, Yong, and Cotarla are employees of AstraZeneca. Drs. Cambron-Mellott, Will, Maculaitis, and Clapp as well as Ms. Mulvihill are employees of Kantar, which received payment from AstraZeneca for this study. Dr. Mehra has received research support from Merck, AstraZeneca, Seattle Genetics, Innate Pharma, and Aduro Biotech.
