(UroToday.com) On the third day of the American Society for Clinical Oncology (ASCO) Genitourinary Cancer Symposium 2023, Poster Session focused on Renal Cell Cancer, Adrenal, Penile, Urethral and Testicular Cancers. In this context, Shawna Calhoun presented a discrete-choice experiment aimed at understanding patient and physician preferences regarding adjuvant treatment in patients with renal cell carcinoma following resection.
While there has been significant progress in treatment options for patients with advanced renal cell carcinoma (RCC), few studies have elicited treatment preferences. Most of these studies have focused on the treatment of advanced disease. However, there have been a number of recent studies evaluating systemic therapy (particularly immune checkpoint inhibitors) as adjuvant therapy following resection of RCC. Thus, these authors sought to assess United States patients’ and physicians’ preferences for adjuvant treatment characteristics.
To do so, the authors enrolled patients with physician-confirmed RCC and (physician-defined) intermediate high or high risk of recurrence and physicians who treat such patients to complete online surveys in Q1-Q2 2022 with a discrete-choice experiment. The authors presented hypothetical treatments and described the following characteristics:
- median disease-free survival (DFS)
- 5-year overall survival (OS) rate
- mode and frequency of administration
- need for concomitant daily pill
- treatment duration
- risks of severe diarrhea, fatigue, and dizziness
The authors calculated calculate the conditional relative importance of attributes and risk tolerance measures based on preference weight estimates from random parameter logit analyses.
The authors enrolled 500 participants of whom 250 were patients (50% post-nephrectomy) and 250 were physicians (64% oncologists; 36% urologists).
Overall survival was the most important attribute to both patients and physicians, but DFS was also important. Interestingly, overall survival had a greater influence on physicians’ choices than on patients’ choices: on average, OS was 3.2 and 2.5 times as important as DFS and 5.8-9.1 and 2.4-3 times more important than the evaluated risks for physicians and patients, respectively. Additionally, DFS was 1.8-2.9 times more important to physicians than the evaluated risks, while the importance of DFS and risks were nearly equivalent for patients. The need for concomitant oral medication was the least important attribute to patients and physicians.
Both patients and physicians were willing to accept more than a 25-percentage-point increase in the risks of severe diarrhea, fatigue, and dizziness for improvements (from 45% to 60% or 85%) in OS.
Thus, the authors conclude that, while both patients and physicians weighted OS improvements more than the other treatment attributes, physicians tended to place lower importance on changes in risk and administration than patients. Thus, when considering adjuvant treatments in RCC, physicians and patients should discuss potential benefits and harms.
Presented by: Shawna R. Calhoun, MPH | Merck & Co., Inc.