Treatment Preferences and Tradeoffs Among Patients with Locally Advanced or Metastatic Urothelial Carcinoma

With the expanding therapeutic options for patients with locally advanced or metastatic urothelial carcinoma (mUC), selecting the most appropriate option for each patient has become increasingly complex. A more patient-centered approach based on collaboration and shared decision-making is emphasized in the literature and guidelines. A recent study by Apolo et al. aimed to characterize attitudes and perspectives toward treatments in this patient population.

A total of 100 patients were included in the study, among whom the mean age was 64.9 years, 54% were female, and 38% were White. Most patients (62%) had been diagnosed with locally advanced or mUC less than a year prior to joining the study. The participants completed a questionnaire that evaluated treatment preferences and perspectives on different factors such as side effects. In terms of treatment goals, 57% of patients reported that their main goal was to extend life while 43% reported that their main goal was to maximize their quality of life.

When identifying factors that would lead to choosing one treatment modality over another, changes in objective response rate (ORR) had the highest effect on patient preferences (mean marginal utility of 0.65; 95% CI, 0.55 – 0.75), followed by cancer-related pain (0.55; 95% CI, 0.47 – 0.62), risk of peripheral neuropathy (0.51; 95% CI, 0.43 – 0.58), risk of severe side effects (0.36; 95% CI, 0.29 – 0.43), risk of mild to moderate nausea (0.24; 95% CI, 0.20 – 0.28), and risk of mild to moderate skin reactions (0.22; 95% CI, 0.18 – 0.26).

When evaluating tradeoffs, patients were willing to trade off an 8.4% decrease in ORR to reduce their pain level by 10 points (pain scored from 0 to 100) or a 7.8% decrease in ORR to reduce their risk of peripheral neuropathy by 10%. For a 10% decrease in severe side effects, mild to moderate nausea, or skin reaction, patients would accept decreases in ORR of 5.5%, 3.7%, or 3.4%, respectively. There were no significant differences in patient responses across patient subgroups and clinical variables. However, patients who had moderate bladder cancer symptoms placed greater importance on ORR compared to patients who had severe symptoms (p < 0.05).

This important study revealed the variations in the weight and value of certain treatment factors between patients and the potential trade-offs that patients consider acceptable. These findings emphasize the need for individualized and patient-centered treatment selection.

Written by: Bishoy M. Faltas, MD, Director of Bladder Cancer Research, Englander Institute for Precision Medicine, Weill Cornell Medicine

Reference:

Apolo AB, Michaels-Igbokwe C, Simon NI, et al. Patient Preferences for First-Line Treatment of Locally Advanced or Metastatic Urothelial Carcinoma: An Application of Multidimensional Thresholding. Patient. Published online August 28, 2024. doi:10.1007/s40271-024-00709-3

Read the Abstract

Login