Krzyzanowska MK, et al. – Investigators conducted this discrete choice experiment to assess how patients’ value the risk of an emergency department (ED) visit or hospitalization during treatment when deciding about chemotherapy. They found that, although the risks of hospitalization and ED visits may contribute to patient treatment preferences, the extent of treatment benefit was the most important attribute irrespective of treatment intent.

Methods

• Researchers recruited patients with breast, head and neck, or colorectal cancer who were considering, receiving, or had previously received systemic treatment from two academic cancer centers (Toronto, Ontario)
• Each study participant completed 10 choice tasks (5 each in the adjuvant and metastatic settings, respectively) from a possible 128 combinations.
• Based on three attributes (likelihood of benefit, risk of requiring an ED visit, and risk of hospitalization during treatment) that differed across four levels, each choice task prompted participants to choose between two hypothetical systemic therapies.
• Data were analyzed using a multinomial logit model.
• Using hierarchal Bayes routines, the investigators estimated individual part-worth utility (PWU) values.

Results

• A total of 293 participants completed the survey between June 2015 and September 2017.
• M patients were female (76%), had a diagnosis of breast cancer (63%), and were currently receiving systemic therapy (72%).
• A total of 59% of patients were receiving treatment with curative intent.
• PWU values differed as expected, with higher PWU values observed for higher treatment benefit, lower risk of ED visits, and lower risk of hospitalization.
• The most important decision attribute in both the adjuvant (59%; 95%CI: 57.8% to 60.1%) and metastatic (67.7%; 95%CI: 66.8% to 68.7%) scenarios was treatment benefit, followed by risk of hospitalization (18.8% vs 22.8%) and risk of ED visits (13.5% vs 18.3%).
• When stratified by patient’s own treatment intent, results were the same.