Patient and General Population Preferences Regarding the Benefits and Harms of Treatment for Metastatic Prostate Cancer: A Discrete Choice Experiment

Dominik Menges; Michela C Piatti; Aurelius Omlin; Richard Cathomas; Daniel Benamran; Stefanie Fischer; Christophe Iselin; Marc Küng; Anja Lorch; Lukas Prause; Christian Rothermundt; Alix O'Meara Stern; Deborah Zihler; Max Lippuner; Julia Braun; Thomas Cerny; Milo A Puhan

doi:10.1016/j.euros.2023.03.001

Patient and General Population Preferences Regarding the Benefits and Harms of Treatment for Metastatic Prostate Cancer: A Discrete Choice Experiment

Eur Urol Open Sci. 2023 Mar 22:51:26-38. doi: 10.1016/j.euros.2023.03.001. eCollection 2023 May.

Authors

Dominik Menges¹, Michela C Piatti¹, Aurelius Omlin^{2

3}, Richard Cathomas⁴, Daniel Benamran⁵, Stefanie Fischer², Christophe Iselin⁵, Marc Küng⁶, Anja Lorch⁷, Lukas Prause⁸, Christian Rothermundt², Alix O'Meara Stern⁹, Deborah Zihler¹⁰, Max Lippuner¹¹, Julia Braun¹, Thomas Cerny^{12

13}, Milo A Puhan¹

Affiliations

¹ Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
² Department of Medical Oncology and Hematology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
³ Onkozentrum Zürich, Zurich, Switzerland.
⁴ Division of Oncology/Hematology, Kantonsspital Graubünden, Chur, Switzerland.
⁵ Department of Urology, Hôpitaux Universitaires Genève, Geneva, Switzerland.
⁶ Department of Oncology, Hôpital Cantonal Fribourg, Fribourg, Switzerland.
⁷ Department of Medical Oncology and Hematology, University Hospital Zurich, Zurich, Switzerland.
⁸ Department of Urology, Kantonsspital Aarau, Aarau, Switzerland.
⁹ Department of Oncology, Réseau Hospitalier Neuchâtelois, Neuchâtel, Switzerland.
¹⁰ Department of Oncology, Hematology and Transfusion Medicine, Kantonsspital Aarau, Aarau, Switzerland.
¹¹ Europa Uomo Switzerland, Ehrendingen, Switzerland.
¹² Foundation Board, Cancer Research Switzerland, Bern, Switzerland.
¹³ Human Medicines Expert Committee, Swissmedic, Bern, Switzerland.

Abstract

Background: Patient preferences for treatment outcomes are important to guide decision-making in clinical practice, but little is known about the preferences of patients with metastatic hormone-sensitive prostate cancer (mHSPC).

Objective: To evaluate patient preferences regarding the attributed benefits and harms of systemic treatments for mHSPC and preference heterogeneity between individuals and specific subgroups.

Design setting and participants: We conducted an online discrete choice experiment (DCE) preference survey among 77 patients with metastatic prostate cancer (mPC) and 311 men from the general population in Switzerland between November 2021 and August 2022.

Outcome measurements and statistical analysis: We evaluated preferences and preference heterogeneity related to survival benefits and treatment-related adverse effects using mixed multinomial logit models and estimated the maximum survival time participants were willing to trade to avert specific adverse effects. We further assessed characteristics associated with different preference patterns via subgroup and latent class analyses.

Results and limitations: Patients with mPC showed an overall stronger preference for survival benefits in comparison to men from the general population (p = 0.004), with substantial preference heterogeneity between individuals within the two samples (both p < 0.001). There was no evidence of differences in preferences for men aged 45-65 yr versus ≥65 yr, patients with mPC in different disease stages or with different adverse effect experiences, or general population participants with and without experiences with cancer. Latent class analyses suggested the presence of two groups strongly preferring either survival or the absence of adverse effects, with no specific characteristic clearly associated with belonging to either group. Potential biases due to participant selection, cognitive burden, and hypothetical choice scenarios may limit the study results.

Conclusions: Given the relevant heterogeneity in participant preferences regarding the benefits and harms of treatment for mHSPC, patient preferences should be explicitly discussed during decision-making in clinical practice and reflected in clinical practice guidelines and regulatory assessment regarding treatment for mHSPC.

Patient summary: We examined the preferences (values and perceptions) of patients and men from the general population regarding the benefits and harms of treatment for metastatic prostate cancer. There were large differences between men in how they balanced the expected survival benefits and potential adverse effects. While some men strongly valued survival, others more strongly valued the absence of adverse effects. Therefore, it is important to discuss patient preferences in clinical practice.

Keywords: Adverse effects; Benefit; Benefit-harm assessment; Discrete choice experiment; Harm; Metastasis; Patient preferences; Patient-centered care; Prostate cancer; Survival; Treatment.