Abstract
Objective: To evaluate and compare patient and physician preferences for the benefits and risks of currently available adjuvant melanoma treatments. Methods: Patients with stage II/III melanoma and oncologists in the USA were recruited from 6 clinical sites and an online panel to complete a survey. Preferences were assessed using a paired comparison discrete choice experiment that allowed for opt-out (i.e. no treatment). The treatments comprised 7 attributes, each with 3 levels associated with pegylated interferon, high-dose interferon, and ipilimumab. Attributes included efficacy outcomes, dosing regimen, and risks of moderate to severe toxicities. In addition, open-ended maximum acceptable risk (MAR) questions assessed tradeoffs between toxicity risk and efficacy. Results: 142 patients (45 stage II; 97 stage III) chose a treatment in 78% of the choice tasks, while physicians (N = 127) chose treatment 79% of the time. The rankings of relative attribute importance were concordant between the patients and physicians for the top 4: 10-year survival in metastatic melanoma, fatigue risk, 3-year recurrence-free survival (RFS), and depression risk. Patients and physicians valued the difference in 21% survival versus no survival benefit about 3 and 4 times as much, respectively, as reducing diarrhea risk from 41% to 1% or reducing depression risk from 40% to 1%. The MAR of severe diarrhea and of a life-threatening event increased as the chance of 3-year RFS increased, with patients reporting higher risks than physicians. Conclusion: Patients and physicians were concordant in their preferences in adjuvant melanoma, preferring treatment versus none and judging potential efficacy to outweigh risks of toxicities.
Highlights
Melanoma is an aggressive type of skin cancer that refers to a malignant tumor of melanocytes, the melanin-producing cells found mostly in the skin [1]
The rankings of relative attribute importance were concordant between the patients and physicians for the top 4: 10-year survival in metastatic melanoma, fatigue risk, 3-year recurrence-free survival (RFS), and depression risk
A total of 142 patients and 127 oncologists responded to the survey, and all were included in the analysis
Summary
Melanoma is an aggressive type of skin cancer that refers to a malignant tumor of melanocytes, the melanin-producing cells found mostly in the skin [1]. In the USA, the American Cancer Society estimates that there will be approximately 76,380 new melanomas diagnosed in 2016, with around 46,870 in men and 29,510 in women. The median age at diagnosis of melanoma is 62 years, and 55.4% of patients are under aged 65 years at diagnosis [2]. When melanoma is found early, it can often be cured by surgery; after it spreads, it is more difficult to treat. In stage III melanoma, the cancer is present in the skin, and in the lymph nodes. Stage III melanoma is described in 3 categories: a, b, and c. The estimated 5-year survival rates for these categories are 78%, 59%, and 40%, respectively [3]
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