Abstract
Background. The aims of this study were to assess patients' preferences to wait or start systemic treatment and understand how patients would make tradeoffs between certain severe adverse events (AEs) and additional months of progression-free survival (PFS). Materials and Methods. Adults in France, Germany, and Spain with a diagnosis of DTC and who have had at least one RAI treatment completed a direct-elicitation question and a discrete-choice experiment (DCE) online. The direct-elicitation question asked respondents whether they would opt out of treatment when their tumor is RAI-R. In the DCE, respondents chose between 12 pairs of hypothetical RAI-R DTC treatment profiles. Profiles were defined by magnitudes of efficacy (PFS) and safety (severe hand-foot skin reaction [HFSR], severe proteinuria, and severe hypertension). A main-effects random-parameters logit model was estimated. Results. 134 patients completed the survey. Most patients (86.6%) opted for treatment rather than “wait and see” decision. Patients placed a greater weight on the risk of severe hypertension than the risk of proteinuria and HFSR. Conclusions. DTC patients showed preference toward treatment for RAI-R DTC over watchful waiting. Patients' concerns about the risk of severe hypertension appeared to have had a greater effect on patients' choice than severe proteinuria or HFSR.
Highlights
Worldwide, thyroid cancer accounts for 2.1% of all new cancers [1]
Differentiated thyroid cancer (DTC) patients showed preference toward treatment for RAI-R DTC over watchful waiting given the tradeoffs offered in the direct-elicitation question
86.6% of patients opted to start treatment rather than to “wait and see,” as patients understood that once DTC progresses to RAI-R, it is no longer a slow-moving disease [5,6,7]
Summary
Thyroid cancer accounts for 2.1% of all new cancers [1]. Differentiated thyroid cancer (DTC), which includes papillary, follicular, and Hurthle cell types, accounts for nearly 94% of thyroid cancers [2]. The overall prognosis for DTC is excellent with a 10-year disease-specific survival rate of 85% [5]. 10%–15% of patients develop distant metastases with a 10-year disease-specific survival rate of 40% [6]. For some DTC patients who develop metastases, the ability to uptake RAI is lost (i.e., the patients become RAIrefractory [RAI-R]) with a 10-year disease-specific survival rate of 10% [7]. Adults in France, Germany, and Spain with a diagnosis of DTC and who have had at least one RAI treatment completed a direct-elicitation question and a discrete-choice experiment (DCE) online. In the DCE, respondents chose between 12 pairs of hypothetical RAI-R DTC treatment profiles. Patients placed a greater weight on the risk of severe hypertension than the risk of proteinuria and HFSR. Patients’ concerns about the risk of severe hypertension appeared to have had a greater effect on patients’ choice than severe proteinuria or HFSR
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