Abstract
BackgroundDecisions on palliative chemotherapy (CT) for locally advanced or metastatic gastric cancer (mGC) require trade-offs between potential benefits and risks for patients. Healthcare providers and payers agree that patient-preferences should be considered. We conducted a choice-based conjoint (CBC) analysis study in pre-treated patients from Germany with mGC or locally advanced or metastatic adenocarcinoma of the gastroesophageal junction (mGEJ-Ca), to evaluate their preferences when hypothetically selecting a CT regimen.MethodsGerman oncologists and gastroenterologists were contacted to identify patients with mGC or mGEJ-Ca who had completed ≥2 cycles of palliative CT in first or later lines of therapy (CT ongoing or complete). The primary objective was to quantify patient preferences for palliative CT by CBC analysis. Six in-depth qualitative interviews identified 3 attributes: treatment tolerability, quality of life in terms of ability of self-care, and additional survival benefit. The CBC matrix was constructed with 4 factor levels per attribute and each participant was presented with 15 different iterations of these levels. A minimum of 50 participants was needed. Consenting patients completed the CBC survey, choosing systematically among profiles. CBC models were estimated by multinomial logistic regression (MLR) and hierarchical Bayesian (HB) analysis. Estimates of importance for each attribute and factor-level were calculated.ResultsFifty-five patients participated in the CBC survey (78.2% male, median age 63 years, 81.8% currently receiving CT). Across this sample, low treatment toxicity was ranked highest (44.6% relative importance, MLR analysis), followed by ability to self-care (32.3%), and an additional survival benefit of up to 3 months (3 months 23.1%, 2 months 18.3%, 1 month 11.2%). The MLR analysis showed high validity (certainty 37.9%, chi square p < 0.01, root-likelihood 0.505). The HB analysis yielded similar results.ConclusionsPatients’ preferences related to a new hypothetical palliative CT of mGC or mGEJ-Ca can be assessed by CBCanalysis. Although in real-life, patients initially need to decide on CT before they have any experience, and patients’ varied experiences with CT will have impacted specific responses, low toxicity and self-care ability were considered as most important by this group of patients with mGC or mGEJ-Ca.
Highlights
Decisions on palliative chemotherapy (CT) for locally advanced or metastatic gastric cancer require trade-offs between potential benefits and risks for patients
We interviewed 55 patients with metastatic gastric cancer (mGC) or locally advanced or metastatic adenocarcinomas of the gastroesophageal junction who had received at least 2 cycles of palliative CT in first or later lines of therapy
The study and all interviews were conducted in accordance with guidelines published by the European Pharmaceutical Market Research Association (EphMRA) and the European Society for Opinion and Marketing Research (ESOMAR) [18, 19]
Summary
Decisions on palliative chemotherapy (CT) for locally advanced or metastatic gastric cancer (mGC) require trade-offs between potential benefits and risks for patients. We conducted a choice-based conjoint (CBC) analysis study in pretreated patients from Germany with mGC or locally advanced or metastatic adenocarcinoma of the gastroesophageal junction (mGEJ-Ca), to evaluate their preferences when hypothetically selecting a CT regimen. In Germany, an incidence of approximately 15,000 new cases was predicted for 2014, and the current 5-year survival rate is 33% [4]. These data include tumors of the gastroesophageal junction which are becoming increasingly common [5]. Patients would have to choose between a median life expectancy of 3 months with best supportive care alone and a median life expectancy of 10–12 months with a modern CT regimen [7,8,9,10]
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