Patient Preferences Regarding Chemotherapy in Metastatic Breast Cancer-A Conjoint Analysis for Common Taxanes.

Saskia Spaich,Axel Gerhardt,Svetlana Hetjens,Johanna Kinder,Marc Sütterlin,Stefan Fuxius

doi:10.3389/fonc.2018.00535

Abstract

Background: The purpose of this investigation was to explore patient perception regarding the importance of efficacy, toxicity, and logistics in the choice of regimen of taxane-based chemotherapy (CHT) for patients with metastatic breast cancer (MBC).Methods: This dual-center study analyzed data of 100 women diagnosed with MBC, who were asked for their preferences regarding chemotherapy by means of conjoint analysis. Included attributes were progression free survival (PFS), application form, time and frequency, need of premedication, risk of alopecia, fatigue, febrile neutropenia, and neuropathy. Furthermore, participants completed a questionnaire about their personal and medical history. Regression analyses were performed to identify factors that influence patient preference in terms of specific treatment choice.Results: Of 8 attributes, severe neutropenia was top priority for the majority of patients, followed by alopecia, neuropathy and PFS. When combining these patient preferences and the results of the questionnaire, patients' age as, well as, relationship status had significant impact on the importance of PFS. Moreover, longer travel time to the treatment center was significantly associated with preferences regarding PFS. Ranking by combination of respective part-worth values demonstrated nab-paclitaxel to be favored over paclitaxel and docetaxel.Conclusion: Side effects of CHT and PFS prove to be critical factors for patients affecting choice of treatment in MBC with severe neutropenia being top priority, followed by alopecia, neuropathy, and PFS. Age, commute time, and relationship status were identified as significant determinants of patient preference. Total utility calculation by combination of part-worth values ranked nab-paclitaxel as the most preferable taxane.

Highlights

Both curative and palliative treatment of breast cancer nowadays are characterized by a multimodal therapeutic approach and have led to significant improvements in survival [1, 2]
These patients with an indication for a palliative treatment regimen were recruited at the University Medical Center Mannheim (UMM) and at the Oncology Center (OC), Outpatient Clinic Fuxius/Karcher in Heidelberg
In terms of quality of life (QoL), approximately 80% of women showed a Karnofsky-index of 70% or more (ECOG < 2) with the remaining women classified as Karnofsky 50–60% (=ECOG 2)

Summary

Introduction

Both curative and palliative treatment of breast cancer nowadays are characterized by a multimodal therapeutic approach and have led to significant improvements in survival [1, 2]. Taxane-based CHT may improve time to progression and survival [4, 5], but associated side effects constitute an important consideration when evaluating the best treatment concept for a patient [6] With regard to the latter, aspects of patient comfort and preference are gaining more attention in oncologic treatment of metastatic breast cancer (MBC). The study of Lindley et al demonstrates that patients who had severe disruptions in QoL are less willing to receive additional treatment for an extension of life compared with patients who experienced only little disruption to normal life [10] The purpose of this investigation was to explore patient perception regarding the importance of efficacy, toxicity, and logistics in the choice of regimen of taxane-based chemotherapy (CHT) for patients with metastatic breast cancer (MBC)

Methods

Results

Discussion

Conclusion