Payers, patients, and physicians understanding of quality of life, functional status, and their importance relative to survival in triple-negative breast cancer.

Abstract

e18156 Background: Value has taken center stage in US oncology treatment as evidenced by the growth of value frameworks and value-based pricing/contracting. These efforts include assessment of quality of life (QoL), survival, and functional status (FS), but the perspectives of payers, patients, and physicians are relatively unknown. We explored the relationships between QoL, FS, and survival in triple negative breast cancer (TNBC) and their importance relative to each other among the 3 key interviewed groups. Methods: Hour-long phone interviews with 6 individuals with TNBC and web-assisted phone interviews with 6 payers and 6 medical oncologists in the US were conducted. Respondents were asked how they differentiate QoL and FS, and how, relative to survival, each impacts their view of TNBC treatment. Results: For payers, QoL and FS are commonly confused and viewed as both supplementary and less important than survival metrics; however, they do desire to understand how each predicts survival. Oncologists prioritized survival, other clinical endpoints, and safety, but believed QoL and FS were very important. Moreover, they assess QoL by the adverse events experienced while on treatment, and view FS as being more objective. For patients, QoL and FS are intermingled, falling under a broad category of QoL. FS was poorly understood, and survival was viewed as critical to meaningful QoL. The threshold at which QoL overrides survival was the point at which patients consider themselves a burden to others. Conclusions: The definitions of QoL and FS used by health services researchers who define “value” is out of sync with patients, payers, and sometimes physicians, making communication of this important information to the individuals interviewed difficult. While the perceived value of QoL and FS varies, and considering the limited treatment options available for TNBC, survival supersedes both measures such that QoL and FS are nearly disregarded. [Table: see text]