The Avatar Acceptability Study: Survivor, Parent and Community Willingness to Use Patient-Derived Xenografts to Personalize Cancer Care

Abstract

Background: Using patient-derived xenografts (PDXs) to assess chemosensitivity to anti-cancer agents in real-time may improve cancer care by enabling individualized clinical decision-making. However, it is unknown whether this new approach will be met with acceptance by patients, family and community. Methods: We used a cross-sectional structured survey to investigate PDX acceptability with 1,550 individuals across Australia and New Zealand (648 survivors of adult and childhood cancer, versus 650 community comparisons; and 48 parents of childhood cancer survivors versus 204 community parents). We identified factors influencing willingness-to-use PDXs, willingness-to-pay, maximum acceptable wait-time, and maximum acceptable number of mice used per patient. Findings: PDXs were highly acceptable: >80% of those affected by cancer felt the potential advantages of PDXs outweighed the disadvantages (community participants: 68%). Survivors' and survivors' parents' most highly endorsed advantage was 'increased chance of survival'. 'Harm to animals' was the least endorsed disadvantage for all groups. Cancer survivors were more willing to use PDXs than community comparisons [p<·001]. Survivors and survivors' parents were willing to pay more [p<·001; p=·004 respectively], wait longer for results [p=·03; p=·01], and use more mice [p=·01; p<·001] than community comparisons. Male survivors found PDXs more acceptable [p=·01] and were willing to pay more [p<·001] than female survivors. Survivors with higher incomes found PDXs more acceptable [p=·002] and were willing to pay more [p<·001] than survivors with lower incomes. Mothers found PDXs more acceptable [p=·04] but were less willing to wait [p=·02] than fathers. Interpretation: We found significant attitudinal support for PDX-guided cancer care. Willingness-to-pay and maximum acceptable number of mice align well with likely future usage. Maximum acceptable wait-times were lower than is currently achievable, highlighting an important area for future patient education until technology has caught up. Funding Statement: Claire Wakefield is supported by a Career Development Fellowship from the National Health and Medical Research Council of Australia (APP1143767). Christina Signorelli and Joanna Fardell are supported by The Kids’ Cancer Project. Richard Lock is supported by a Fellowship from the National Health and Medical Research Council of Australia (APP1059804). Glenn Marshall is supported by NHMRC, CINSW, and CCNSW. This study was supported by the Kids Cancer Alliance, funded by the Cancer Institute NSW. The Behavioural Sciences Unit (BSU) is proudly supported by the Kids with Cancer Foundation. The BSU’s survivorship research program is funded by The Kids’ Cancer Project and a Cancer Council NSW Program Grant PG16-02 with the support of the Estate of the Late Harry McPaul. Declaration of Interests: Kathy M. Tucker has received Honoria from AstraZeneca Australia with respect to mainstreaming BRCA genetic testing in adults. No other authors have conflicts of interest to declare. Ethics Approval Statement: The Institutional Review Boards of 11 Australian and New Zealand hospitals and UNSW Sydney provided ethical approval.