Abstract
Objectives: There has been a recent proliferation in treatment options for patients with metastatic breast cancer. Such treatments often involve trade-offs between overall survival and side effects. Our study aims to estimate the trade-offs which could be used to inform decision making at the individual and policy level.
Design: We designed a discrete choice experiment (DCE) to look at preferences for avoiding severity levels of side effects when choosing treatment for metastatic breast cancer. Treatment attributes were: fatigue; nausea; diarrhoea; other side effects (peripheral neuropathy, hand foot syndrome, and mucositis); urgent hospital admission and overall survival. Responses were analysed using an error component logit model. We estimated the relative importance of attributes and minimum acceptable survival for improvements in side effects. Setting: The DCE was completed online by UK residents with self-reported diagnosis of breast cancer.
Participants: 105 respondents participated, comprising of 72 patients with metastatic breast cancer and 33 patients with primary breast cancer.
Results: Overall survival had the largest relative importance, followed by other side effects, diarrhoea, nausea, and fatigue. Risk of urgent hospital admission was not significant. Whilst overall survival was the most important attribute, respondents were willing to forgo some absolute probability of overall survival for reductions in all Grade 2 side effects (12.02% for hand foot syndrome; 11.01% for mucositis; 10.42% for peripheral neuropathy, 6.33% for diarrhoea, and 3.62% for nausea). Grade 1 side effects were not significant, suggesting respondents have a general tolerance for them. Conclusions: Patients are willing to forgo overall survival to avoid particular severity levels of side effects. Our results have implications for data collected in research studies and can help inform person-centred care and shared decision making.
Design: We designed a discrete choice experiment (DCE) to look at preferences for avoiding severity levels of side effects when choosing treatment for metastatic breast cancer. Treatment attributes were: fatigue; nausea; diarrhoea; other side effects (peripheral neuropathy, hand foot syndrome, and mucositis); urgent hospital admission and overall survival. Responses were analysed using an error component logit model. We estimated the relative importance of attributes and minimum acceptable survival for improvements in side effects. Setting: The DCE was completed online by UK residents with self-reported diagnosis of breast cancer.
Participants: 105 respondents participated, comprising of 72 patients with metastatic breast cancer and 33 patients with primary breast cancer.
Results: Overall survival had the largest relative importance, followed by other side effects, diarrhoea, nausea, and fatigue. Risk of urgent hospital admission was not significant. Whilst overall survival was the most important attribute, respondents were willing to forgo some absolute probability of overall survival for reductions in all Grade 2 side effects (12.02% for hand foot syndrome; 11.01% for mucositis; 10.42% for peripheral neuropathy, 6.33% for diarrhoea, and 3.62% for nausea). Grade 1 side effects were not significant, suggesting respondents have a general tolerance for them. Conclusions: Patients are willing to forgo overall survival to avoid particular severity levels of side effects. Our results have implications for data collected in research studies and can help inform person-centred care and shared decision making.
| Original language | English |
|---|---|
| Article number | e076798 |
| Number of pages | 11 |
| Journal | BMJ Open |
| Volume | 14 |
| Issue number | 4 |
| Early online date | 28 Apr 2024 |
| DOIs | |
| Publication status | Published - 28 Apr 2024 |
Bibliographical note
AcknowledgementsWe thank all the patients and volunteers who agreed to participate in this study and the study contributors.
Data Availability Statement
The dataset used for this analysis is available from the University of Edinburgh Datashare, https://datashare.ed.ac.uk/handle/10283/4436.Keywords
- Breast neoplasms
- quality of life
- decision making
- shared
- patient preference
- surveys and questionnaires
Access to Document
- Bullen_etal_BMJO_Trade-offs_Between_Overall_VoR
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