Trade-offs between overall survival and side-effects in the treatment of metastatic breast cancer: eliciting preferences of patients with primary and metastatic breast cancer using a discrete choice experiment

Alistair J  Bullen; Mandy Ryan; Holly  Ennis; Ewan Gray; Luis Loria Rebolledo; Morag  McIntyre; Peter Hall

doi:10.1136/bmjopen-2023-076798

Trade-offs between overall survival and side-effects in the treatment of metastatic breast cancer: eliciting preferences of patients with primary and metastatic breast cancer using a discrete choice experiment

Alistair J Bullen^* (Corresponding Author)
, Mandy Ryan
, Holly Ennis
, Ewan Gray
, Luis Loria Rebolledo
, Morag McIntyre
, Peter Hall

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

7 Citations (Scopus)

15 Downloads (Pure)

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.

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	https://doi.org/10.1136/bmjopen-2023-076798
Publication status	Published - 28 Apr 2024

Bibliographical note

Acknowledgements
We 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.

Funding

This research was supported by a charitable grant from the Edinburgh and Lothians Health Foundation (Scottish Registered Charity No: SC007342). Mandy Ryan and Luis E Loría-Rebolled are funded by the University of Aberdeen and the Chief Scientist Office of the Scottish Government Health and Social Care Directorates. The funders had no role in considering the study design or in the collection, analysis, or interpretation of data, the writing of the paper, or the decision to submit the article for publication

Funders	Funder number
Edinburgh and Lothians Health Foundation	SC007342
Cancer Research UK	CTRQQR2021\100006

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

SDG 3 Good Health and Well-being

Keywords

Breast neoplasms
quality of life
decision making
shared
patient preference
surveys and questionnaires

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Bullen, A. J., Ryan, M., Ennis, H., Gray, E., Loria Rebolledo, L., McIntyre, M., & Hall, P. (2024). Trade-offs between overall survival and side-effects in the treatment of metastatic breast cancer: eliciting preferences of patients with primary and metastatic breast cancer using a discrete choice experiment. BMJ Open, 14(4), Article e076798. https://doi.org/10.1136/bmjopen-2023-076798

Trade-offs between overall survival and side-effects in the treatment of metastatic breast cancer: eliciting preferences of patients with primary and metastatic breast cancer using a discrete choice experiment. / Bullen, Alistair J (Corresponding Author); Ryan, Mandy; Ennis, Holly et al.
In: BMJ Open, Vol. 14, No. 4, e076798, 28.04.2024.

Research output: Contribution to journal › Article › peer-review

Bullen, AJ, Ryan, M, Ennis, H, Gray, E, Loria Rebolledo, L, McIntyre, M & Hall, P 2024, 'Trade-offs between overall survival and side-effects in the treatment of metastatic breast cancer: eliciting preferences of patients with primary and metastatic breast cancer using a discrete choice experiment', BMJ Open, vol. 14, no. 4, e076798. https://doi.org/10.1136/bmjopen-2023-076798

Bullen AJ, Ryan M, Ennis H, Gray E, Loria Rebolledo L, McIntyre M et al. Trade-offs between overall survival and side-effects in the treatment of metastatic breast cancer: eliciting preferences of patients with primary and metastatic breast cancer using a discrete choice experiment. BMJ Open. 2024 Apr 28;14(4):e076798. Epub 2024 Apr 28. doi: 10.1136/bmjopen-2023-076798

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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.",

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AU - Ennis, Holly

AU - Gray, Ewan

AU - Loria Rebolledo, Luis

AU - McIntyre, Morag

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N2 - 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.

AB - 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.

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