VP and Global Head Epidemiology & Benefit - Risk Evaluation, Sanofi Bridgewater, United States
Background: Patients with non-small cell lung cancer (NSCLC) face difficult decisions in managing their disease and making choices regarding their treatment options. Various studies have evaluated different attributes among different populations, but there remains a lack of understanding about what aspects of treatment are valued most by patient groups.
Objectives: To better understand patient preferences regarding attributes and available treatment options and how patients weigh and trade-off multiple benefits and risks.
Methods: A literature review was performed on NSCLC patient preference studies with patients at varying stages of the disease. Of the 50 articles reviewed, 29 were included in the final evaluation: 19 quantitative, 7 qualitative, and 1 study with mixed methods. About half of the studies included patients with a mean age of 60 years or above, slightly below the average age of NSCLC patients at 70 years old. Seven studies also included or exclusively looked at physician and caregiver preferences.
Results: The most highly reported want from treatment by far was life extension/progression free survival (PFS). Additionally, maintaining quality of life, often in the form of continuing daily functioning and not losing independence, contributed to patients’ decisions regarding treatment. Side effect was another factor, with fatigue and nausea/vomiting reported as the most important side effects to avoid. Patients were willing to make tradeoffs between side effects and survival, with 90% of patients willing to accept treatment with more severe functional long-term effects for 8.4 additional PFS months in one study. Preferences differed between age groups and the cancer stages with those in later cancer stages often valuing PFS even more over toxicity and side effects. Physicians tended to not guess accurately what patient preferences were while caregivers were generally on the same page but placed more concern on quality of life and toxicity than patients.
Conclusions: Overall, patients wanted treatment that would give them the best chance of life extension while also reducing the negative impact on everyday quality of life and the ability to live independently. Preferences differed depending on age and cancer stage with physicians and caregivers often not holding the exact same viewpoints as the patients themselves. Future research needs to continue evaluating patient preferences to ensure treatment is tailored towards patient wants in NSCLC care.
