Aims
Men with metastatic castration-resistant prostate cancer (mCRPC) have numerous treatment options. These include first and second-line anti-androgens and chemotherapy with docetaxel or cabazitaxel. A choice between these treatments is made by clinicians in collaboration with the patient. This study aims to determine the patient preferences for attributes associated with treatment for mCRPC.
Methods
Qualitative phase: 11 men with mCRPC were interviewed for 1 hour by phone. Unprompted and prompted discussion and thematic analyses identified treatment attributes contributing to decision-making. Treatment attributes identified in the qualitative phase and literature review were: overall survival, response duration, effect on bone pain, effect on fatigue, chance of moderate/severe side effects, administration mode and frequency, combination with radiotherapy and cost.
Quantitative phase: 75 (of 100 planned) men completed a 20-min online survey, consisting of a Discrete Choice Experiment, treatment history and demographics. Respondents were presented with a treatment choice experiment, focusing on the clinical benefits of treatments and associated risks of attributes. They selected their preferred option from a set of competing alternatives, presented in 10 choice scenarios. Hypothetical treatments only were assessed. A latent class (segmentation-based) model was used for data analysis with p<.05 criteria for statistical significance.
Results
The best fitted latent class model identified two groups of men based on treatment preferences. Survival was the most important attribute for both groups. Men in group 1 placed higher importance on survival, compared to men group 2, who also considered the effects on fatigue and bone pain as highly influential. Surprisingly, out-of-pocket costs were of little importance.
Conclusions
When choosing between alternative treatments, men with mCRPC had the greatest preference for a treatment associated with longest survival, followed by effects on bone pain and fatigue. These findings can be used by clinicians and patients to better understand the needs of men with mCRPC.