Calhoun SR, Vass C, Myers K, Imai K, Bussberg C, Bhattacharya R, Pinto CA, Poulos C. Patient and physician preferences for adjuvant treatment of renal cell carcinoma: a discrete-choice experiment. Poster presented at the 2023 ASCO Genitourinary Cancers Symposium; February 16, 2023. San Franciso, CA. [abstract] J Clin Oncol. 2023 Feb 20; 41(Suppl 6):635. doi: 10.1200/JCO.2023.41.6_suppl.635

BACKGROUND: Although a handful of studies have elicited treatment preferences in renal cell carcinoma (RCC), most focused on advanced disease. This study elicited United States patients’ and physicians’ preferences for adjuvant treatment characteristics.

METHODS: Patients with physician-confirmed RCC and (physician-defined) intermediate high or high risk of recurrence and physicians who treat such patients completed online surveys in Q1-Q2 2022 with a discrete-choice experiment. Hypothetical treatments were described by median disease-free survival (DFS); 5-year overall survival (OS) rate; mode and frequency of administration; need for concomitant daily pill; treatment duration; and the risks of severe diarrhea, fatigue, and dizziness. Preference weight estimates from random parameter logit analysis were used to calculate the conditional relative importance of attributes and risk tolerance measures.

RESULTS: 250 patients (50% post-nephrectomy) and 250 physicians (64% oncologists; 36% urologists) completed the survey. OS was the most important attribute to both patients and physicians, but DFS was also important (Table). OS had a greater influence on physicians’ choices than on patients’ choices. On average, OS was 3.2 and 2.5 times as important as DFS and 5.8-9.1 and 2.4-3 times more important than the evaluated risks for physicians and patients, respectively. Further, DFS was 1.8-2.9 times more important to physicians than the evaluated risks, while the importance of DFS and risks were nearly equivalent for patients. The need for concomitant oral medication was the least important attribute to patients and physicians. Both groups were willing to accept more than a 25-percentage-point increase in the risks of severe diarrhea, fatigue, and dizziness for improvements (from 45% to 60% or 85%) in OS.

CONCLUSIONS: While both patients and physicians weighted OS improvements more than the other treatment attributes, including risks, physicians tended to place lower importance on changes in risk and administration than patients. Physicians and patients should discuss potential benefits and harms when considering adjuvant RCC therapies.

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