Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA.
Lung Cancer. 2012 Jul;77(1):224-31. doi: 10.1016/j.lungcan.2012.01.016. Epub 2012 Feb 25.
Treatment decisions for advanced non-small cell lung cancer (NSCLC) are complex and require trade-offs between the benefits and risks experienced by patients. We evaluated the benefits that patients judged sufficient to compensate for the risks associated with therapy for NSCLC.
Participants with a self-reported diagnosis of NSCLC (n=100) were sampled from an online panel in the United Kingdom. Eligible and consenting participants then completed a self-administered online survey about their disease and their treatment preferences were assessed. This involved respondents choosing among systematically paired profiles that spanned eight attributes: progression-free survival [PFS], symptom severity, rash, diarrhoea, fatigue, nausea and vomiting, fever and infection, and mode of treatment administration (infusion and oral). A choice model was estimated using mixed-logit regression. Estimates of importance for each attribute level and attribute were then calculated and acceptable tradeoffs among attributes were explored.
A total of 89 respondents (73% male) completed all choice tasks appropriately. Increases in PFS together with improvements in symptom severity were judged most important and increased with PFS benefit - 4 months: 5.7; 95% CI: 3.5-7.9; 5 months: 7.1; 95% CI: 4.4-9.9; and 7 months: 10.0; 95% CI: 6.1-13.9. However, improvements in PFS were viewed as most beneficial when disease symptoms were mild and as detrimental when patients had severe symptoms. Fatigue (5.0; 95% CI: 2.7-7.3) was judged to be the most important risk, followed by diarrhoea (2.8; 95% CI: 0.7-4.9), nausea and vomiting (2.1; 95% CI: 0.1-4.1), fever and infection (2.1; 95% CI: 0.2-4.1), and rash (2.0; 95% CI: 0.2-3.9). Oral administration was preferred to infusion (1.8; 95% CI: 0.0-3.6). Patients with mild and moderate symptoms traded PFS for less risks or more convenience if the severe symptoms were not experienced.
This study demonstrates the value of conjoint analysis in the study of patient preferences for cancer treatments. In this small sample of patients with NSCLC from the UK, we demonstrate that the value of improvements in PFS is conditional upon the severity of disease symptoms; and that risks are valued differently.
晚期非小细胞肺癌（NSCLC）的治疗决策较为复杂，需要在患者的获益与风险之间进行权衡。我们评估了患者认为足以补偿 NSCLC 治疗相关风险的获益。
从英国的一个在线面板中抽取了 100 名自报 NSCLC 诊断的参与者。合格并同意的参与者随后完成了一份关于他们疾病的自我管理在线调查，并评估了他们的治疗偏好。这涉及到受访者在系统配对的特征之间进行选择，这些特征跨越了 8 个属性：无进展生存期（PFS）、症状严重程度、皮疹、腹泻、疲劳、恶心和呕吐、发热和感染，以及治疗管理方式（输注和口服）。使用混合对数回归估计选择模型。然后计算每个属性水平和属性的重要性估计值，并探讨属性之间可接受的权衡。
共有 89 名受访者（73%为男性）完整地完成了所有选择任务。PFS 的增加以及症状严重程度的改善被认为是最重要的，并且随着 PFS 获益的增加而增加 - 4 个月：5.7；95%置信区间：3.5-7.9；5 个月：7.1；95%置信区间：4.4-9.9；7 个月：10.0；95%置信区间：6.1-13.9。然而，当疾病症状轻微时，PFS 的改善被视为最有益的，而当患者出现严重症状时则被视为有害的。疲劳（5.0；95%置信区间：2.7-7.3）被认为是最重要的风险，其次是腹泻（2.8；95%置信区间：0.7-4.9）、恶心和呕吐（2.1；95%置信区间：0.1-4.1）、发热和感染（2.1；95%置信区间：0.2-4.1）和皮疹（2.0；95%置信区间：0.2-3.9）。口服给药比输注给药更受欢迎（1.8；95%置信区间：0.0-3.6）。如果没有出现严重症状，轻度和中度症状的患者可以通过换取 PFS 获益来换取更少的风险或更多的便利。
本研究证明了联合分析在癌症治疗患者偏好研究中的价值。在来自英国的这个 NSCLC 小样本患者中，我们证明了 PFS 改善的价值取决于疾病症状的严重程度，并且风险的价值是不同的。
