Division of Gynecologic Oncology, Duke University Medical Center, Durham, NC, United States of America; Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, United States of America; Duke Cancer Institute, Duke University Medical Center, Durham, NC, United States of America.
Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, NC, United States of America.
Gynecol Oncol. 2020 Mar;156(3):561-567. doi: 10.1016/j.ygyno.2020.01.026. Epub 2020 Jan 22.
To measure preferences of women with ovarian cancer regarding risks, side effects, costs and benefits afforded by maintenance therapy (MT) with a poly ADP ribose polymerase (PARP) inhibitor.
A discrete-choice experiment elicited preferences of women with ovarian cancer regarding 6 attributes (levels in parentheses) relevant to decisions for MT versus treatment break: (1) overall survival (OS; 36, 38, 42 months); (2) progression-free survival (PFS; 15, 17, 21 months); (3) nausea (none, mild, moderate); (4) fatigue (none, mild, moderate); (5) probability of death from myelodysplastic syndrome/acute myelogenous leukemia (MDS/AML; 0% to 10%); (6) monthly out-of-pocket cost ($0 to $1000). Participants chose between 2 variable MT scenarios and a static scenario representing treatment break, with multiple iterations. Random-parameters logit regression was applied to model choices as a function of attribute levels.
95 eligible participants completed the survey; mean age was 62, 48% had recurrence, and 17% were ever-PARP inhibitor users. Participants valued OS (average importance weight 24.5 out of 100) and monthly costs (24.6) most highly, followed by risk of death from MDS/AML (17.9), nausea (14.7), PFS (10.5) and fatigue (7.8). Participants would accept 5% risk of MDS/AML if treatment provided 2.2 months additional OS or 4.8 months PFS. Participants would require gains of 2.6 months PFS to accept mild treatment-related fatigue and 4.4 months to accept mild nausea.
When considering MT, women with ovarian cancer are most motivated by gains in OS. Women expect at least 3-4 months of PFS benefit to bear mild side effects of treatment.
测量卵巢癌女性对维持治疗（MT）与聚 ADP 核糖聚合酶（PARP）抑制剂相关风险、副作用、成本和获益的偏好。
离散选择实验诱发了卵巢癌女性对 6 个属性（括号内的水平）的偏好，这些属性与 MT 与治疗中断的决策相关：（1）总生存期（OS；36、38、42 个月）；（2）无进展生存期（PFS；15、17、21 个月）；（3）恶心（无、轻度、中度）；（4）疲劳（无、轻度、中度）；（5）骨髓增生异常综合征/急性髓系白血病（MDS/AML）死亡的概率（0%至 10%）；（6）每月自付费用（0 至 1000 美元）。参与者在 2 种可变 MT 方案和代表治疗中断的静态方案之间进行选择，进行了多次迭代。随机参数对数回归用于将选择建模为属性水平的函数。
95 名符合条件的参与者完成了调查；平均年龄为 62 岁，48%有复发，17%曾使用过 PARP 抑制剂。参与者最看重 OS（平均重要性权重为 100 分中的 24.5 分）和每月费用（24.6），其次是 MDS/AML 死亡风险（17.9）、恶心（14.7）、PFS（10.5）和疲劳（7.8）。如果治疗提供 2.2 个月的额外 OS 或 4.8 个月的 PFS，参与者愿意接受 5%的 MDS/AML 风险。参与者需要获得 2.6 个月的 PFS 获益，才能接受轻度治疗相关疲劳，需要获得 4.4 个月的获益，才能接受轻度恶心。
在考虑 MT 时，卵巢癌女性最受 OS 获益的驱动。女性期望至少获得 3-4 个月的 PFS 获益，才能忍受治疗的轻度副作用。
