Edinburgh Clinical Trials Unit, The University of Edinburgh Usher Institute of Population Health Sciences and Informatics, Edinburgh, UK
Health Economics Research Unit, University of Aberdeen, Aberdeen, UK.
BMJ Open. 2024 Apr 28;14(4):e076798. doi: 10.1136/bmjopen-2023-076798.
There has been a recent proliferation in treatment options for patients with metastatic breast cancer. Such treatments often involve trade-offs between overall survival and side effects. Our study aims to estimate the trade-offs that could be used to inform decision-making at the individual and policy level.
We designed a discrete choice experiment (DCE) to look at preferences for avoiding severity levels of side effects when choosing treatment for metastatic breast cancer. Treatment attributes were: fatigue, nausea, diarrhoea, other side effects (peripheral neuropathy, hand-foot syndrome and mucositis) and urgent hospital admission and overall survival. Responses were analysed using an error component logit model. We estimated the relative importance of attributes and minimum acceptable survival for improvements in side effects.
The DCE was completed online by UK residents with self-reported diagnoses of breast cancer.
105 respondents participated, of which 72 patients had metastatic breast cancer and 33 patients had primary breast cancer.
Overall survival had the largest relative importance, followed by other side effects, diarrhoea, nausea and fatigue. The risk of urgent hospital admission was not significant. While overall survival was the most important attribute, respondents were willing to forgo some absolute probability of overall survival for reductions in all Grade 2 side effects (12.02% for hand-foot syndrome, 11.01% for mucositis, 10.42% for peripheral neuropathy, 6.33% for diarrhoea and 3.62% for nausea). Grade 1 side effects were not significant, suggesting respondents have a general tolerance for them.
Patients are willing to forgo overall survival to avoid particular severity levels of side effects. Our results have implications for data collected in research studies and can help inform person-centred care and shared decision-making.
转移性乳腺癌患者的治疗选择最近有所增加。这些治疗方法通常在总生存和副作用之间存在权衡。我们的研究旨在估计可以用于在个人和政策层面做出决策的权衡。
我们设计了一个离散选择实验（DCE），以研究在选择转移性乳腺癌治疗时避免副作用严重程度的偏好。治疗属性包括：疲劳、恶心、腹泻、其他副作用（周围神经病变、手足综合征和黏膜炎）、紧急住院和总生存。使用误差成分对数模型分析反应。我们估计了属性和最小可接受的生存改善对副作用的相对重要性。
DCE 通过自我报告患有乳腺癌的英国居民在线完成。
105 名参与者参加，其中 72 名患者患有转移性乳腺癌，33 名患者患有原发性乳腺癌。
总生存的相对重要性最大，其次是其他副作用、腹泻、恶心和疲劳。紧急住院的风险并不显著。虽然总生存是最重要的属性，但受访者愿意为减少所有 2 级副作用而放弃一些总生存的绝对概率（手足综合征为 12.02%，黏膜炎为 11.01%，周围神经病变为 10.42%，腹泻为 6.33%，恶心为 3.62%）。1 级副作用并不显著，表明受访者普遍容忍它们。
患者愿意放弃总生存以避免特定严重程度的副作用。我们的结果对研究中收集的数据有影响，并有助于为以患者为中心的护理和共同决策提供信息。
