Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Health Technology and Services Research, University of Twente, Enschede, The Netherlands.
Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
Acta Oncol. 2024 Sep 10;63:701-709. doi: 10.2340/1651-226X.2024.40276.
High-dose chemotherapy with autologous stem cell rescue (HDCT) is currently under investigation as a potential therapy for patients with stage III HER2-negative breast cancer with homologous recombination deficiency (HRD). In addition to survival, the impact on short- and long-term side effects might influence the uptake of HDCT by healthcare professionals. As part of the SUBITO trial, we investigated healthcare professionals' treatment (outcome) preferences for patients with HRD stage III HER2-negative breast cancer and established how healthcare professionals make trade-offs between these treatment outcomes.
PATIENTS/MATERIAL AND METHODS: We conducted a discrete choice experiment in which healthcare professionals were asked to choose repeatedly between scenarios with two treatment options (HDCT or standard of care (SOC)) that varied in outcome with respect to 10-year overall survival (OS), short-term toxicity, long-term cognitive impairment, and premature menopause. We analysed treatment preferences, relative importance, and trade-offs using a multinomial logistic model.
Thirty-five of the 151 dedicated breast cancer professionals with extensive experience in treating breast cancer patients completed the survey. The 10-year OS and long-term cognitive impairment were the most important attributes. The results indicate a requirement of 10.4% and 25.1% absolute additional improvement in the 10-year survival rate to justify accepting moderate or severe long-term cognitive impairment as a trade-off, respectively. Therefore, we found in our dataset that healthcare professionals expected a large improvement in 10-year OS to accept moderate to severe cognitive impairment. This information calls for further research into chemotherapy-related cognitive impairment, shared decision-making, and treatment preferences for patients with stage III breast cancer.
大剂量化疗联合自体干细胞解救（HDCT）目前正在作为同源重组缺陷（HRD）的 III 期 HER2 阴性乳腺癌患者的潜在治疗方法进行研究。除了生存之外，对短期和长期副作用的影响可能会影响医疗保健专业人员对 HDCT 的接受程度。作为 SUBITO 试验的一部分，我们调查了医疗保健专业人员对 HRD 期 III 期 HER2 阴性乳腺癌患者的治疗（结局）偏好，并确定了医疗保健专业人员如何在这些治疗结局之间进行权衡。
患者/材料和方法：我们进行了一项离散选择实验，要求医疗保健专业人员反复在两种治疗方案（HDCT 或标准护理（SOC））之间进行选择，这两种方案在 10 年总生存（OS）、短期毒性、长期认知障碍和过早绝经方面的结果有所不同。我们使用多项逻辑回归模型分析了治疗偏好、相对重要性和权衡。
151 名专门从事乳腺癌治疗的乳腺癌专业人员中有 35 名完成了调查，他们在治疗乳腺癌患者方面经验丰富。10 年 OS 和长期认知障碍是最重要的属性。结果表明，需要绝对额外提高 10 年生存率 10.4%和 25.1%，才能接受中度或重度长期认知障碍作为权衡，分别。因此，我们在数据集发现，医疗保健专业人员期望 10 年 OS 有较大改善，以接受中度至重度认知障碍。这些信息呼吁进一步研究与化疗相关的认知障碍、共同决策和 III 期乳腺癌患者的治疗偏好。
