Patient-Centered Research, Evidera, London, UK.
Ipsen, Boulogne-Billancourt, Paris, France.
Cancer Med. 2024 Oct;13(19):e70177. doi: 10.1002/cam4.70177.
Patients with follicular lymphoma (FL) often relapse or become refractory to treatment (R/R). While the R/R FL treatment landscape evolves, little is known about the priorities of patients and physicians. This discrete-choice experiment (DCE) study assessed patients' and physicians' treatment preferences, and the trade-offs they would be willing to make between efficacy, tolerability, and administration.
An online survey was conducted in US-based patients (≥18 years) with R/R FL and FL-treating physicians. The DCE was informed by a targeted literature review, clinical data, expert oncologist input, and pilot interviews. Participants completed eight experimental choice tasks where they chose between two hypothetical treatment profiles defined by six attributes: progression-free survival (PFS), administration/monitoring, risks of laboratory abnormalities requiring intervention, severe infections, diarrhea, and cytokine release syndrome (CRS). Relative attribute importance (RAI) and willingness to trade-off between PFS and other attributes were estimated.
Two-hundred patients (mean age 63.5 years; median three prior lines of therapy) and 151 FL-treating physicians participated. Increasing PFS was most important for both groups, although it was relatively less important to patients than physicians (RAI 35.2% vs. 45.7%). Administration/monitoring was three times more important to patients than physicians (RAI 28.8% vs. 9.5%); patients preferred oral treatment and would be willing to tolerate a significant reduction in PFS for oral administration over weekly intravenous infusions. Avoiding CRS was less important to patients than to physicians (RAI 7.7% vs. 15.8%). Both groups would accept shorter PFS for reduced risks of side effects (especially of laboratory abnormalities for patients and of CRS for physicians).
Although PFS was the most important attribute to patients and physicians, both would tolerate lower PFS for reduced side effects. Patients would also accept a substantial reduction in PFS for oral administration. Differences between the preferences/priorities of patients and physicians highlight the importance of shared decision-making.
滤泡性淋巴瘤（FL）患者常发生复发或对治疗产生耐药（R/R）。尽管 R/R FL 的治疗现状在不断发展，但患者和医生的治疗优先事项知之甚少。本离散选择实验（DCE）研究评估了患者和医生的治疗偏好，以及他们在疗效、耐受性和给药方面愿意做出的权衡取舍。
在美国开展了一项基于网络的 R/R FL 患者（≥18 岁）和 FL 治疗医生的调查。DCE 是基于目标文献回顾、临床数据、专家肿瘤学家意见和试点访谈制定的。参与者完成了八项实验性选择任务，在这些任务中，他们在由六个属性定义的两种假设治疗方案之间进行选择：无进展生存期（PFS）、给药/监测、需要干预的实验室异常风险、严重感染、腹泻和细胞因子释放综合征（CRS）。估计了相对属性重要性（RAI）和在 PFS 与其他属性之间进行权衡的意愿。
200 名患者（平均年龄 63.5 岁；中位既往三线治疗）和 151 名 FL 治疗医生参与了研究。增加 PFS 对两组患者均最为重要，但与医生相比，其对患者的重要性相对较低（RAI 为 35.2% vs. 45.7%）。给药/监测对患者的重要性是医生的三倍（RAI 为 28.8% vs. 9.5%）；患者更倾向于口服治疗，愿意忍受口服给药与每周静脉输注相比显著降低 PFS 来换取。与医生相比，患者对避免 CRS 的重视程度较低（RAI 为 7.7% vs. 15.8%）。两组患者均会为减少副作用风险（尤其是患者的实验室异常风险和医生的 CRS 风险）而接受较短的 PFS。
尽管 PFS 对患者和医生都是最重要的属性，但两者均会为降低副作用而接受较低的 PFS。患者也会为接受口服治疗而接受 PFS 的大幅降低。患者和医生的偏好/优先事项之间的差异突显了共同决策的重要性。
