Patient and Oncologist Preferences for the Treatment of Adults with Advanced Soft Tissue Sarcoma: A Discrete Choice Experiment
There has been no single standard-of-care treatment of patients with advanced/metastatic soft tissue sarcoma (STS). This study was designed to understand patient and oncologist preferences in the advanced/metastatic setting.
Adult patients diagnosed with STS and oncologists treating patients with STS completed discrete choice experiment surveys. Study participants chose between pairs of hypothetical treatment profiles for advanced STS characterized by varying levels of overall survival (14, 20, or 26 months), progression-free survival (3, 5, or 7 months), objective tumor response rate (12, 18, or 26%), risk of hospitalization due to side effects (12, 30, or 46%), and days/month to administer treatment (1, 2, or 4 days). A hierarchical Bayes model was used to estimate preferences and relative importance of attributes.
Seventy-six patients (23.7% male, mean age 52.8 years) and 160 oncologists (73.8% male, mean 16.9 years in practice) completed the surveys. Among patients, overall survival had the highest relative importance (39.5%, standard deviation [SD] 18.2%), followed by response rate (21.2%, SD 10.4%), and hospitalization (19.8%, SD 12.5%). Among oncologists, overall survival had the highest relative importance (44.6%, SD 16.0%), followed by hospitalization (18.4%, SD 8.3%).
Both patients with STS and oncologists preferred a treatment that maximizes the life of patients while avoiding hospitalizations.
All authors made significant contributions to the study design, analysis and interpretation of the data, and preparing and reviewing the manuscript. All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this manuscript, take responsibility for the integrity of the work as a whole, and have given final approval of the version to be published. All authors had full access to all of the data presented in this study and take complete responsibility for the integrity of the data and accuracy of the data analysis.
Research funding was provided by Eli Lilly and Company to Analysis Group, Inc.
Compliance with ethical standards
All study procedures were reviewed and approved as exempt under 45 CFR §46.101(b)(2) by the Western Institutional Review Board, Puyallup, WA, USA. Informed consent was obtained from all individual participants included in the study.
Conflict of interest
Lisa M. Hess, Yajun Zhu, and Steven Nicol are employees of Eli Lilly and Company. Jasmina Ivanova, Viviana Garcia-Horton, Sophia Graham, and Xinyue Liu are employees of Analysis Group, Inc.
- 1.Zahm SH, Fraumeni JF. The epidemiology of soft tissue sarcoma. Semin Oncol. 1997;24(5):504–14.Google Scholar
- 2.NCCN Guidelines Version 2.2017, February 8, 2017—Soft Tissue Sarcoma.Google Scholar
- 3.Wagner MJ, Amodu LI, Duh MS, Korves C, Solleza F, Manson SC, et al. A retrospective chart review of drug treatment patterns and clinical outcomes among patients with metastatic or recurrent soft tissue sarcoma refractory to one of more prior chemotherapy treatments. BMC Cancer. 2015;15:175.CrossRefGoogle Scholar
- 7.Drugs approved for soft tissue sarcoma. Rockville: National Cancer Institute; 2015 [cited 15 Aug 2017]. Available at: https://www.cancer.gov/about-cancer/treatment/drugs/soft-tissue-sarcoma.
- 12.Gonzalez JM, Morlock R, Ogale S, Sommer N, Posner J, Grothey A. Patients’ and physicians’ risk-benefit trade-off preferences for metastatic colorectal cancer treatments. J Clin Oncol. 2015;33(15 Suppl):3591.Google Scholar
- 15.McFadden D. Conditional logit analysis of qualitative choice behavior. In: Zarenmbka P, editor. Frontiers in econometrics. New York: Academic; 1989. p. 105–42.Google Scholar
- 19.Roth AJ. Adding new agent to chemotherapy boosts survival in small trial of soft tissue sarcoma. Cure Today, Nov 13, 2015 [cited 15 Nov 2016]. Available at: http://www.curetoday.com/articles/adding-new-agent-to-chemotherapy-boosts-survival-in-small-trial-of-soft-tissue-sarcoma.
- 20.Judson I, Verweij J, Gelderblom H, Hartmann JT, Schöffski P, Blay JY, et al. Doxorubicin alone versus intensified doxorubicin plus ifosfamide for first-line treatment of advanced or metastatic soft-tissue sarcoma: a randomised controlled phase 3 trial. Lancet Oncol. 2014;15(4):415–23.CrossRefGoogle Scholar
- 21.Kuhfeld WF. Marketing research methods in SAS. Experimental Design, Choice, and Graphical Techniques; SAS 9.2 Edition. Cary, NC: SAS Institute Inc.; 2010 [cited 15 Nov 2016]. Available at: http://support.sas.com/techsup/technote/mr2010.pdf.
- 22.SawtoothSoftware.com. Orem, UT: Sawtooth Software, Inc.; 2016 [cited 15 Nov 2016]. Available at: http://www.sawtoothsoftware.com/.
- 23.Orme B. Sample size issues for conjoint analysis studies. Sequim: Sawtooth Software Technical Paper. Orem, UT: Sawtooth Software; 1998.Google Scholar
- 24.Johnson R, Orme B. Getting the most from CBC. Sequim: Sawtooth Software Research Paper Series. Orem, UT: Sawtooth Software; 2003.Google Scholar
- 25.Orme BK, Chrzan K. Becoming an expert in conjoint analysis: choice modeling for pros. Orem: Sawtooth Software; 2017.Google Scholar