• Article

Patients' and physicians' risk-benefit trade-off preferences for metastatic colorectal cancer treatments

Background: Preferences for treatment-related benefits and risks associated with metastatic colorectal cancer (mCRC) therapies may vary between patients and physicians. Methods: A literature review and clinician interviews were carried out to develop risk-benefit profiles. PFS and probabilistic adverse outcomes were described in an online discrete-choice experiment completed by patients and physicians. Participants assessed a series of 10 choices between pairs of hypothetical medication profiles . Each profile included attributes within a pre-determined range: PFS (12 months, 8 months, 6 months), severe papulopustular rash (PR) (0%, 5%, 10%, 25%), serious hemorrhage (0%, 2%, 10%, 35%), cardiopulmonary arrest (0%, 2%, 10%, 20%), and gastrointestinal perforations (0%, 2%, 10%, 20%). Choice questions were based on an experimental design with known statistical properties. Random-parameter choice models produced preference weights indicating the strength of trade-off. These weights were used to calculate the maximum acceptable risk of different adverse events associated with various mCRC therapies. Results: A total of 127 patients and 150 physicians completed the discrete-choice survey. The mean maximum level of treatment-related risk patients were willing to accept for a 4-month increase in PFS from 8 to 12 months was 16.7% (0.0%-82.9%) for PR, 13.8% (4.6%-23.2%) for gastrointestinal perforation, 10.3% (3.3%-17.1%) for serious hemorrhage and 5.1% (1.7%-8.7%) for cardiopulmonary arrest. For the same PFS improvement, physicians were willing to accept a risk of severe PR that exceeded 25% and more than 20% risk for gastrointestinal perforation, which were the maximum levels shown in the survey for each of these treatment-related adverse events. Physicians were also willing to accept 18.9% (12.3%-24.5%) risk for serious hemorrhage and 7.0% (3.0%-10.8%) for cardiopulmonary arrest for the same 4-month PFS improvement. Conclusions: The benefit-risk tradeoff data obtained in this study show potential risk-tolerance differences between patients and oncologists, highlighting the importance of understanding preferences from the patient’s perspective when making treatment decisions.

Citation

Gonzalez, J., Morlock, R., Ogale, S., Sommer, N., Posner, J., & Grothey, A. (2015). Patients' and physicians' risk-benefit trade-off preferences for metastatic colorectal cancer treatments. Journal of Clinical Oncology, 33(15 suppl), 3591.