Introduction:
Intravenous treatment options for Her2 non-amplified metastatic breast cancer (MBC) have increased in recent years with the development of targeted therapies to supplement existing chemotherapy agents. These differ in their treatment schedules, side effects, and out of pocket costs.
Aims:
To understand better what people would value for decision making in MBC in order to assist oncologists in consent discussions and planning supportive care strategies.
Methods:
A discrete choice experiment was designed using attributes of the available therapies that oncology clinicians deemed to be of relevance These included likely duration of disease control (time), risks of hair loss, pneumonitis, gastrointestinal side effects and neuropathy as well as practical considerations such as frequency of administration and cost. This was made available as an online survey. Inclusion: Adults with MBC recruited through community organisations and referral from oncologists. Exclusion: People with Her2 smplified MBC.
Results:
134 Adults with metastatic breast cancer completed the survey. 47 had Triple Negative MBC and 87 had HR+ Her2- MBC. Overall, efficacy (time) was the most important aspect of a treatment choice. Gastrointestinal toxicity was considered tolerable by most when a more effective therapy was chosen. Neuropathy had a low influence on decision making. There were different patient segments: Some were more risk averse and concerned about hair loss and pneumonitis. Others were looking for a treatment with a low side effect burden, particularly in the HR+ subset. Affordability played a significant role in treatment choice when non-PBS approved therapies were included.
Conclusion:
These results identify the diversity of perspectives that need to be considered when discussing therapies with patients. Supportive care needs to be personalised to manage the most concerning toxicities for different individuals. Affordable access to new therapies is a priority for MBC patients.
This study was funded by an independent research grant by Gilead Sciences.