Patient and clinician preferences for adjuvant treatment following surgical resection in early-stage non-small cell lung cancer: A multi-country discrete choice experiment.

BACKGROUND: For patients with early-stage non-small cell lung cancer (NSCLC), post-resection adjuvant therapy can improve survival outcomes. This study evaluated patient and clinician preferences for attributes of adjuvant treatments.

METHODS: Patients with fully-resected stage IB-IIIA NSCLC and treating clinicians completed an online discrete choice experiment with 10 choice tasks. Each task included three profiles described according to: disease-free survival (DFS), post-recurrence survival (PRS), and risk of adverse events (grade 1-2 and 3-4). DFS and PRS were presented individually and the sum represented as overall survival (OS). Preference data were analysed using a mixed logit approach.

RESULTS: 504 patients and 515 clinicians from Europe, Asia, and the Americas completed the survey. Overall, DFS was the most important attribute, contributing to 34.5% and 50.7% of patients' and clinicians' decision-making, followed by changes in PRS and the risk of adverse events. Given two treatment profiles with the same duration of OS, respondents preferred the treatment with a larger proportion of DFS. For each level of PFS, patients valued an additional month of DFS equally. Among clinicians, value of an additional month of DFS increased with the duration of PFS. Patients and clinicians valued longer DFS even when the duration of PRS was uncertain, meaning that OS was unknown.

CONCLUSIONS: Across multiple countries, patients and clinicians value the improved survival outcomes associated with adjuvant treatment following resection of early-stage NSCLC. Where OS data are complete, respondents value treatments with a greater proportion of DFS, however; even in scenarios where OS data are not known, patients and physicians value the potential increase in DFS associated with adjuvant treatment.