Review for 10.1186/s12876-024-03167-1 (2024)

Title: Scoping Review of Values Elicitation Tools for Treatment Decisions in Hepatocellular
Carcinoma
Version: 1 Date: 24 Dec 2023
Reviewer's report:
In this study, Dr Ritaccioand colleagues, assessed evidences for the use of preference elicitation
tools or willingness to pay/willingness to accept methods for hepatocellular carcinoma (HCC)
treatment decision-making from both the patient and provider perspective.
They took into account ten published studies reporting the role of preference elicitation tools for
HCC treatments, and Three of 10 studies were industry funded.
Regarding Patient-oriented preference elicitation, Five studies explored patient preferences
for HCC treatment. One of these studies was conducted in patients with very early or early-
stage HCC and the others were in patients with unresectable HCC. Considering preference
elicitation studies of HCC treatments involving physicians. Three studies explored physician
preferences for initial HCC treatment. They also performed a Comparison of patient preferences
and physician recommendations.
Most studies reviewed suggest that although patients place the highest value on extending overall
survival, they are willing to give up overall survival to avoid treatment risks and preserve quality
of life. Studies of physicians and surgeons have found that operator preferences depend on
patient characteristics, operator specialty, and surgeon- or hospital-related factors.
The authors argue that the available studies have revealed a wide range of potential factors
that may be important to patients and that many patients are willing to forgo survival in order
to maintain quality of life. Therefore, further research should explore both the elicitation of
preferences on currently available and emerging therapies for HCC and the use of these data to
develop patient-facing tools to help patients navigate treatment options.
The study addresses an important issue related to the patient's perspective in choosing the most
appropriate therapy for the treatment of HCC. In this sense, the study takes an interesting
approach.
However, some issues could be improved.
In a study addressing the important topic of patient preferences, it would also be relevant to
report data on the model of care received by patients. It would be important, for instance, to
report whether patients had a physician/nurse referral for the management of adverse events
of therapies. This would certainly reassure the patient about the initiation of therapies and,
of major relevance, would have a higher likelihood of successful therapy and longer survival
as previously demonstrated for sorafenib therapy if individualized and properly managed (J
Hepatol. 2019;71(6):1175-1183. doi: 10.1016/j.jhep.2019.08.015.).
One additional matter that would deserve to be analyzed is that of the appropriate selection of
patients who are eligible for the different therapies since a suboptimal selection of patients could
result in a higher risk of adverse events and toxicity. This issue needs to be more analyzed and
discussed by the authors as various studies have proposed scoring systems to select patients
more likely to respond to therapies (Clin Transl Gastroenterol. 2021 Jan 14;12(1):e00286. doi:
10.14309/ctg.0000000000000286).
Finally, the authors should also discuss the available data on off-label treatment with systemic
therapies for patients who do not meet the requirements to receive guideline-recommended
therapies, such as sorafenib, lenvatinib, and others, but still have a condition (liver reserve
function, performance status) that makes them suitable to receive other systemic therapies that
have been shown to be effective in patients intolerant, ineligible (due to liver functional reserve)
or unresponsive to sorafenib.
As minor point, in my opinion, in the discussion should recall the recent changing scenario
of HCC observed in the last decade since an improvement in patient survival observed in the
last period was likely because of a larger use surveillance policy leading to an higher rate of
treatments by thermal ablation as well as to an improved management of intermediate stage
patients, as recently reported (Liver Int. 2021;41(3):585-597. doi: 10.1111/liv.14735), thus
improving also patient compliance, satisfaction and involvement in the treatment decision.