Treatment preferences in advanced pancreatic ductal adenocarcinoma (PDAC) from qualitative patient (PT), caregiver (CG), and oncologist (OC) interviews.
Authors: Lewis Mark Andrew , Meginnis Keila , Fuldeore Rupali , Trapali Myrto , Samuelson Ashley , Schild Arianne , Lamkin Anica , deGrazia Janet , Harmon Katrina , Picozzi Vincent J. , Whitty Jennifer A. 
Published: January 2025

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Background:
Most treatment regimens for patients with PDAC focus on extending survival while managing symptoms and maintaining quality of life (QoL). Here we report insights from PT, CG, and OC interviews on PDAC treatment preferences.
Methods:
A targeted literature review of 7 quantitative/preference and 12 qualitative/patient-reported outcome studies was used to develop semi-structured interview guides. Single 60-minute interviews of US PTs with stage 4 PDAC, CGs, and OCs with ≥5 years’ experience treating PDAC were undertaken virtually by staff from March to April 2024. Interviews had 5 sections: background/clinical experience (OC only); key treatment benefits and risks to avoid (ranked by importance); treatment convenience; and 2 hypothetical treatment preference questions. Participants completed a sociodemographic and clinical questionnaire. Interviews were recorded with permission, transcribed, and analyzed with ATLAS.ti v8+.
Results:
Ten PTs, CGs, and OCs completed interviews (N=30 total), including 4 PT/CG dyads. Mean PT age was 56.8 (standard deviation [SD] 12.15) years; 6 were men and 4 did not have CGs. Mean CG age was 51.1 (SD 14.2) years; 9 were women and 7 cared for their partners. OCs had mean 18.5 (SD 6.9) years’ clinical experience and 10 were men. Top-ranked treatment benefits were increased overall survival (OS) (6 PTs [60%], 8 CGs [80%], 7 OCs [70%]); improved QoL (6 PTs [60%], 5 CGs [50%], 7 OCs [70%]); stopping disease progression (5 PTs [50%], 3 CGs [30%], 7 OCs [70%]), and increased life expectancy (7 PTs [70%], 5 CGs [50%], 3 OCs [30%]). PTs’ top 3-ranked side effects to avoid included fatigue (n=4 [40%]), nausea (n=4 [40%]), and vomiting (n=3 [30%]). CGs ranked trouble remembering (n=4 [40%]), neutropenia (n=4 [40%]), and neuropathy (n=3 [30%]) in the top 3, while OCs ranked vomiting (n=5 [50%]), neuropathy [n=5 [50%]), and neutropenia (n=4 [40%]) highest. Most PTs/CGs were indifferent to ≥1 infusion/visit and infusion duration. In the first hypothetical treatment preference question, the treatment with higher efficacy but higher side effect risk and longer infusion time was preferred by 80% of PTs/CGs and 70% of OCs. In the second hypothetical treatment question, treatments had the same efficacy; 90% of PTs/CGs/OCs preferred the treatment with shorter infusion time and lower risk of gastrointestinal side effects and hypersensitivity reactions, despite higher risk of severe hypokalemia and severe neutropenia.
Conclusions:
OS and QoL were ranked as similarly important by participants, suggesting that extending survival is insufficient without acceptable QoL. Avoiding side effects was important to all participants, though PTs, CGs, and OCs ranked specific risks with differing importance. More studies are needed to quantify tradeoffs between treatment efficacy and side effects in the care of patients with advanced PDAC.