Abstract P6-02-08: Identifying preferences that may motivate choice of ovarian cancer risk prevention strategies using a discrete choice experiment
Authors: Daly Mary , Egleston Brian , Lew Kaitlyn , Bealin Lisa , Husband Alexander , Stopfe Jill , Przybysz Pawel , Tchuvatkina Olga , Wong Yu-Ning , Garber Judy , Rebbeck Timothy 
Published: March 2023

Abstract
Background: Women with a familial or hereditary risk for ovarian cancer are at a much greater risk of developing ovarian cancer compared with women in the general population. This high risk demands prevention strategies to reduce ovarian cancer incidence and mortality. Currently there is little information about how women with a hereditary risk for ovarian cancer make trade-offs when choosing among prevention strategies and their associated risks. In anticipation of the likelihood that when given more personalized risk estimates, patients may have different preferences based on their mutation specific cancer risk as well as demographic and clinical factors, it is critical that we have the necessary information to develop counseling models that are tailored to individual patients’ preferences for cancer risk reduction and tolerance of associated risks. Methods: We performed a discrete choice experiment to investigate how women at higher risk of ovarian cancer weigh benefits (e.g. reduced risk of ovarian) versus costs (e.g. increased risk of heart disease) in choosing a treatment strategy. N=396 pre-menopausal women with a personal history of breast cancer or familial history suggestive of increased breast and/or ovarian cancer risk were surveyed from August, 2019, to January, 2022. Participants were asked to choose between two sets of attributes that specified type of surgery (risk-reducing salpingo-oophorectomy [RRSO], risk reducing salpingectomy [RRS] vs. non-surgical surveillance), age of menopause (natural versus immediate), quality of menopausal symptoms (mild, moderate, severe), and risk of ovarian cancer, heart disease, or osteoporosis. Risks of disease varied in discrete intervals. We fit a Bradley-Terry logistic regression to estimate preferences. The binary response was the randomly generated choice set selected versus the set not selected. Results: Women were more likely to choose sets with either surveillance (odds ratio [OR]= 1.28, 95% confidence interval [CI] 0.98, 1.67) or RRSO (OR= 1.39, 95% CI 1.07, 1.81) over RSS. In weighing trade-offs in the choice sets that included type of surgery, women had a stronger independent preference for reducing the risk of ovarian cancer (OR= 0.66 of choosing set per 10% increase in risk, 95% CI 0.62, 0.71) than in reducing the risk of osteoporosis (OR= 0.82 per 10% increase, 95% CI 0.75, 0.90) or heart disease (OR = 0.82 per 10% increase, 95% CI 0.76,0.88). Women also had a strong preference for delaying the expected age of ovarian cancer (OR= 1.34 per 10-year increase in age, 95% CI 1.19, 1.51). Women had strong preferences for having a natural age of menopause (OR= 1.58 compared to immediate menopause post-treatment, 95% CI 1.27, 1.95), and better less severe symptoms (OR= 0.65 for each ordinal increase in the severity of symptoms, 95% CI 0.60, 0.70). Conclusions: Our results suggest that women may prefer either surveillance or the most extensive type of surgery (RRSO) over more limited surgery (RRS). In weighing trade-offs, reducing the risk of ovarian cancer seemed to be more important than reducing the risk of osteoporosis or heart disease. Still, having a natural age of menopause and reducing the severity of symptoms could motivate the choice of treatment. Our work will allow us to estimate thresholds of measured factors that may motivate women to choose a specific treatment strategy.
Citation Format: Mary Daly, Brian Egleston, Kaitlyn Lew, Lisa Bealin, Alexander Husband, Jill Stopfe, Pawel Przybysz, Olga Tchuvatkina, Yu-Ning Wong, Judy Garber, Timothy Rebbeck. Identifying preferences that may motivate choice of ovarian cancer risk prevention strategies using a discrete choice experiment. [abstract]. In: Proceedings of the 2022 San Antonio Breast Cancer Symposium; 2022 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2023;83(5 Suppl):Abstract nr P6-02-08.