Oncologists’ and urologists’ preferences for adjuvant therapy in renal cell carcinoma: a discrete-choice experiment
Creators: name: Vass, Caroline
name: Pinto, Cathy Anne
name: Myers, Kelley
name: Imai, Kentaro
name: Bussberg, Cooper
name: Bhattacharya, Rituparna
name: Calhoun, Shawna R.
name: Poulos, Christine
Publisher: name: Taylor & Francis
Year: 2025
Subjects: Medicine
Cell Biology
Pharmacology
Biotechnology
Marine Biology
Cancer
Virology

description: To quantify physicians’ preferences for adjuvant renal cell carcinoma (RCC) treatments. A discrete-choice experiment was administered online to board-certified/eligible physicians. Physicians chose between pairs of hypothetical adjuvant therapies for a high-risk patient who had recently undergone a radical nephrectomy. Data were analyzed using random-parameters logit and latent-class models. Physicians (<i>n</i> = 250; 64% oncologists; 36% urologists) placed most importance on improvements in the chance of 5-year overall survival, followed by increased median disease-free survival and reduced risk of side effects. The analyses also highlighted their willingness to make tradeoffs between these benefits and risks. Physicians were generally tolerant of increases in the risks of treatment-related severe diarrhea, dizziness, and fatigue and were willing to accept increases in these risks in exchange for improvements in overall or disease-free survival. Subgroup analysis revealed heterogeneity between oncologists and urologists, and latent-class analysis revealed significant heterogeneity among the whole physician sample. Most physicians in this study would recommend adjuvant therapy to a typical high-risk postnephrectomy RCC patient. Renal cell carcinoma is a common type of kidney cancer that can be hard to treat. If possible, most patients with renal cell carcinoma will have surgery to remove the tumor from the kidney. New treatments are being developed that can be taken after this surgery, when patients are free from cancer, that aim to prevent the cancer returning. However, choosing to recommend a treatment after surgery requires a balance among the benefits (living longer, remaining cancer free for longer), the chance of side effects, and the burden of taking extra medicine. We wanted to better understand how doctors balanced the benefits, risks, and burdens of these treatments. In a survey, we asked doctors who specialize in treating people with kidney cancer to make these tradeoffs. The survey required the doctors to choose their preferred option from a series of hypothetical treatments (with different features) that could be taken after surgery. From the choices they made, it was revealed which treatment features were most important to them and their willingness to trade off among the different features. In our sample, on average, the most important feature for doctors choosing treatments was increasing the chance of the patient living for at least 5 more years after starting treatment. The next most important feature was increasing how long the patient could live without cancer returning. The doctors also thought it was important for the treatment to avoid possible side effects, but they were willing to risk severe side effects for their patients if the treatment kept the patients alive longer. For a typical patient who was cancer free after surgery to remove the tumor in their kidney, most doctors would recommend a treatment, but some would not and would prefer their patients to avoid the risk of severe side effects.