Abstract PO1-18-01: Patient Preferences for HR+/HER2- Metastatic Breast Cancer Treatments in Italy: A Qualitative Assessment
Authors: Grazia Arpino, Carmine De Angelis, Lorenzo Gerratana, Matteo Lambertini, Sarah Igidbashian, Martina Bellini, Serena Giuntoli, Xavier Guillaume, Julie Behillil, Claire Graziani-Taugeron
Journal: Cancer Research (2024)

Abstract Objectives: Factors that influence treatment preferences of patients with hormone receptor-positive/HER2-negative (HR+/HER2-) metastatic breast cancer (mBC) are being investigated using discrete choice experiment (DCE) methodology. Appropriate attributes for the ongoing quantitative online survey phase were identified by this initial qualitative pilot study. Methods: To generate hypotheses and inform variables of the quantitative survey, the pilot phase consisted in online telephone interviews with patients with a diagnosis of Stage IV HR+/HER2- breast cancer at various stages of treatment. Interviews focused on exploring patients' perspectives on their interaction with physicians, preferences, and treatment experiences. Transcripts were coded using NVivo software to identify key themes. The ongoing DCE online survey aims to recruit patients meeting the same selection criteria as in the qualitative phase, also at various stages of treatment. Results: Fifteen mBC patients (median age, 43 years [range, 29-64]), including nine chemotherapy-treated and six without chemotherapy exposure, were enrolled in the pilot qualitative study. Eight and four patients reported receiving little information about their treatment plan and their risk status beyond the risk of relapse, respectively. Most participants did not know what to expect from their therapy but expressed trust in their physician’s decision in terms of treatment goals. Few patients (n=3) looked for a second opinion before starting treatment. Four out of fifteen patients declared that they were actively involved in their treatment plan decision, although all relied on their physician’s knowledge and decision. Reduced symptoms and improved quality of life (QoL) were patients’ main treatment goals, and side-effects and efficacy of treatment were their main concerns. When asked about the degree of acceptability of certain side effects, some participants considered hair loss and vomiting as unacceptable side effects, regardless of severity, while others considered them to be the most acceptable. This discrepancy is to be interpreted in the light of participants’ own treatment journey. Severity and duration of side-effects were mentioned by three patients as acceptability factors. In a choice task, patients were asked to express preferences between two hypothetical treatments. Efficacy (n=9) and administration mode (n=6) were spontaneously deemed important for treatment selection. While assessing the difference in risk between the two hypothetical treatments, ten patients explained that the main choice feature was extended progression-free survival (PFS) rate. Risk of infection and neutropenia (n=12) were concerns expressed by most patients in the post-COVID-19 period. Considering their substantial impact on QoL, alopecia (n=9) and vomiting (n=9) were presented by patients as particularly important, regardless of their degree of severity; whereas almost all patients reported that only severe fatigue (n=12), diarrhea (n=13) or nausea (n=13) would be an issue. These results allowed selection of the following attributes for further quantification of their preference weights in a DCE: PFS, risk of neutropenia, risk of alopecia, risk of vomiting, risk of diarrhea, risk of grade 3/4 side effects and mode of administration. Conclusions: This qualitative pilot study allowed for identification of what matters most to patients when selecting a treatment for mBC, which will be further assessed in the DCE. It also highlighted the need of patients with HR+/HER2- mBC for information about their treatment, potential side-effects, and health management. This research suggests that there is a need for patients to be more involved in treatment plans, and that taking patient preferences into account may help improve the treatment selection experiences. Citation Format: Grazia Arpino, Carmine De Angelis, Lorenzo Gerratana, Matteo Lambertini, Sarah Igidbashian, Martina Bellini, Serena Giuntoli, Xavier Guillaume, Julie Behillil, Claire Graziani-Taugeron. Patient Preferences for HR+/HER2- Metastatic Breast Cancer Treatments in Italy: A Qualitative Assessment [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr PO1-18-01.