Background: Despite demonstrated clinical benefits of first line (1L) cyclin-dependent kinases 4/6 inhibitors (CDK4/6i) and their preferred status in the NCCN guidelines, many appropriate patients with hormone receptor positive (HR+)/human epidermal growth factor receptor 2 negative (HER2-) metastatic breast cancer (mBC) in the United States (US) may still receive chemotherapy or endocrine monotherapy. US oncologists may consider treatment expectations, patient clinical characteristics, and non-clinical factors (e.g., cost, anticipated adherence) when selecting 1L mBC treatment regimens. However, little is known about how prevalent these decision factors are among US oncologists. Comprehensively understanding the decision-making process in 1L treatment selection is a critical step towards ensuring equitable care for patients with HR+/HER2- mBC. Objective: To describe self-reported clinical and non-clinical factors considered by US oncologists in selection of 1L treatment for HR+/HER2- mBC. Methods: Data were collected through from an anonymous cross-sectional online survey from a convenience sample of US oncologists from August-October 2021. Eligible oncologists were board certified, in practice 2-30 years, ≥50% of time spent in direct patient care, and managed ≥5 1L patients with HR+/HER2- mBC in past 3 months. Respondents were sampled from a national research database of physicians sourced from multiple databases (e.g., American Medical Association Physician Masterfile). The survey captured self-reported demographic and practice characteristics and reported importance of the following factors in selecting 1L treatment for patients with HR+/HER2-mBC: anticipated treatment efficacy and safety, patient demographics, and clinical and non-clinical characteristics. Study variables were summarized via descriptive statistics. Correlation analyses evaluated associations between patient demographics, clinical characteristics, treatment expectations, and non-clinical characteristics and oncologists’ self-reported 1L prescribing rates of CDK4/6i, aromatase inhibitor (AI) monotherapy, and chemotherapy. Results: 250 oncologists participated; 67% from community practice and the remainder from academic institutions (Table 1). Anticipated treatment efficacy and safety/tolerability were ranked as the most important factor considered by oncologists when selecting 1L treatments. 1L CDK4/6i prescribing was most strongly correlated with patient Medicare eligibility (r, 0.54, p< 0.05) and postmenopausal status (r, 0.67, p< 0.05). 1L chemotherapy prescribing was most strongly correlated with patient premenopausal status (r, 0.42, p< 0.05) and perimenopausal status (r, 0.31, p< 0.05), and physician consideration for patient symptom burden (r, 0.31, p< 0.05). 1L AI monotherapy prescribing was most strongly correlated with concerns with expected patient compliance to treatment (r, 0.42, p< 0.05) and patient cost/logistical challenges (r, 0.41, p< 0.05). Conclusion: This study found a variety of patient, clinical, and non-clinical factors may underlie US oncologists’ selection of 1L treatment for HR+/HER2- mBC. Anticipated efficacy and safety/tolerability were reported as the most important factors in 1L treatment decisions. Patient demographics, clinical characteristics, and considerations for cost and compliance challenges varied in association with 1L CDK4/6i, chemotherapy, and AI monotherapy prescribing patterns among US oncologists. Table 1. Oncologist Demographic and Practice Characteristics Citation Format: Adam M. Brufsky, Martine C. Maculaitis, Lewis Kopenhafer, Patrick Olsen, Ashley S. Cha, Lillian Shahied Arruda, Wendy Heck, Samantha K. Kurosky. Identifying Drivers of First-Line HR+/HER2- Metastatic Breast Cancer Treatment Choices [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 P4-07-09.

94 Background: Androgen deprivation therapies (ADTs) for prostate cancer (PC) vary in delivery mode, T (testosterone) surge occurrence, time to T recovery, adverse event profile, and costs. Data are limited on how men differ in their evaluation of ADT attributes. This study identified subgroups of men who vary in their preferences for key ADT attributes. Methods: A cross-sectional survey of US men aged >40 years, who had healthcare coverage for the past 3 years and self-reported a PC diagnosis, were recruited via healthcare research panels. Men were ineligible if they did not know/recall whether they had received ADT or were unable to complete the survey independently. Quotas ensured an approximate even split of ADT-experienced and ADT-naïve men. A discrete choice experiment assessed preferences for ADT attributes. In a series of choice tasks, men were presented with 2 ADT treatment profiles side-by-side and asked to select the one they prefer. Hierarchical Bayes models computed attribute level preference weights. Relative importance (RI), based on differences between the most and least favorable attribute level preference weight and standardized to sum to 100%, was estimated for each attribute; the higher the RI value, the more influential an attribute is to treatment choice. Latent class analysis (LCA) identified groups (Gs) of men with similar ADT preferences. Results: 304 men were included in the analyses, their mean age was 64.4±7.2 years, and 16.8% were African American. Mean PC duration was 5.4±4.8 years, 55.3% reported organ-confined PC, and 49.0% had prior ADT use. LCA identified 4 preference Gs. While impact on sexual activity was most important to G1, out-of-pocket (OOP) costs, mode of administration, and time to T recovery were choice drivers for G2. Mode of administration and OOP costs predominated in importance for G3 and G4, respectively. More than half of men in G1 and G3 were <65 years; G1, but not G3, included mainly men who planned to be sexually active. G2 and G4 were predominantly composed of men aged ≥65 years who often had Medicare insurance. Conclusions: Younger, sexually active men consider the potential impact on sexual activity when choosing PC therapy, while for older men administration burden or OOP costs are important choice drivers. Thus, ADT attributes often vary in salience to men and should be considered in shared PC treatment decision-making. [Table: see text]

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Background Vaccine recommendations in the United States (US) are made using the Evidence to Recommendation framework, which incorporates values and preferences of the target population. Vaccines for Clostridioides difficile infection (CDI) are in development, but data on preferences to inform potential recommendations are lacking. This study assessed willingness to receive a CDI vaccine and how selected vaccine attributes affect choice. Methods An online survey including a discrete choice experiment (DCE) was conducted with a commercial survey panel October – December 2021 among US adults aged ≥ 50 years. Important vaccine attributes were identified through interviews and literature. Included attributes were vaccine effectiveness (VE), duration of protection, impact on severity of breakthrough infections, dosing schedule, injection site reactions, systemic side effects, and out-of-pocket (OOP) cost (see Figure for levels). Respondents chose among 3 alternatives in a series of 11 choice tasks after reviewing information on CDI. Each choice included 2 hypothetical vaccine profiles and no-vaccine. Preference weights for all attribute levels were estimated via hierarchical Bayesian modelling; attribute relative importance (RI) was based on the difference between least and most preferred levels (the sum of RI across attributes was scaled to equal 100%). Stratified analyses by age, race, gender, and medical conditions were conducted to explore whether preferences varied by these characteristics. Results The sample (N=1,216) was primarily white (91%), female (71%), and retired (54%); vaccination was chosen in 58% of the choice tasks. RI values showed OOP had the most impact on preferences (56%), followed by VE (18%), impact on breakthrough infections (10%), injection site pain (6%), side effects (4%), duration of protection (4%), and dosing schedule (2%), and varied little across subgroups. Attribute-level preference weights for the total sample are depicted in the Figure. Figure.Preference Weights for Clostridioides difficile Vaccine Attributes Values are means. Vertical distance between preference weights indicates strength of preferences for changes within an attribute. Conclusion Survey respondents were receptive to vaccination against CDI, especially when OOP costs were low. The impact of severity of breakthrough infections on preferences highlight the importance of considering effectiveness against severe outcomes alongside overall vaccine effectiveness. Disclosures Jeffrey T. Vietri, PhD, Pfizer Inc: Stocks/Bonds Martine C. Maculaitis, PhD, Cerner Enviza: Employee of Cerner Enviza, which received funding from Pfizer to conduct and report on the study. Joseph C. Cappelleri, PhD, Pfizer Inc.: Stocks/Bonds Holly Yu, MSPH, Pfizer Inc: Employee|Pfizer Inc: Stocks/Bonds Mary M. Moran, MD, Pfizer Inc.: Stocks/Bonds Kathleen Beusterien, MPH, Pfizer: Employee of Cerner Enviza, which consults for Pfizer.

Study question Beyond reducing pain, how do women with moderate-severe-endometriosis pain prioritize treatment features and outcomes associated with gonadotropin-releasing hormone (GnRH) analogues? Summary answer Moderate-severe-endometriosis patients prioritized safe long-term treatment, feeling treatment-effects within a few cycles, being able to maintain employment, reducing fatigue, depression, and headaches, and improving libido. What is known already The importance of pain management in endometriosis treatment is well-established. Poor health-related quality of life has been attributed to endometriosis pain, with greater impact as the number of endometriosis symptoms and symptom severity increase. Endometriosis treatment options include analgesics for acute pain episodes and surgery in more severe cases, as well as hormone therapies, including GnRH analogues. The potential risks, benefits, and outcomes associated with currently available GnRH analogues for endometriosis treatment can vary. Data are lacking on the patient perspective with respect to potential treatment features and outcomes beyond just pain reduction. Study design, size, duration Treatment-naïve patients with moderate-severe-endometriosis pain (rating scale ≥4 for menstrual pain) in the United States completed a cross-sectional online survey. Best-worst scaling (BWS) was used to assess preferences for key non-pain treatment attributes that were identified based on the literature. Cognitive pre-test interviews were conducted to confirm content validity of the questionnaire. Data collection for this ongoing survey was initiated in December 2021. Participants/materials, setting, methods Patients (English-speaking, premenopausal, 18-50 years-old) were recruited via healthcare research panel. Eligible patients self-reported laparoscopy-confirmed-endometriosis, no endometriosis/other gynecological surgery in past 3 months, no osteoporosis/bone disease/uterine fibroids history, and healthcare coverage for previous 3 years. Treatment features in the BWS exercise included dosage flexibility, short treatment onset, reversibility of side effects, reducing fatigue, depression, headache, impact on libido, impact on sleep, ability to maintain employment, duration of treatment, and additional need for contraceptive use. Main results and the role of chance Overall, 115 patients (31.1±7.5 years-old) were included in the analyses. On a 0 (no pain) to 10 (pain as bad as you can imagine) scale, the mean worst menstrual and non-menstrual pelvic pain (during past month) were 7.7±1.6 and 5.4±2.7, respectively. The most common endometriosis treatments ever used included over-the-counter pain medications (90.4%) and prescription contraceptives (74.8%). Of 11 BWS features tested, patients prioritized: “You can safely take the treatment for a long period of time” (relative importance=11.4%) “Your ability to get or maintain a job” (11.1%) “When starting a treatment, you will begin to feel the treatment’s effects within the first few menstrual cycles” (10.9%) “You will be less depressed” (10.8%) “Your interest in sex will not be affected” (10.7%) “Any side-effects you may experience are resolved quickly after treatment stops” (10.1%) “You will be less fatigued or tired” (9.5%) “You will have fewer headaches or migraines” (8.6%) Least important to patients were: “Your sleep will not be affected” (6.8%) “Your doctor offers different options for the dose strength and how often you take it, as appropriate to your needs” (5.9%) “You are not required to take additional contraceptives along with the treatment” (4.0%) Limitations, reasons for caution The preferences of patients who participated may differ from those who did not participate, thereby reducing the ability to generalize results. All data were self-reported; diagnosis and treatment could not be independently confirmed. The BWS exercise cannot include all possible attributes and outcomes relevant to patients. Wider implications of the findings Beyond pain reduction, patients most highly valued having safe long-term treatment, feeling treatment effects within a few cycles, rapid resolution of side effects, being able to work, maintaining libido, and reducing fatigue, depression, and headaches. These factors can help physicians to better align endometriosis treatment decision-making with patient preferences. Trial registration number Not applicable