Patient Preferences for Adjuvant Interferon Alfa-2b Treatment

Kilbridge, Kerry L.; Weeks, Jane C.; Sober, Arthur J.; Haluska, Frank G.; Slingluff, Craig L.; Atkins, Michael B.; Sock, Dana E.; Kirkwood, John M.; Nease, Robert F.

doi:10.1200/jco.2001.19.3.812

Cited by 84 publications

(83 citation statements)

References 17 publications

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“…Kilbridge et al found that at least half of low-risk melanoma patients were willing to tolerate mild-moderate and severe IFN toxicity for 4% and 10% improvements, respectively, in 5-year disease-free survival [9]. Krammer and Heinzerling found that patients with melanoma in different stages of the disease showed a high willingness to endure side effects despite very small survival gains (down to 1 extra week) or even only hope with no survival benefit [10].…”

Section: Discussionmentioning

confidence: 99%

“…Previous research has demonstrated that melanoma patients are willing to endure toxicities for an improvement in survival [9] [10], yet there is a paucity of evidence focused on the preferences of patients with melanoma or oncologists in the value of particular adjuvant treatments where multiple treatment options exist. Moreover, even if patients are eligible for adjuvant treatment, it is unknown whether or not they prefer to receive treatment at this stage, when there is only a risk of recurrence, or wait until a recurrence occurs.…”

Section: Introductionmentioning

confidence: 99%

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Patient and Physician Preferences for Treating Adjuvant Melanoma: A Discrete Choice Experiment

Beusterien¹,

Middleton²,

Wang³

et al. 2017

JCT

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Objective: To evaluate and compare patient and physician preferences for the benefits and risks of currently available adjuvant melanoma treatments. Methods: Patients with stage II/III melanoma and oncologists in the USA were recruited from 6 clinical sites and an online panel to complete a survey. Preferences were assessed using a paired comparison discrete choice experiment that allowed for opt-out (i.e. no treatment). The treatments comprised 7 attributes, each with 3 levels associated with pegylated interferon, high-dose interferon, and ipilimumab. Attributes included efficacy outcomes, dosing regimen, and risks of moderate to severe toxicities. In addition, open-ended maximum acceptable risk (MAR) questions assessed tradeoffs between toxicity risk and efficacy. Results: 142 patients (45 stage II; 97 stage III) chose a treatment in 78% of the choice tasks, while physicians (N = 127) chose treatment 79% of the time. The rankings of relative attribute importance were concordant between the patients and physicians for the top 4: 10-year survival in metastatic melanoma, fatigue risk, 3-year recurrence-free survival (RFS), and depression risk. Patients and physicians valued the difference in 21% survival versus no survival benefit about 3 and 4 times as much, respectively, as reducing diarrhea risk from 41% to 1% or reducing depression risk from 40% to 1%. The MAR of severe diarrhea and of a life-threatening event increased as the chance of 3-year RFS increased, with patients reporting higher risks than physicians. Conclusion: Patients and physicians were concordant in their preferences in adjuvant melanoma, preferring treatment versus none and judging potential efficacy to outweigh risks of toxicities.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Patient and Physician Preferences for Treating Adjuvant Melanoma: A Discrete Choice Experiment

Beusterien¹,

Middleton²,

Wang³

et al. 2017

JCT

View full text Add to dashboard Cite

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“…If included, respondents would be required to imagine that they had melanoma but that it was in complete remission; we felt that this may be too complex an undertaking to include as a part of the standard gamble exercise. However, an estimate for living disease free has been reported by Kilbridge as 0.96 (Kilbridge et al, 2001). In addition, our study did not consider health states with multiple toxicities.…”

Section: Discussionmentioning

confidence: 99%

“…Health status utility assessments enable the quantification of preferences for health outcomes and the estimation of qualityadjusted life expectancy. Utility measurement in melanoma to date has primarily focused on toxicities associated with interferon (IFN) therapy (Kilbridge et al, 2001;Dixon et al 2006). No studies have obtained utilities for a broader set of health states that capture both the intended (clinical response) and unintended (toxicity) effects of available treatments for advanced melanoma.…”

mentioning

confidence: 99%

Societal preference values for advanced melanoma health states in the United Kingdom and Australia

Beusterien

Szabo²,

Kotapati

et al. 2009

Br J Cancer

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Background: No studies measure preference-based utilities in advanced melanoma that capture both intended clinical response and unintended toxicities associated with treatment. Methods: Using standard gamble, utilities were elicited from 140 respondents in the United Kingdom and Australia for 13 health states. Results: Preferences decreased with reduced treatment responsiveness and with increasing toxicity. Conclusions: These general population utilities can be incorporated into treatment-specific cost-effectiveness evaluations.

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“…Kilbridge et al (2001), for instance, used the standard gamble technique to value a series of health states describing the QOL associated with interferon toxicity, melanoma recurrence and disease-free health. Their study, based on 107 patient interviews, showed that the side effects from interferon treatment reduced QoL, from 0.96 for the disease-free health state to 0.81 from severe side effects.…”

Section: Discussionmentioning

confidence: 99%

Quality of life and cost-effectiveness of interferon-alpha in malignant melanoma: results from randomised trial

et al. 2006

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A definitive conclusion regarding the value of low-dose extended duration adjuvant interferon-alpha therapy in the treatment of malignant melanoma is only possible once data on health-related quality of life (HRQoL) and costs have been considered. This trial randomised 674 patients to interferon alpha-2a (3 megaunits three times per week for 2 years or until recurrence) or placebo. Health-related quality of life (QoL) was to be assessed up to 60 months using the European Organisation for Research and Treatment of Cancer (EORTC) QLQ-C30. Data for the economic analysis, including cost information and the EQ-5D were also collected. Patients in the observation (OBS) group had significantly better mean follow-up quality of on five dimensions of the EORTC QLQ-C30 functional scales: role functioning (P ¼ 0.033), emotional functioning (P ¼ 0.003), cognitive functioning (P ¼ 0.001), social functioning (P ¼ 0.003) and global health status (P ¼ 0.001). Patients in the OBS group had significantly better mean follow-up symptom scores on seven dimensions of the EORTC QLQ-C30 V1 symptom scales. Economic data showed that costs were d3066 higher in the interferon group and produces an incremental cost per quality-adjusted life year of d41 432 at 5 years. The results show that interferon has significant effects on QoL and symptomatology and is unlikely to be cost-effective in this patient group in the UK.

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Patient Preferences for Adjuvant Interferon Alfa-2b Treatment

Cited by 84 publications

References 17 publications

Patient and Physician Preferences for Treating Adjuvant Melanoma: A Discrete Choice Experiment

Patient and Physician Preferences for Treating Adjuvant Melanoma: A Discrete Choice Experiment

Societal preference values for advanced melanoma health states in the United Kingdom and Australia

Quality of life and cost-effectiveness of interferon-alpha in malignant melanoma: results from randomised trial

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