Verity Watson1, Neil McCartan2, Nicolas Krucien, Victor Abu3, Divine Ikenwilo1, Mark Emberton2,4, Hashim U Ahmed5,6. 1. Health Economics Research Unit, University of Aberdeen, Aberdeen, Scotland. 2. Research Department of Urology, Division of Surgery and Interventional Science, Faculty of Medicine, University College London, London, UK. 3. Health and Social Care, Adult Nursing, London South Bank University, London, UK. 4. Department of Urology, UCLH NHS Foundation Trust, London, UK. 5. Division of Surgery (HUA), Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, UK. 6. Imperial Urology, Healthcare NHS Trust, London, UK.
Abstract
PURPOSE: The COMPARE (COMparing treatment options for ProstAte cancer) study aimed to evaluate and quantify the trade-offs patients make between different aspects of active surveillance and definitive therapy. MATERIALS AND METHODS: A discrete choice experiment tool was used to elicit patient preferences for different treatment characteristics in 34 urology departments. Patients with localized prostate cancer completed the discrete choice experiment within 1 week of being diagnosed and before they made treatment decisions. The discrete choice experiment was pretested (5) and piloted (106) with patients. Patients chose their preferred treatment profile based on the 6 characteristics of treatment type (active surveillance, focal therapy, radical therapy), return to normal activities, erectile function, urinary function, not needing more cancer treatment and 10 to 15-year cancer specific survival. Different tools were designed for patients with low-intermediate (468) and high risk (166) disease. An error components conditional logit model was used to estimate preferences and trade-offs between treatment characteristics. RESULTS: Patients with low-intermediate risk disease were willing to trade 6.99% absolute decrease in survival to have active surveillance over definitive therapy. They were willing to trade 0.75%, 0.46% and 0.19% absolute decrease in survival for a 1-month reduction in time to return to normal activities and 1% absolute improvements in urinary and sexual function, respectively. Patients with high risk disease were willing to trade 3.10%, 1.04% and 0.41% absolute decrease in survival for a 1-month reduction in time to return to normal activities and 1% absolute improvements in urinary and sexual function, respectively. CONCLUSIONS: Patients with low-intermediate risk prostate cancer preferred active surveillance to definitive therapy. Patients of all risk levels were willing to trade cancer specific survival for improved quality of life.
PURPOSE: The COMPARE (COMparing treatment options for ProstAte cancer) study aimed to evaluate and quantify the trade-offs patients make between different aspects of active surveillance and definitive therapy. MATERIALS AND METHODS: A discrete choice experiment tool was used to elicit patient preferences for different treatment characteristics in 34 urology departments. Patients with localized prostate cancer completed the discrete choice experiment within 1 week of being diagnosed and before they made treatment decisions. The discrete choice experiment was pretested (5) and piloted (106) with patients. Patients chose their preferred treatment profile based on the 6 characteristics of treatment type (active surveillance, focal therapy, radical therapy), return to normal activities, erectile function, urinary function, not needing more cancer treatment and 10 to 15-year cancer specific survival. Different tools were designed for patients with low-intermediate (468) and high risk (166) disease. An error components conditional logit model was used to estimate preferences and trade-offs between treatment characteristics. RESULTS:Patients with low-intermediate risk disease were willing to trade 6.99% absolute decrease in survival to have active surveillance over definitive therapy. They were willing to trade 0.75%, 0.46% and 0.19% absolute decrease in survival for a 1-month reduction in time to return to normal activities and 1% absolute improvements in urinary and sexual function, respectively. Patients with high risk disease were willing to trade 3.10%, 1.04% and 0.41% absolute decrease in survival for a 1-month reduction in time to return to normal activities and 1% absolute improvements in urinary and sexual function, respectively. CONCLUSIONS:Patients with low-intermediate risk prostate cancer preferred active surveillance to definitive therapy. Patients of all risk levels were willing to trade cancer specific survival for improved quality of life.
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