Patients' and doctors' preferences in early-stage triple-negative breast cancer treatment in Asia-Pacific: a multi-territory discrete choice experiment using a cross-sectional survey.
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OBJECTIVES: This study aimed to assess preferences of patients and doctors regarding treatment attributes for early-stage triple-negative breast cancer (eTNBC) in the Asia-Pacific region. DESIGN: A discrete choice experiment (DCE) by cross-sectional survey was conducted with patients and doctors. Key attributes relevant to eTNBC treatment decision-making were verified through a consultative process with clinical experts. The levels and description of seven attributes were refined through cognitive interviews. A D-efficient fractional-factorial design was employed to create 15 choice sets with seven key attributes. SETTING: An online web-based DCE with the 15 choice sets was developed and made available to participants in Australia, Japan, Korea, the Philippines and Taiwan. PARTICIPANTS: The final dataset comprised 115 patients who self-reported a diagnosis of eTNBC and 86 medical oncologists, breast and general surgeons with at least five years of experience managing eTNBC patients. PRIMARY OUTCOMES: Patients' and doctors' preferences on seven attributes: pathological complete response (pCR), disease-free/event-free survival (DFS/EFS), chance of undergoing breast-conserving surgery after receiving anticancer treatment, febrile neutropenia, peripheral sensory neuropathy (PSN), diarrhoea and irreversible endocrine-related side effects requiring lifelong medication. Data were analysed using a mixed logit model to determine preference weights for attribute levels, which were then used to compute the relative importance score (RIS) for each attribute. RESULTS: The median age of patients was 44.0 (IQR 38.0-56.5) years. Most patients (68%) were married, and 77% had children. Additionally, 40% were employed full-time, and 70% held a college degree. Nearly half (46%) were diagnosed before the age of 40. Among the doctors, 58% were medical oncologists and the remaining breast or general surgeons. pCR, DFS/EFS and PSN were the three most important attributes in both doctor and patient groups. pCR had the highest weighted preference among patients and doctors (RIS, 28.5 and 32.9, respectively). In general, patients assigned more weight to safety attributes compared with doctors, while doctors assigned more weight to efficacy attributes than patients did. Surgeons assigned more weight to irreversible endocrine-related side effects than medical oncologists (RIS, 14.4 vs 5.4). Differences in preferences within the regions were noted. CONCLUSIONS: While our study revealed a concordance between patients' and doctors' ranking of the seven assessed treatment attributes, patients generally assigned greater emphasis on safety-related attributes in comparison to doctors.