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Introduction/Background: This study aimed to describe patient and caregiver preferences for treatments of relapsed or refractory multiple myeloma (MM). Materials and Methods: A survey including discrete-choice experiment (DCE) and best-worst scaling (BWS) exercises was conducted among US patients with relapsed or refractory MM and their caregivers. The DCE included six attributes with varying levels including progression-free survival (PFS), toxicity, and mode and frequency of administration. In addition, the impact of treatment cost was assessed using a fixed-choice question. The BWS exercise included 18 items (modes and frequency of administration, additional treatment convenience, and toxicity items). The survey was administered online to patients recruited from the Multiple Myeloma Research Foundation CoMMpass study (NCT01454297). Results: The final samples consisted of 94 patients and 32 caregivers. Avoiding severe nerve damage was most important to patients, followed by longer PFS. Caregivers considered PFS to be the most important attribute. We estimate that a third or more of patients were cost-sensitive, meaning their treatment preference was altered based on cost implications. Caregivers were not cost-sensitive. The three most bothersome treatment features in the BWS exercise were risk of kidney failure, lowering white blood cell counts, and weakening the immune system. Conclusion: Patients with relapsed or refractory MM and their caregivers consider many factors including efficacy, toxicity, mode/frequency of administration, and cost in their decisions regarding treatment options. The study provides a basis for future Research on patient and caregiver treatment preferences, which could be incorporated into shared decision-making with physicians.
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BACKGROUND: The balance between quality of life and aggressive treatment fuels strong debate in cancer care. Recently, more attention is focused on blending advanced care, palliative care and hospice treatments in a patient-specific, tailored manner. This case study explores quality of life, the role of psychosocial factors in treatment selection, and the role of medical bias in end-of-life decision-making. CASE REPORT: The patient was a 55-year-old woman with advanced recurrent epithelial ovarian cancer. The disease course was essentially unremitting with only 5 months of non-progression after initial treatment. Multiple courses of chemotherapy were provided, in addition to a wide range of advanced and aggressive therapies to treat the cancer, as well as prolong life. Hospice care was an active part of treatment over 2 separate time periods, with a 1-year hiatus between admissions into hospice care. CONCLUSION: This case study provides an example of blending aggressive treatment, palliative care and hospice care to allow a patient to achieve specific life milestones, while attempting to preserve quality of life.
