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Patient preferences are an important consideration in clinical medicine and health services research and are rapidly gaining importance on a regulatory level in determining the value of novel drugs or technologies to patients and healthcare systems. Whether the benefits of a treatment outweigh its harms for an individual patient often depends on the patient's preferences. Advanced prostate cancer is one of the areas in which the optimal choice of treatment is likely to depend on patient preferences, as patients face a difficult decision between undergoing chemotherapy or taking one of the novel hormonal agents.
We conducted a patient preference study regarding the benefits and harms of advanced prostate cancer treatment in Switzerland. The study aimed at deriving preference values that reflect the trade-offs between expected benefits and potential harms of the different cancer drugs used in advanced prostate cancer from a patient perspective. We assessed preferences both in prostate cancer patients and men over 45 years without cancer history, and investigated preference heterogeneity between individuals and important subgroups.
We found that survival benefits and side effects were both rated to be very important by the study participants. Men affected by advanced prostate cancer valued survival more strongly than men from the general population that had no cancer diagnosis. We also found that there were relevant differences between individual participants in how strongly they valued survival, both among patients and among men from the general population. When looking at subgroups within our study, we did not find evidence that certain factors (for example the patients' age or disease stage) have a clear influence on the preferences. Meanwhile, we found evidence that there are two main groups, in which men either preferred to live as long as possible (accepting several side effects) or to have as little side effects as possible (accepting that they may survive less long). In summary, the trade-offs made by participants varied strongly from person to person.
This study was one of the first to elicit patient preferences related to prostate cancer treatment in Switzerland and provided important insights into how advanced prostate cancer patients value the trade-offs between the benefits and harms of their treatment. We were able to show that there are large differences between men in how they balance the benefits and harms of advanced prostate cancer treatment. Our study suggests that it is very difficult to predict the preferences of affected men, and that there may be two groups that either prefer longer survival or not to suffer from side effects. Thus, choosing a treatment solely based on its benefits is likely inappropriate. Overall, our findings demonstrate that it is highly important to individually discuss patient preferences in clinical practice to ensure the optimal treatment of advanced prostate cancer patients.
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