DOI

https://doi.org/10.25772/27VG-TS62

Author ORCID Identifier

https://orcid.org/0000-0003-0061-0637

Defense Date

2023

Document Type

Dissertation

Degree Name

Doctor of Philosophy

Department

Pharmaceutical Sciences

First Advisor

Teresa M Salgado

Second Advisor

John F P Bridges

Third Advisor

Daniel L Hertz

Fourth Advisor

Erin Hickey Zacholski

Fifth Advisor

Dave L Dixon

Abstract

Background: Women with breast cancer describe chemotherapy-induced peripheral neuropathy (CIPN) as one of the most distressing treatment-related symptoms, significantly affecting their quality of life. The progression of CIPN can lead to treatment discontinuation, potentially compromising treatment effectiveness among patients with metastatic breast cancer (mBC). Clinical guidelines offer limited guidance on when to discontinue treatment, making it crucial to incorporate patient preferences into shared decision-making processes. This dissertation aimed to measure preferences among patients with mBC in the context of treatment discontinuation due to CIPN.

Methods: An online survey, incorporating both a best-worst scaling (BWS) and a discrete-choice experiment (DCE), was created through a 5-stage process, which included evidence synthesis, consultation with clinicians (n=3), engagement with patients (n=7), pretesting (n=20), and pilot testing (n=61). Seven objects were incorporated into the BWS: relieving current neuropathy symptoms, reducing risk of long-term neuropathy, having another cancer treatment option, understanding the risk of treatment discontinuation, and receiving support for treatment discontinuation from the oncologist, loved ones, or patients with similar experiences. Four risk-benefit attributes were incorporated into the DCE: progression-free survival (6, 12, 24 months), neuropathy in hands (mild, moderate, severe), neuropathy in feet (mild, moderate, severe), and neuropathy persistence (short-term, long-term, permanent). The refined final survey was distributed to women who had mBC and CIPN. The priorities and preferences obtained from both the BWS and DCE were analyzed using the conditional logit model.

Results: A total of 189 respondents completed the survey. The BWS results showed that when patients were faced with the decision to discontinue treatment because of CIPN, respondents prioritized having another cancer treatment option the most (coefficient=0.96, SE=0.06). Patients also highly prioritized understanding the risk of treatment discontinuation (coefficient=0.61, SE=0.06), followed by reducing risk of long-term neuropathy (coefficient=0.60, SE=0.06), and relieving current neuropathy symptoms (coefficient=0.38, SE=0.06). Support from the oncologist (coefficient=0.07, SE=0.05), loved ones (coefficient=-1.07, SE=0.06) and other patients (coefficient=-1.55, SE=0.07) were prioritized the least. The DCE found that higher preference weights for attribute levels were associated with better clinical outcomes or lower harm. Regarding the relative attribute importance (RAI), progression-free survival (RAI=34.03%) and neuropathy persistence (RAI=34.03%) were the most important attributes, followed by neuropathy in hands (RAI=24.37%), and feet (RAI=7.56%). Respondents required a minimum of 2.80, 6.65, and 9.30 additional months of progression-free survival to accept a one-level increase in the severity of neuropathy in the hands or feet, and in the duration of neuropathy persistence, respectively.

Conclusions: Prolonging progression-free survival and reducing the risk of neuropathy persistence were the primary factors driving patient priorities and preferences when considering treatment discontinuation. Patients were less willing to tolerate CIPN risk if it becomes long-term or permanent. These findings offer valuable insights for clinicians when discussing CIPN treatment discontinuation with their patients.

Rights

© The Author

Is Part Of

VCU University Archives

Is Part Of

VCU Theses and Dissertations

Date of Submission

11-30-2023

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