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A systematic review of patients' values, preferences, and expectations for the treatment of metastatic prostate cancer

A systematic review of patients' values, preferences, and expectations for the treatment of metastatic prostate cancer
A systematic review of patients' values, preferences, and expectations for the treatment of metastatic prostate cancer

Context: advances in systemic agents have increased overall survival for men diagnosed with metastatic prostate cancer. Additional cytoreductive prostate treatments and metastasis-directed therapies are under evaluation. These confer toxicity but may offer incremental survival benefits. Thus, an understanding of patients' values and treatment preferences is important for counselling, decision-making, and guideline development.

Objective: to perform a systematic review of patients' values, preferences, and expectations regarding treatment of metastatic prostate cancer.

Evidence acquisition: the MEDLINE, Embase, and CINAHL databases were systematically searched for qualitative and preference elucidation studies reporting on patients' preferences for treatment of metastatic prostate cancer. Certainty of evidence was assessed using Grading of Recommendation, Assessment, Development and Evaluation (GRADE) or GRADE Confidence in the Evidence from Reviews of Qualitative Research (CERQual). The protocol was registered on PROSPERO as CRD42020201420.

Evidence synthesis: a total of 1491 participants from 15 studies met the prespecified eligibility for inclusion. The study designs included were discrete choice experiments (n = 5), mixed methods (n = 3), and qualitative methods (n = 7). Disease states reported per study were: metastatic castration-resistant prostate cancer in nine studies (60.0%), metastatic hormone-sensitive prostate cancer in two studies (13.3%), and a mixed cohort in four studies (26.6%). In quantitative preference elicitation studies, patients consistently valued treatment effectiveness and delay in time to symptoms as the two top-ranked treatment attributes (low or very low certainty). Patients were willing to trade off treatment-related toxicity for potential oncological benefits (low certainty). In qualitative studies, thematic analysis revealed cancer progression and/or survival, pain, and fatigue as key components in treatment decisions (low or very low certainty). Patients continue to value oncological benefits in making decisions on treatments under qualitative assessment.

Conclusions: there is limited understanding of how patients make treatment and trade-off decisions following a diagnosis of metastatic prostate cancer. For appropriate investment in emerging cytoreductive local tumour and metastasis-directed therapies, we should seek to better understand how this cohort weighs the oncological benefits against the risks.

Patient summary: We looked at how men with advanced (metastatic) prostate cancer make treatment decisions. We found that little is known about patients' preferences for current and proposed new treatments. Further studies are required to understand how patients make decisions to help guide the integration of new treatments into the standard of care.

2666-1683
9-18
Connor, Martin J
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Genie, Mesfin G
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Burns, David
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Bass, Edward J
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Gonzalez, Michael
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Sarwar, Naveed
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Falconer, Alison
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Mangar, Stephen
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Dudderidge, Tim
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Khoo, Vincent
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Winkler, Mathias
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Ahmed, Hashim U
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Watson, Verity
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Connor, Martin J
d396252b-f431-4edf-b081-90231a4e228f
Genie, Mesfin G
a4734ec9-ebc6-4e8b-bf2b-f6cef6db11a9
Burns, David
d9c2e699-a538-470b-bc9f-c1356d51f269
Bass, Edward J
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Gonzalez, Michael
0ebc5ee8-757e-4fa3-88a7-e3e3984426df
Sarwar, Naveed
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Falconer, Alison
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Mangar, Stephen
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Dudderidge, Tim
124ffc67-a11c-4428-9638-6d97576f9652
Khoo, Vincent
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Winkler, Mathias
96fd3570-1c9a-46d9-883a-5ee264dd708d
Ahmed, Hashim U
3d2ebcef-5883-48f9-b343-a70992956332
Watson, Verity
069e46f2-2507-4fec-8b4e-55b5dcb614f5

Connor, Martin J, Genie, Mesfin G, Burns, David, Bass, Edward J, Gonzalez, Michael, Sarwar, Naveed, Falconer, Alison, Mangar, Stephen, Dudderidge, Tim, Khoo, Vincent, Winkler, Mathias, Ahmed, Hashim U and Watson, Verity (2021) A systematic review of patients' values, preferences, and expectations for the treatment of metastatic prostate cancer. European urology open science, 36, 9-18. (doi:10.1016/j.euros.2021.10.003).

Record type: Review

Abstract

Context: advances in systemic agents have increased overall survival for men diagnosed with metastatic prostate cancer. Additional cytoreductive prostate treatments and metastasis-directed therapies are under evaluation. These confer toxicity but may offer incremental survival benefits. Thus, an understanding of patients' values and treatment preferences is important for counselling, decision-making, and guideline development.

Objective: to perform a systematic review of patients' values, preferences, and expectations regarding treatment of metastatic prostate cancer.

Evidence acquisition: the MEDLINE, Embase, and CINAHL databases were systematically searched for qualitative and preference elucidation studies reporting on patients' preferences for treatment of metastatic prostate cancer. Certainty of evidence was assessed using Grading of Recommendation, Assessment, Development and Evaluation (GRADE) or GRADE Confidence in the Evidence from Reviews of Qualitative Research (CERQual). The protocol was registered on PROSPERO as CRD42020201420.

Evidence synthesis: a total of 1491 participants from 15 studies met the prespecified eligibility for inclusion. The study designs included were discrete choice experiments (n = 5), mixed methods (n = 3), and qualitative methods (n = 7). Disease states reported per study were: metastatic castration-resistant prostate cancer in nine studies (60.0%), metastatic hormone-sensitive prostate cancer in two studies (13.3%), and a mixed cohort in four studies (26.6%). In quantitative preference elicitation studies, patients consistently valued treatment effectiveness and delay in time to symptoms as the two top-ranked treatment attributes (low or very low certainty). Patients were willing to trade off treatment-related toxicity for potential oncological benefits (low certainty). In qualitative studies, thematic analysis revealed cancer progression and/or survival, pain, and fatigue as key components in treatment decisions (low or very low certainty). Patients continue to value oncological benefits in making decisions on treatments under qualitative assessment.

Conclusions: there is limited understanding of how patients make treatment and trade-off decisions following a diagnosis of metastatic prostate cancer. For appropriate investment in emerging cytoreductive local tumour and metastasis-directed therapies, we should seek to better understand how this cohort weighs the oncological benefits against the risks.

Patient summary: We looked at how men with advanced (metastatic) prostate cancer make treatment decisions. We found that little is known about patients' preferences for current and proposed new treatments. Further studies are required to understand how patients make decisions to help guide the integration of new treatments into the standard of care.

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Accepted/In Press date: 20 October 2021
Published date: 20 December 2021
Additional Information: Financial disclosures: Martin J. Connor certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: Martin J. Connor receives grant funding from the Wellcome Trust and University College London Hospitals Charity. Vincent Khoo is supported by personal fees and nonfinancial support from Accuray, Astellas, Bayer, Janssen, and Boston Scientific. Hashim U. Ahmed is supported by core funding from the UK National Institute of Health Research (NIHR) Imperial Biomedical Research Centre and funding from the Wellcome Trust, Medical Research Council (UK), Prostate Cancer UK, Cancer Research UK, The BMA Foundation, The Urology Foundation, The Imperial Health Charity, Sonacare, Trod Medical, and Sophiris Biocorp for trials and studies in prostate cancer; is a paid medical consultant for Sophiris Biocorp, Sonacare, and BTG/Galil; and is a paid proctor for high-intensity focused ultrasound, cryotherapy, and Rezūm water vapour therapy. The remaining authors have nothing to disclose.

Identifiers

Local EPrints ID: 454522
URI: http://eprints.soton.ac.uk/id/eprint/454522
ISSN: 2666-1683
PURE UUID: 1058fd45-0f54-43b3-83b0-ef2f50e402eb

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Date deposited: 15 Feb 2022 17:36
Last modified: 16 Mar 2024 15:46

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Contributors

Author: Martin J Connor
Author: Mesfin G Genie
Author: David Burns
Author: Edward J Bass
Author: Michael Gonzalez
Author: Naveed Sarwar
Author: Alison Falconer
Author: Stephen Mangar
Author: Tim Dudderidge
Author: Vincent Khoo
Author: Mathias Winkler
Author: Hashim U Ahmed
Author: Verity Watson

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