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P. Gorayski

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    MINI 33 - Radiotherapy and Complications (ID 164)

    • Event: WCLC 2015
    • Type: Mini Oral
    • Track: Treatment of Locoregional Disease – NSCLC
    • Presentations: 1
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      MINI33.13 - Locally Advanced NSCLC: Patient Preferences Regarding Prophylactic Cranial Irradiation - A Discrete Choice Experiment (ID 1516)

      18:30 - 20:00  |  Author(s): P. Gorayski

      • Abstract
      • Presentation
      • Slides

      Brain metastases (BM) develop in 22-55% of patients with locally advanced Non-small cell lung cancer (LA-NSCLC) treated with curative intent. Prophylactic cranial irradiation (PCI) reduces the incidence of BM by40- 60% but is not part of standard practice due to a lack of proven survival benefit and concerns regarding toxicity. This study aimed to determine patient preferences with respect to the survival gain or reduction in BM PCI would need to provide and the amount of toxicity considered acceptable for them to accept PCI.

      A Discrete Choice Experiment (DCE) was used. Patients undergoing definitive chemoradiation therapy for LA-NSCLC were asked to make 15 hypothetical choices between two alternative PCI treatments at each of two time points (i.e. pre- and post their own treatment). Each alternative PCI treatment was described by four attributes: amount of life gained, ability to care for oneself, loss of memory and the chance of BM. Participants were also given the option of no PCI treatment. The choice data were analysed using multinomial and mixed logit regression models, to indicate the relative importance of improvements in each attribute for treatment preference.

      There were 54 and 46 surveys completed pre- and post-treatment respectively. Participants had a mean age of 63.6 (range 39-82) years, 74% were male. Participants chose to accept PCI versus no PCI in approximately one third of the choices (34.8% pre- and 33.3% post - treatment). Overall, participants preferred a treatment alternative if it was associated with a longer survival, better ability to take care of oneself, lower loss of memory, and lower chance of BM. Before treatment, an increase in survival of more than 6 months was the most important benefit (relative importance weight 61.2), followed by avoiding severe problems with memory (39.4), avoiding severe problems with self-care (30.3), and a 15% reduction in risk of BM (15.0). After treatment, the rank order of importance remained similar but a reduction in the risk of BM became more important, relative to gains in the other attributes. Preliminary analysis suggests if PCI is able to reduce BM risk by 15% and increase survival by >6months, participants have a probability of uptaking PCI of 0.66 pre- and 0.55 post-treatment, even if they are left with severe problems caring for themselves and severe memory loss.

      The majority of patients would accept PCI for an increase in survival >6months, with a reduction in BM by 15%, , even if severe memory/self-care problems occurred. Patients would avoid PCI if it caused severe problems with memory/ self-care versus mild-moderate problems with memory/self-care, when survival gain is less than 6 months. Patients care more about avoiding BM following the completion of therapy.

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