Wednesday, January 4, 2017

Patients vs Docs - Treatment goals for cancer patients

Also from the Boston Conference, Society for Melanoma Research -

Differences in the value that patients and physicians place on durable survival: implications for the treatment of advanced melanoma.  Shafrin, et a.

Cancer patients value therapies that offer long-term durable survival gains, but it is unknown whether physicians place similar value on durable survival. To address this issue, we surveyed patients with advanced stage melanoma and oncologists. We measured the share of respondents who selected a therapy with a fixed survival duration (ie,nonvarying therapy) versus one with a variable survival profile, with some patients experiencing long-term durable survival and others experiencing below-average survival. Initially, both therapies had the same average survival, calibrated to ipilimumab long-term survival data.We then applied parameter estimation by sequential testing to calculate the length of nonvarying survival that would make respondents indifferent between it and the therapy with durable survival. We also tested whether patient preferences were sensitive to adverse event (AE) severity. In our sample of 81 patients and 91 physicians, 63% of patients preferred the therapy with durable survival compared to 30% of physicians. The average patient preferred the therapy with durable survival even if the nonvarying treatment had 13.6 months longer average survival.  The presence of more severe AEs did not change these preferences.   In contrast, the average oncologist preferred treatments with fixed survival unless the survival had 7.5 months shorter average survival compared to the treatment with durable survival gains. These findings suggest patients value therapies that provide a chance at durable survival, and this result holds even when compared to therapies with more severe AEs. To reinforce the tenets of patient-centered care, physicians should take into account melanoma patient preferences for treatments with durable survival.

I found this research question and result very interesting.  While I have questioned docs and therapies and the choices we all make relentlessly over the past 30 plus years as a healthcare provider and the past 13 plus years as a melanoma patient...I had never thought about it this concretely...this succinctly.  It is hard to say what I would choose - sitting here - not currently being REQUIRED to choose a therapy at this moment....  BUT.  As I was reading this report for the first time, I was thinking that I would definitely choose as the majority of cancer peeps did.  I want the thing that will fix me....not just help me!!!  I mean, we all do what we can when we are running out of options...but yes...if the options were:  This treatment will help you....but this one could cure you....  Yeah.  I want that last one.  Thus far I am luckier than ever so many melanoma folks in that my one blitz of SRS, surgery and nivo has served me well, leaving me NED and with manageable side effects, though, in the flavor of truth in reporting, my tongue has a serious case of road rash as I type...again....over three years post last dose of nivo....BUT, a small price to pay!!!  Reading this brought back a thought I had when taking nivo in my Phase 1 trial and wondering what deleterious effects it might have on me and if it was going to work.  I felt exactly like Demi Moore's character in GI Jane, when she was told that she was to be pulled from her training program for investigation, but promised if cleared, she could repeat her training, she replied, "I can't go through this shit again!"  Melanoma treatment is so hard and miserable and expensive and time consuming and such a damn crap shoot, that it presses upon the body and psyche like an unbearable weight. many brave souls do more than just bear it. They survive and prosper and light our way.  Ultimately, these thoughts, this report, and the limitations that life itself presents to us all, makes at least one point very clear to me.  Doctors should evaluate patients, explain their condition, work to find all available treatment options and present them, but PATIENTS should have the ultimate choice in the treatment they find right for them. Because it doesn't seem that docs and patients agree - and docs aren't the ones who could lose.

Bless you one and all. - les

1 comment:

  1. Once again where you sit decides where you stand. And think of the incredible bravery and courage of all those who GO FOR IT, DAMN THE ODDS. love,b.