Monday, April 10, 2017

Perception....patient vs doctors in cancer care

I touched on this report when it came out of the Boston meeting here:  Patients vs Docs - Treatment goals for cancer patients

Patient Versus Physician Valuation of Durable Survival Gains: Implications for Value Framework Assessments. Shafrin, Schwartz, Okoro, Romley. Value Health. 2017 Feb;20.

Previous research indicates that patients value therapies that provide durable or tail-of-the-curve survival gains, but it is unclear whether physicians share these preferences.
To compare patient and physician preferences for treatments with a positive probability of durable survival gains relative to those with fixed survival gains.

Patients with advanced stage melanoma or lung cancer and the oncologists who treated these patients were surveyed. The primary end point was the share of respondents who selected a therapy with a variable survival profile, with some patients experiencing long-term durable survival and others experiencing much shorter survival, compared to a therapy with a fixed survival duration. Parameter estimation by sequential testing was applied to calculate the length of nonvarying survival that would make respondents indifferent between that survival and therapy with durable survival.

The sample comprised 165 patients (lung = 84, melanoma = 81) and 98 physicians. For lung cancer, 65.5% of patients preferred the therapy with a variable survival profile, compared with 40.8% of physicians. For melanoma, these figures were 63.0% for patients and 29.7% for physicians . Patients' indifference point implied that therapies with a variable survival profile are preferred unless the treatment with fixed survival had 13.6 months (melanoma) or 11.6 months (lung) longer mean survival; physicians would prescribe treatments with a fixed survival if the treatment had 7.5 months (melanoma) or 1.0 month (lung) shorter survival than the variable survival profile. 

Patients place a high value on therapies that provide a chance of durable or "tail-of-the-curve" survival, whereas physicians do not. Value frameworks should incorporate measures of tail-of-the-curve survival gains into their methodologies.

Just putting it out there one more one!!  A patient's perspective should be INCLUDED (at the very least) in their own health care decisions AND in research/trial development and implementation!!!  Cause, yeah!  We noted in the middle of this post:  Nivolumab Shows Impressive OS in riding the tail!!!

Hang tough and fight for the treatment YOU think best for YOU!!! - c

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