title: Patient preferences for treatments to delay bone metastases.
abstract: BACKGROUND
  Most patients with advanced prostate cancer (PCa) develop bone metastases (BM) and present with bone complications like fracture. Bone-targeted agents that prevent metastasis-induced bone complications can cause adverse events. Understanding how patients view treatment options may optimize care. This study aimed to quantify how PCa patients value a hypothetical treatment that delays BM but can cause osteonecrosis of the jaw (ONJ). The study also assessed the value patients place on avoiding metastasis-induced bone complications versus increased survival.
  
  
  METHODS
  PCa patients from the United Kingdom (n = 201) and Sweden (n = 200) on androgen-deprivation therapy or hormone therapy for ≥ 3 years completed a 10-question discrete-choice-experiment survey examining whether patients would accept a BM-delaying treatment. Two time-tradeoff questions assessed patients' willingness to tradeoff between survival and bone complications. Percentages of patients choosing treatment were summarized by levels of treatment efficacy and ONJ risk. Odds ratios from a logit model were used to evaluate how patient and medication characteristics affected treatment choice. Proportions of patients choosing each tradeoff scenario were calculated.
  
  
  RESULTS
  A majority of patients accepted treatment at the lowest benefit level (5-month BM delay) and highest risk level (9% ONJ risk). PCa symptoms and prior treatment affected patient preferences. Nearly 80% of patients would tradeoff at least 3 months of survival to avoid bone complications.
  
  
  CONCLUSIONS
  PCa patients in the U.K and Sweden may value a medication that delays BM, despite the risk of ONJ. Furthermore, patients were willing to tradeoff up to 5 months of survival for prevention of bone complications.
authors.affiliation: RTI Health Solutions, Research Triangle Park, North Carolina.
authors.forename: A Brett
authors.initials: AB
authors.lastname: Hauber
authors.forename: Jorge
authors.initials: J
authors.lastname: Arellano
authors.forename: Yi
authors.initials: Y
authors.lastname: Qian
authors.forename: Juan Marcos
authors.initials: JM
authors.lastname: González
authors.forename: Joshua D
authors.initials: JD
authors.lastname: Posner
authors.forename: Ateesha F
authors.initials: AF
authors.lastname: Mohamed
authors.forename: Francesca
authors.initials: F
authors.lastname: Gatta
authors.forename: Bertrand
authors.initials: B
authors.lastname: Tombal
authors.forename: Jean-Jacques
authors.initials: JJ
authors.lastname: Body
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001859:Bone Neoplasms / Q000517:prevention & control* / Q000523:psychology / Q000556:secondary; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D057240:Patient Preference / Q000523:psychology; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000523:psychology; D011795:Surveys and Questionnaires; D013548:Sweden; D016896:Treatment Outcome; D006113:United Kingdom
chemical_list: D000970:Antineoplastic Agents
keywords: bone pain; discrete-choice experiment; osteonecrosis of the jaw (ONJ); prostate cancer; skeletal-related events (SREs); time tradeoff