title: Endpoints in clinical trials: What do patients consider important? A survey of the Ovarian Cancer National Alliance.
abstract: OBJECTIVE
  In order to understand the patient's perspective in regards to meaningful surrogate clinical trial endpoints and the impact of treatment-related toxicity, and quality of life, we surveyed women with gynecological cancers to ascertain their preferences.
  
  
  METHODS
  A 28-question anonymous online survey was posted on the OCNA website (www.ovariancancer.org). Survey questions included demographic factors, tumor data, and patients' preference regarding side effects and therapy endpoints. Data was analyzed for frequency and percentage of each response. Student t-test, Fisher's exact test and Wilcoxon rank sums were preformed.
  
  
  RESULTS
  There were 1413 survey responses. Participants reported that for a new agent to be meaningful, the minimum extension of progression-free survival (PFS) and overall survival (OS) should be five or more months, 77% and 85% of the time, respectively. Most subjects (55%, n=612) were interested in an agent that would keep tumor growth relatively static without change in OS. Addressing the impact of adverse aspects from a hypothetical new agent as a function of response, there was significant migration (p<0.0001) to acceptance of greater toxicity and cost under the scenario of a 5-6months OS gain, despite three-fold higher neurotoxicity, as compared to a PFS gain of 3-4months/no OS gain without toxicity. Response patterns weren't altered by recurrence status.
  
  
  CONCLUSIONS
  Herein, we show that magnitude of outcome is a desired effect, even given the prospect of significant toxicity and cost. However, these preferences appear to differ between those with primary and recurrent disease.
authors.affiliation: Dignity Health at St. Joseph's Hospital and Medical Center, 500 West Thomas Road, Suite 600, Phoenix, AZ 85013, United States.
authors.forename: Lindsey E
authors.initials: LE
authors.lastname: Minion
authors.affiliation: The University of Texas at MD Anderson Medical Center, 1155 Herman Presslier Drive, Unit Number 1362, Houston, TX 77030, United States.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Coleman
authors.affiliation: University of Alabama at Birmingham, 1700 6th Avenue South, Room 10250, Birmingham, AL 35233, United States.
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Alvarez
authors.affiliation: University of Cincinnati College of Medicine, 234 Goodman Street, Cincinnati, OH 45219, United States. Electronic address: thomas.herzog@uc.edu.
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Herzog
mesh_terms: D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D023381:Endpoint Determination / Q000379:methods*; D005260:Female; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000188:drug therapy*; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D057566:Self Report; D011795:Surveys and Questionnaires; D015996:Survival Rate; D055815:Young Adult
keywords: Clinical trial endpoints; Overall survival; Patient-reported outcomes; Progression free survival