Background: The landscape of treatment options and associated prognosis for patients with metastatic breast cancer (MBC) is rapidly evolving. In response to these advances in therapy, numerous organizations have invested considerable resources into developing evaluation frameworks seeking to clarify the value of new therapies. While some of these frameworks foster patient-provider shared decision making, others are more payer focused, and all are limited in their incorporation of patient perceptions of value and evidence on treatment aspects most meaningful to patients.
Objectives: 1) To identify the attributes of treatment that patients with MBC value most, and 2) to explore the alignment between patient valuation of treatment attributes and healthcare provider perceptions of what patients value.
METHODS: Four 90-minute focus groups were conducted: two with patients (aged <50 years and aged ≥50 years) and two with healthcare providers (oncologists and oncology nurses) who treat patients with MBC. Using semi-structured discussion guides tailored to each participant group, patient and provider perceptions of the factors most important to patients when considering treatment were explored as well as various sources of perceived value in cancer care. Discussions were audio recorded and transcribed. Thematic analysis identified attributes patients with MBC consider when making treatment decisions, and concordance between patients and healthcare providers was assessed.
Results: A total of 24 patients and providers (n=5 patients <50 years, n=5 patients ≥50 years, n=7 oncologists, and n=7 nurses) participated in four different focus groups. The factors of greatest importance to patients included: impact of treatment side effects on daily life, depth of treatment response, longevity of life, and the value of hope in traversing their illness and achieving survival landmarks and goals. In contrast, oncologists focused predominantly on clinical considerations, such as treatment effectiveness and managing side effects. Oncology nurses noted similar clinical factors as oncologists, but also aligned more closely with patients on humanistic elements informing treatment decision-making.
Conclusion: This analysis reveals that while patient and healthcare provider assessments of value in treating MBC are well-aligned with respect to clinical factors such as managing side effects and depth of treatment response; patients also prioritize emotional and psychological factors, -- like having hope and avoiding suffering -- in addition to clinical factors. Moving forward, patient-centered value frameworks for MBC will need to address this gap between what providers and payers value and patient goals and priorities.
Citation Format: May SG, Chung AH, Vania DK, Hou N, MacEwan J, Batt K, Kurian AW, Zacker C, Globe D, Goldman DP. Value of cancer care for metastatic breast cancer patients and providers [abstract]. In: Proceedings of the 2016 San Antonio Breast Cancer Symposium; 2016 Dec 6-10; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2017;77(4 Suppl):Abstract nr P4-20-02.