gms | German Medical Science

Introduction: Involving patients with breast cancer (BC) in treatment decision making has shown to improve their satisfaction, short and long-term well-being, as well as increasing their level of comfort with the decision made [1]. A better understanding how BC patients value different aspects of drug therapy might improve treatment effectiveness, satisfaction and adherence [2]. Compared with early stages (eBC), metastatic BC (mBC) is incurable. In mBC, aggressive treatment may increase the duration of survival but may also cause severe treatment side effects [3]. This systematic review aimed to summarise and compare studies evaluating patient preferences for drug therapy of patients with eBC and mBC.

Methods: The systematic review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We included all original studies available in PubMed or Web of Science up to 22 June 2023 that used a discrete choice experiment (DCE) to determine patients' preferences for BC drug therapy. For each study, a narrative synthesis of effect measures was reported in the form of relative importance ratings, trade-offs or willingness-to-pay for treatment attributes. Risk of bias for individual studies was assessed using the checklist for observational studies from the STROBE Statement [4] and the checklist from “Conducting Discrete Choice Experiments to Inform Healthcare Decision Making: A User's Guide” [5]. The study protocol was registered in PROSPERO (CRD42022377031).

Results: 34 studies that investigated the preferences of patients with early stage (n=18), mBC (n=10), or any stage (n=6) for chemotherapy, endocrine therapy, or hormonal therapy using DCE were included in the analysis. Regardless of BC stage, most patients rated treatment effectiveness in terms of survival as more important than potential adverse drug reactions (ADRs). Treatment cost, route of administration, treatment regimen and monitoring aspects were considered the least important treatment attributes. Regarding the preferences for 16 different ADRs, high heterogeneity was observed within BC stages. However, comparable preferences were observed between BC stages. These results were published in The Patient – Patient Centered Outcomes Research (https://doi.org/10.1007/s40271-024-00679-6). In addition, factors associated with greater willingness to accept BC therapy were identified: younger age, previous positive experience with BC therapy, higher level of education, being married, and having children.

Conclusion: Regardless of stage, BC patients rated survival as the most important attribute of drug therapies and were willing to accept the risk of potential ADRs. Incorporating patient preferences in shared decision making may improve the effectiveness of therapies by promoting medication adherence.

The authors declare that they have no competing interests.

The authors declare that an ethics committee vote is not required.

The contribution has already been published: [6]