Identifying Patient Preferences in MM Treatment Improves Shared Decision Making

New treatments for multiple myeloma (MM) may delay disease progression and improve survival, but the efficacy, safety, and dosing of these treatments may vary, making patient involvement in decision making important.

Two abstracts presented at the 60th American Society of Hematology Annual Meeting and Exposition examined patient preferences in MM treatment and attempt to quantify preferences and identify priorities and unmet needs.

In one paper,¹ the authors used semistructured interviews to interpret how patients understand treatment-related factors, such as overall survival (OS), progression-free survival (PFS), and tolerability. The researchers then used that information to develop a quantitative online survey sent to patients with MM who had received or were receiving first-line, second-line, or third-line therapy.

Overall, 25 patients were on first-line therapy, 25 were on second-line therapy, and 24 were on third-line therapy. The patients on first-line and second-line therapy indicated that they placed greater importance on OS and on tolerability than patients on third-line therapy. The vast majority of patients (92%) preferred a treatment with that had a lower dosing frequency but a longer infusion time (>5 hours) over a 1-year period compared with the option of a treatment with a higher dosing frequency but a shorter infusion time (<2 hours) if efficacy was the same.

The authors concluded that patient preferences may vary based on their own treatment history and that patients consider treatment options inclusive of the whole treatment experience.

“This study provides insight into how patients with MM value and assess meaningful ‘benefit-risk’ when making treatment decisions, which can be useful for facilitating physician-patient communications and shared decision making,” the authors concluded.

In the second study, the researchers studied 94 patients with relapsed/refractory MM. They used a survey design utilizing a discrete-choice experiment (DCE). The DCE included 6 attributes: PFS, risk of heart failure, peripheral neuropathy, risk of low blood counts, thrombocytopenia and neutropenia, gastrointestinal problems, and mode and frequency of administration.

The survey was administered online to patients recruited from the Multiple Myeloma Research Foundation CoMMpass study.

The researchers used a latent-class analysis to identify 2 patient subgroups for the DCE data that had systematically different preferences. Members of subgroup 1 placed greater importance on toxicities. The most important attribute for subgroup 1 was a change in nerve damage from none to severe. Members in subgroup 2 placed the greatest importance on PFS, considering a change in PFS from 6 months to 1 year to be the attribute of greatest importance.

“Results from the preference study indicate that there are subgroups of patients with systematically different treatment preferences,” the authors concluded. “Understanding how different patients value treatment attributes may help decision makers improve the quality of patient-centered care.”

References

1. McKay C, Maiese EM, Chiarappa J, et al. Patient preferences for multiple myeloma (MM) treatment: interim analysis of a discrete choice experiment. Presented at the 60th American Society of Hematology Annual Meeting & Exposition; December 2, 2019. San Diego, CA. Abstract 3568.
2. Auclair D, Mansfield C, Chari A, et al. Patient treatment preferences for relapsed/refractory multiple myeloma: are patients willing to trade off efficacy for tolerability. Presented at the 60th American Society of Hematology Annual Meeting & Exposition; December 3, 2019. San Diego, CA. Abstract 614.