Latent Class Analysis on Heterogeneity in Physician and Patient Preferences for RCC Treatment

A research team sought to learn how patients and physicians trade off the features of adjuvant renal cell carcinoma (RCC) treatments, and if there is heterogeneity among preferences, to inform shared decision-making. They presented their findings at the 2023 American Society of Clinical Oncology Genitourinary Cancers Symposium.

The team utilized an online, discrete-choice experiment survey that was given to patients with physician-confirmed RCC and physician-defined intermediate-to-high/high risk of recurrence and to physicians who treat such patients. The hypothetical treatment choices were defined by median disease-free survival (DFS); 5-year overall survival (OS) rate; mode and frequency of administration; need for concomitant daily pill; treatment duration; and the risks of severe diarrhea, fatigue, and dizziness.

After selecting an adjuvant treatment choice, patients were given the opportunity to opt out of treatment. Patient and physician choice data were analyzed separately using latent class (LC) models, which identify clusters of patients and physicians making similar choices. Preference weights were used to determine the conditional relative attribute importance.

LC analysis found 3 separate classes among the 250 patients who placed a greater importance on (1) 5-year OS and opting into treatment (37.5% of patients), (2) median DFS and opting into treatment (26.9%), and (3) treatment duration and opting out of treatment (35.5%).

Out of 250 physicians, the LC analysis identified 3 classes that placed a greater relative importance on (1) 5-year OS and recommending treatment (37.5% of physicians), (2) median DFS and recommending treatment (37.8%), and (3) not recommending treatment (24.7%). Each LC analysis also showed that the other treatment attributes evaluated were less important, but the importance varied by LC.

The survey found heterogeneity in both physician and patient preferences for RCC adjuvant therapy, demonstrating a need for shared decision-making. Discordance among patients and physicians in the inclination to opt out of adjuvant treatment suggests that patient-physician dialogue is important.