Patients’ Preferences for Attributes of Oral vs Injectable Androgen Deprivation Therapy in Prostate Cancer: A Discrete Choice Experiment

Sean P Collins,1 Agnes Hong,2 Brett Hauber,2 Scott C Flanders,3 Oliver Will,4 Martine C Maculaitis,4 Sergio C Gatoulis,2 Marty Chakoian,5 Jared Thorley6 1Department of Radiation Medicine, Georgetown University; MedStar Georgetown University Hospital, Washington, DC, USA; 2Pfizer Inc., New York, NY, USA; 3Sumitomo Pharma America, Inc., Cambridge, MA, USA; 4Oracle Life Sciences, Austin, TX, USA; 5UsTOO in Seattle Prostate Cancer Support Group, Seattle, WA, USA; 6Intermountain Healthcare, Murray, UT, USACorrespondence: Sean P Collins, Department of Radiation Oncology, University of South Florida, 3 Tampa General Circle, Tampa, FL, 33606, Tel +1 (813) 844-8910, Email [email protected]: Patient involvement in treatment decisions improves outcomes, but data on patients’ perspectives of medical androgen deprivation therapy (ADT) options for prostate cancer are limited. This study quantified the impact of multiple attributes of currently available oral and injectable ADTs on patient treatment choice.Patients and Methods: From February to July 2022, US males aged > 40 years with localized or advanced prostate cancer completed a cross-sectional survey, including a discrete choice experiment (DCE), to assess preferences for ADT attributes. In each DCE task, participants were asked to choose between two hypothetical ADT treatment profiles defined by administration mode, testosterone surge after initiation, cardiovascular risk, impact on sexual interest, time to testosterone recovery after discontinuation, and out-of-pocket cost. Hierarchical Bayesian models generated preference weights, which were used to estimate attribute relative importance (RI). RIs were compared by five subgroups (cancer stage, race/ethnicity, cardiovascular comorbidities, age, and ADT experience) with two-sample t-tests.Results: A total of 304 participants in the US were included in analyses (median age: 65.0 years). Holding out-of-pocket cost constant, mode of administration, and impact on sexual interest were most important, followed by risk of cardiovascular events. Across all subgroups, on average respondents preferred a once-daily ADT pill over less frequent intramuscular or subcutaneous injections. This preference was significantly stronger among respondents with advanced prostate cancer, those with cardiovascular comorbidities, and among racial/ethnic minorities. Treatment preferences did not differ between ADT-experienced and ADT-naïve respondents.Conclusion: On average, patients preferred to treat prostate cancer by taking a once-daily ADT pill at home rather than receiving less frequent injections. Shared decision-making between healthcare providers and patients, including discussing the benefits, risks, and administration burden of available ADT options, should be encouraged to ensure that patients receive the prostate cancer treatment that is best suited for their care and needs.Plain language summary: Androgen deprivation therapy (ADT) lowers testosterone levels in patients with advanced prostate cancer to stop the spread of cancer. There are a few available ADT options, and each option has different features. These features include the way that the medicine is taken (for example, a pill taken by mouth every day at home or an injection received every 3– 4 months at a doctor’s office), as well as the medicine’s side effects, costs, and its impact on a person’s interest in sexual activity.Researchers wanted to see which features of ADT were most important to patients and whether patients with different characteristics (such as age or if they had received ADT in the past) had different preferences. Researchers asked 304 patients a series of questions. In each question, patients chose between two hypothetical (meaning not real) ADT options with different features. Researchers found that, in general, patients preferred to take a pill by mouth once a day at home, rather than an injection every 3– 4 months at a doctor’s office. This preference was stronger for patients with advanced prostate cancer, patients who were non-White, and patients who had heart or blood vessel problems. Patients who had received ADT in the past had similar preferences to patients who had never received ADT. These results can help doctors learn about the types of treatments that patients with different characteristics may prefer. Doctors and patients should discuss the features of available ADT options to find the right one for each patient. Keywords: mode of administration, patient preferences, shared decision-making, gonadotropin-releasing hormone agonists, gonadotropin-releasing hormone antagonists, testosterone recovery