Tolerance for chemotherapy-induced peripheral neuropathy among women with metastatic breast cancer: a discrete-choice experiment

Abstract

Purpose: To quantify preferences for chemotherapy-induced peripheral neuropathy (CIPN) risks and survival benefits of continuing neurotoxic chemotherapy and explore differences in preferences by race among women with metastatic breast cancer (mBC).

Methods: Women with mBC and CIPN experience completed a discrete-choice experiment that included 12 choice tasks presenting paired profiles that varied four attributes across three levels each: progression-free survival (PFS) (6, 12, 24 months), neuropathy in hands (mild, moderate, severe), neuropathy in feet (mild, moderate, severe), and neuropathy persistence (short-term, long-term, permanent). Aggregate and exploratory stratified (White versus non-White) conditional logit models were estimated from which patients' minimum acceptable benefit was calculated using the willingness-to-pay approach.

Results: Women (n = 189) were on average 52.5 years and 47.1% were non-White. Fewer women who were non-White held a bachelor's degree or higher (p < 0.01) and reported a household income of $85,000 or higher (p = 0.03). In both the aggregate and the stratified analyses, women preferred longer duration of PFS, less severe CIPN in hands and feet, and shorter CIPN duration. In aggregate, respondents were willing to tolerate a one-level increase in neuropathy severity (mild to moderate or moderate to severe) in their hands and feet in exchange for 6.7 and 2.9 months of PFS, respectively. In exchange for 9.3 months of PFS, respondents were willing to tolerate a one-level increase in neuropathy persistence (short-term to long-term or long-term to permanent). Exploratory stratified analysis showed that non-White women had different preferences from White women (p < 0.01), with non-White women requiring more months of PFS benefit to tolerate increases in neuropathy severity and duration compared to White women.

Conclusion: Women with mBC favored longer duration of progression-free survival, less severe CIPN in hands and feet, and shorter CIPN duration. Different preferences by race warrant additional future investigation.

Keywords: Chemotherapy-induced peripheral neuropathy; Discrete-choice experiment; Metastatic breast cancer; Patient preference* [MeSH].

Fig. 1

Example of a choice task

Fig. 2

Mean preference weights of attribute levels for both the aggregate and the stratified analysis by race. The vertical bars surrounding each mean preference weight estimate denote the 95% confidence interval around the point estimate. White and non-White women had different preferences (p < 0.01)