Abstract Introduction The management of early-stage and adjuvant UC and RCC has undergone a paradigm shift with the availability of multiple treatment options. However, there is limited understanding about the treatment attributes preferred by patients and physicians in these settings in Asia-Pacific. Methods This cross-sectional web-based discrete choice experiment (DCE) survey aimed to assess treatment preferences for early-stage and adjuvant UC and RCC in Asia-Pacific. Participants were patients (aged ≥ 18 years, RCC: n=50, UC: n=50) and physicians (medical oncologists: n=46; urologists: n=44). The DCE included 8 attributes covering efficacy, risks of treatment-related adverse events (TRAEs), and mode of administration (MOA). Relative preference weights, relative importance (RI), and minimum acceptable benefit were analyzed using hierarchical Bayesian logistic regression. Results Both patients and physicians placed higher importance on efficacy attributes: one-year disease-free survival (DFS) (patients: RI=25.1%; physicians: RI=36.3%) and overall survival (OS) (patients: RI=27.6%; physicians: RI=22.1%). Among patients, this was followed by risks of treatment-related fatigue (RI=9.9%), and risk of long-term/permanent TRAEs (RI=9.4%). For physicians, it was risk of treatment-related skin rash (RI=8.5%) and risk of treatment-related fatigue (RI=8.0%). Patients would accept a 5-35% risk increase in treatment-related fatigue for 11.4% DFS/0.67-year OS increase, and a 1-15% risk increase in long-term/permanent TRAE (1%-15%) for 10.8% DFS/0.64-year OS increase. Physicians would accept 5-25% risk increases in treatment-related skin rash for 8.0% DFS/0.74-year OS increase and in fatigue for 6.1% DFS/0.56-year OS increase. Most patients (87-92%) and physicians (88-96%) would initiate earlier systemic treatment for UC/RCC than at the advanced or metastatic stage. Conclusion Patients and physicians valued efficacy attributes over TRAE-attributes. Both groups would trade higher risks for greater efficacy, though these trade-offs vary based on TRAE type. This indicates a need for shared decision-making for early-stage and adjuvant UC and RCC in Asia-Pacific.
Chiong et al. (Fri,) studied this question.