Comparison of Patient, General Population and Clinician Preferences for Management of Esophageal Cancer: A Discrete Choice Experiment

Background Esophageal cancer is the eighth most common cancer and sixth leading cause of cancer-related mortality worldwide. The main treatment modalities for locally advanced disease are surgery with perioperative chemo +/− radiotherapy, and definitive chemoradiotherapy (CRT) without surgery. The aim of this study was to assess patient, clinician and general population preferences and the trade-offs they are willing to make when choosing between these treatments. Methods A discrete choice experiment (DCE) was conducted based on four attributes: cure rate, risk of hospital death, quality of life (QoL) and follow-up schedule. Four respondent groups were recruited: patients under Barrett’s esophagus surveillance, cancer survivors, clinicians, and the general population. Data was analyzed within the framework of random utility theory. To test change in preference with change in attribute levels, reference levels were set for definite treatment (cure rate = 30%, death = 1%, QoL = a little worse, follow-up = 3 more years) and surgery (cure rate = 40%, death = 3%, QoL = moderately worse, follow-up = standard). Results 92 surveillance patients, 80 clinicians, 35 survivors and 100 from the general population completed the DCE. All respondent groups had significant preference for a higher cure rate (40% and 60% vs 30%) and were averse to a worse quality of life. When attribute levels for surgery were compared to reference for definitive treatment, all participants preferred surgery except with a lot worse QoL and when cure rate for surgery was 30%. On varying attribute levels for definitive treatment, cancer survivors always preferred surgery whilst clinicians, surveillance and general population switched preference to definitive treatment when cure rate increased to 40%. Conclusion Although there does not appear to be a preference for preoperative CRT with surgery compared to definitive CRT for esophageal cancer care, the option which has the highest cure rate and quality of life is preferred. This highlights the importance of a patient-tailored approach in treatment recommendations with a discussion about which attributes are valued most by patients.