Treatment Priorities in Patients With a History of Laryngeal Cancer: A Conjoint Analysis

OBJECTIVE: To investigate patient priorities that may inform the choice of laryngeal cancer treatment. STUDY DESIGN: Multi-institutional, survey-based, conjoint analysis study focusing on seven attributes: lifespan, treatment type, cancer cure, self-image, mode of breathing, voicing, and swallowing. Patients with a history of treated laryngeal cancer (>6 months from treatment completion with no evidence of recurrent disease) were recruited. SETTING: Tertiary care medical centers. METHODS: Conjoint analysis yields utility scores, a quantitative measure of preference for an attribute. Higher utility scores indicate greater preference. Chi-squared, univariate logistic regression, and univariate linear regression analyses were used to evaluate associations between patient demographic and medical features with relative attribute preference. RESULTS: This study included 151 patients with previously treated laryngeal cancer. For the cohort, the mean importance scores (±standard deviation) were swallowing 25.7% (±8.4%), lifespan 21.5% (±9.3%), cancer cure 14.0% (±6.4%), mode of breathing 12.8% (±4.8%), voicing 9.2% (±3.5%), treatment type 9.1% (±5.0%), and self-image 7.7% (±4.4%). Patients who required salvage surgery after upfront chemoradiotherapy placed more value on cancer cure compared to the other treatment groups (coefficient 2.76, 95% CI 0.33-5.19). CONCLUSION: In patients with a history of treated laryngeal cancer, swallowing is the most important treatment priority, followed closely by lifespan. However, patients who underwent salvage surgery placed more value on cancer cure during decision-making. These findings demonstrate that patient treatment preferences are diverse and may change throughout the cancer care journey, with some patients placing a higher value on quality of life than lifespan and cancer cure.