INTRODUCTION: Targeted novel oral agents have expanded CLL treatment (tx) options beyond chemoimmunotherapy (CIT) as standard of care. BTK and BCL2 inhibitors are now commonly utilized, highly effective chemo-free treatments for patients with CLL in first-line and relapsed/refractory settings. Novel agents differ in efficacy, tx duration, mode of administration, side effect profile and cost compared with traditional CIT. Patient preferences for CLL tx attributes are not well characterized. This study identifies tx attributes in CLL that are important from a patient perspective.
METHODS: A convenience sample, recruited from US patient panels and clinics, of 20 adults with a self-reported CLL diagnoses, participated in qualitative telephone interviews in Aug 2020. Interviews were conducted according to a semi-structured interview guide comprised of both open-ended questions and more targeted probes (pertaining to attributes such as tx duration, mode of administration, side effects, and chemotherapy) to ensure a comprehensive list of tx attributes that influence preference was obtained. Rating and ranking exercises were employed to understand the relative importance of each attribute. Content analysis was conducted to identify themes in patients’ responses; descriptive statistics summarized quantitative data.
RESULTS: Participants (n= 14, 70%) were tx experienced (n = 5; ≥ 2 tx lines), 9 were male, mean age = 59 years. All participants reported that efficacy (e.g., remission, delay in symptom progression, improvement in specific symptoms) and safety (e.g., nausea, fatigue) were “very important” or “important” in influencing tx preference. Of the 93 unique attributes identified, 10 were rated as “very important” or “important” in influencing tx preference by at least 50% of participants: tx duration (n = 18); tx mode (oral, infused, injected), tx location (at home, in clinic), and frequency of administration/how often tx is taken/administered (n = 17, n = 15, n = 11, respectively); cost (n = 16); chemo-free (n = 16); remission (n = 14); and side effects (fatigue, n = 13; long-term side effects, n = 12; nausea, n = 10). Most participants (85%) reported preference for a tx with fixed duration, if safety and efficacy were similar. Reasons for this preference included cost, convenience, reduced risk of long-term side effects, and return to normal life.
CONCLUSIONS: Patient-centered care is providing care that is responsive to individual patient preferences, needs and values. These study results indicate that while efficacy and safety are most frequently reported as the most important tx attributes for adults with CLL, tx duration, tx mode, location and frequency of administration, and cost are also influential in determining tx preferences. Elucidating patient preference aids in shared decision-making between patients and physicians to optimize tx satisfaction and outcomes.
