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Program Number: B163
Session Name: Poster Session

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

Sindhura Sridhar, BS¹; Montana Upton, MD¹; Thomas Issa, BS²; Whitney Jin, BA¹; Elliot Abemayor, MD²; Abie H Mendelsohn, MD²; Patrick Tassone, MD³; Michael C Topf, MD, MSCI¹; ¹Vanderbilt University Medical Center, Department of Otolaryngology -- Head and Neck Surgery; ²UCLA, Department of Head and Neck Surgery; ³University of Missouri, Department of Otolaryngology -- Head and Neck Surgery

BACKGROUND: Current National Comprehensive Cancer Network guidelines indicate that surgery or radiotherapy with or without chemotherapy can be utilized for management of early-stage and locally advanced laryngeal cancer. As such, the treatment decision is often a personal conversation between provider and patient, including a discussion of the oncologic outcomes and toxicities associated with each treatment. In this study, we investigate this complex decision-making paradigm in patients with a history of treated laryngeal cancer using conjoint analysis, a stated-preference marketing strategy that determines the value placed on product attributes by consumers. In doing so, we aim to better understand patient priorities that may inform choice of laryngeal cancer treatment moving forward.

METHODS: A prospective, multi-institutional, survey-based, conjoint analysis study was conducted. Patients with a history of treated laryngeal cancer (>6 months from treatment completion with no evidence of recurrent disease) were recruited for study participation. Sawtooth Software (Lighthouse Studio, version 9.14.2) was used to construct a 15-question survey focusing on seven attributes: lifespan, treatment type (surgery, radiation, chemotherapy), cancer cure, self-image, mode of breathing, voicing, and swallowing. In each question, participants were asked to choose between two hypothetical treatment alternatives comprised of four attributes. Conjoint analysis yields utility scores, a quantitative measure of preference for an attribute. Higher utility scores indicate greater preference. Hierarchical Bayesian analysis was used for conjoint analysis, and frequentist statistics was conducted using chi-squared, univariate logistic regression, and univariate linear regression analyses to evaluate associations between patient demographic and medical features with relative attribute preference.

RESULTS: This study included 151 patients with previously treated laryngeal cancer. Prior treatment included surgery alone (26), radiation alone (16), chemoradiation (35), surgery followed by radiation ± chemotherapy (37), radiation ± chemotherapy followed by surgery (34), and other treatment regimens (3). For the entire cohort, the average 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%). However, patients who required salvage surgery after upfront chemoradiation significantly valued cancer cure over all other treatment attributes (OR 1.07, 95% CI 1.01-1.15, p = 0.03). Patients who were not employed placed lower value on treatment type compared to other treatment attributes (OR 0.98, 95% CI 0.97-0.99, p = 0.03).

CONCLUSION AND RELEVANCE: In patients with a history of treated laryngeal cancer, swallowing is the most important treatment priority, followed closely by lifespan. Treatment modality and self-image were the least valued treatment attributes. However, patients who underwent salvage surgery as opposed to primary surgical management or (chemo)radiotherapy alone valued cancer cure over all other treatment attributes. 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.

Figure: Example survey question presenting a choice between two hypothetical laryngeal cancer treatments with four attributes.

 

 

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