Patient and Physician Preferences for Add-On Systemic Therapy to Transarterial Chemoembolization for Hepatocellular Carcinoma in Japan: A Discrete Choice Experiment.

Introduction: Transarterial chemoembolization (TACE) is the primary treatment for intermediate-stage hepatocellular carcinoma (HCC). Synergistic effects are expected by adding recently developed systemic therapies onto TACE. We investigated patient and physician preferences for this treatment approach.

Methods: Preferences of patients with HCC who underwent TACE and physicians treating HCC were assessed using a discrete choice experiment. Eighteen hypothetical treatment profiles were set based on seven attributes, including survival outcomes, treatment burden, and side effects, with two or three levels. A mixed-logit model estimated the preference weights for each attribute level.

Results: The 85 HCC patients surveyed had a median age of 69 (interquartile range 59-75) years. Most were male (84.7% [72/85]). Most physicians (70.4% [69/98]) were ≥40 years old, and 93.9% (92/98) were male. Both patients and physicians showed the largest positive preferences for 5-year overall survival (OS) {preference weight (95% confidence interval [CI]) 3.41 (2.85, 3.97) and 4.84 (3.90, 5.79), < 0.001, respectively}, relative to 2-year OS. Following this, patients preferred minimizing the risk of fatigue with negative preferences (95% CI) for a 50% risk relative to a 10% risk (-0.84 [-1.24, -0.43], < 0.001), and physicians preferred extended time to progression (TTP) from 6 months to 2 years (1.39 [0.82, 1.95], < 0.001). Physicians, but not patients, exhibited a significant negative preference (95% CI) for a 40% increase in the risk of immune-related side effects (-1.03 [-1.67, -0.39], = 0.002, and -0.41 [-0.84, 0.02], = 0.063, respectively). Preferences varied depending on patient and physician characteristics.

Conclusion: OS was the most important factor for both patients and physicians in TACE-based treatment for HCC, with fatigue the second largest preference factor for patients and TTP for physicians. Understandings of immune-related side effects seemed to vary among participants. These findings enhance patient-physician communication and shared decision-making.