For patients with hepatocellular carcinoma, the impact of treatment on QOL is a significant driver of their treatment preferences.
Daneng Li, MD, is the 2023 recipient of the Blue Faery Award for Excellence in Liver Cancer Research. The award honors one researcher who has made significant contributions to the advancement of scientific knowledge in the diagnosis, treatment, prevention, or understanding of liver cancer.
One of Dr. Li’s recent research projects focused on patient preferences in the treatment of hepatocellular carcinoma (HCC). For a study published in Cancers, Dr. Li and colleagues conducted a discrete-choice experiment survey of 200 US patients with unresectable HCC. Participants responded to nine questions, all of which provided a choice between two hypothetical treatment profiles defined by six attributes: overall survival, months of maintained daily function, severity of palmar-plantar syndrome, severity of hypertension, risk for digestive-tract bleeding, and mode and frequency of administration.
Physician’s Weekly spoke with Dr. Li about his research.
Physician’s Weekly: Why is patient preference in HCC treatment an important topic to study?
Dr. Li: With HCC, the curative potential of treatment needs to be weighed against the effects on patient QOL. As more treatments become available for advanced HCC, it is important to understand patients’ priorities and goals and the drug benefit-risk profiles. For some patients with advanced HCC, maintaining QOL and avoiding moderate to severe side effects may be more important than a medicine’s potential survival benefit. QOL is especially important in this group, which often reports feelings of fear, worry, and anxiety upon their diagnosis due to the often-poor prognosis associated with advanced HCC.
What findings are important to emphasize?
The impact of treatment on QOL was a significant driver of patient preference (Figure). Patients prioritized avoiding side effects that would severely impact QOL during treatment, such as moderate to severe hand-foot syndrome and moderate to severe high blood pressure. Patients preferred survival-extending treatments that also provided the benefit of maintaining independence and QOL overall; they considered 10 additional months of sustained daily functioning to be as important or more important than 10 additional months of survival. Patients placed the least importance on a 5-percentage-point reduction in the risk for bleeding in the digestive tract.
What are the implications of your results?
Physicians need to have more honest dialogue with all patients with HCC about treatment goals and priorities, as well as drug benefit-risk profiles. Don’t shy away from asking sometimes difficult questions regarding goals of care and specifically asking patients what potential side effects they absolutely want to avoid. This is vital to ensure that we are truly respecting patients’ desires.
To achieve the best patient outcome, consider allocating more time to a frank and open discussion about patient preferences across the six features listed in our study. Then, shape the treatment plan to serve the patient’s preference model.
What would you like future research to focus on?
Traditionally in oncology, overall survival is the gold standard for the primary outcome in clinical trials. However, as our study shows, this might not be the only important outcome for HCC. To better align with patient goals, we need to incorporate other outcomes, such as maintenance of independence or reducing symptoms or pain, as key outcomes in clinical trials and the drug approval process. We hope to incorporate various patient assessment measures in future clinical trials as the next step in our research to ensure that the treatments that are approved not only help patients live longer, but also really help them live better.
