Patient, Care Partner, and Oncologist Perspectives on Clinically Important Survival Thresholds After Considering Time Toxicity in Advanced Cancer
Arjun Gupta, Kendall Lin, Rick J Jansen, Samuel X Stevens, Manju George, Allison Breininger, Christopher M Booth, Helen M Parsons, Jeanette Y Ziegenfuss, Rachel I Vogel, Anne H BlaesAbstract
A treatment’s time toxicity (measured using contact days) can decrease days spent at home (home days). We evaluated the minimum clinically important difference (MCID) and non-inferiority margin (NIM) of home days, and treatment acceptance when all additional survival time was spent in health care, by surveying people with lived (patients, n = 42; informal care partners, n = 29) and professional (oncologists, n = 8) experience of advanced cancer. All 3 groups reported similar MCIDs and NIMs (6-month survival; median MCID range, 14-15; p = 0.79; median NIM range, 5-11; p = 0.14). Care partners (48%) and patients (21%) more often accepted 2-week survival gains without increase in home days, than oncologists (0%), p = 0.09. Caregivers reported altruism guided their responses, and clinicians’ responses in stated-preference work may differ from revealed-preferences in clinic. By empirically deriving MCID/NIM for home days and evaluating treatment acceptance, this work will aid trial design and decision studies using an endpoint of home days.