Drivers of Treatment Preferences in High-Risk Non-Muscle Invasive Bladder Cancer (HR-NMIBC) Patients: Qualitative Interviews to Inform a Patient-Preference Study

OBJECTIVES: Non-muscle invasive bladder cancer (NMIBC) represents 75% of bladder cancer diagnoses. Bacillus Calmette-Guerin (BCG) is the standard of care in high-risk NMIBC (HR-NMIBC), although the disease may recur or progress to more life-threatening muscle-invasive disease. This study aimed to explore HR-NMIBC patient perspectives on treatment attributes to inform development of a patient-preference survey.

METHODS: A draft attributes and levels (A&L) grid reflecting features of approved and investigational therapies was created following a targeted literature review of clinical and patient-focused literature, publicly available resources, and feedback from clinicians, preference experts, and a patient advocate. Qualitative interviews were conducted with HR-NMIBC patients (N=12) to evaluate content validity of the grid. Concept elicitation explored patient experience and perspectives regarding treatment and drivers for treatment choice. Cognitive debriefing assessed patient comprehension of attribute descriptions concerning treatment administration, efficacy, and safety. Patients’ perceived importance of attributes, independence of levels, and meaningfulness of level differences were examined.

RESULTS: Efficacy (event-free survival) was a key driver of treatment choice. Patients considered adverse events (i.e., bladder problems, serious immune-related AEs, the likelihood of developing chronic conditions, such as diabetes and adrenal insufficiency), and route of administration (RoA) to be important. For RoA, most participants preferred a subcutaneous injection over intravenous infusion. Thyroid problems, flu-like symptoms, and treatment duration were of lesser importance. Following in-depth cognitive debriefing, the attributes, their descriptions and levels were well understood, interpreted as intended, and meaningful to patients.

CONCLUSIONS: Preliminary investigation of perspectives among HR-NMIBC patients highlighted a range of considerations concerning efficacy, administration, and safety attributes that may influence preference toward current and investigational therapies. Findings from this qualitative study will inform a future patient-preference study that will quantify benefit-risk trade-offs and relative importance of treatment attributes among HR-NMIBC patients and thereby contribute to filling a gap in the existing literature.