Factors Associated With Adjuvant Treatment Options in Resected Stage III Melanoma, From a Patient and Physician Perspective: Preference Assessment Using the Discrete Choice Experiment Method (Pamela Study)

OBJECTIVES:

With the rapid development of new treatments in the adjuvant setting of melanoma, the main objective of this study is to describe the criteria governing the preference of adjuvant treatment in patients with resected stage III melanoma, from both the patient's and the onco(dermato)logist’s perspective.

METHODS:

Pamela is a transversal observational study conducted in 16 French hospitals, enrolling onco(dermato)logists and patients with resected stage III melanoma, from November 2021 to March 2023.

A discrete-choice experiment (DCE) was conducted among onco(dermato)logists and patients. In a serie of scenarios, respondents had to choose between hypothetical treatment alternatives. Each had seven attributes selected via a literature review, patient interviews and expert consensus: risk of recurrence after 3 years (RFS), of melanoma-related premature death (MSS), that the treatment disrupts the everyday life, that the treatment leads to another long-term condition or permanent condition that may require long-term or even life-long treatment, that the treatment may cause very severe toxicity, method of administration and frequency of hospital visits. Then respondents were also asked to rate attributes in a non-trade-off setting.

RESULTS:

47 physicians and 126 patients (mean age 61.4±14, 62% of men), were involved in the study.

Using DCE, for both physicians and patients decision, efficacy criteria were the most important: RFS first (significant OR=8,16 and OR=6,20 respectively), followed by MSS (OR=6,37 and OR=3,43). Other criteria did not impact similarly physicians and patients preference: daily disruptions and modalities of administration doesn’t weigh on the physicians decision while the risk that the treatment leads to another condition doesn’t influence the patient's preferences compared with other attributes.

CONCLUSIONS:

The study confirms the value of DCE method to reveal which criteria influence the treatment preferences and to what extent. Oncologists and patients converge on efficacy criteria, but preferences vary when it comes to side effects and modalities of administration.