OBJECTIVES: Studies of outcome preferences in oncology have presented the value that patients and physicians place on improvements in mean or median progression-free or overall survival. Furthermore, a recent study showed that patients with metastatic melanoma or breast cancer prefer treatments with greater potential for long-term survival, even when expected survival is no different, a phenomenon termed the “value of hope.” Our objective was to evaluate oncologist and patient preferences for advanced non-small cell lung cancer (NSCLC) treatments, defined by mean expected overall survival (ES), best-case survival (BCS), worst-case survival (WCS), and treatment toxicities.

METHODS: A discrete-choice experiment (DCE) was administered online to oncologists and patients with NSCLC. Each treatment profile in the DCE was defined by different levels of ES, BCS, and WCS, along with fatigue, nausea, and risk of febrile neutropenia. BCS and WCS were defined as the expected survival for the top and bottom 15% of patients, respectively. In separate surveys, physicians and patients chose among pairs of profiles representing possible second-line treatments for advanced NSCLC. Data were examined using random parameters logit analysis.

RESULTS: A total of 102 physicians completed the survey. The preference weight for each 1-month improvement in BCS was positive, independent of the effect of all other attributes. The preference weight for ES was also positive and statistically significant, but the preference weight for WCS was not statistically significant. Severe nausea and severe fatigue were statistically significantly (negatively) more important to treatment choice than mild-to-moderate nausea or fatigue, respectively. A 10% risk of febrile neutropenia was statistically significantly preferred to a 40% risk. The patient data collection is ongoing.

CONCLUSIONS: ES, BCS, and toxicities impacted physicians’ choice of advanced NSCLC treatments. Strong preference for longer BCS, holding ES, WCS, and toxicities constant, confirms that the “value of hope” matters to oncologists in the advanced NSCLC setting.