HOW PATIENTS' PRIMARY TREATMENT CHOICES FOR LOCALIZED PROSTATE CANCER SHIFT WITH PATIENTS' DIFFERENT PREFERENCES ON SIDE EFFECTS
Method: A Markovian model is utilized to estimate survival and quality adjusted life years (QALYs) for different treatments. Stochastic sensitivity analysis is done to obtain confidence intervals of the estimates. Since the confidence intervals for different treatments could overlap for most of the patients, we estimate the probability of being the best treatment option for each treatment. We simulate newly-diagnosed patients to get population-based results.
Result: Our initial computational experiments focus on patients’ preferences about erectile dysfunction. Assuming other side effects has no QoL impact on patients, when erectile dysfunction doesn’t matter to the patients (QALY decrement is 0), more than 99% of the simulated patients’ best choice is RP or EBRT. When QALY decrement for erectile dysfunction increases to 0.2 QALYs each year, 47% of the simulated patient’s best choice is AS, while 12%, 21%, and 20% should choose RP, EBRT, and BT, respectively.
Conclusion: Patients’ preferences on QoL tradeoffs about side effects after treatment is could significantly shift their choice of primary treatment. Therefore, it is very important to help patients understand their own preferences during the shared decision making process for localized prostate cancer patients. Further experiments are needed to uncover how other side effects and their combinations could shift patient’s treatment choices.