#0449

Physician and patient preferences for early-stage and adjuvant treatment of genitourinary cancer in Asia-Pacific

J. Teoh¹, L. Spain², Y. Tsai³, E. Chiong⁴, T. Ong⁵, S. Wang⁶, E. Chan¹, A. D'Souza⁷, L. Vandervoort⁸, M. Patel⁹

¹The Chinese University of Hong Kong, S.H. Ho Urology Centre, Department of Surgery, Faculty of Medicine,, Hong Kong, Hong Kong, China
²Peter MacCallum Cancer Centre, Melbourne, Australia
³National Taiwan University Hospital, Taiwan, Taiwan
⁴National University Hospital and National University of Singapore, Department of Urology and Surgery, Singapore, Singapore
⁵Universiti Malaya, Department of Surgery, Faculty of Medicine,, Kuala Lumpur, Malaysia
⁶Taichung Veterans General Hospital, Taiwan, Taiwan
⁷MSD, Singapore, Singapore
⁸Oracle Life Sciences, Singapore, Singapore
⁹Westmead Hospital, University of Sydney, Specialty of Surgery, Sydney, Australia

Introduction:

There is limited understanding of the attributes of adjuvant systemic therapy that are preferred by patients and physicians in the management of early-stage genitourinary (GU) cancers in Asia-Pacific, particularly renal cell carcinoma (RCC) and urothelial carcinoma (UC).

Material and methods:

This multi-territory, cross-sectional study was conducted using a discrete-choice experiment (October 2024-January 2025) to assess the treatment preferences of physicians (medical oncologists and urologists) and GU cancer patients (aged ≥18 years; RCC: n=50, UC: n=50) in Australia, Hong Kong, Singapore, Malaysia, and Taiwan. Relative preference weights, relative importance (RI) of each attribute and the minimum acceptable benefit for maximum acceptable risk were analysed using hierarchical Bayesian logistic regression. The DCE survey included 8 attributes spanning efficacy, risk of select treatment-related adverse events (AEs) and mode of administration. The preferred timing for using a hypothetical treatment approved for use in both early and late-stage GU cancers was also assessed.

Results:

Amongst physicians, 46 medical oncologists and 44 urologists were included. A total of 50 RCC, 35 non-muscle invasive bladder cancer (NMIBC) and 15 muscle-invasive bladder cancer (MIBC) patient respondents were included, with the majority of RCC patients categorized as Stage 2. Physicians regarded “Probability of disease-free survival (DFS) in 1-year” (RI=36.3%) as the most important treatment attribute when choosing early-stage cancer treatments, followed by “Overall survival (OS)” (RI=22.1%) and “Risk of treatment-related skin rash” (RI=8.5%). Patients placed similar importance to “OS” (RI=27.6%) and “Probability of DFS in 1-year” (RI=25.1%), followed by “Risk of treatment-related fatigue” (RI=9.9%). Physicians were most willing to accept increase in risks (from 5% to 35%) of treatment-related skin rash for 8.0% DFS /0.74-year OS increase and fatigue for 6.1% DFS /0.56-year OS increase. Patients were willing to accept a higher likelihood (from 5% to 35%) of treatment-related fatigue for 11.4% DFS /0.67-year OS increase, and long-term/permanent adverse events (AEs) (from 1% to 15%) for 10.8% DFS/0.64-year OS increase. Most physicians (88-96%) and patients (87-92%) prefer starting systemic treatment early in the disease course, rather than reserve the treatment for an advanced stage.