Treatment Priorities in Patients With a History of Laryngeal Cancer: A Conjoint Analysis.

Abstract

To investigate patient priorities that may inform the choice of laryngeal cancer treatment. Multi-institutional, survey-based, conjoint analysis study focusing on seven attributes: lifespan, treatment type, cancer cure, self-image, mode of breathing, voicing, and swallowing. Patients with a history of treated laryngeal cancer (>6 months from treatment completion with no evidence of recurrent disease) were recruited. Tertiary care medical centers. Conjoint analysis yields utility scores, a quantitative measure of preference for an attribute. Higher utility scores indicate greater preference. Chi-squared, univariate logistic regression, and univariate linear regression analyses were used to evaluate associations between patient demographic and medical features with relative attribute preference. This study included 151 patients with previously treated laryngeal cancer. For the cohort, the mean importance scores (±standard deviation) were swallowing 25.7% (±8.4%), lifespan 21.5% (±9.3%), cancer cure 14.0% (±6.4%), mode of breathing 12.8% (±4.8%), voicing 9.2% (±3.5%), treatment type 9.1% (±5.0%), and self-image 7.7% (±4.4%). Patients who required salvage surgery after upfront chemoradiotherapy placed more value on cancer cure compared to the other treatment groups (coefficient 2.76, 95% CI 0.33-5.19). In patients with a history of treated laryngeal cancer, swallowing is the most important treatment priority, followed closely by lifespan. However, patients who underwent salvage surgery placed more value on cancer cure during decision-making. These findings demonstrate that patient treatment preferences are diverse and may change throughout the cancer care journey, with some patients placing a higher value on quality of life than lifespan and cancer cure.