Unmet needs in non-metastatic castration-resistant prostate cancer from the Japanese patient perspective: a discrete choice experiment.

OBJECTIVES: With novel antiandrogen treatments of varying clinical benefits and risks becoming available, this study investigates how patients with castration-resistant prostate cancer (CRPC) value differences in treatment characteristics. DESIGN: Cross-sectional observational study. SETTING: A discrete choice experiment was conducted. Patients chose between two hypothetical non-metastatic CRPC (nmCRPC) treatments defined by six attributes: risk of fatigue, falls or fracture, cognitive impairment, hypertension, rashes as side effects to treatment and extension of time until cancer-related pain occurs. PARTICIPANTS: A total of 137 adult male patients with CRPC with no prior experience with chemotherapy and with Eastern Cooperative Oncology Group status 0-1 were recruited. Patients were excluded if they participated in an investigational programme outside of routine clinical practice, had a clinically relevant medical or psychiatric condition, or diagnosis of visceral/other metastases not related to the prostate, or were otherwise deemed ineligible by the referring physician. PRIMARY OUTCOME MEASURES: Relative preference weights and relative importance of the attributes was estimated by hierarchical Bayesian logistic regression. RESULTS: Among the treatment attributes, 'risk of cognitive impairment as a side effect of treatment' was the most important attribute (relative importance (RI) (95% CI): 27.47% (24.80% to 30.14%)), followed by 'extension of time until cancer-related pain occurs' (RI (95% CI): 17.87% (15.49% to 20.25%)) and the 'risk of falls or fracture' (RI (95% CI): 15.99% (14.73% to 17.25%)). The 'risk of hypertension as a side effect of treatment' (RI (95% CI): 13.77% (12.73% to 14.81%)) had similar RI as 'risk of rashes as a side effect of treatment' (RI (95% CI): 13.17% (12.15% to 14.19%)), followed by the 'risk of fatigue as a side effect of treatment' (RI (95% CI): 11.74% (10.75% to 12.73%)). CONCLUSIONS: Patients consider the risk of cognitive impairment as a side effect of treatment as the most important attribute in nmCRPC, followed by the extension of time until cancer-related pain occurs, and the risk of falls and fracture. These features should be considered in treatment decision making for nmCRPC in Japan.

Understanding Treatment Strategies and Preferences in Nonmetastatic Castration-Resistant Prostate Cancer From the Japanese Physician Perspective.

PURPOSE: Sixteen percent (16%) of patients with castration-resistant prostate cancer (CRPC) show no bone metastasis at diagnosis. However, 33% will become metastatic within 2 years. The goal of treatment in patients with nonmetastatic CRPC (nmCRPC), therefore, is to delay symptomatic metastases without undue toxicity. With novel antiandrogen treatments of different strengths and limitations available, physician preferences for nmCRPC treatment in Japan should be understood. METHODS: A discrete choice experiment was conducted. Physicians chose between two hypothetical treatments in nmCRPC defined by six attributes: risk of fatigue, falls or fracture, cognitive impairment, hypertension, rashes as side effects of treatment, and extension of time until cancer-related pain occurs. Relative preference weights and relative importance were estimated by hierarchical Bayesian logistic regression. Physicians were also asked to make treatment decisions based on four hypothetical patient profiles to understand the most important factors driving decision making. RESULTS: A total of 151 physicians completed the survey. Extension of time until cancer-related pain occurs was the most important attribute (relative importance, 32.3%; CI, 31.3% to 33.3%). Based on summed preference weights across all attributes, preferences for hypothetical treatment profiles I, II, and III were compared. A hypothetical treatment profile with better safety though shorter extension time was preferred (I: mean [standard deviation] = 1.7 [1.6 to 2.1]) over treatment profiles with lower safety but longer extension time (II: -2.7 [-2.8 to -2.6] and III: -0.2 [-0.3 to -0.1]). Treatment characteristics were more important factors for physicians' decision making than patient characteristics in prescribing treatment. CONCLUSION: Physicians preferred a treatment with better safety profile, and treatment characteristics were the most important factors for decision making. This might have implications in physicians' decision making for nmCRPC treatment in the future in Japan.

Not all prostate cancer is the same - patient perceptions: an Asia-Pacific region study.

OBJECTIVE: To explore the perceptions of patients living with different stages of prostate cancer across the Asia-Pacific (APAC) region, as while extensive quantitative research has been undertaken into outcomes of treatments for prostate cancer, little in the way of qualitative research has been performed looking at subjective perceptions of patients in regard to their perceived deficits in the treatment of this condition and such research is particularly lacking in reference to the APAC region. PATIENTS AND METHODS: Initial 45-min qualitative research interrogatory interviews were conducted with 12 patients from Australia, China and Japan to identify themes that were significant to patients in the management of prostate cancer. Thereafter, 150 patients with different stages of prostate cancer underwent 30-min online (Australia) or computer-assisted/personal interviews categorised on the five key themes identified, in order to more fully clarify the nature of patient perceptions of how their prostate cancer had been treated and the issues they felt could be more fully addressed in order to improve the management of this condition. RESULTS: Interviews indicated common challenges and unmet needs among patients, including: (i) patients' feelings and emotional state change during their disease journey, (ii) patients lack of knowledge about prostate cancer and disease progression prior to diagnosis, (iii) patients felt shared decision-making was uncommon, (iv) patients have misperceptions about surgery, and (v) patients have unmet needs for greater information and support to manage their condition. CONCLUSIONS: These patient perceptions of unmet needs in prostate cancer management stand in contrast to patient awareness of other common diseases such as heart failure and diabetes. Such unmet needs vary across disease stages and between different nationalities. Patients with prostate cancer in the APAC region appear to have gaps in knowledge about their disease and wish for greater information, support and public awareness about prostate cancer.

Attitudes & beliefs that influence healthy eating behaviours among mothers of young children in Singapore: A cross-sectional study.

BACKGROUND: Many countries recommend parental involvement to enhance the effectiveness of healthy lifestyle interventions focusing on behavioural modifications that encourage weight management in children. Our study investigates to what extent the different constructs of the Theory of Planned Behaviour (TPB) are influencing healthy eating behaviour among mothers of pre-school and primary school children in Singapore. METHODS: A total of 716 mothers of pre-schoolers, 3-6 years old (N = 358) and primary school students, 7-12 years old (N = 358) were administered a survey to assess healthy eating behaviour using the TPB constructs. Bivariate correlations among TPB constructs were calculated and tested using Pearson's correlation. Multivariate generalized regression was performed to examine the associations between TPB constructs and healthy eating behaviour. RESULTS: More than 80% of children consumed less than the daily recommended servings of at least 1 glass of dairy,2 servings of fruit and 2 servings of vegetables per day advised by the Singapore Health Board. More primary school children consumed less dairy per day compared to pre-school children (48.9% vs 26.3%; p < 0.001). Primary school children's healthy eating behaviours were correlated with mother's perceived behavioural control (PBC) such as adequate discipline (ß = 0.40; p = 0.001), self-efficacy (ß = 0.35; p = 0.01) and a lower barrier that healthy food does not satisfy hunger (ß = -1.16; p < 0.001). Barriers that significantly reduced pre-school children's healthy food intake were lack of motivation among mothers (ß = -1.13; p < 0.001) and children (ß = -0.49; p = 0.02), lack of satiety (ß = -1.06; p = 0.02), difficulty in changing child's eating habits (ß = -0.58; p = 0.03), lack of family support (ß = -0.62; p = 0.03). CONCLUSIONS: Findings from this study provides a formative foundation for future research and exploration of plausible interventions around improving mother's PBC, self-efficacy and reducing barriers, which could increase mother's engagement in improving their children's healthy eating behaviours in Singapore.