Preferences for oral and parenteral antitumor therapy: A survey of 260 patients with metastatic breast cancer

Abstract

619 Background: Oral, intravenous (IV), intramuscular (IM) and subcutaneous (SQ) therapies are commonly utilized to treat patients with metastatic breast cancer (PMBC), and often the risk-benefit ratios of these palliative options are similar. Two common clinical scenarios that offer choices for women with metastatic breast disease are: (1) The oral fluoropyrimidine prodrug, capecitabine or IV agents/ regimens, and (2) For postmenopausal women, daily oral endocrine agents, such as tamoxifen and aromatase inhibitors, or fulvestrant, a monthly IM injection. It is widely assumed that oral therapy is preferable, because of the perceived inconvenience and discomfort of parenteral therapy (PT). This study evaluated these preferences. Methods: PMBC were recruited to participate in an anonymous 250-item, 45-minute telephone survey focusing on a variety of issues, including preferences for oral chemotherapy (OC) vs IV chemotherapy (IC) and oral (OE) vs IM endocrine therapy (IME). Results: 260 PMBC were interviewed. Current and prior therapies included IC (88%), OC (32%), OE (84%), IME (fulvestrant: 23%), SQ endocrine therapy (12%), and IV bisphosphonates (65%). When asked to decide between two equally effective and tolerable treatments, 63% of PMBC preferred OC, 29% preferred IC and 8% were neutral. Similarly, 54% preferred OE, 36% preferred IME and 10% were neutral. Reasons for preferring PT included convenience, the belief that PT is more effective, and concerns about personal compliance with oral medications. Conclusions: Other data from this project demonstrate that medical oncologists (MO) and oncology nurses (ON) estimate that — assuming equivalent efficacy and side effects — approximately one third or more of PMBC in their practices would prefer PT. These estimates correlate with the findings in this survey. Additional data from the PMBC survey demonstrate that these patients have frequent, extended visits to the MO’s office, hold MO and ON in high regard, and value interactions with other patients during office visits. Within this context, a substantial percentage of PMBC prefers PT. These preferences should be considered when making treatment decisions with PMBC. Author Disclosure Employment or Leadership Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration AstraZeneca, EMD, Onyx, Pfizer AstraZeneca, Genentech, Novartis, Pfizer, Roche Genentech, GlaxoSmithKline