Physician decisions related to maintenance therapy for advanced non-small cell lung cancer (NSCLC) in the United States (US).

182 Background: In 2006, maintenance therapy was added as a treatment guideline for patients with advanced non-squamous (nsq) NSCLC. This study aimed to identify patient- and disease-related factors that impact maintenance therapy decision making.

METHODS: An online discrete choice survey was administered to physicians currently managing patients with advanced nsq NSCLC in the US. Physicians viewed 12 patient profiles differing in levels of the following attributes: 1st line treatment response (complete, partial, stable, progression), adverse events during 1st line therapy (none, mild, moderate, severe), comorbidities (none, mild renal, severe renal, other), patient motivation/convenience (+/+, +/-, -/+, -/-), patient insurance co-pay rate (0, 5, 10, 20%), and age (45, 58, 68, 80 years). No specific maintenance treatments were stated. For each profile, physicians indicated if they would recommend maintenance therapy. Recommendations were analyzed using a mixed-effects logistic regression model. Odds ratios (ORs) were calculated to estimate the relative odds of a maintenance therapy recommendation for levels of each attribute.

RESULTS: The survey was completed by 100 physicians (81% male; mean years of experience: 15.4). The study design was balanced and orthogonal. Maintenance therapy was recommended for 75% of the profiles; 98% of physicians recommended maintenance therapy for at least 1 profile, with 26% recommending it for all profiles. The odds of recommending maintenance therapy were significantly lower when the patient profile included disease progression relative to stable response (OR: 0.17; p<0.01), severe renal impairment relative to no comorbidities (OR: 0.38; p<0.01), or low motivation/convenience relative to high motivation/convenience (OR: 0.25; p<0.01). The odds also decreased with increasing age (OR: 0.97 per year increase in age; p<0.01).

CONCLUSIONS: Treatment response, age, motivation/convenience, and comorbidities were relevant factors for physicians when recommending maintenance therapy. Physicians report recommending maintenance even in the presence of less desirable patient and disease characteristics indicative of a real world setting.