Patient preferences for maintenance PARP inhibitor therapy in ovarian cancer treatment

Gynecol Oncol. 2020 Mar;156(3):561-567. doi: 10.1016/j.ygyno.2020.01.026. Epub 2020 Jan 22.


Objective: To measure preferences of women with ovarian cancer regarding risks, side effects, costs and benefits afforded by maintenance therapy (MT) with a poly ADP ribose polymerase (PARP) inhibitor.

Methods: A discrete-choice experiment elicited preferences of women with ovarian cancer regarding 6 attributes (levels in parentheses) relevant to decisions for MT versus treatment break: (1) overall survival (OS; 36, 38, 42 months); (2) progression-free survival (PFS; 15, 17, 21 months); (3) nausea (none, mild, moderate); (4) fatigue (none, mild, moderate); (5) probability of death from myelodysplastic syndrome/acute myelogenous leukemia (MDS/AML; 0% to 10%); (6) monthly out-of-pocket cost ($0 to $1000). Participants chose between 2 variable MT scenarios and a static scenario representing treatment break, with multiple iterations. Random-parameters logit regression was applied to model choices as a function of attribute levels.

Results: 95 eligible participants completed the survey; mean age was 62, 48% had recurrence, and 17% were ever-PARP inhibitor users. Participants valued OS (average importance weight 24.5 out of 100) and monthly costs (24.6) most highly, followed by risk of death from MDS/AML (17.9), nausea (14.7), PFS (10.5) and fatigue (7.8). Participants would accept 5% risk of MDS/AML if treatment provided 2.2 months additional OS or 4.8 months PFS. Participants would require gains of 2.6 months PFS to accept mild treatment-related fatigue and 4.4 months to accept mild nausea.

Conclusions: When considering MT, women with ovarian cancer are most motivated by gains in OS. Women expect at least 3-4 months of PFS benefit to bear mild side effects of treatment.

Keywords: Benefit; Cost; Maintenance therapy; PARP inhibitors; Patient preferences; Risk.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Decision Making
  • Female
  • Humans
  • Maintenance Chemotherapy
  • Middle Aged
  • Neoplasm Recurrence, Local / drug therapy
  • Neoplasm Recurrence, Local / economics
  • Neoplasm Recurrence, Local / psychology
  • Ovarian Neoplasms / drug therapy*
  • Ovarian Neoplasms / economics
  • Ovarian Neoplasms / psychology
  • Patient Preference / psychology*
  • Poly(ADP-ribose) Polymerase Inhibitors / administration & dosage*
  • Poly(ADP-ribose) Polymerase Inhibitors / adverse effects
  • Poly(ADP-ribose) Polymerase Inhibitors / economics
  • Progression-Free Survival
  • Survival Rate
  • United States


  • Poly(ADP-ribose) Polymerase Inhibitors