Factors influencing the decision to discontinue treatment due to chemotherapy-induced peripheral neuropathy among patients with metastatic breast cancer: a best-worst scaling

Rotana M Radwan; John F P Bridges; Daniel L Hertz; Maryam B Lustberg; Hetal Vachhani; Erin Hickey Zacholski; Vanessa B Sheppard; Teresa M Salgado

doi:10.1007/s00520-025-09508-4

Factors influencing the decision to discontinue treatment due to chemotherapy-induced peripheral neuropathy among patients with metastatic breast cancer: a best-worst scaling

Support Care Cancer. 2025 May 10;33(6):467. doi: 10.1007/s00520-025-09508-4.

Authors

Rotana M Radwan¹, John F P Bridges², Daniel L Hertz³, Maryam B Lustberg⁴, Hetal Vachhani⁵, Erin Hickey Zacholski¹, Vanessa B Sheppard^{6

7}, Teresa M Salgado^{8

9}

Affiliations

¹ Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, 410 N 12 Street, PO Box 98053, Richmond, VA, 23298, USA.
² Department of Biomedical Informatics, College of Medicine, The Ohio State University Wexner Medical Center, 250 Lincoln Tower, 1800 Cannon Drive, Columbus, OH, 43210, USA.
³ Department of Clinical Pharmacy, College of Pharmacy, University of Michigan, 428 Church St, Ann Arbor, MI, 48109, USA.
⁴ Department of Medical Oncology, School of Medicine, Yale University, 20 York St, New Haven, CT, 06510, USA.
⁵ Department of Internal Medicine, School of Medicine, Virginia Commonwealth University, VCU Medical Center, 1201 E Marshall St #4-100, Richmond, VA, 23298, USA.
⁶ Department of Social and Behavioral Sciences, School of Public Health, Virginia Commonwealth University, 830 E Main Street, Richmond, VA, 23219, USA.
⁷ Massey Comprehensive Cancer Center, Virginia Commonwealth University, 401 College St, Richmond, VA, 23298, USA.
⁸ Department of Pharmacotherapy & Outcomes Science, School of Pharmacy, Virginia Commonwealth University, 410 N 12 Street, PO Box 98053, Richmond, VA, 23298, USA. tmsalgado@vcu.edu.
⁹ Massey Comprehensive Cancer Center, Virginia Commonwealth University, 401 College St, Richmond, VA, 23298, USA. tmsalgado@vcu.edu.

Abstract

Purpose: To measure the importance of factors that influence the decision to discontinue treatment due to chemotherapy-induced peripheral neuropathy (CIPN) among patients with metastatic breast cancer (mBC).

Methods: An online survey incorporating a best-worst scaling (BWS) was conducted among women in the USA with mBC and experiencing CIPN. In the BWS, women chose the most and least important factors influencing their decision to discontinue treatment due to CIPN. Seven factors were included: relieving current neuropathy symptoms, reducing risk of long-term neuropathy, having another cancer treatment option, understanding the risk of treatment discontinuation, and receiving support for treatment discontinuation from the oncologist, loved ones, or patients with similar experiences. To measure the importance of each factor, a conditional logit model estimated coefficients, which were subsequently rescaled to importance scores that summed to 100. The dependent variable was the choice of a factor as most or least important across seven choice tasks.

Results: The sample included 189 women with a mean age of 52.5 (SD = 12.65) years, 52.9% were White, 33.9% were Black, and 64.6% held a bachelor's degree or higher. When faced with the decision to discontinue treatment due to CIPN, the most important factors were having another cancer treatment option (score 23.5), followed by understanding the risk of treatment discontinuation (score 19.2), and reducing risk of long-term neuropathy (score 19.1). The least important factors in the decision to discontinue treatment due to CIPN were: support from loved ones (score 5.2) and support from other patients (score 3.3).

Conclusion: When faced with the decision to discontinue treatment due to CIPN, women with mBC attributed more importance to survival and reducing the risk of long-term CIPN. Knowledge of what matters most to patients may assist with shared decision-making to optimize therapeutic outcomes in patients receiving neurotoxic chemotherapy.

Keywords: Best–worst scaling; Chemotherapy-induced peripheral neuropathy; Metastatic breast cancer; Patient preferences.

MeSH terms

Adult
Aged
Antineoplastic Agents* / administration & dosage
Antineoplastic Agents* / adverse effects
Breast Neoplasms* / drug therapy
Breast Neoplasms* / pathology
Decision Making*
Female
Humans
Middle Aged
Neoplasm Metastasis
Peripheral Nervous System Diseases* / chemically induced
Peripheral Nervous System Diseases* / psychology
Surveys and Questionnaires
United States
Withholding Treatment*

Substances

Antineoplastic Agents

Abstract

MeSH terms

Substances

Grants and funding