Intro
At the 2025 American Society of Clinical Oncology (ASCO) annual meeting, researchers shared innovative work on using discrete choice data to tailor pharmacy counseling for patients with anaplastic lymphoma kinase–positive non–small cell lung cancer (ALK+ NSCLC). By capturing what matters most to patients—be it side-effect profiles, dosing schedules, or out-of-pocket costs—pharmacists can craft personalized conversations that boost treatment adherence, patient satisfaction, and quality of life.
Background
ALK+ NSCLC represents about 5% of all non–small cell lung cancers. Thanks to targeted therapies like alectinib, brigatinib, ceritinib, and lorlatinib, patients now enjoy longer survival and better symptom control than ever before. Yet these benefits hinge on consistent medication use. Real-world studies show that side effects, complex dosing, and financial burdens often lead patients to skip doses or stop treatment altogether. Pharmacists, as accessible members of the oncology care team, are in a prime position to address these barriers. But what is the best way to focus each counseling session so it resonates with an individual patient’s priorities?
What Are Discrete Choice Experiments?
Discrete choice experiments (DCEs) are survey-based methods used to quantify preferences. In a DCE, participants choose between hypothetical treatment profiles that vary across several attributes. By analyzing their choices, researchers infer the relative importance of each attribute. DCEs have been used in health care to guide drug development, regulatory decisions, and policy. The ASCO 2025 study represents one of the first efforts to apply DCEs specifically to inform pharmacy counseling in ALK+ NSCLC.
Study Design
The research team enrolled 150 patients with documented ALK+ NSCLC who were either on or had recently completed ALK inhibitor therapy. Participants received an online survey presenting a series of paired treatment profiles. Each profile varied across six key attributes:
1. Efficacy (progression-free survival gain)
2. Side-effect severity (mild, moderate, severe)
3. Dosing frequency (once daily, twice daily, every other day)
4. Pill burden (1 tablet, 3 tablets, 5 tablets per dose)
5. Monitoring requirements (monthly lab tests vs quarterly)
6. Out-of-pocket cost per month ($50, $200, $500)
Patients chose their preferred option in each pair. The researchers then used multinomial logistic regression to calculate the relative weight of each attribute.
Key Findings
• Efficacy topped the list. A 6-month gain in progression-free survival was 2.5 times more important than reducing moderate side effects to mild.
• Side effects mattered a great deal. Patients were willing to trade up to 3 months of progression-free survival to move from severe to moderate side effects.
• Dosing frequency and pill burden were linked. Patients strongly preferred once-daily, single-tablet regimens over more complex schedules.
• Monthly lab tests were tolerable, but quarterly monitoring was twice as appealing.
• Cost loomed large. At a $500 monthly price, patients were 40% less likely to choose a profile—even if it offered the best efficacy.
Translating Data into Practice
Armed with these insights, pharmacists can personalize their counseling by prioritizing topics that align with each patient’s preferences. Here’s how:
1. Pre-visit Assessment
• Have patients complete a brief preference questionnaire mirroring the DCE attributes.
• Identify which factors rank highest for them—efficacy, side effects, convenience, or cost.
2. Personalized Counseling Script
• Efficacy Focus: “I know staying on treatment longer is your top priority. Let’s talk about how this drug works and how to manage any side effects so you can keep going.”
• Side-Effect Focus: “Your comfort matters most. We’ll review ways to prevent and treat nausea, fatigue, or skin changes so you can feel your best.”
• Convenience Focus: “Taking one pill in the morning is easier than juggling multiple doses. Here are some tips to build that habit into your daily routine.”
• Cost Focus: “Let’s explore assistance programs and insurance strategies to keep your out-of-pocket costs manageable.”
3. Follow-Up Strategies
• Schedule regular check-ins focused on the patient’s top concerns.
• Use adherence aids—pill organizers, reminders, or mobile apps—that match their lifestyle.
• Connect patients with financial navigators or co-pay assistance if cost is a barrier.
Benefits of a Personalized Approach
• Better Adherence: Addressing the most pressing concerns from the start can prevent missed doses.
• Improved Satisfaction: Patients feel heard when counseling zeroes in on what they value.
• Enhanced Outcomes: Consistent treatment use maximizes the clinical benefits of ALK inhibitors.
Next Steps and Future Directions
The ASCO 2025 study paves the way for larger trials and real-world implementation projects. Researchers are exploring digital tools that integrate DCE-based questionnaires directly into pharmacy management systems. There is also interest in expanding this model to other molecular subtypes of NSCLC and even different tumor types. Ultimately, the goal is to create a patient-centered pharmacy service that adapts to individual needs across the cancer care continuum.
Three Key Takeaways
1. Patient preferences in ALK+ NSCLC heavily favor efficacy and manageable side effects, but convenience and cost remain critical.
2. Discrete choice experiments offer a structured way to quantify these preferences and guide one-on-one pharmacy counseling.
3. Personalizing discussions around what each patient values most can drive adherence, satisfaction, and better health outcomes.
Three-Question FAQ
Q1: What exactly is discrete choice data?
A1: Discrete choice data come from surveys where patients pick between hypothetical treatment options with different features. The choices reveal how much they value each feature relative to others.
Q2: How can I, as a pharmacist, start using these insights?
A2: Begin with a brief preferences survey for your patients. Use their top attributes to shape your counseling priorities—whether that’s focusing on side-effect management, dosing tips, or financial resources.
Q3: What challenges might arise when implementing this in practice?
A3: Time constraints and workflow integration can be hurdles. Overcome them by using digital tools for quick preference capture and by training support staff to administer questionnaires.
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