Does real option value influence oncologists' treatment recommendations? A survey of U.S. oncologists.

Objectives: Survival benefit from anticancer treatments, even if modest, improves a patient's chances of accessing future innovations, thereby creating real option value (ROV). There is no empirical evidence on the impact of potential future innovations on oncologists' treatment recommendations.

Methods: We conducted a national online survey of practicing medical and hematological oncologists. We presented a hypothetical metastatic cancer patient with median survival of 6 months under four decision-making scenarios with varying expected efficacy and time to arrival of future innovations. We assessed the likelihood of discussing future innovations with their patients and the likelihood that future innovations would influence their current treatment recommendation, as well as factors associated with these 2 outcomes using multivariate logistic regressions.

Results: 201 oncologists completed the survey. When future innovations were expected to improve survival by 6 months and be available in 6 months, 76% of oncologists were likely or very likely to discuss the innovations with their patients, and 68% reported they would influence their current treatment recommendations. A one-month increase in the expected survival improvement of future innovation was associated with a 1.17 (95% CI: 1.1-1.25) greater odds of reporting likely or very likely to discuss future innovations with their patients, while a one-month increase in the expected time to arrival was associated with a 0.91 (95% CI: 0.88-0.94) lower odds.

Conclusions: As potential future innovations appear to influence oncologists' treatments recommendations, evidence to inform clinical guidelines and value assessments should consider data on ROV impacts to support informed treatment decision-making.