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BCC patients preferred topical treatment vs. surgery

Patients with low-risk basal cell carcinoma preferred treatment with topical imiquimod 5% rather than surgery, according to questionnaire results in a recent study.

Researchers in England studied 174 participants (median age, 65 years; 60.9% men) in a randomized control trial evaluating long-term success of excisional surgery vs. imiquimod for low-risk nodular and superficial basal cell carcinoma (BCC). Fifty-six patients had previous experience with BCC symptoms and treatment, while 118 patients did not. A self-completed discrete choice experiment (DCE) questionnaire measured patients’ preference strength in choosing surgery, imiquimod cream or current situation for their skin cancer treatment, and included various scenarios. A mixed logit model was used for analysis, taking into account sample preference variability and impact of previous BCC treatment.

Patients chose imiquimod cream compared with surgery or current situation, regardless of previous BCC symptoms and treatment. Cosmetic outcomes and side effects were the top concerns, compared with cost and chance of clearance. Patients who had not experienced surgery placed more willingness-to-pay value on the imiquimod option (1,013 pounds) than surgery (445 pounds) compared with patients who had experienced BCC symptoms and treatment (781 pounds vs. 488 pounds). Treatment characteristics significantly affected treatment choice. Participants showed significant variability in preferences.

Researchers said the study was limited by participants who were unlikely to have experienced topical imiquimod and could not be asked how previous treatment influenced their preferences.

“Understanding how people with BCC value alternative interventions using the DCE technique may better inform the development of health care interventions, although this particular application proved data collection to be challenging and time consuming,” the researchers concluded. “Elderly participants are likely to need help and support.”