Treatment-related regret common in localized prostate cancer patients
medwireNews: Around 10% of men with localized prostate cancer experience treatment-related regret but this rate varies by treatment modality and is mediated by posttreatment functional outcomes and patient expectations, study findings indicate.
Christopher Wallis (Mount Sinai Hospital, Toronto, Ontario, Canada) and colleagues therefore believe that “treatment-related regret may be more modifiable than other contributors, such as functional outcomes, to the survivorship experience of patients with prostate cancer, given its link to pretreatment expectations.”
They suggest that “improved counseling at the time of diagnosis and before treatment, including identification of patient values and priorities, may decrease regret among these patients.”
Wallis and team found that 13% of 2072 men with clinically localized prostate cancer in the Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) cohort reported treatment-related regret at 5 years after diagnosis.
Regret was more common in men who said that treatment-effectiveness was much worse than expected than in those who said it was better, the same, or a little worse than expected (71 vs 13%), and was also more common in men who felt that treatment-related adverse effects were much worse than expected, relative to those who did not (48 vs 10%).
People who underwent surgery had the highest levels of regret, at a rate of 16% in the 1136 participants who received this treatment. By comparison, the rates were 11% in the 667 men who underwent radiotherapy and 7% in the 269 who received active surveillance.
After adjusting for baseline demographic and tumor characteristics, individuals who underwent surgery were a significant 2.40 times more likely to experience regret than those who underwent active surveillance, report Wallace and co-authors in JAMA Oncology. In addition, the likelihood of regret was a significant 1.57 times higher with surgery relative to radiotherapy.
However, further adjustment for longitudinal change in patient-reported functional outcomes, treatment-related health problems, and patients’ perceptions of treatment efficacy and adverse effects relative to their expectations attenuated the link between treatment type and regret.
By comparison, the investigators observed that perceiving treatment efficacy and adverse effects as a lot worse than expected was associated with 5.40-fold and 5.83-fold increased probabilities of regret, respectively, relative to better perceived outcomes.
Furthermore, having a smaller change in sexual function relative to baseline (lowest vs highest quartile of the EPIC-26 survey) was associated with a significantly lower likelihood of regret (adjusted odds ratio [aOR]=0.65), as was the use of patient decision-making tools (aOR=0.77).
In a linked commentary, Randy Jones, from the University of Virginia School of Nursing in Charlottesville, USA, says the findings show that “[i]t is imperative for clinicians to be aware of patients’ comfort in the patient-clinician interaction, assess patients’ treatment outcome expectations, provide realistic treatment expectations, use interactive decision aids to enhance communication, and provide guidance through difficult treatment decisions to decrease decisional regret and increase quality of life.”
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