Men with localized prostate cancer who choose to have radical prostatectomy are more likely to regret their decision than those who choose radiation therapy or active surveillance, according to a survey of 2,072 patients.
After 5 years, 13% of the men surveyed experienced treatment-related regrets, which varied depending on the type of treatment – 16% (183) of the surgery patients regretted their decision compared to 11% (76) of the men who had opted for radiation therapy and 7% ( 20) who have chosen active surveillance.
The main reason for regret was the feeling of not being fully aware of the risks and benefits of the three options, and the risks of surgery in particular.
“A discrepancy between patient expectations and treatment outcomes, both for efficacy and toxicity of treatment, is a major contributor to treatment-related regret than patient-reported functional outcomes,” which include erectile dysfunction, urinary incontinence, and bowel dysfunction according to the authors, led by Christopher Wallis, MD, PhD, a urological oncologist at Mount Sinai Hospital in Toronto, Canada.
The study appeared online November 18 in JAMA Oncology.
In an accompanying editorial, Randy Jones, PhD, RN, professor of nursing at the University of Virginia, Charlottesville said the study makes a strong case for the role of in-depth counseling and shared decision-making.
Given the “potential to improve quality of life and diminish decisions, it is well worth the time for clinicians to assess and address patient treatment concerns,” he wrote.
Although not often used in routine practice, Jones found that interactive decision-making aids can be helpful. These tools “provide the space for patients, caregivers, and clinicians to discuss the patient’s key concerns, assess and address any challenges that patients and caregivers may face with treatment options, and provide clear information about treatment options To help patients make the best decision for them, “wrote Jones.
Study details
The men surveyed in the analysis were diagnosed with low-risk prostate cancer at multiple centers in the United States between January 2011 and December 2012.
Study participants were members of the Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) cohort, launched a decade ago to compare the effectiveness of surgery and radiation.
The median age at diagnosis was 64 years. Radiation therapy patients (32%) were older and had more comorbidities and a slightly higher risk of disease than surgery patients (55%). Men who chose active surveillance (13%) were typically older than those who had surgery, but younger than the radiation therapy group, and were more likely to have low-risk disease.
The authors measured the patient’s regret using a validated questionnaire with statements such as “I would [have been] Better off with another treatment “,” I feel the treatment was the wrong one “,” I would choose another treatment if I could “and” I wish I could change my mind about the treatment I have chosen . “
The men were interviewed 6 months after the diagnosis and then again after 1, 3 and 5 years. After 5 years the response rate was 71%.
Taking into account the initial differences, men who had undergone surgery regret their decision more than twice as often after 5 years as men who had chosen active monitoring. Men who chose radiation therapy were about 50% more likely to feel remorse, although this finding was not statistically significant.
Unsurprisingly, men who rated their treatment much less effective than expected and their side effects much more severe were much more likely to experience regrets.
Interestingly, participatory decision-making and social support seemed to protect against regret as well as older age.
The authors noted that many low-risk men in the study who had surgery or radiation would likely be advised to be monitored today, given the recommendations of the National Comprehensive Cancer Network.
Nevertheless, the results can now be used in practice. “Improved counseling at the time of diagnosis and prior to treatment, including identifying patient values and priorities, can reduce the regrets of these patients,” the authors concluded.
The study was funded by the Agency for Health Research and Quality. Several investigators reported ties to the industry, including Wallis, who disclosed having received personal fees from Janssen Canada. Jones has not reported any disclosures.
JAMA Oncol. Published online November 18, 2021. Abstract, Editorial
M. Alexander Otto is a doctor’s assistant with a master’s degree in medical science and an award-winning medical journalist who worked for several major news agencies before joining Medscape. He is a fellow at MIT Knight Science Journalism. Email: aotto@mdedge.com.
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