In a prospective cohort study (CEASAR) reported in JAMA Oncology, Wallis et al found that patient expectations of treatment efficacy and adverse effects were associated with treatment-related regret at 5 years after diagnosis in men with localized prostate cancer.
As stated by the investigators, “Treatment-related regret is an integrative, patient-centered measure that accounts for morbidity, oncologic outcomes, and anxiety associated with prostate cancer diagnosis and treatment…. [We assessed] the association between treatment approach, functional outcomes, and patient expectations and treatment-related regret among patients with localized prostate cancer.”
The study involved data on 2,072 men from five Surveillance, Epidemiology, and End Results (SEER)-based registries diagnosed with clinically localized prostate cancer between January 2011 and December 2012. Patient-reported treatment-related regret was analyzed according to demographic and clinicopathologic characteristics, treatment approach, and patient-reported functional outcomes.
The findings of this cohort study suggest that more than 1 in 10 patients with localized prostate cancer experience treatment-related regret. The rates of regret appear to differ between treatment approaches in a manner that is mediated by functional outcomes and patient expectations.— Wallis et al
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Among the 2,072 men (median age = 64 years, interquartile range = 59–69), 1,136 (55%) underwent surgery, 667 (32%) received radiotherapy, and 269 (13%) underwent active surveillance.
Treatment-related regret was reported by 279 patients (13%, 95% confidence interval [CI] =12%–15%) at 5 years, including 183 (16%) who underwent surgery, 76 (11%) who received radiotherapy, and 20 (7%) who underwent active surveillance. Regret was more common among patients who rated treatment effectiveness (n = 31 [71%] vs 1,797 [13%]) and treatment adverse effects (190 [48%] vs 1,621 [10%]) as much worse than expected vs not much worse than expected. Compared with active surveillance, analysis adjusting for baseline differences showed that active treatment was associated with significantly increased likelihood of regret for those undergoing surgery (adjusted odds ratio [OR] = 2.40, 95% CI = 1.44–4.01) but not for those receiving radiotherapy (adjusted OR = 1.53, 95% CI = 0.88–2.66).
In analysis accounting for patient-reported functional outcomes, treatment modality was not independently associated with regret. Sexual dysfunction—but not other functional outcomes—was significantly associated with regret (adjusted OR for change in sexual function from baseline = 0.65, 95% CI = 0.52–0.81).
In analysis accounting for functional outcomes, treatment modality, and baseline demographic and clinical characteristics, effect estimates for association of patient perception of both treatment effectiveness (adjusted OR = 5.40, 95% CI = 2.51–13.56) and treatment adverse effects (adjusted OR = 5.83, 95% CI = 3.97–8.58) compared with expectations were larger than for any other variable assessed.
In multivariate analysis of baseline variables, higher participatory decision-making tool (PDM-7) scores (adjusted OR = 0.80, 95% CI = 0.69–0.92), greater social support (adjusted OR = 0.78, 95% CI = 0.67–0.90), and younger age at diagnosis (adjusted OR = 0.78, 95% CI = 0.62–0.97) were inversely correlated with the likelihood of regret.
The investigators concluded, “The findings of this cohort study suggest that more than 1 in 10 patients with localized prostate cancer experience treatment-related regret. The rates of regret appear to differ between treatment approaches in a manner that is mediated by functional outcomes and patient expectations. Treatment preparedness that focuses on expectations and treatment toxicity and is delivered in the context of shared decision-making should be the subject of future research to examine whether it can reduce regret.”
Christopher J.D. Wallis, MD, PhD, of the Division of Urology, Mount Sinai Hospital, Toronto, is the corresponding author for the JAMA Oncology article.
Disclosure: This study was supported by grants from the Agency for Healthcare Research and Quality, Patient-Centered Outcomes Research Institute, and National Cancer Institute. For full disclosures of the study authors, visit jamanetwork.com.