More than 1 in 10 patients with localized prostate cancer experienced treatment-related regret, a study published in JAMA Oncology suggests. And the major driver of that regret seems to be a disconnect between patient expectations and outcomes.1
In an interview with The ASCO Post, the study’s lead author, Christopher J.D. Wallis, MD, PhD, listed several ways clinicians can help set realistic expectations among patients diagnosed with localized prostate cancer. Dr. Wallis is a urologic oncologist at Mount Sinai Hospital in Toronto and Assistant Professor, Division of Urology, University of Toronto.
On a global level, physicians need to stay up to date on studies that “give us good population-level estimates of the risks of side effects” from prostate cancer treatments, Dr. Wallis said. Then, as part of the counseling and shared decision-making process, they should use that data to set realistic expectations for patients. “We can also use big studies that cite the risk of disease recurrence or the efficacy of our treatments,” he continued. “I like to use nomograms that give you an estimate of the chance of biochemical recurrence after treatment.”
On an individual physician level, “it is also important to understand what the outcomes are for the patients we treat. There is certainly a variation between urologists in terms of continence and erectile function rates. We need to have both that global picture but also understand our own local outcomes and be able to cite them to our patients,” Dr. Wallis noted. A multidisciplinary consultation, involving a urologist and a radiation oncologist, is also needed “to understand all appropriate treatment options before deciding,” Dr. Wallis stated.
“It is our obligation as physicians to make sure we do everything we can in the counseling process before a patient decides on treatment and embarks on it, that we have given them the information necessary, so their expectations are in line with what can truly be expected to come from treatment.”
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“There is also value in peer support groups, or peer-to-peer counseling, to gain an understanding from other patients about what they experienced, though we need to recognize that those individual experiences may not directly apply to any given patient moving forward. That said, there is certainly value in gaining that perspective, that lived experience, of another patient with prostate cancer,” Dr. Wallis said.
“I always point my patients to resources such as the Prostate Cancer Foundation, or in Canada, Prostate Cancer Canada,” Dr. Wallis said. “I try to curate a trusted list of sources patients can find online to get additional information to help guide their decision-making process. There is great value in having informed patients who have read up on and gained information on their own, although some treatment options may be better or worse for an individual patient in ways that are difficult to capture through online resources. The general frame setting from an online resource is valuable, and then the nuances of applying that to any given patient are best done in the context of a clinical consultation,” Dr. Wallis said.
“My perspective is that no one prostate cancer treatment option is certainly ideal for all patients, so we need to help give patients a realistic perspective on what life would look like after each of our treatment options. Then, they can use their own priorities and view of the world to decide which of those profiles is most consistent with their goals.”
DISCLOSURE: Dr. Wallis has received personal fees from Janssen Canada outside this study.
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