Study examines determinants of treatment-related regret in men with prostate cancer

A study published in JAMA Oncology showed that treatment regret in men with localized prostate cancer varies by treatment approach based on patient expectations and outcomes for those approaches.1

Overall, the study found that one in 10 patients had treatment-related regrets. Five years after diagnosis, treatment-related regret was most common among patients who underwent surgery (16%), followed by radiation therapy (11%) and active surveillance (7%).

Patients receiving active treatment versus active surveillance had increased regret among those who had surgery (adjusted OR, 2.40; 95% CI, 1.44-4.01) and not radiotherapy (adjusted OR, 1.53; 95% CI, 0.88-2.66). In particular, change in sexual function from baseline was significantly associated with regret, although similar associations were not identified with respect to other patient-reported functional outcomes (HR, 0.65; CI at 95%, 0.52-0.81).

A total of 3277 patients from the population-based comparative analysis of the effectiveness of surgery and radiotherapy (CEASAR) prospective cohort were included, of whom 2072 were included in the analysis. Within this cohort, 1136 men were operated on, 667 had radiotherapy and 269 had active surveillance. At diagnosis, the median age was 64 years.

At 5 years, 13% (95% CI, 12%-15%) of patients declared that they regretted the treatment. This was commonly observed in 71% of patients (95% CI, 55% to 87%) who subjectively judged the effectiveness of treatment and 48% of patients (95% CI, 41% to 55%) who believed that adverse effects of treatment were worse than expected. .

Compared to active surveillance, patients with low-risk disease who underwent surgery were more likely to regret their decision (adjusted OR, 2.73; 95% CI, 1.45-5.14 ), although the same was not true for those who received radiotherapy (adjusted OR , 1.82; 95% CI, 0.90-3.68). The same was found for the intermediate risk population for surgery (adjusted OR, 2.26; 95% CI, 0.85-6.05) and radiotherapy (adjusted OR, 1.56; 95% CI %, 0.56-4.32). Finally, people with high-risk disease had a non-significantly lower likelihood of regret during surgery (adjusted OR, 0.51; 95% CI, 0.09-2.99) or radiotherapy (adjusted OR, 0.19; 95% CI, 0.03-1.27). However, statistical significance was confirmed only in the low-risk group that underwent surgery (P = .002).

As treatment-related regret was likely modified by functional outcomes, the analysis was repeated including longitudinal change in patient-reported functional outcomes, treatment-related health issues, and patient perceptions of efficacy. of the treatment. Patients at low risk of disease on active treatment continued to have the highest likelihood of regret among those undergoing surgery (adjusted OR, 2.08; 95% CI, 1.05-4.13), but not radiation therapy (adjusted OR, 1.69; 95% CI, 0.79-3.62). Similar results were reported in the intermediate risk group for surgery (adjusted OR, 1.51; 95% CI, 0.51-4.43) and radiotherapy (adjusted OR, 1.42; 95% CI %, 0.47-4.35). Additionally, patients with high-risk disease who underwent radiation therapy (adjusted OR, 0.12; 95% CI, 0.02-0.92) and surgery (adjusted OR, 0.27; 95% CI, 0.04-1.81) had a lower likelihood of regret.

Compared to other variables examined such as expectations, patient’s view of treatment effectiveness (adjusted OR, 5.40; 95% CI, 2.51-13.56), and adverse effects of treatment (adjusted OR, 5.83; 95% CI, 3.97-8.58) were particularly associated with regret.

For characteristics that were assessed at baseline, including Participatory Decision-Making Tool (PDM-7) scores (adjusted OR, 0.80; 95% CI, 0.69-0, 92), social support (adjusted OR, 0.78; 95% CI, 0.67-0.90) and age (adjusted OR, 0.78; 95% CI, 0.62-0, 97) were independently inversely correlated with regret.

The investigators found that social support and age at diagnosis were no longer significantly associated with the development of regret, although higher education status was protective (adjusted OR, 0.69; 95% CI %, 0.51-0.93).

Reference

1. Wallis CJD, Zhao Z, Huang LC, et al. Association of treatment modality, functional outcomes, and baseline characteristics with treatment regret in men with localized prostate cancer. JAMA Oncol. 2022;8(1):50-59. doi:10.1001/jamaoncol.2021.5160

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