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Achard V, Zilli T, Lamanna G, Jorcano S, Bral S, Rubio C, Oliveira A, Bottero M, Bruynzeel AME, Ibrahimov R, Minn H, Symon Z, Constantin G, Miralbell R. Urethra-Sparing Prostate Cancer Stereotactic Body Radiation Therapy: Sexual Function and Radiation Dose to the Penile Bulb, the Crura, and the Internal Pudendal Arteries From a Randomized Phase 2 Trial. Int J Radiat Oncol Biol Phys 2024; 119:1137-1146. [PMID: 38160915 DOI: 10.1016/j.ijrobp.2023.12.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/17/2023] [Accepted: 12/23/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE Erectile dysfunction (ED) is a common side effect after prostate cancer stereotactic body radiation therapy (SBRT). We aimed to assess the correlation between the dose to the penile bulb (PB), internal pudendal arteries (IPA), and crura with the development of ED after ultrahypofractionation as part of a phase 2 clinical trial of urethra-sparing prostate SBRT. METHODS AND MATERIALS Among the 170 patients with localized prostate cancer from 9 centers included in the trial, 90 men with Common Terminology Criteria for Adverse Events version 4.03 grade 0 to 1 ED (ED-) at baseline treated with 36.25 Gy in 5 fractions were selected for the present analysis. Doses delivered to the PB, crura, and IPA were analyzed and correlated with grade 2 to 3 ED (ED+) development. The effect on quality of life, assessed by the European Organisation for Research and Treatment of Cancer (EORTC QLQ-PR25) questionnaire, was reported. RESULTS After a median follow-up of 6.5 years, 43% (n = 39) of the patients developed ED+, and 57% (n = 51) remained ED-. The dose delivered to the crura was significantly higher in ED+ patients than in ED- patients (7.7 vs 3.6 Gy [P = .014] for the Dmean and 18.5 vs 7.2 Gy [P = .015] for the D2%, respectively). No statistically significant difference between ED+ and ED- patients was observed for the dose delivered to the PB and IPA. The median ED+-free survival was worse in patients receiving a crura Dmean ≥ 4.7 versus < 4.7 Gy (51.5% vs 71.7%, P = .005) and a crura D2% > 12 versus ≤ 12 Gy (54.9% vs 68.9%, P = .015). No ED+-free survival differences were observed for doses delivered to the PB and IPA. Decline in EORTC QLQ-PR25 sexual functioning was significantly more pronounced in patients with higher doses to the crura. CONCLUSIONS By keeping a Dmean and D2% to crura below 4.7 and 12 Gy, respectively, the risk of developing ED+ after prostate SBRT may be significantly reduced.
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Affiliation(s)
- Vérane Achard
- Radiation Oncology, Geneva University Hospital, Geneva, Switzerland; Radiation Oncology, HFR Fribourg, Villars-sur-Glâne, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Thomas Zilli
- Radiation Oncology, Geneva University Hospital, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland; Radiation Oncology, Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland; Faculty of Medicine, Università della Svizzera Italiana, Lugano, Switzerland.
| | - Giorgio Lamanna
- Radiation Oncology, Geneva University Hospital, Geneva, Switzerland; Radiation Oncology, HFR Fribourg, Villars-sur-Glâne, Switzerland
| | - Sandra Jorcano
- Radiation Oncology, Teknon Oncologic Institute, Barcelona, Spain
| | - Samuel Bral
- Radiation Oncology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium
| | - Carmen Rubio
- Radiation Oncology, Hospital Universitario Sanchinarro, Madrid, Spain
| | - Angelo Oliveira
- Radiation Oncology, Portuguese Institut of Oncology, Porto, Portugal
| | - Marta Bottero
- Radiation Oncology, Geneva University Hospital, Geneva, Switzerland; Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Anna M E Bruynzeel
- Radiation Oncology, Amsterdam UMC, Location Vrije Universteit, Amsterdam, The Netherlands
| | - Roman Ibrahimov
- Radiation Oncology, Neolife Medical Center, Istanbul, Turkey
| | - Heikki Minn
- Radiation Oncology, University Hospital Turku, Turku, Finland
| | - Zvi Symon
- Radiation Oncology, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Raymond Miralbell
- Radiation Oncology, Geneva University Hospital, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland; Radiation Oncology, Teknon Oncologic Institute, Barcelona, Spain
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Corsini C, Bergengren O, Carlsson S, Garmo H, Hjelm-Eriksson M, Fransson P, Kindblom J, Robinson D, Westerberg M, Stattin P, Carlsson SV. Patient-reported Side Effects 1 Year After Radical Prostatectomy or Radiotherapy for Prostate Cancer: A Register-based Nationwide Study. Eur Urol Oncol 2024; 7:605-613. [PMID: 38233329 PMCID: PMC11102330 DOI: 10.1016/j.euo.2023.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Revised: 12/13/2023] [Accepted: 12/22/2023] [Indexed: 01/19/2024]
Abstract
BACKGROUND Data on functional and psychological side effects following curative treatment for prostate cancer are lacking from large, contemporary, unselected, population-based cohorts. OBJECTIVE To assess urinary symptoms, bowel disturbances, erectile dysfunction (ED), and quality of life (QoL) 12 mo after robot-assisted radical prostatectomy (RARP) and radiotherapy (RT) using patient-reported outcome measures in the Swedish prostate cancer database. DESIGN, SETTING, AND PARTICIPANTS This was a nationwide, population-based, cohort study in Sweden of men who underwent primary RARP or RT between January 1, 2018 and December 31, 2020. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Absolute proportions and odds ratios (ORs) were calculated using multivariable logistic regression, with adjustment for clinical characteristics. RESULTS AND LIMITATIONS A total of 2557 men underwent RARP and 1741 received RT. Men who underwent RT were older (69 vs 65 yr) and had more comorbidities at baseline. After RARP, 13% of men experienced incontinence, compared to 6% after RT. The frequency of urinary bother was similar, at 18% after RARP and 18% after RT. Urgency to defecate was reported by 14% of men after RARP and 34% after RT. At 1 yr, 73% of men had ED after RARP, and 77% after RT. High QoL was reported by 85% of men after RARP and 78% of men after RT. On multivariable regression analysis, RT was associated with lower risks of urinary incontinence (OR 0.25, 95% confidence interval [CI] 0.19-0.33), urinary bother (OR 0.79, 95% CI 0.66-0.95), and ED (OR 0.54, 95% CI 0.46-0.65), but higher risk of bowel symptoms (OR 2.86, 95% CI 2.42-3.39). QoL was higher after RARP than after RT (OR 1.34, 95% CI 1.12-1.61). CONCLUSIONS Short-term specific side effects after curative treatment for prostate cancer significantly differed between RARP and RT in this large and unselected cohort. Nevertheless, the risk of urinary bother was lower after RT, while higher QoL was common after RARP. PATIENT SUMMARY In our study of patients treated for prostate cancer, urinary bother and overall quality of life are comparable at 1 year after surgical removal of the prostate in comparison to radiotherapy, despite substantial differences in other side effects.
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Affiliation(s)
- Christian Corsini
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden; Division of Experimental Oncology/Unit of Urology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Oskar Bergengren
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Stefan Carlsson
- Department of Urology, Karolinska University Hospital, Solna, Sweden
| | - Hans Garmo
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | | | - Per Fransson
- Department of Nursing, Umeå University, Umeå, Sweden; Cancercentrum, Norrlands University Hospital, Umeå, Sweden
| | - Jon Kindblom
- Department of Oncology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - David Robinson
- Department of Urology, Ryhov Hospital, Jönköping, Sweden
| | - Marcus Westerberg
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Pär Stattin
- Department of Surgical Sciences, Uppsala University, Uppsala, Sweden
| | - Sigrid V Carlsson
- Departments of Surgery (Urology Service) and Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer Center, New York, NY, USA; Department of Urology, Sahlgrenska Academy at Gothenburg University, Gothenburg, Sweden; Department of Translational Medicine, Division of Urological Cancers, Medical Faculty, Lund University, Lund, Sweden.
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Arch JJ, Bright EE, Finkelstein LB, Fink RM, Mitchell JL, Andorsky DJ, Kutner JS. Anxiety and Depression in Metastatic Cancer: A Critical Review of Negative Impacts on Advance Care Planning and End-of-Life Decision Making With Practical Recommendations. JCO Oncol Pract 2023; 19:1097-1108. [PMID: 37831973 PMCID: PMC10732500 DOI: 10.1200/op.23.00287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 07/14/2023] [Accepted: 08/15/2023] [Indexed: 10/15/2023] Open
Abstract
PURPOSE Providers treating adults with advanced cancer increasingly seek to engage patients and surrogates in advance care planning (ACP) and end-of-life (EOL) decision making; however, anxiety and depression may interfere with engagement. The intersection of these two key phenomena is examined among patients with metastatic cancer and their surrogates: the need to prepare for and engage in ACP and EOL decision making and the high prevalence of anxiety and depression. METHODS Using a critical review framework, we examine the specific ways that anxiety and depression are likely to affect both ACP and EOL decision making. RESULTS The review indicates that depression is associated with reduced compliance with treatment recommendations, and high anxiety may result in avoidance of difficult discussions involved in ACP and EOL decision making. Depression and anxiety are associated with increased decisional regret in the context of cancer treatment decision making, as well as a preference for passive (not active) decision making in an intensive care unit setting. Anxiety about death in patients with advanced cancer is associated with lower rates of completion of an advance directive or discussion of EOL wishes with the oncologist. Patients with advanced cancer and elevated anxiety report higher discordance between wanted versus received life-sustaining treatments, less trust in their physicians, and less comprehension of the information communicated by their physicians. CONCLUSION Anxiety and depression are commonly elevated among adults with advanced cancer and health care surrogates, and can result in less engagement and satisfaction with ACP, cancer treatment, and EOL decisions. We offer practical strategies and sample scripts for oncology care providers to use to reduce the effects of anxiety and depression in these contexts.
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Affiliation(s)
- Joanna J. Arch
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO
- Division of Cancer Prevention and Control, University of Colorado Cancer Center, Aurora, CO
| | - Emma E. Bright
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO
| | - Lauren B. Finkelstein
- Department of Psychology and Neuroscience, University of Colorado Boulder, Boulder, CO
| | - Regina M. Fink
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO
- University of Colorado College of Nursing, Anschutz Medical Campus, Aurora, CO
| | | | | | - Jean S. Kutner
- Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Anschutz Medical Campus, Aurora, CO
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McErlean G, Tapp C, Brice L, Pradhan A, Gilroy N, Kabir M, Greenwood M, Larsen SR, Moore J, Gottlieb D, Hertzberg M, Brown L, Hogg M, Huang G, Ward C, Kerridge I. Decisional Regret in Long-Term Australian Allogeneic Hematopoietic Stem Cell Transplantation Survivors: A Cross-Sectional Survey. Clin Nurs Res 2023; 32:1134-1144. [PMID: 37329124 PMCID: PMC10504814 DOI: 10.1177/10547738231180337] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/18/2023]
Abstract
Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is an intensive but effective treatment for malignant and non-malignant diseases. However, long-term survival often comes at a cost, with survivors experiencing chronic morbidity and are at risk of relapse and secondary malignancy. This study aimed to describe decisional regret in a large cohort of Australian long-term allo-HSCT survivors. A cross-sectional survey was conducted with 441 adults in New South Wales, assessing quality of life (QoL), psychological, social, demographic, and clinical variables. Less than 10% of survivors expressed regret, with chronic graft-versus-host disease being the most important clinical factor. Psycho-socioeconomic factors such as depression, lower QoL scores, lower household income, higher treatment burden, and not resuming sex post-HSCT were also associated with regret. Findings highlight the need for valid informed consent and ongoing follow-up and support for allo-HSCT survivors dealing with life post-transplant. Nurses and healthcare professionals play a critical role in addressing decisional regret in these patients.
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Affiliation(s)
- Gemma McErlean
- University of Wollongong, Sydney, NSW, Australia
- New South Wales Agency for Clinical Innovation, Sydney, Australia
| | - Caley Tapp
- University of Queensland, Herston, Australia
- Queensland Centre for Mental Health Research, Wacol, Australia
| | - Lisa Brice
- Royal North Shore Hospital, Sydney, NSW, Australia
| | | | - Nicole Gilroy
- New South Wales Agency for Clinical Innovation, Sydney, Australia
- Westmead Hospital, Sydney, NSW, Australia
| | - Masura Kabir
- Westmead Breast Cancer Institute, Sydney, NSW, Australia
| | - Matt Greenwood
- Royal North Shore Hospital, Sydney, NSW, Australia
- University of Sydney, NSW, Australia
| | | | - John Moore
- St Vincents Hospital, Sydney, NSW, Australia
| | - David Gottlieb
- Westmead Hospital, Sydney, NSW, Australia
- University of Sydney, NSW, Australia
| | | | - Louisa Brown
- Calvary Mater Hospital, Newcastle, NSW, Australia
| | - Megan Hogg
- Westmead Hospital, Sydney, NSW, Australia
| | | | - Christopher Ward
- Royal North Shore Hospital, Sydney, NSW, Australia
- University of Sydney, NSW, Australia
| | - Ian Kerridge
- Royal North Shore Hospital, Sydney, NSW, Australia
- University of Sydney, NSW, Australia
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5
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Lunger L, Meissner VH, Kopp BCG, Dinkel A, Schiele S, Ankerst DP, Gschwend JE, Herkommer K. Prevalence and determinants of decision regret in long-term prostate cancer survivors following radical prostatectomy. BMC Urol 2023; 23:139. [PMID: 37612591 PMCID: PMC10464370 DOI: 10.1186/s12894-023-01311-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 08/16/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Patients with localized prostate cancer (PC) are faced with a wide spectrum of therapeutic options at initial diagnosis. Following radical prostatectomy (RP), PC patients may experience regret regarding their initial choice of treatment, especially when oncological and functional outcomes are poor. Impacts of psychosocial factors on decision regret, especially after long-term follow-up, are not well understood. This study aimed to investigate the prevalence and determinants of decision regret in long-term PC survivors following RP. METHODS 3408 PC survivors (mean age 78.8 years, SD = 6.5) from the multicenter German Familial PC Database returned questionnaires after an average of 16.5 (SD = 3.8) years following RP. The outcome of decision regret concerning the initial choice of RP was assessed with one item from the Decision Regret Scale. Health-related quality of life (HRQoL), PC-anxiety, PSA-anxiety, as well as anxiety and depressive symptoms were considered for independent association with decision regret via multivariable logistic regression. RESULTS 10.9% (373/3408) of PC survivors reported decision regret. Organ-confined disease at RP (OR 1.39, 95%CI 1.02-1.91), biochemical recurrence (OR 1.34, 1.00-1.80), low HRQoL (OR 1.69,1.28-2.24), depressive symptoms (OR 2.32, 1.52-3.53), and prevalent PSA anxiety (OR 1.88,1.17-3.01) were significantly associated with increased risk of decision regret. Shared decision-making reduced the odds of decision regret by 40% (OR 0.59, 0.41-0.86). CONCLUSIONS PC survivors may experience decision regret even after 16 years following RP. Promoting shared decision-making in light of both established and novel, potentially less invasive treatments at initial diagnosis may help mitigate long-term regret. Awareness regarding patients showing depressive symptoms or PSA anxiety should be encouraged to identify patients at risk of decision regret in need of additional psychological support.
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Affiliation(s)
- Lukas Lunger
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Valentin H Meissner
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Benedikt C G Kopp
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Stefan Schiele
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Donna P Ankerst
- Departments of Mathematics and Life Science Systems, Munich Data Science Institute, Technical University of Munich, Garching, Germany
| | - Jürgen E Gschwend
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany
| | - Kathleen Herkommer
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Ismaninger Strasse 22, 81675, Munich, Germany.
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Martinez-Marroquin E, Chau M, Turner M, Haxhimolla H, Paterson C. Use of artificial intelligence in discerning the need for prostate biopsy and readiness for clinical practice: a systematic review protocol. Syst Rev 2023; 12:126. [PMID: 37461083 DOI: 10.1186/s13643-023-02282-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 06/25/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Variability and inaccuracies in the diagnosis of prostate cancer, and the risk of complications from invasive tests, have been extensively reported in the research literature. To address this, the use of artificial intelligence (AI) has been attracting increased interest in recent years to improve the diagnostic accuracy and objectivity. Although AI literature has reported promising results, further research is needed on the identification of evidence gaps that limit the potential adoption in prostate cancer screening practice. METHODS A systematic electronic search strategy will be used to identify peer-reviewed articles published from inception to the date of searches and indexed in CINAHL, IEEE Xplore, MEDLINE, Scopus, and Web of Science Core Collection databases. Registries including Cochrane Central Register of Controlled Trials, ClinicalTrials.gov and International Clinical Trials Registry Platform (ICTRP) will be searched for unpublished studies, and experts were invited to provide suitable references. The research and reporting will be based on Cochrane recommendations and PRISMA guidelines, respectively. The screening and quality assessment of the articles will be conducted by two of the authors independently, and conflicts will be resolved by a third author. DISCUSSION This systematic review will summarise the use of AI techniques to predict the need for prostate biopsy based on clinical and demographic indicators, including its diagnostic accuracy and readiness for adoption in clinical practice. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42022336540.
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Affiliation(s)
- Elisa Martinez-Marroquin
- Faculty of Science and Technology, University of Canberra, Canberra, Australian Capital Territory, 2617, Australia.
| | - Minh Chau
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, Faculty of Health, University of Canberra, Canberra, ACT, 2617, Australia
| | - Murray Turner
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, Faculty of Health, University of Canberra, Canberra, ACT, 2617, Australia
| | - Hodo Haxhimolla
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, Faculty of Health, University of Canberra, Canberra, ACT, 2617, Australia
| | - Catherine Paterson
- Prehabilitation, Activity, Cancer, Exercise and Survivorship (PACES) Research Group, Faculty of Health, University of Canberra, Canberra, ACT, 2617, Australia
- Robert Gordon University, Aberdeen, AB10 7AQ, Scotland, UK
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7
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Lejeune C, Bourredjem A, Binquet C, Cussenot O, Boudrant G, Papillon F, Bruyère F, Haillot O, Koutlidis N, Bassard S, Fournier G, Valeri A, Moreau JL, Pierfitte B, Moulin M, Berchi C, Cormier L. Eliciting men's preferences for decision-making relative to treatments of localized prostate cancer with a good or moderate prognosis. World J Urol 2023:10.1007/s00345-023-04416-w. [PMID: 37173454 DOI: 10.1007/s00345-023-04416-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 04/23/2023] [Indexed: 05/15/2023] Open
Abstract
PURPOSE In diseases where there is no real consensus regarding treatment modalities, promoting shared decision-making can contribute to improving safety and quality of care. This is the case in low- or intermediate-risk localized prostate cancer (PC) treatment. The aim of this study was to investigate the preferences guiding men's decisions regarding the characteristics of the treatment strategies for PC to help physicians adopt a more patient-centered approach. METHODS This prospective multicenter study used a discrete choice experiment (DCE). The attributes and the modalities were identified from a qualitative study and a literature review. Relative preferences were estimated using a logistic regression model. Interaction terms (demographic, clinical and socio-economic characteristics) were added to the model to assess heterogeneity in preferences. RESULTS 652 men were enrolled in the study and completed a questionnaire with 12 pairs of hypothetical therapeutic alternatives between which they had to choose. Men's choices were significantly negatively influenced by the risk of impotence and urinary incontinence, death, and the length and frequency of care. They preferred treatments with a rescue possibility in case of deterioration or recurrence and the use of innovative technology. Surprisingly, the possibility of undergoing prostate ablation negatively influenced their choice. The results also highlighted differences in trade-offs according to socio-economic level. CONCLUSION This study confirmed the importance of considering patients' preferences in the decision-making process. It appears essential to better understand these preferences to allow physicians to improve communication and promote case-by-case decision-making.
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Affiliation(s)
- Catherine Lejeune
- CHU Dijon Bourgogne, Inserm, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, 7 bd Jeanne d'Arc, BP 87900, 21000, Dijon, France.
| | - Abderrahmane Bourredjem
- CHU Dijon Bourgogne, Inserm, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, 7 bd Jeanne d'Arc, BP 87900, 21000, Dijon, France
| | - Christine Binquet
- CHU Dijon Bourgogne, Inserm, Université de Bourgogne, CIC 1432, Module Épidémiologie Clinique, 7 bd Jeanne d'Arc, BP 87900, 21000, Dijon, France
| | - Olivier Cussenot
- Academic Department of Urology, Tenon Hospital, Assistance Publique-Hôpitaux de Paris, UPMC Sorbonne Universités, Paris, France
| | | | | | - Franck Bruyère
- Department of Urology, CHU-Tours University Hospital, Tours, France
- Université Francois Rabelais de Tours, PRES Centre Val de Loire, Tours, France
| | - Olivier Haillot
- Department of Urology, CHU-Tours University Hospital, Tours, France
- Université Francois Rabelais de Tours, PRES Centre Val de Loire, Tours, France
| | - Nicolas Koutlidis
- Department of Urology, William Morey Hospital, Chalon-sur-Saône, France
| | - Sébastien Bassard
- Department of Urology, William Morey Hospital, Chalon-sur-Saône, France
| | - Georges Fournier
- Department of Urology, CHU Brest University Hospital, Brest, France
| | - Antoine Valeri
- Department of Urology, CHU Brest University Hospital, Brest, France
| | | | | | - Morgan Moulin
- Department of Urology, CHU University Hospital François Mitterrand, Dijon, France
| | - Célia Berchi
- Normandie Univ, UniCaen, Inserm, Anticipe, 14000, Caen, France
| | - Luc Cormier
- Department of Urology, CHU University Hospital François Mitterrand, Dijon, France
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Ghoreifi A, Kaneko M, Peretsman S, Iwata A, Brooks J, Shakir A, Sugano D, Cai J, Cacciamani G, Park D, Lebastchi AH, Ukimura O, Bahn D, Gill I, Abreu AL. Patient-reported Satisfaction and Regret Following Focal Therapy for Prostate Cancer: A Prospective Multicenter Evaluation. EUR UROL SUPPL 2023; 50:10-16. [PMID: 37101771 PMCID: PMC10123415 DOI: 10.1016/j.euros.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/03/2023] [Indexed: 02/22/2023] Open
Abstract
Background Several reports are available regarding the treatment decision regret of patients receiving conventional treatments for localized prostate cancer (PCa); yet data on patients undergoing focal therapy (FT) are sparse. Objective To evaluate the treatment decision satisfaction and regret among patients who underwent FT for PCa with high-intensity focused ultrasound (HIFU) or cryoablation (CRYO). Design setting and participants We identified consecutive patients who underwent HIFU or CRYO FT as the primary treatment for localized PCa at three US institutions. A survey with validated questionnaires, including the five-question Decision Regret Scale (DRS), International Prostate Symptom Score (IPSS), and International Index of Erectile Function (IIEF-5), was mailed to the patients. The regret score was calculated based on the five items of the DRS, and regret was defined as a DRS score of >25. Outcome measurements and statistical analysis Multivariable logistic regression models were applied to assess the predictors of treatment decision regret. Results and limitations Of 236 patients, 143 (61%) responded to the survey. Baseline characteristics were similar between responders and nonresponders. During a median (interquartile range) follow-up of 43 (26-68) mo, the treatment decision regret rate was 19.6%. On a multivariable analysis, higher prostate-specific antigen (PSA) at nadir after FT (odds ratio [OR] 1.48, 95% confidence interval [CI] 1.1-2, p = 0.009), presence of PCa on follow-up biopsy (OR 3.98, 95% CI 1.5-10.6, p = 0.006), higher post-FT IPSS (OR 1.18, 95% CI 1.01-1.37, p = 0.03), and newly diagnosed impotence (OR 6.67, 95% CI 1.57-27, p = 0.03) were independent predictors of treatment regret. The type of energy treatment (HIFU/CRYO) was not a predictor of regret/satisfaction. Limitations include retrospective abstraction. Conclusions FT for localized PCa is well accepted by the patients, with a low regret rate. Higher PSA at nadir, presence of cancer on follow-up biopsy, bothersome postoperative urinary symptoms, and impotence after FT were independent predictors of treatment decision regret. Patient summary In this report, we looked at the factors affecting satisfaction and regret in patients with prostate cancer undergoing focal therapy. We found that focal therapy is well accepted by the patients, while presence of cancer on follow-up biopsy as well as bothersome urinary symptoms and sexual dysfunction can predict treatment decision regret.
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David R, Buckby A, Kahokehr AA, Lee J, Watson DI, Leung J, O'Callaghan ME. Long term genitourinary toxicity following curative intent intensity-modulated radiotherapy for prostate cancer: a systematic review and meta-analysis. Prostate Cancer Prostatic Dis 2023; 26:8-15. [PMID: 35260794 PMCID: PMC10023565 DOI: 10.1038/s41391-022-00520-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/10/2022] [Accepted: 02/16/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Recent studies have shown that radiation-induced pelvic toxicity often requires urological consultation. However, the 10-year incidence of genitourinary toxicity following intensity-modulated radiotherapy (IMRT) amongst patients with localised prostate cancer remains unclear. Hence, we conducted a systematic review and meta-analysis to determine the incidence of late genitourinary toxicity relying on Radiation Therapy Oncology Group (RTOG) and Common Terminology Criteria for Adverse Events (CTCAE) grade as well as the incidence of specific genitourinary toxicity. Secondary objectives involved quantifing the number of studies reporting 120-month follow-up endpoints, time to event analysis, predictive factors or economic evaluation. METHODS Articles published from January 2008 to December 2021 describing prospective studies were systematically searched in MEDLINE, EMBASE and Cochrane (PROSPERO protocol CRD42019133320). Quality assessment was performed by use of the Cochrane Risk of Bias 2 Tool for RCTs and the Newcastle Ottowa Scale for non-RCTs. Meta-analysis was performed on the 60-month incidence of RTOG and CTCAE Grade ≥2 genitourinary toxicity, haematuria, urinary retention and urinary incontinence. RESULTS We screened 4721 studies and six studies met our inclusion criteria. All included studies involved normofractionation, three included a hypofractionation comparator arm and none involved nodal irradiation. The pooled 60-month cumulative incidence of RTOG and CTCAE Grade ≥2 genitourinary toxicity were 17% (95% CI: 5-20%, n = 678) and 33% (95% CI: 27-38%, n = 153), respectively. The pooled 60-month cumulative incidence of Haematuria was 5% (95% CI: -4-14%, n = 48), Urinary incontinence 12% (95% CI: 6-18%, n = 194), Urinary retention 24% (95% CI: 9-40%, n = 10). One study reported time to event analyses, one reported predictive factors, no studies reported economic analysis or 120-month toxicity. There was considerable heterogeneity amongst the studies. CONCLUSION There are few high-quality studies reporting 60-month toxicity rates after IMRT. Conservative estimates of 60-month toxicity rates are high and there is need for longer follow-up and consistent toxicity reporting standards.
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Affiliation(s)
- Rowan David
- College of Medicine and Public Health, Bedford Park, Flinders University, Bedford, SA, Australia.
- Department of Urology, SA Health, Flinders Medical Centre, Bedford, SA, Australia.
| | - Alex Buckby
- Department of Urology, SA Health, Flinders Medical Centre, Bedford, SA, Australia
| | - Arman A Kahokehr
- College of Medicine and Public Health, Bedford Park, Flinders University, Bedford, SA, Australia
- Discipline of Medicine, Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, SA, Australia
| | - Jason Lee
- College of Medicine and Public Health, Bedford Park, Flinders University, Bedford, SA, Australia
- Department of Urology, SA Health, Flinders Medical Centre, Bedford, SA, Australia
| | - David I Watson
- College of Medicine and Public Health, Bedford Park, Flinders University, Bedford, SA, Australia
| | - John Leung
- College of Medicine and Public Health, Bedford Park, Flinders University, Bedford, SA, Australia
- GenesisCare, Adelaide, SA, Australia
| | - Michael E O'Callaghan
- College of Medicine and Public Health, Bedford Park, Flinders University, Bedford, SA, Australia
- Department of Urology, SA Health, Flinders Medical Centre, Bedford, SA, Australia
- Discipline of Medicine, Freemasons Foundation Centre for Men's Health, University of Adelaide, Adelaide, SA, Australia
- South Australian Prostate Cancer Clinical Outcomes Collaborative, Adelaide, SA, Australia
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10
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Wysock J, Thakker S, Rapoport E, Gogaj R, Lepor H. Two Year Functional Outcomes Stratified According to Baseline Erectile Function Following Partial Gland Cryo-Ablation. Urology 2023; 171:158-163. [PMID: 36272564 DOI: 10.1016/j.urology.2022.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2022] [Revised: 09/20/2022] [Accepted: 10/04/2022] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To critically evaluate time dependent sexual function following primary partial gland cryo-ablation (PGCA) stratified according to baseline erectile function. METHODS Between March 2017 and March 2022, all men undergoing primary PGCA by 2 surgeons were enrolled in an IRB approved outcomes registry. All subjects with PIRADS 2-5 lesion concordant with unilateral GGG 1-3 disease, no gross extra-prostatic extension on mpMRI, GGG >1 contralateral to the ROI, or distal apical disease on mpMRI were enrolled. Patients completed the Sexual Health Inventory for Men (SHIM) scale at baseline, 6, and 24 months. Men were stratified by baseline erectile function. Men with SHIM Score < 8 were excluded. Ability to sustain erection (aka "potency") was defined as a score of 3 or greater on question 2 of the SHIM index. Median SHIM scores and the proportion of men reporting "potency" at baseline, 6, and 24 months was recorded with comparisons between each timepoint. A univariate analysis was used to determine if clinical factors were associated with loss of "potency" at 24 months. RESULTS 106 men met the inclusion criteria. There was a statistically significant decrease in the mean SHIM scores for the entire cohort between baseline to 6 months and baseline to 24 months. SHIM scores increased significantly for the total cohort between 6 and 24 months. "Potency" was preserved in 70% at 24 months. CONCLUSION Those patients most likely to exhibit a decrease in sexual function have moderate ED at baseline. Only baseline ED was shown to predict preservation of "potency".
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11
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Meissner VH, Simson BW, Dinkel A, Schiele S, Ankerst DP, Lunger L, Gschwend JE, Herkommer K. Treatment decision regret in long-term survivors after radical prostatectomy: a longitudinal study. BJU Int 2022; 131:623-630. [PMID: 36545828 DOI: 10.1111/bju.15955] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To investigate prevalence, course, and predictors of longitudinal decision regret in long-term prostate cancer (PCa) survivors treated by radical prostatectomy (RP). PATIENTS AND METHODS A total of 1003 PCa survivors from the multicentre German Familial PCa Database completed questionnaires on average 7 years after RP in 2007 and at follow-up 13 years later in 2020. Patients completed standardised patient-reported outcome measures on decision regret, decision-making, health-related quality of life, and psychosocial factors. Hierarchical multivariable logistic regression was used to assess predictors of longitudinal decision regret. RESULTS Decision regret increased significantly over time (9.0% after 6.9 years in 2007 and 12% after 19 years in 2020; P = 0.009). Favourable localised PCa (odds ratio [OR] 1.97, 95% confidence interval [CI] 1.05-3.68), decision regret in 2007 (OR 6.38, 95% CI 3.55-11.47), and a higher depression score (OR 1.37, 95% CI 1.03-1.83) were associated with decision regret in 2020. Shared decision-making (OR 0.55, 95% CI 0.33-0.93) was associated with less decision regret. CONCLUSION The findings of the present study underline the perseverance of decision regret in long-term PCa survivors and the definitive need for involving patients in the decision-making process to mitigate regret over the long term.
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Affiliation(s)
- Valentin H Meissner
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Barbara W Simson
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Andreas Dinkel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Stefan Schiele
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Donna P Ankerst
- Departments of Mathematics and Life Science Systems, Munich Data Science Institute, Technical University of Munich, Garching, Germany
| | - Lukas Lunger
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Jürgen E Gschwend
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
| | - Kathleen Herkommer
- Department of Urology, Klinikum rechts der Isar, School of Medicine, Technical University of Munich, Munich, Germany
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12
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Wolff I, Burchardt M, Gilfrich C, Peter J, Baunacke M, Thomas C, Huber J, Gillitzer R, Sikic D, Fiebig C, Steinestel J, Schifano P, Löbig N, Bolenz C, Distler FA, Huettenbrink C, Janssen M, Schilling D, Barakat B, Harke NN, Fuhrmann C, Manseck A, Wagenhoffer R, Geist E, Blair L, Pfitzenmaier J, Reinhardt B, Hoschke B, Burger M, Bründl J, Schnabel MJ, May M. Patients Regret Their Choice of Therapy Significantly Less Frequently after Robot-Assisted Radical Prostatectomy as Opposed to Open Radical Prostatectomy: Patient-Reported Results of the Multicenter Cross-Sectional IMPROVE Study. Cancers (Basel) 2022; 14:cancers14215356. [PMID: 36358775 PMCID: PMC9654391 DOI: 10.3390/cancers14215356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/22/2022] [Accepted: 10/24/2022] [Indexed: 11/16/2022] Open
Abstract
Patient’s regret (PatR) concerning the choice of therapy represents a crucial endpoint for treatment evaluation after radical prostatectomy (RP) for prostate cancer (PCA). This study aims to compare PatR following robot-assisted (RARP) and open surgical approach (ORP). A survey comprising perioperative-functional criteria was sent to 1000 patients in 20 German centers at a median of 15 months after RP. Surgery-related items were collected from participating centers. To calculate PatR differences between approaches, a multivariate regressive base model (MVBM) was established incorporating surgical approach and demographic, center-specific, and tumor-specific criteria not primarily affected by surgical approach. An extended model (MVEM) was further adjusted by variables potentially affected by surgical approach. PatR was based on five validated questions ranging 0−100 (cutoff >15 defined as critical PatR). The response rate was 75.0%. After exclusion of patients with laparoscopic RP or stage M1b/c, the study cohort comprised 277/365 ORP/RARP patients. ORP/RARP patients had a median PatR of 15/10 (p < 0.001) and 46.2%/28.1% had a PatR >15, respectively (p < 0.001). Based on the MVBM, RARP patients showed PatR >15 relative 46.8% less frequently (p < 0.001). Consensual decision making regarding surgical approach independently reduced PatR. With the MVEM, the independent impact of both surgical approach and of consensual decision making was confirmed. This study involving centers of different care levels showed significantly lower PatR following RARP.
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Affiliation(s)
- Ingmar Wolff
- Department of Urology, University Medicine Greifswald, 17475 Greifswald, Germany
- Correspondence:
| | - Martin Burchardt
- Department of Urology, University Medicine Greifswald, 17475 Greifswald, Germany
| | - Christian Gilfrich
- Department of Urology, St. Elisabeth Hospital Straubing, 94315 Straubing, Germany
| | - Julia Peter
- Department of Urology, St. Elisabeth Hospital Straubing, 94315 Straubing, Germany
| | - Martin Baunacke
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Christian Thomas
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
| | - Johannes Huber
- Department of Urology, University Hospital Carl Gustav Carus, Technische Universität Dresden, 01307 Dresden, Germany
- Department of Urology, Philipps-University Marburg, 35043 Marburg, Germany
| | - Rolf Gillitzer
- Department of Urology, Klinikum Darmstadt, 64283 Darmstadt, Germany
| | - Danijel Sikic
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Christian Fiebig
- Department of Urology and Pediatric Urology, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nuremberg, 91054 Erlangen, Germany
| | - Julie Steinestel
- Department of Urology, University Hospital Augsburg, 86156 Augsburg, Germany
| | - Paola Schifano
- Department of Urology, University Hospital Augsburg, 86156 Augsburg, Germany
| | - Niklas Löbig
- Department of Urology, University Hospital Ulm, 89081 Ulm, Germany
| | - Christian Bolenz
- Department of Urology, University Hospital Ulm, 89081 Ulm, Germany
| | - Florian A. Distler
- Department of Urology, Paracelsus Medical University, 90419 Nuremberg, Germany
| | | | - Maximilian Janssen
- Department of Urology, Isarklinikum Hospital Munich, 80331 Munich, Germany
| | - David Schilling
- Department of Urology, Isarklinikum Hospital Munich, 80331 Munich, Germany
| | - Bara Barakat
- Department of Urology and Pediatric Urology, Hospital Viersen, 41747 Viersen, Germany
| | - Nina N. Harke
- Department of Urology and Urologic Oncology, Hanover Medical School, 30625 Hanover, Germany
| | - Christian Fuhrmann
- Department of Urology and Urologic Oncology, Hanover Medical School, 30625 Hanover, Germany
| | - Andreas Manseck
- Department of Urology, Klinikum Ingolstadt, 85049 Ingolstadt, Germany
| | | | - Ekkehard Geist
- Department of Urology, Klinikum Neumarkt, 92318 Neumarkt Oberpfalz, Germany
| | - Lisa Blair
- Department of Urology, Klinikum Neumarkt, 92318 Neumarkt Oberpfalz, Germany
| | - Jesco Pfitzenmaier
- Department of Urology, Evangelical Hospital Bethel, University Hospital Ostwestfalen-Lippe of the University Bielefeld, 33611 Bielefeld, Germany
| | - Bettina Reinhardt
- Department of Urology, Evangelical Hospital Bethel, University Hospital Ostwestfalen-Lippe of the University Bielefeld, 33611 Bielefeld, Germany
| | - Bernd Hoschke
- Department of Urology and Pediatric Urology, Carl-Thiem-Klinikum Cottbus, 03048 Cottbus, Germany
| | - Maximilian Burger
- Department of Urology, Caritas - St. Josef Medical Center, University of Regensburg, 93053 Regensburg, Germany
| | - Johannes Bründl
- Department of Urology, Caritas - St. Josef Medical Center, University of Regensburg, 93053 Regensburg, Germany
| | - Marco J. Schnabel
- Department of Urology, Caritas - St. Josef Medical Center, University of Regensburg, 93053 Regensburg, Germany
| | - Matthias May
- Department of Urology, St. Elisabeth Hospital Straubing, 94315 Straubing, Germany
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13
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Adequacy of sexual care information given to prostate cancer patients receiving radical external beam radiotherapy. JOURNAL OF RADIOTHERAPY IN PRACTICE 2022. [DOI: 10.1017/s1460396922000310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Background:
Despite the acknowledged value of providing prostate radiotherapy patients with sexual dysfunction (SD) information, there is little evidence related to patient perceptions of this or the extent to which information is provided to them. This study aimed to critically evaluate the quality and format of SD information given to patients before, during and after radical EBRT to treat prostate cancer.
Method:
Members of UK prostate cancer support groups were asked to complete an anonymous online survey tool seeking opinions of the SD information they were given before, during and after external beam radiotherapy (EBRT).
Results:
There were 56 responses to the survey with over 42% of respondents reporting that they had not received any SD information. Of those who did, 78·1% (25/32) received information before the start of EBRT. Physicians were the most involved in the provision of SD information, with nurses and therapeutic radiographers being underutilised. Responses were mostly negative, or neutral regarding the quality of SD information and the information received about impact on relationships, psychological and emotional health. Many participants wanted more information and support.
Conclusion:
This study demonstrates that prostate cancer patients who have undergone radical EBRT have not received adequate information relating to potential sexual function side effects and the psychological and emotional effects of SD. This information should be included in verbal and written information provided at all stages of the radiotherapy pathway.
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14
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Joyce DD, Wallis CJD, Huang LC, Hoffman KE, Zhao Z, Koyama T, Goodman M, Hamilton AS, Wu XC, Paddock LE, Stroup A, Cooperberg MR, Hashibe M, O’Neil BB, Kaplan SH, Greenfield S, Penson DF, Barocas DA. The Association Between Financial Toxicity and Treatment Regret in Men With Localized Prostate Cancer. JNCI Cancer Spectr 2022; 6:6762868. [PMID: 36255249 PMCID: PMC9731205 DOI: 10.1093/jncics/pkac071] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 09/13/2022] [Accepted: 10/03/2022] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Financial toxicity is emerging as an important patient-centered outcome and is understudied in prostate cancer patients. We sought to understand the association between financial burden and treatment regret in men with localized prostate cancer to better evaluate the role of financial discussions in patient counseling. METHODS Utilizing the Comparative Effectiveness Analysis of Surgery and Radiation dataset, we identified all men accrued between 2011 and 2012 who underwent surgery, radiation, or active surveillance for localized prostate cancer. Financial burden and treatment regret were assessed at 3- and 5-year follow-up. The association between financial burden and regret was assessed using multivariable longitudinal logistic regression controlling for demographic and disease characteristics, treatment, functional outcomes, and patient expectations. RESULTS Of the 2924 eligible patients, regret and financial burden assessments for 3- and/or 5-year follow-up were available for 81% (n = 2359). After adjustment for relevant covariates, financial burden from "finances in general" was associated with treatment regret at 3 years (odds ratio [OR] = 2.47, 95% confidence interval [CI] = 1.33 to 4.57; P = .004); however, this association was no longer statistically significant at 5-year follow-up (OR = 1.19, 95% CI = 0.56 to 2.54; P = .7). CONCLUSIONS In this population-based sample of men with localized prostate cancer, we observed associations between financial burden and treatment regret. Our findings suggest indirect treatment costs, especially during the first 3 years after diagnosis, may impact patients more profoundly than direct costs and are important for inclusion in shared decision making.
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Affiliation(s)
- Daniel D Joyce
- Correspondence to: Daniel D. Joyce, MD, Department of Urology, Mayo Clinic, 200 1st Street SW, Rochester, MN 55902, USA (e-mail: )
| | | | - Li-Ching Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Karen E Hoffman
- Department of Radiation Oncology, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA
| | - Zhiguo Zhao
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Tatsuki Koyama
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael Goodman
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA, USA
| | - Ann S Hamilton
- Department of Population and Public Health Sciences, Keck School of Medicine at the University of Southern California, Los Angeles, CA, USA
| | - Xiao-Cheng Wu
- Department of Epidemiology, Louisiana State University New Orleans School of Public Health, New Orleans, LA, USA
| | - Lisa E Paddock
- Department of Epidemiology, Cancer Institute of New Jersey, Rutgers Health, New Brunswick, NJ, USA
| | - Antoinette Stroup
- Department of Epidemiology, Cancer Institute of New Jersey, Rutgers Health, New Brunswick, NJ, USA
| | | | - Mia Hashibe
- Department of Family and Preventative Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Brock B O’Neil
- Department of Urology, University of Utah Health, Salt Lake City, UT, USA
| | - Sherrie H Kaplan
- Department of Medicine, University of California Irvine, Irvine, CA, USA
| | - Sheldon Greenfield
- Department of Medicine, University of California Irvine, Irvine, CA, USA
| | - David F Penson
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA,Geriatric Research Education and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, TN, USA
| | - Daniel A Barocas
- Department of Urology, Vanderbilt University Medical Center, Nashville, TN, USA
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15
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Amano K, Suzuki K. Self‐management
of lower urinary tract symptoms in
post‐prostatectomy
cancer patients: Content analysis. INTERNATIONAL JOURNAL OF UROLOGICAL NURSING 2022. [DOI: 10.1111/ijun.12327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Koji Amano
- Doctoral Program, Graduate School of Nursing Osaka Medical and Pharmaceutical University Osaka Japan
- Faculty of Nursing Doshisha Women's College of Liberal Arts Kyoto Japan
| | - Kumi Suzuki
- Faculty of Nursing Osaka Medical and Pharmaceutical University Osaka Japan
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16
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Monsen KV, Fosså SD, Myklebust TÅ, Smeland S, Dahl AA, Stensvold A. Long-term satisfaction with curative treatment and follow-up in prostate cancer survivors. Acta Oncol 2022; 61:357-362. [PMID: 35103559 DOI: 10.1080/0284186x.2021.2006775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
PURPOSE In a cross-sectional observational study to explore long-term satisfaction with treatment among men who had undergone radical prostatectomy (RP) or definitive pelvic radiotherapy (RT) for prostate cancer (PCa). METHODS After mean 7 years from therapy (range: 6-8), 431 PCa-survivors (RP: n = 313, RT: n = 118) completed a mailed questionnaire assessing persistent treatment-related adverse effects (AEs) (Expanded Prostate cancer Index Composite [EPIC-26]) and seven Quality indicators describing satisfaction with the health care service following a most often general practitioner (GP)-led follow-up plan. A logistic regression model evaluated the associations between long-term satisfaction and treatment modality, age, the seven satisfaction-related Quality indicators, and persistent AEs. The significance level was set at p< .05. RESULTS Four of five (81%) PCa-survivors reported long-term satisfaction with their treatment. In a multivariable model, satisfaction was positively associated with sufficient information about treatment and AEs, patient-perceived sufficient cooperation between the hospital and the GP and sufficient follow-up of AEs (ref.: insufficient). Age ≥70 years (ref.: <70) and a rising summary score within the EPIC-26 sexual domain additionally increased long-term satisfaction. The treatment modality itself (RP versus RT) did not significantly impact on satisfaction. CONCLUSIONS The majority of curatively treated PCa-survivors are satisfied with their treatment more than 5 years after primary therapy. Sufficient information, improved cooperation between the hospital specialists and the responsible GP and optimized follow-up of AEs may further increase long-term satisfaction among prostatectomized and irradiated PCa-survivors.
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Affiliation(s)
- Kari V. Monsen
- Section for Clinical Cancer Research, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Norway
| | - Sophie D. Fosså
- Section for Clinical Cancer Research, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Norway
| | - Tor Å. Myklebust
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Cancer Registry of Norway, Oslo, Norway
| | - Sigbjørn Smeland
- Faculty of Medicine, University of Oslo, Norway
- Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - Alv A. Dahl
- Section for Clinical Cancer Research, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Norway
| | - Andreas Stensvold
- Division of Clinical Oncology, Østfold Hospital Trust, Kalnes, Norway
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17
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Pignot G, Touzani R, Bendiane MK, Mancini J, Walz J, Marino P, Rybikowski S, Maubon T, Salem N, Gravis G, Bouhnik AD. Self-reported functional assessment after treatment for prostate cancer: 5-year results of the prospective cohort VICAN. Future Oncol 2022; 18:1733-1744. [PMID: 35172586 DOI: 10.2217/fon-2021-1420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective: We aimed to assess the long-term association of therapeutic strategies with urinary, sexual function and health-related quality of life (HR-QOL) for 5-year prostate cancer (PC) survivors. Materials & methods: The VICAN survey consisted of self-reported data prospectively collected, including living conditions, treatment side effects and quality of life (QOL) of cancer survivors. Results: Among the 434 PC survivors, 52.8% reported urinary incontinence (UI) and 55.8% reported erectile dysfunction (ED). Patients treated with radical prostatectomy with salvage radiotherapy reported significantly more UI (p = 0.014) and more ED (p = 0.012) compared with other strategies. UI was significantly associated with physical and mental health-related QOL (p = 0.045 and p = 0.049, respectively). Conclusion: Self-assessed functional outcomes 5 years after PC diagnosis remain poor and could have an impact on health-related QOL.
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Affiliation(s)
- Géraldine Pignot
- Department of Surgical Oncology 2, Institut Paoli-Calmettes, Marseille, France
| | - Rajae Touzani
- Institut Paoli-Calmettes, Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | | | - Julien Mancini
- Institut Paoli-Calmettes, Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | - Jochen Walz
- Department of Surgical Oncology 2, Institut Paoli-Calmettes, Marseille, France
| | - Patricia Marino
- Institut Paoli-Calmettes, Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | | | - Thomas Maubon
- Department of Surgical Oncology 2, Institut Paoli-Calmettes, Marseille, France
| | - Naji Salem
- Department of Radiotherapy, Institut Paoli-Calmettes, Marseille, France
| | - Gwenaelle Gravis
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Anne-Déborah Bouhnik
- Institut Paoli-Calmettes, Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
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18
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Wallis CJD, Zhao Z, Huang LC, Penson DF, Koyama T, Kaplan SH, Greenfield S, Luckenbaugh AN, Klaassen Z, Conwill R, Goodman M, Hamilton AS, Wu XC, Paddock LE, Stroup A, Cooperberg MR, Hashibe M, O’Neil BB, Hoffman KE, Barocas DA. Association of Treatment Modality, Functional Outcomes, and Baseline Characteristics With Treatment-Related Regret Among Men With Localized Prostate Cancer. JAMA Oncol 2022; 8:50-59. [PMID: 34792527 PMCID: PMC8603232 DOI: 10.1001/jamaoncol.2021.5160] [Citation(s) in RCA: 49] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
IMPORTANCE Treatment-related regret is an integrative, patient-centered measure that accounts for morbidity, oncologic outcomes, and anxiety associated with prostate cancer diagnosis and treatment. OBJECTIVE To assess the association between treatment approach, functional outcomes, and patient expectations and treatment-related regret among patients with localized prostate cancer. DESIGN, SETTING, AND PARTICIPANTS This population-based, prospective cohort study used 5 Surveillance, Epidemiology, and End Results (SEER)-based registries in the Comparative Effectiveness Analysis of Surgery and Radiation cohort. Participants included men with clinically localized prostate cancer from January 1, 2011, to December 31, 2012. Data were analyzed from August 2, 2020, to March 1, 2021. EXPOSURES Prostate cancer treatments included surgery, radiotherapy, and active surveillance. MAIN OUTCOMES AND MEASURES Patient-reported treatment-related regret using validated metrics. Regression models were adjusted for demographic and clinicopathologic characteristics, treatment approach, and patient-reported functional outcomes. RESULTS Among the 2072 men included in the analysis (median age, 64 [IQR, 59-69] years), treatment-related regret at 5 years after diagnosis was reported in 183 patients (16%) undergoing surgery, 76 (11%) undergoing radiotherapy, and 20 (7%) undergoing active surveillance. Compared with active surveillance and adjusting for baseline differences, active treatment was associated with an increased likelihood of regret for those undergoing surgery (adjusted odds ratio [aOR], 2.40 [95% CI, 1.44-4.01]) but not radiotherapy (aOR, 1.53 [95% CI, 0.88-2.66]). When mediation by patient-reported functional outcomes was considered, treatment modality was not independently associated with regret. Sexual dysfunction, but not other patient-reported functional outcomes, was significantly associated with regret (aOR for change in sexual function from baseline, 0.65 [95% CI, 0.52-0.81]). Subjective patient-perceived treatment efficacy (aOR, 5.40 [95% CI, 2.15-13.56]) and adverse effects (aOR, 5.83 [95% CI, 3.97-8.58]), compared with patient expectations before treatment, were associated with treatment-related regret. Other patient characteristics at the time of treatment decision-making, including participatory decision-making tool scores (aOR, 0.80 [95% CI, 0.69-0.92]), social support (aOR, 0.78 [95% CI, 0.67-0.90]), and age (aOR, 0.78 [95% CI, 0.62-0.97]), were significantly associated with regret. Results were comparable when assessing regret at 3 years rather than 5 years. CONCLUSIONS AND RELEVANCE 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.
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Affiliation(s)
- Christopher J. D. Wallis
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee,Division of Urology, Department of Surgery, University of Toronto, Toronto, Ontario, Canada,Division of Urology, Department of Surgery, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Zhiguo Zhao
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Li-Ching Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David F. Penson
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tatsuki Koyama
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | | | - Amy N. Luckenbaugh
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | | | - Ralph Conwill
- Office of Patient and Community Education, Patient Advocacy Program, Vanderbilt Ingram Cancer Center, Vanderbilt University Medical Center, Franklin, Tennessee
| | - Michael Goodman
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Ann S. Hamilton
- Department of Preventative Medicine, Keck School of Medicine at the University of Southern California, Los Angeles
| | - Xiao-Cheng Wu
- Department of Epidemiology, Louisiana State University New Orleans School of Public Health, New Orleans
| | - Lisa E. Paddock
- Department of Epidemiology, Cancer Institute of New Jersey, Rutgers Health, New Brunswick
| | - Antoinette Stroup
- Department of Epidemiology, Cancer Institute of New Jersey, Rutgers Health, New Brunswick
| | | | - Mia Hashibe
- Department of Family and Preventative Medicine, University of Utah School of Medicine, Salt Lake City
| | - Brock B. O’Neil
- Department of Urology, University of Utah Health, Salt Lake City
| | - Karen E. Hoffman
- Department of Radiation Oncology, The University of Texas MD Anderson Center, Houston
| | - Daniel A. Barocas
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
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19
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Brown A, Pain T, Tan A, Anable L, Callander E, Watt K, Street D, De Abreu Lourenco R. Men's preferences for image-guidance in prostate radiation therapy: A discrete choice experiment. Radiother Oncol 2021; 167:49-56. [PMID: 34890737 DOI: 10.1016/j.radonc.2021.11.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Revised: 11/19/2021] [Accepted: 11/30/2021] [Indexed: 11/26/2022]
Abstract
INTRODUCTION There are several options for real-time prostate monitoring during radiation therapy including fiducial markers (FMs) and transperineal ultrasound (TPUS). However, the patient experience for these procedures is very different. This study aimed to determine patient preferences around various aspects of prostate image-guidance, focusing on FMs and TPUS. METHODS A discrete choice experiment (DCE) was conducted, describing the image-guidance approach by: pain, cost, accuracy, side effects, additional appointments, and additional time. Participants were males with prostate cancer (PCa) and from the general Australian population. A DCE survey required participants to make hypothetical choices in each of 8 choice sets. Multinomial logit modelling and Latent Class Analysis (LCA) were used to analyse the responses. Marginal willingness to pay (mWTP) was calculated. RESULTS 476 respondents completed the survey (236 PCa patients and 240 general population). The most important attributes for both cohorts were pain, cost and accuracy (p < 0.01). PCa patients were willing to pay more to avoid the worst pain than the general population, and willing to pay more for increased accuracy. LCA revealed 3 groups: 2 were focused more on the process-related attributes of pain and cost, and the third was focused on the clinical efficacy attributes of accuracy and side effects. CONCLUSION Both cohorts preferred less cost and pain and improved accuracy, with men with PCa valuing accuracy more than the general population. In addition to the clinical and technical evidence, radiation oncology centres should consider the preferences of patients when considering choice of image-guidance techniques.
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Affiliation(s)
- Amy Brown
- Townsville Hospital and Health Service, Townsville, Australia; James Cook University - Bebegu Yumba Campus, Townsville, Australia.
| | - Tilley Pain
- Townsville Hospital and Health Service, Townsville, Australia; James Cook University - Bebegu Yumba Campus, Townsville, Australia
| | - Alex Tan
- Townsville Hospital and Health Service, Townsville, Australia; James Cook University - Bebegu Yumba Campus, Townsville, Australia
| | - Lux Anable
- Townsville Hospital and Health Service, Townsville, Australia
| | - Emily Callander
- Monash University, Melbourne, Australia; James Cook University - Bebegu Yumba Campus, Townsville, Australia
| | - Kerrianne Watt
- James Cook University - Bebegu Yumba Campus, Townsville, Australia
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20
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Owens OL, Estrada RM, Johnson K, Cogdell M, Fried DB, Gansauer L, Kim S. 'I'm not a chance taker': A mixed methods exploration of factors affecting prostate cancer treatment decision-making. ETHNICITY & HEALTH 2021; 26:1143-1162. [PMID: 30987436 PMCID: PMC7184517 DOI: 10.1080/13557858.2019.1606165] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Accepted: 03/26/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVES African American prostate cancer survivors experience post-treatment decisional regret more often than European Americans, which can lead to negative long-term effects on quality of life. A prominent driver of health-related decision-making is emotion, yet little work has examined the impact emotions may have on decisional regret. The goal of this study was to explore experiences, perceptions, and emotions of prostate cancer survivors in relation to their diagnostic and treatment decision-making processes, prostate cancer treatment, and outcomes. Additionally, we sought to identify factors that might explain differences in prostate cancer outcomes between African and European Americans. DESIGN This mixed-methods study utilized a convergent parallel design, in which quantitative and qualitative data were collected simultaneously and then integrated to more robustly explain relationships between variables. Survivors were eligible for the study if they had been previously diagnosed with localized prostate cancer and were no more than six months post-treatment. The study was guided by the Risk as Feelings Model, which predicts the relationship between emotion and cognition in high-risk decision-making. RESULTS No men experienced decisional regret following treatment, even if they experienced side effects. While all men reported being surprised about their prostate cancer diagnosis, strong negative emotions were more common among men under 65. Family support and spirituality appeared to mitigate negative emotions. Perceived authenticity of provider communication was the most influential mediator in men's decision-making and positive perceptions of their outcomes. CONCLUSIONS To mitigate the impact emotional responses have on decision-making and post-treatment regret, providers should explore alternate therapies (e.g. counseling for men diagnosed with prostate cancer at a young age) and include family members in prostate cancer treatment discussions. Most importantly, providers should be aware of the importance of quality communication on men's cognitive and emotional processes and their perceptions of treatment outcomes.
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Affiliation(s)
- Otis L Owens
- College of Social Work, University of South Carolina, Columbia, SC, USA
| | - Robin M Estrada
- College of Nursing, University of South Carolina, Columbia, SC, USA
| | - Kim Johnson
- Spartanburg Gibbs Cancer Center and Research Institute, Spartanburg, SC, USA
| | - Micheal Cogdell
- Spartanburg Gibbs Cancer Center and Research Institute, Spartanburg, SC, USA
| | - Daniel B Fried
- Spartanburg Gibbs Cancer Center and Research Institute, Spartanburg, SC, USA
| | - Lucy Gansauer
- Spartanburg Gibbs Cancer Center and Research Institute, Spartanburg, SC, USA
| | - Simon Kim
- Yale University Cancer Outcomes Public Policy and Effectiveness Research (COPPER) Center, Urology Institute, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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21
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Owens OL, Dawson RM, Thomas T. Development of the Prostate Cancer Treatment Decision Framework: A Context-Specific Expansion of the Risk-as-Feelings Hypothesis. Cancer Nurs 2021; 44:E467-E475. [PMID: 33332918 PMCID: PMC8609530 DOI: 10.1097/ncc.0000000000000918] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Over the past 2 decades, numerous decision-making interventions have been developed to guide the prostate cancer (PrCA) treatment choices of patients and families. These interventions are often supported by economic decision frameworks, which do not account for the role of emotions in treatment decisions. In some instances, emotion-driven decisions can override an individual's cognitive evaluation of a decision, leading to unfavorable outcomes such as decision regret. OBJECTIVES To produce a Prostate Cancer Treatment Decision Framework based on the Risk-as-Feelings Hypothesis. METHODS The authors reviewed seminal research in emotion and decision-making in an effort to create a context-specific decision framework. RESULTS Five variables, not germane to the Risk-as-Feelings Hypothesis, play prominent roles in PrCA decision-making including age, spirituality, family support, healthcare provider communication, and perception of treatment outcomes. While family support only affects decision outcomes by influencing emotion and cognitive evaluation of a PrCA decision, age, spirituality, and healthcare provider communication can have direct effects on an individual's perception of treatment outcomes. CONCLUSIONS The Prostate Cancer Treatment Decision Framework combines new variables with older models to explain the PrCA treatment decision-making process and elucidate relationships affecting treatment outcomes and survivors' perceptions of these outcomes. The core premise of this model can be applied to other high-risk health decisions. IMPLICATIONS FOR PRACTICE Healthcare providers have the greatest influence on PrCA treatment decision-making. Using a shared decision-making approach, providers should take into account a patient's personal characteristics and values, in addition to clinical presentation, to help patients with treatment decisions.
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Affiliation(s)
- Otis L Owens
- Author Affiliations: College of Social Work (Dr Owens) and College of Nursing (Dr Dawson), University of South Carolina, Columbia; and Department of Health Sciences, College of Health and Behavioral Studies, James Madison University, Harrisonburg, Virginia (Dr Thomas)
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22
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Changes in quality of life and lower urinary tract symptoms over time in cancer patients after a total prostatectomy: systematic review and meta-analysis. Support Care Cancer 2021; 30:2959-2970. [PMID: 34642791 DOI: 10.1007/s00520-021-06595-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 09/26/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE This study aimed to clarify associations between and changes over time in lower urinary tract symptoms (LUTS) and quality of life (QOL) in cancer patients after a total prostatectomy. METHODS The subjects were cancer patients who had undergone total prostatectomy and had participated in non-randomized controlled trials, cohort studies, or case-control studies with outcomes of changes over time in LUTS or QOL. Fourteen studies were included for systematic review and meta-analysis. RESULTS Compared to preoperatively, the International Prostate Symptom Score (IPSS)-a LUTS indicator-yielded the following, 3 months after operation (MD [95% confidence interval, CI] = -0.27 [-2.22 to 1.68], p = .7855), 6 months after operation (MD [95% CI] = -2.12 [-3.04 to -1.20], p < .0001), and 12 months after operation (MD [95% CI] = -2.27 [-2.63 to -1.92], p < .0001), demonstrating significant decrease and, therefore, improvement of symptoms after 6 months. International Prostate Symptom Score-Quality of Life (IPSS-QOL), a QOL indicator, was significantly reduced at 12 months after surgery, indicating improved QOL (MD [95% CI] = -0.49 [-0.87 to -0.11], p = .0107), but there was heterogeneity between different studies (I2 = 89.19%). A cumulative meta-analysis showed a tendency for greater improvements in IPSS-QOL at 12 months after surgery, the older the mean age and the higher the mean pre-surgery IPSS. Factors of age, prostate volume, and pre-surgery IPSS were related to postoperative LUTS; exacerbation of both urinary incontinence and urinary tract obstruction was related to QOL. CONCLUSION While LUTS improves over time after total prostatectomy, it takes 6 to 12 months after surgery. As there is an association between LUTS and QOL, support to promote self-management of LUTS is important.
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23
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Bensley JG, Dhillon HM, Evans SM, Evans M, Bolton D, Davis ID, Dodds L, Frydenberg M, Kearns P, Lawrentschuk N, Murphy DG, Millar JL, Papa N. Self-reported lack of energy or feeling depressed 12 months after treatment in men diagnosed with prostate cancer within a population-based registry. Psychooncology 2021; 31:496-503. [PMID: 34623735 DOI: 10.1002/pon.5833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/28/2021] [Accepted: 09/29/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Feeling depressed and lethargic are common side effects of prostate cancer (PCa) and its treatments. We examined the incidence and severity of feeling depressed and lack of energy in patients in a population based PCa registry. METHODS We included men diagnosed with PCa between 2015 and 2019 in Victoria, Australia, and enrolled in the Prostate Cancer Outcomes Registry. The primary outcome measures were responses to two questions on the Expanded Prostate Cancer Index Composite (EPIC-26) patient reported instrument: problems with feeling depressed and problems with lack of energy 12 months following treatment. We evaluated associations between these and age, cancer risk category, treatment type, and urinary, bowel, and sexual function. RESULTS Both outcome questions were answered by 9712 out of 12,628 (77%) men. 981 patients (10%) reported at least moderate problems with feeling depressed; 1563 (16%) had at least moderate problems with lack of energy and 586 (6.0%) with both. Younger men reported feeling depressed more frequently than older men. Lack of energy was more common for treatments that included androgen deprivation therapy than not (moderate/big problems: 31% vs. 13%), irrespective of disease risk category. Both outcomes were associated with poorer urinary, bowel, and sexual functional domain scores. CONCLUSIONS Self-reported depressive feelings and lack of energy were frequent in this population-based registry. Problems with feeling depressed were more common in younger men and lack of energy more common in men having hormonal treatment. Clinicians should be aware of the incidence of these symptoms in these at-risk groups and be able to screen for them.
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Affiliation(s)
- Jonathan G Bensley
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Haryana M Dhillon
- Psycho-Oncology Cooperative Research Group, School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia.,Centre for Medical Psychology and Evidence-Based Decision-Making, School of Psychology, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Sue M Evans
- Victorian Cancer Registry, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Melanie Evans
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Damien Bolton
- Department of Surgery, Austin Health, The University of Melbourne, Melbourne, Victoria, Australia.,Olivia Newton-John Cancer and Wellness Centre, Austin Health, Melbourne, Victoria, Australia
| | - Ian D Davis
- Medical Oncology Unit, Eastern Health, Melbourne, Victoria, Australia.,Eastern Health Clinical School, Monash University, Melbourne, Victoria, Australia
| | - Lachlan Dodds
- Ballarat Health Services, Ballarat, Victoria, Australia
| | - Mark Frydenberg
- Department of Surgery, Cabrini Institute, Cabrini Health, Monash University, Melbourne, Victoria, Australia
| | | | - Nathan Lawrentschuk
- Department of Surgery and Department of Urology, University of Melbourne at Royal Melbourne Hospital, Melbourne, Victoria, Australia.,EJ Whitten Prostate Cancer Research Centre, Epworth Healthcare, Melbourne, Victoria, Australia.,Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Declan G Murphy
- Division of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Victoria, Australia
| | - Jeremy L Millar
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.,Radiation Oncology, Alfred Health, Melbourne, Victoria, Australia.,Central Clinical School, Monash University, The Alfred Centre, Melbourne, Victoria, Australia
| | - Nathan Papa
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
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24
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Bradley C, Ilie G, MacDonald C, Massoeurs L, Jasmine Dang Cam-Tu V, Rutledge RDH. Treatment Regret, Mental and Physical Health Indicators of Psychosocial Well-Being among Prostate Cancer Survivors. Curr Oncol 2021; 28:3900-3917. [PMID: 34677251 PMCID: PMC8535109 DOI: 10.3390/curroncol28050333] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 01/04/2023] Open
Abstract
Prostate cancer (PCa) patients and survivors are at high risk of mental health illness. Here, we examined the contribution of treatment regret, mental and physical health indicators to the social/family, emotional, functional and spiritual well-being of PCa survivors. The study assessed 367 men with a history of PCa residing in the Maritimes Canada who were surveyed between 2017 and 2021. The outcomes were social/family, emotional, functional and spiritual well-being (FACT-P,FACIT-Sp). Predictor variables included urinary, bowel and sexual function (UCLA-PCI), physical and mental health (SF-12), and treatment regret. Logistic regression analyses were controlled for age, income, and survivorship time. Poor social/family, emotional, functional and spiritual well-being was identified among 54.4%, 26.5%, 49.9% and 63.8% of the men in the sample. Men who reported treatment regret had 3.62, 5.58, or 4.63 higher odds of poor social/family, emotional, and functional well-being, respectively. Men with low household income had 3.77 times higher odds for poor social/well-being. Good mental health was a protective factor for poor social/family, emotional, functional, or spiritual well-being. Better physical and sexual health were protective factors for poor functional well-being. Seeking to promote PCa patients' autonomy in treatment decisions and recognizing this process' vulnerability in health care contexts is warranted.
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Affiliation(s)
- Cassidy Bradley
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS B3H 1V7, Canada; (C.B.); (C.M.); (L.M.)
| | - Gabriela Ilie
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS B3H 1V7, Canada; (C.B.); (C.M.); (L.M.)
- Department of Urology, Dalhousie University, Halifax, NS B3H 4R2, Canada;
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Department of Radiation Oncology, Dalhousie University, Halifax, NS B3H 4R2, Canada;
- Faculty of Medicine, Dalhousie University, Halifax, NS B3H 1V7, Canada
| | - Cody MacDonald
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS B3H 1V7, Canada; (C.B.); (C.M.); (L.M.)
| | - Lia Massoeurs
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS B3H 1V7, Canada; (C.B.); (C.M.); (L.M.)
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25
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Fiard G, Chowdhury A, Potter AR, Pook CJ, Kelly D, Emberton M, Yap T. Detailing Sexual Outcomes After Focal Therapy for Localised Prostate Cancer: A Systematic Review and Meta-analysis. Eur Urol Focus 2021; 8:926-941. [PMID: 34580049 DOI: 10.1016/j.euf.2021.09.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2021] [Revised: 08/04/2021] [Accepted: 09/10/2021] [Indexed: 11/04/2022]
Abstract
CONTEXT Focal therapy has emerged as a promising option to treat well-selected men with localised prostate cancer while preserving healthy prostate tissue and key structures, such as the urethral sphincter and neurovascular bundles. However, how this tissue preservation may translate into improved outcomes, particularly into improved sexual outcomes, is still an active research field. OBJECTIVE We conducted a systematic review and meta-analysis of the literature to summarise the existing evidence, in order to provide patients with updated data on what to expect after treatment and help identify gaps in current knowledge that may warrant future research. EVIDENCE ACQUISITION A systematic literature search was conducted on Medline, EMBASE, Scopus, and Web of Science. The search strategy was defined using the "litsearchr" function in R based on a preliminary "naïve" search using the following terms on Medline: (("focal therapy" OR "focal treatment") AND ("prostate cancer") AND ("sexual function" OR "erectile function")). A total of 42 studies, comprising 3117 patients treated and 2352 with available sexual outcomes, were included in the qualitative data synthesis and 26 in a random-effect meta-analysis. EVIDENCE SYNTHESIS The five-item International Index of Erectile Function (IIEF-5) was the most frequently used questionnaire (30/42 studies), with completion rates ranging from 24% to 100% at 18-24 mo. A decrease was noted at 3 mo (IIEF-5 decrease estimate -3.70 [95% confidence interval -4.43, -2.96]), with improvements at 6 mo (-2.18 [-2.91, -1.46]) and 12 mo (-2.14 [-2.96, -1.32]). Studies in which patients had an altered baseline sexual function were more likely to report a significant and durable postoperative decrease in erectile function scores. The patient-reported outcome questionnaires used were not designed for a diverse population. Functional outcomes were not the primary endpoint and have not been reported consistently in most studies considered. CONCLUSIONS Focal therapy led to changes in erectile function in most cases under the significance threshold of the patient-reported outcome questionnaires used. However, patients should be counselled according to their baseline erectile function. More research is warranted to detail aspects other than erectile function, such as ejaculation or orgasm. The early postoperative period appears key to study sexual changes after focal therapy, while only a moderate decrease is expected at 12 mo. PATIENT SUMMARY We reviewed the published literature detailing the sexual consequences of focal therapy for localised prostate cancer using patient-reported outcome questionnaires. Patients were likely to describe a significant decrease in their erectile function at 3 mo, with improvements noted at 6 and 12 mo. The results obtained may not be reproducible in a more diverse population, and further research is warranted to better study aspects other than erectile function, such as ejaculation or orgasm.
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Affiliation(s)
- Gaelle Fiard
- UCL Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK; Department of Urology, Grenoble Alpes University Hospital, Grenoble, France; Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France.
| | - Aminah Chowdhury
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK; GKT School of Medical Education, King's College London, London, UK
| | - Aneirin R Potter
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK; GKT School of Medical Education, King's College London, London, UK
| | - Celina J Pook
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK; GKT School of Medical Education, King's College London, London, UK
| | - Daniel Kelly
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Mark Emberton
- UCL Division of Surgery & Interventional Science, University College London, London, UK; Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
| | - Tet Yap
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
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26
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Pighin S, Tentori K. The challenge of mental simulation in preference-sensitive treatment decisions. Transl Behav Med 2021; 11:276-278. [PMID: 31816031 DOI: 10.1093/tbm/ibz181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This commentary discusses the importance for preference-sensitive treatment decisions of episodic future thinking, which is the capacity to mentally simulate and pre-experience what might occur in one's personal future. Our aim is to call attention to this important topic since patients confronted with preference-sensitive treatment decisions could benefit from professional support that promotes the construction of comprehensive and detailed mental simulations of what might affect their future well-being and satisfaction.
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Affiliation(s)
- Stefania Pighin
- Center for Mind/Brain Sciences, University of Trento, Rovereto, TN, Italy
| | - Katya Tentori
- Center for Mind/Brain Sciences, University of Trento, Rovereto, TN, Italy
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27
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Skyring TA, Mansfield KJ, Mullan JR. Factors Affecting Satisfaction with the Decision-Making Process and Decision Regret for Men with a New Diagnosis of Prostate Cancer. Am J Mens Health 2021; 15:15579883211026812. [PMID: 34261353 PMCID: PMC8287369 DOI: 10.1177/15579883211026812] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
For men with newly diagnosed prostate cancer the decisions about
treatment options are complex and difficult. The aim of this study was
to investigate any association between the extent to which men wanted
to be involved in the decision making process, their satisfaction with
that process, and their levels of decision regret after treatment. The
study population consisted of men diagnosed with prostate cancer at a
regional center in Australia. Men (n = 324) were
invited to complete a mail out survey which included demographic
questions, the treatment chosen, and three validated tools: The
Control Preference Scale to measure the degree of control assumed when
making decisions about medical interventions; the Treatment
Decision-Making Satisfaction Scale (TDM- SAT) to assess satisfaction
with the treatment decision making process; and the Decision Regret
Scale to assess the level of regret after treatment. The majority of
the 151 respondents (47% response rate) expressed an active decision
control preference. There was no correlation between age and the
treatment chosen or the degree of control men exerted over the
decision-making process. Men who preferred a passive role were less
satisfied with the decision-making process than were those who took an
active or collaborative approach. A strong inverse correlation was
demonstrated between regret experienced and satisfaction with the
decision-making process. In conclusion, for men newly diagnosed with
prostate cancer, taking an active role in the treatment decision
making process led to greater satisfaction with that process, which in
turn reduced their chances of experiencing regret following
treatment.
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Affiliation(s)
- Timothy A Skyring
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia.,South Coast Urology, Wollongong, NSW, Australia
| | - Kylie J Mansfield
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia
| | - Judy R Mullan
- School of Medicine, University of Wollongong, Wollongong, NSW, Australia.,CHRISP, University of Wollongong, Wollongong, NSW Australia
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28
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Flannery MA, Culakova E, Canin BE, Peppone L, Ramsdale E, Mohile SG. Understanding Treatment Tolerability in Older Adults With Cancer. J Clin Oncol 2021; 39:2150-2163. [PMID: 34043433 PMCID: PMC8238902 DOI: 10.1200/jco.21.00195] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 03/15/2021] [Accepted: 04/05/2021] [Indexed: 01/03/2023] Open
Affiliation(s)
- Marie A. Flannery
- University of Rochester Medical Center, School of Nursing, Rochester, NY
| | - Eva Culakova
- Department of Surgery, University of Rochester Medical Center, Rochester, NY
| | - Beverly E. Canin
- SCOREboard Stakeholder Advisory Group, University of Rochester Medical Center, Rochester, NY
| | - Luke Peppone
- Department of Surgery, University of Rochester Medical Center, Rochester, NY
| | - Erika Ramsdale
- Department of Medicine, University of Rochester, Rochester, NY
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29
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Time pressure predicts decisional regret in men with localized prostate cancer: data from a longitudinal multicenter study. World J Urol 2021; 39:3755-3761. [PMID: 34021406 PMCID: PMC8519821 DOI: 10.1007/s00345-021-03727-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/04/2021] [Indexed: 12/24/2022] Open
Abstract
PURPOSE A substantial proportion of men with localized prostate cancer (lPCa) later regret their treatment decision. We aimed to identify factors contributing to decisional regret. METHODS We conducted a longitudinal study, in which men with lPCa were surveyed at four measurement points: T0 (baseline) = prior to treatment; T1 = 6; T2 = 12; T3 = 18 months after baseline. χ2-tests and independent t-tests were used to compare men undergoing different treatments [Active Surveillance (AS) vs. local treatment]. Logistic regression models were fitted to investigate the associations between predictors (time pressure, information provided by the urologist, impairment of erectile functioning, satisfaction with sexual life) and the criterion decisional regret. RESULTS At baseline, the sample included N = 176 men (AS: n = 100; local treatment: n = 76). At T2 and T3, men after local therapies reported higher regret than men under AS. Decisional regret at T3 was predicted by time pressure at baseline (OR 2.28; CI 1.04-4.99; p < 0.05), erectile dysfunction at T2 and T3 (OR 3.40; CI 1.56-7.42; p < 0.01), and satisfaction with sexual life at T1-T3 (OR 0.44; CI 0.20-0.96; p < 0.05). CONCLUSIONS Time pressure, erectile dysfunction, and satisfaction with sexual life predict decisional regret in men with lPCa. Mitigating time pressure and realistic expectations concerning treatment side effects may help to prevent decisional regret in PCa survivors. TRIAL REGISTRATION NUMBER DRKS00009510; date of registration: 2015/10/28.
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30
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Tillier CN, Vromans RD, Boekhout AH, Veerman H, Wollersheim BM, van Muilekom HAM, Boellaard TN, van Leeuwen PJ, van de Poll-Franse LV, van der Poel HG. Individual risk prediction of urinary incontinence after prostatectomy and impact on treatment choice in patients with localized prostate cancer. Neurourol Urodyn 2021; 40:1550-1558. [PMID: 34004044 DOI: 10.1002/nau.24703] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 04/10/2021] [Accepted: 04/27/2021] [Indexed: 11/12/2022]
Abstract
AIMS Individualized information about the risk of incontinence after prostatectomy could help patients in shared decision-making. METHODS We compared a historical control cohort (n = 254; between June 2016 and 2017) that received standardized information about the risk of incontinence after robot-assisted radical prostatectomy (RARP) with a prospective patient cohort (n = 254; between June 2017 and May 2018) that received individualized information of the chance of recovery of incontinence within 6 months postoperatively based on the continence prediction tool (CPRED). We measured switch in treatment choice, health-related quality of life (QoL) in both cohorts and the accuracy of the CPRED tool. RESULTS Patients in the individualized information group with RARP as initial preference switched more often to another treatment than patients who received standardized information (16% vs. 5%; p = 0.001). Patients in the individualized information group with a high risk of incontinence and with RARP as initial preference switched more often to other treatments than patients in intermediate/low risk of incontinence (35% vs. 9.8%; p = 0.001). Patients with a low risk of incontinence choosing RARP after individualized information were less likely to use more than one diaper a day at any time postoperative (p = 0.001) compared to men with an intermediate/high incontinence risk. Overall QoL was worse in patients with incontinence than patients with continence 6 and 12 months after RARP (respectively; p < 0.0001 and p = 0.007). CONCLUSION Personalized information about the risk of incontinence after RARP makes more patients reconsidering their initial treatment preference. The CPRED correlated strongly with continence outcome after RARP and is a useful tool for shared decision-making.
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Affiliation(s)
- Corinne N Tillier
- Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Ruben D Vromans
- Department of Communication and Cognition, Tilburg University, Tilburg, The Netherlands.,Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Annelies H Boekhout
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Hans Veerman
- Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.,Department of Urology, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Barbara M Wollersheim
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Henricus A M van Muilekom
- Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Thierry N Boellaard
- Department of Radiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Pim J van Leeuwen
- Department of Urology, Antoni van Leeuwenhoek Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Lonneke V van de Poll-Franse
- Division of Psychosocial Research and Epidemiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.,Department of Research, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands.,Department of Medical and Clinical Psychology, CoRPS - Center of Research on Psychology in Somatic Diseases, Tilburg University, Tilburg, The Netherlands
| | - Henk G van der Poel
- Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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31
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Westhoff N, Ernst R, Kowalewski KF, Schmidt L, Worst TS, Michel MS, von Hardenberg J. Treatment decision satisfaction and regret after focal HIFU for localized prostate cancer. World J Urol 2021; 39:1121-1129. [PMID: 32533247 PMCID: PMC8124049 DOI: 10.1007/s00345-020-03301-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Accepted: 06/03/2020] [Indexed: 11/15/2022] Open
Abstract
PURPOSE Focal therapies (FTs) are investigated within prospective studies on selected patients treated for localized prostate cancer (PCa). Benefits are preservation of genitourinary function and reduced complications, but follow-up is elaborate and is associated with uncertainty as cancer-free survival appears to be lower compared to standard radical treatments. The aim of this study was to analyse patient-reported acceptance of FT and evaluate factors associated with treatment decision regret. METHODS 52 patients who received focal high-intensity focused ultrasound for low- to intermediate-risk PCa between 2014 and 2019 within two prospective trials were eligible for a survey regarding PCa-related treatment regret and quality-of-life (Clark's scale) and the following potential predictors: sociodemographic variables, Charlson Comorbidity Index, subjective aging (AARC-10 SF), and general health-related quality-of-life (SF-12). Cancer persistence/recurrence (multiparametric MRI and fusion biopsy after 12 months) and functional outcomes (EPIC-26 UI/UIO/S) data were also included in this study. RESULTS The overall survey response rate was 92.3% (48/52 patients). Median follow-up was 38 months (interquartile range = 25-50 months). In total, ten patients (20.8%) reported treatment decision regret. In univariable analyses, a clinically meaningful increase in urinary incontinence showed a significant association (OR 4.43; 95% CI 0.99-20.53; p = 0.049) with regret. Cancer recurrence (OR 12.31; 95% CI 1.78-159.26; p = 0.023) and general health worry as a domain of Clark's scale (OR 1.07; 95% CI 1.03-1.14; p < 0.01) were predictors of regret in a multivariable logistic regression model (AUC = 0.892). CONCLUSION Acceptance of FT is comparable to standard treatments. Extensive follow-up including regular PSA testing does not cause additional regret but careful patient selection and information before FT is crucial.
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Affiliation(s)
- Niklas Westhoff
- Department of Urology and Urosurgery, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
| | - Ramona Ernst
- Department of Urology and Urosurgery, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Karl Friedrich Kowalewski
- Department of Urology and Urosurgery, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Laura Schmidt
- Department of Health Psychology, Institute of Psychology, Heidelberg University, Hauptstraße 47-51, 69117, Heidelberg, Germany
| | - Thomas Stefan Worst
- Department of Urology and Urosurgery, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Maurice Stephan Michel
- Department of Urology and Urosurgery, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
| | - Jost von Hardenberg
- Department of Urology and Urosurgery, Medical Faculty Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany
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32
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Lindsay J, Uribe S, Moschonas D, Pavlakis P, Perry M, Patil K, Kusuma VRM. Patient Satisfaction and Regret After Robot-assisted Radical Prostatectomy: A Decision Regret Analysis. Urology 2020; 149:122-128. [PMID: 33359493 DOI: 10.1016/j.urology.2020.12.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 11/02/2020] [Accepted: 12/10/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To assess treatment satisfaction and decision regret post robot-assisted radical prostatectomy (RARP) and correlate these with clinical, demographic and quality of life indicators. Our study took place at a high-volume United Kingdom center and patients were assessed at a minimum of 18 months postsurgery. METHODS Patients who underwent RARP between June 2011 and May 2016 were invited to participate through mailed questionnaires. A total of 207 patients formed our cohort. The questionnaires included European Organization for Research and Treatment of Cancer Quality of Life of Cancer patients 30 and PR25 modules, sexual health inventory in men and Likert decisional regret scale. A Decisional Regret Scale score of >15 was used to define an outcome of high decision regret. RESULTS The mean patient age was 63 years and the mean duration of follow up was 36 months. Of the 106 responders, 51 (48%) were fully satisfied with the decision to undergo RARP and 32 (30%) recorded high regret. The mean Decisional Regret Scale score was 11.3. High decision regret associated with the length of time from RARP to questionnaire administration, higher prostate specific quality of life symptom scores and lower sexual and erectile function scores. CONCLUSION Our study represents the first contemporary United Kingdom series assessing decision regret following the management of localised prostate cancer with RARP. Higher regret was seen in one third of patients and was associated with worse disease-specific quality of life, sexual and erectile function measures. To minimize regret, collaborative and detailed discussion should take place pre-operatively when counselling patients about RARP. The potential longevity and impact on quality of life of these side effects should be made clear.
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Affiliation(s)
- Jamie Lindsay
- Department of Urology, Royal Surrey County Hospital, Guildford, United Kingdom
| | - Santiago Uribe
- Department of Urology, Royal Surrey County Hospital, Guildford, United Kingdom
| | - Dimitrios Moschonas
- Department of Urology, Royal Surrey County Hospital, Guildford, United Kingdom
| | - Pavlos Pavlakis
- Department of Urology, Royal Surrey County Hospital, Guildford, United Kingdom
| | - Matthew Perry
- Department of Urology, Royal Surrey County Hospital, Guildford, United Kingdom
| | - Krishnaji Patil
- Department of Urology, Royal Surrey County Hospital, Guildford, United Kingdom
| | - Venkata R M Kusuma
- Department of Urology, Royal Surrey County Hospital, Guildford, United Kingdom.
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33
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Berry DL, Hong F, Blonquist TM, Halpenny B, Xiong N, Filson CP, Master VA, Sanda MG, Chang P, Chien GW, Jones RA, Krupski TL, Wolpin S, Wilson L, Hayes JH, Trinh QD, Sokoloff M. Decision regret, adverse outcomes, and treatment choice in men with localized prostate cancer: Results from a multi-site randomized trial. Urol Oncol 2020; 39:493.e9-493.e15. [PMID: 33353864 DOI: 10.1016/j.urolonc.2020.11.038] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Revised: 11/15/2020] [Accepted: 11/23/2020] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Men diagnosed with localized prostate cancer must navigate a highly preference-sensitive decision between treatment options with varying adverse outcome profiles. We evaluated whether use of a decision support tool previously shown to decrease decisional conflict also impacted the secondary outcome of post-treatment decision regret. METHODS Participants were randomized to receive personalized decision support via the Personal Patient Profile-Prostate or usual care prior to a final treatment decision. Symptoms were measured just before randomization and 6 months later; decision regret was measured at 6 months along with records review to ascertain treatment choices. Regression modeling explored associations between baseline variables including race and D`Amico risk, study group, and 6-month variables regret, choice, and symptoms. RESULTS At 6 months, 287 of 392 (73%) men returned questionnaires of which 257 (89%) had made a treatment choice. Of that group, 201 of 257 (78%) completely answered the regret scale. Regret was not significantly different between participants randomized to the P3P intervention compared to the control group (P = 0.360). In univariate analyses, we found that Black men, men with hormonal symptoms, and men with bowel symptoms reported significantly higher decision regret (all P < 0.01). Significant interactions were detected between race and study group (intervention vs. usual care) in the multivariable model; use of the Personal Patient Profile-Prostate was associated with significantly decreased decisional regret among Black men (P = 0.037). Interactions between regret, symptoms and treatment revealed that (1) men choosing definitive treatment and reporting no hormonal symptoms reported lower regret compared to all others; and (2) men choosing active surveillance and reporting bowel symptoms had higher regret compared to all others. CONCLUSION The Personal Patient Profile-Prostate decision support tool may be most beneficial in minimizing decisional regret for Black men considering treatment options for newly-diagnosed prostate cancer. TRIAL REGISTRATION NCT01844999.
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Affiliation(s)
- Donna L Berry
- Dana-Farber Cancer Institute, Boston, MA; University of Washington School of Nursing, Seattle, WA.
| | | | | | | | - Niya Xiong
- Dana-Farber Cancer Institute, Boston, MA
| | - Christopher P Filson
- Department of Urology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute, Emory Healthcare, Atlanta, GA; Atlanta VA Medical Center, Decatur, GA
| | - Viraj A Master
- Department of Urology, Emory University School of Medicine, Atlanta, GA; Winship Cancer Institute, Emory Healthcare, Atlanta, GA
| | - Martin G Sanda
- Department of Urology, Emory University School of Medicine, Atlanta, GA
| | - Peter Chang
- Beth Israel Deaconess Medical Center, Boston, MA
| | - Gary W Chien
- Department of Urology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, CA
| | - Randy A Jones
- University of Virginia School of Nursing, Charlottesville, VA
| | | | - Seth Wolpin
- University of Washington School of Nursing, Seattle, WA
| | - Leslie Wilson
- Department of Clinical Pharmacy, University of California, San Francisco, San Francisco, CA
| | - Julia H Hayes
- Dana-Farber Cancer Institute at St. Elizabeth's Medical Center, Boston, MA
| | - Quoc-Dien Trinh
- Department of Urology, Brigham and Women's Hospital, Boston, MA
| | - Mitchell Sokoloff
- Department of Urology, University of Massachusetts Medical Center, Worchester, MA
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34
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Fiard G, Kelly D, Yap T, Emberton M. Detailing sexual outcomes after treatment of localised prostate cancer with focal therapy using various energy sources: protocol for a mixed-methods study. BMJ Open 2020; 10:e045500. [PMID: 33323452 PMCID: PMC7745515 DOI: 10.1136/bmjopen-2020-045500] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
INTRODUCTION Focal therapy has emerged as a promising treatment option for men with localised prostate cancer. However, most of the evaluation of postoperative function has taken place at a relatively high, non-granular level. Most of the data we use to provide informed consent for our patients is obtained from retrospective series, or derived from prospective studies whose primary outcome was oncological. Finally, most studies have focused on erectile function and overlooked other, presumably important, elements of male sexual function. The present study aims at studying in-depth the sexual consequences of focal therapy with various energy sources. METHODS AND ANALYSIS This will be a mixed-methods research study based on a retrospective and prospective cohort, recruited in parallel. The retrospective cohort will consist of patients treated with focal irreversible electroporation, and the prospective cohort of patients treated with three focal therapy energies. Participants will be recruited from two UK urology centres, one National Health Service and one private. On consent, patients will fill in self-administered validated questionnaires (International Index of Erectile Function-15 (IIEF-15), Male Sexual Health Questionnaire-Ejaculatory Dysfunction-Short Form (MSHQ-EjD-SF)) and semistructured interviews will be organised to collect patients' expectations and postoperative changes in domains such as erection, ejaculation, orgasm, libido/sexual desire, masculinity/virility, penile morphology, pain or discomfort, regret, shame, cancer-related stress, overall impact and partner satisfaction. An exploratory thematic analysis will be performed to detail recurring themes that will be grouped into clusters of experiences. We will then be able to find clusters of agreement and disagreement that will be illustrated using exemplar patient quotations. ETHICS AND DISSEMINATION Ethical approval was obtained (Regional Ethics Committee reference 20/NW/0335), as well as Health Research Authority approval. Results will be published in open-access peer-reviewed journals. Findings will also be translated into patient information resources (leaflets, online information sheets). TRIAL REGISTRATION NUMBER ISRCTN11634296; Pre-results.
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Affiliation(s)
- Gaelle Fiard
- UCL Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
- Department of Urology, Grenoble Alpes University Hospital, Grenoble, France
- Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, Grenoble, France
| | - Daniel Kelly
- School of Healthcare Sciences, Cardiff University, Cardiff, UK
| | - Tet Yap
- Department of Urology, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Mark Emberton
- UCL Division of Surgery & Interventional Science, University College London, London, UK
- Department of Urology, University College London Hospital NHS Foundation Trust, London, UK
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35
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Szproch AK, Maguire R. A systematic review of the factors associated with regret post-cancer treatment. J Psychosoc Oncol 2020; 40:1-25. [PMID: 33191874 DOI: 10.1080/07347332.2020.1844846] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PROBLEM IDENTIFICATION Expanding on previous work in specific cancer populations, this review aimed to explore factors associated with decisional regret following treatment for a range of cancer types. LITERATURE SEARCH A systematic search of four databases identified 1747 studies, using search terms relating to cancer survivors and decisional regret. Following quality appraisal, correlates of regret were abstracted and analyzed using narrative synthesis. DATA EVALUATION/SYNTHESIS Seventy-two studies met the inclusion criteria. Factors associated with treatment regret were categorized as being either modifiable or less modifiable. Regret was associated with various sociodemographic factors, physical health, treatment type, an unsatisfactory decision-making process, poorer mental health and lack of social support. CONCLUSION Results highlight the complex nature of regret and illustrate how this can be experienced following a range of cancer treatments. As regret can be an obstacle to full-recovery from cancer, this review suggests some ways in which the emergence of regret may be mitigated.
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Affiliation(s)
| | - Rebecca Maguire
- Department of Psychology, Maynooth University, Maynooth, Co. Kildare, Ireland
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36
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Shiridzinomwa C, Harding S. The role of body image in treatment decision-making and post-treatment regret following prostatectomy. ACTA ACUST UNITED AC 2020; 29:S8-S16. [PMID: 33035099 DOI: 10.12968/bjon.2020.29.18.s8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Three main treatments are offered to men with localised prostate cancer: active monitoring, radiotherapy and prostatectomy. The aim of this research was to explore the role of body image in treatment decision-making and post-treatment regret following prostatectomy for localised prostate cancer. Data were collected via nine semi-structured interviews. Interviews underwent thematic analysis and four themes emerged: need to prolong life, loss of function and self, post-surgery effects on body image and confidence, and coping strategies. Participants revealed that loss of erectile function following surgery resulted in reduced self-confidence, and changes in their perception of their body.
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Affiliation(s)
| | - Sam Harding
- Senior Research Associate, North Bristol NHS Trust, Southmead Hospital, Bristol
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37
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Te Marvelde L, Milne RL, Hornby CJ, Chapman AB, Giles GG, Haines IE. Differences in treatment choices for localised prostate cancer diagnosed in private and public health services. Med J Aust 2020; 213:411-417. [PMID: 32996611 DOI: 10.5694/mja2.50794] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 03/12/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE To compare treatments for localised prostate cancer for men diagnosed in private and public health services in Victoria. DESIGN Retrospective analysis of Victorian Cancer Registry data linked to population-based administrative health datasets. SETTING, PARTICIPANTS 29 325 Victorian men diagnosed with prostate cancer during 2011-2017. MAIN OUTCOME MEASURES Proportions of men in private and public health services receiving radical prostatectomy (with or without curative radiation therapy) or curative external beam radiation therapy alone within 12 months of diagnosis. RESULTS After adjusting for age, tumour classification and comorbidity, men diagnosed in private health services received radical treatment more frequently than men diagnosed in public health services (odds ratio [OR], 1.40; 95% confidence interval [CI], 1.31-1.49). The proportion of private patients who underwent radical prostatectomy was larger than that for public patients (44% v 28%; OR, 2.28; 95% CI, 2.13-2.44) and the proportion of private patients who received curative external beam radiation therapy alone (excluding brachytherapy) was smaller (9% v 19%; OR, 0.45; 95% CI, 0.42-0.49). These differences were apparent for all International Society of Urological Pathology (ISUP) tumour grades. The magnitude of the difference for prostatectomy was greater for men aged 70 years or more; for radiation therapy alone, it was larger for those diagnosed before age 70. The differences between private and public services narrowed during 2011-2017 for men with ISUP grade 1 disease, but not ISUP grade 2-5 tumours. CONCLUSION Prostate cancer treatment choices differ substantially between men diagnosed in private and public health services in Victoria. These differences are not explained by disease severity or comorbidity.
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Affiliation(s)
- Luc Te Marvelde
- Cancer Council Victoria, Melbourne, VIC.,Victorian Department of Health and Human Services, Melbourne, VIC
| | - Roger L Milne
- Cancer Council Victoria, Melbourne, VIC.,Centre for Epidemiology and Biostatistics, the University of Melbourne, Melbourne, VIC.,Monash University, Melbourne, VIC
| | - Colin J Hornby
- Victorian Department of Health and Human Services, Melbourne, VIC
| | - Adam B Chapman
- Victorian Department of Health and Human Services, Melbourne, VIC
| | - Graham G Giles
- Cancer Council Victoria, Melbourne, VIC.,Centre for Epidemiology and Biostatistics, the University of Melbourne, Melbourne, VIC.,Monash University, Melbourne, VIC
| | - Ian E Haines
- Monash University, Melbourne, VIC.,Cabrini Health, Melbourne, VIC
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Campagna JP, Baumgarten L, Labine LP, Palma I, Albersheim JA, Sathianathen N, Weight CJ. Prostate Cancer Survival Estimates by the General Public Using Unrestricted Internet Searches and Online Nomograms. Eur Urol Focus 2020; 6:959-966. [PMID: 30723050 DOI: 10.1016/j.euf.2019.01.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 01/02/2019] [Accepted: 01/16/2019] [Indexed: 10/27/2022]
Abstract
BACKGROUND Patient understanding of cancer-associated risk influences treatment preferences and is vital for making informed treatment decisions. Although patients traditionally relied on physician visits for cancer information, most adults now use the Internet as a primary source of health information. OBJECTIVE To evaluate whether US adults can accurately estimate survival for hypothetical prostate cancer patients using unrestricted Internet searching and an online nomogram. DESIGN, SETTING, AND PARTICIPANTS Adults were recruited at the Minnesota State Fair. Participants were shown a pathology report for a prostatectomy cancer specimen and asked to estimate the patient's 15-yr survival using an unrestricted Internet search. Participants were then asked to re-estimate using a freely available, validated prostate cancer nomogram. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Participants' answers were compared to a "reference" estimate and a "ballpark" estimate of ±10 percentage points of the "reference" value. RESULTS AND LIMITATIONS A total of 129 participants met the inclusion criteria and generated complete responses. Only 12% (95% confidence interval [CI] 7.8-19.2%) were within the "ballpark" estimate when using unrestricted Internet searching for overall survival estimates. 23% (95% CI 16.8-31.3%) correctly used the nomogram and 51% (95% CI 42.6-59.6%) estimated within the "ballpark" when using the nomogram. CONCLUSIONS Use of an unrestricted Internet search often yields inaccurate estimations of life expectancy, while estimations significantly improve with nomogram use. Physicians should educate and guide patients towards credible online health resources, facilitate their effective use, and engage in discussion with patients regarding the utility of this information. PATIENT SUMMARY The general public finds it difficult to estimate prostate cancer survival using unrestricted Internet searches. Most patients would benefit from Internet guidance from their clinicians to better understand prostate cancer pathology reports.
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Affiliation(s)
| | | | | | - Isaac Palma
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
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39
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Unmet expectations in prostate cancer patients and their association with decision regret. J Cancer Surviv 2020; 14:731-738. [DOI: 10.1007/s11764-020-00888-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Accepted: 04/24/2020] [Indexed: 10/24/2022]
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40
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Wilding S, Downing A, Selby P, Cross W, Wright P, Watson EK, Wagland R, Kind P, Donnelly DW, Hounsome L, Mottram R, Allen M, Kearney T, Butcher H, Gavin A, Glaser A. Decision regret in men living with and beyond nonmetastatic prostate cancer in the United Kingdom: A population-based patient-reported outcome study. Psychooncology 2020; 29:886-893. [PMID: 32065691 PMCID: PMC7317932 DOI: 10.1002/pon.5362] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 01/28/2020] [Accepted: 02/11/2020] [Indexed: 11/26/2022]
Abstract
Objective Clinical options for managing nonmetastatic prostate cancer (PCa) vary. Each option has side effects associated with it, leading to difficulty in decision‐making. This study aimed to assess the relationship between patient involvement in treatment decision‐making and subsequent decision regret (DR), and quantify the impact of health‐related quality of life (HRQL) outcomes on DR. Methods Men living in the United Kingdom, 18 to 42 months after diagnosis of PCa, were identified from cancer registration data and sent a questionnaire. Measures included the Decision Regret Scale (DRS), Expanded Prostate cancer Index Composite short form (EPIC‐26), EQ‐5D‐5L, and an item on involvement in treatment decision‐making. Multivariable ordinal regression was utilized, with DR categorized as none, mild, or moderate/severe regret. Results A total of 17 193 men with stage I‐III PCa completed the DRS: 36.6% reported no regret, 43.3% mild regret, and 20.0% moderate/severe regret. The odds of reporting DR were greater if men indicated their views were not taken into account odds ratio ([OR] = 6.42, 95% CI: 5.39‐7.64) or were involved “to some extent” in decision‐making (OR = 4.63, 95% CI: 4.27‐5.02), compared with men who were “definitely” involved. After adjustment, including for involvement, men reporting moderate/big problems with urinary, bowel, or sexual function were more likely to experience regret compared with men with no/small problems. Better HRQL scores were associated with lower levels of DR. Conclusions This large‐scale study demonstrates the benefit of patient involvement in treatment decision‐making for nonmetastatic PCa. However, men experiencing side effects and poorer HRQL report greater DR. Promoting engagement in clinical decision‐making represents good practice and may reduce the risk of subsequent regret.
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Affiliation(s)
- Sarah Wilding
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.,Leeds Institute for Data Analytics, University of Leeds, Leeds, UK.,School of Psychology, University of Leeds, Leeds, UK
| | - Amy Downing
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.,Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Peter Selby
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - William Cross
- Leeds Teaching Hospitals NHS Trust, University of Leeds, Leeds, UK
| | - Penny Wright
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Eila K Watson
- Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University, Oxford, UK
| | - Richard Wagland
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Paul Kind
- Academic Unit of Health Economics, University of Leeds, Leeds, UK
| | - David W Donnelly
- Northern Ireland Cancer Registry, Queen's University Belfast, Belfast, UK
| | - Luke Hounsome
- National Cancer Registration and Analysis Service, Public Health England, Bristol, UK
| | - Rebecca Mottram
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.,Leeds Institute for Data Analytics, University of Leeds, Leeds, UK
| | - Majorie Allen
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.,Leeds Institute for Data Analytics, University of Leeds, Leeds, UK.,Leeds Teaching Hospitals NHS Trust, University of Leeds, Leeds, UK
| | - Therese Kearney
- Northern Ireland Cancer Registry, Queen's University Belfast, Belfast, UK
| | - Hugh Butcher
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK
| | - Anna Gavin
- Northern Ireland Cancer Registry, Queen's University Belfast, Belfast, UK
| | - Adam Glaser
- Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.,Leeds Institute for Data Analytics, University of Leeds, Leeds, UK.,Leeds Teaching Hospitals NHS Trust, University of Leeds, Leeds, UK
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Adaptation and Initial Psychometric Evaluation of an Informed Prostate Cancer Screening Decision Self-Efficacy Scale for African-American Men. J Racial Ethn Health Disparities 2020; 7:746-759. [PMID: 31997285 DOI: 10.1007/s40615-020-00702-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/20/2019] [Accepted: 01/09/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE To evaluate whether computer-based prostate cancer screening decision aids enhance decision self-efficacy for African-American men, culturally relevant and reliable measures are needed. However, limited psychometric evidence exists on the health-related decision self-efficacy of African-American men. This study describes the development and psychometric evaluation of the 11-item Informed Prostate Cancer Screening Decision Self-Efficacy Scale among 354 African-American men. METHODS Exploratory factor analysis was conducted with maximum-likelihood estimation and polychoric correlations followed by Promax and Varimax rotations. RESULTS Exploratory factor analysis yielded a one-factor, 11-item model of the modified scale with excellent internal consistency reliability at 0.95 and factor loadings ranging from 0.70 to 0.90. Both parallel analysis and a scree plot confirmed the retention of one factor, and the standardized root mean square residual (0.06) indicated that the factor structure explained most of the correlations. CONCLUSIONS Findings suggest the one-factor, 11-item Informed Prostate Cancer Screening Decision Self-Efficacy Scale has excellent psychometric properties and utility in reliably measuring health-related decision self-efficacy in African-American men. Future research is needed to confirm this factor structure among socio-demographically diverse African Americans.
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Quality of Life and Decision Regret After Postoperative Radiation Therapy to the Prostatic Bed Region With or Without Elective Pelvic Nodal Radiation Therapy. Pract Radiat Oncol 2019; 9:e516-e527. [DOI: 10.1016/j.prro.2019.06.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 05/10/2019] [Accepted: 06/10/2019] [Indexed: 12/25/2022]
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Agochukwu NQ, Wittmann D, Boileau NR, Dunn RL, Montie JE, Kim T, Miller DC, Peabody J, Carlozzi NE. Validity of the Patient-Reported Outcome Measurement Information System (PROMIS) Sexual Interest and Satisfaction Measures in Men Following Radical Prostatectomy. J Clin Oncol 2019; 37:2017-2027. [PMID: 31232671 DOI: 10.1200/jco.18.01782] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
PURPOSE Patient-reported outcomes after radical prostatectomy have focused on erectile function. To date, no studies have validated the Patient-Reported Outcome Measurement Information System (PROMIS) Sexual Interest and Satisfaction single item measures in patients with prostate cancer, nor have studies examined how these measures relate to erectile function. In addition, data are lacking with regard to the clinical responsiveness of these measures to treatment. We sought to validate and examine the clinical utility of these measures in men after radical prostatectomy. PATIENTS AND METHODS We identified men who underwent a robotic radical prostatectomy from May 2014 to January 2016 in the Michigan Urological Surgery Improvement Collaborative. A single item from the PROMIS Global Satisfaction With Sex Life subdomain and a single item from the PROMIS Interest in Sexual Activity subdomain were administered. Erectile function was also assessed. Differences between baseline and 24-month T-scores for both PROMIS interest and satisfaction were examined. Multilevel models were constructed to examine change over time. RESULTS A total of 1,604 patients were included in the analysis. Convergent and discriminant validity of the PROMIS measures was supported. The mean PROMIS interest T-score decreased significantly from baseline to 3 months (P = .001) and significantly increased from 3 months to 24 months in this cohort, with 24-month scores exceeding baseline scores (P < .001). The mean PROMIS satisfaction T-score declined from baseline to 3 months and increased from 3 months to 24 months (P < .002). CONCLUSION PROMIS Global Satisfaction With Sex Life and Interest in Sexual Activity single-item measures are fundamental measures in prostate cancer survivorship. Patients are interested in sex despite functional losses and can salvage satisfaction, thereby giving insight into attainable patient-centered survivorship goals for sexual recovery after radical prostatectomy.
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Affiliation(s)
- Nnenaya Q Agochukwu
- 1University of Michigan Health System, Ann Arbor, MI.,2University of Michigan, Ann Arbor, MI
| | - Daniela Wittmann
- 1University of Michigan Health System, Ann Arbor, MI.,2University of Michigan, Ann Arbor, MI
| | | | - Rodney L Dunn
- 1University of Michigan Health System, Ann Arbor, MI.,2University of Michigan, Ann Arbor, MI
| | - James E Montie
- 1University of Michigan Health System, Ann Arbor, MI.,2University of Michigan, Ann Arbor, MI
| | - Tae Kim
- 1University of Michigan Health System, Ann Arbor, MI.,2University of Michigan, Ann Arbor, MI
| | - David C Miller
- 1University of Michigan Health System, Ann Arbor, MI.,2University of Michigan, Ann Arbor, MI
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Mack JW, Fasciano KM, Block SD. Adolescent and Young Adult Cancer Patients' Experiences With Treatment Decision-making. Pediatrics 2019; 143:peds.2018-2800. [PMID: 31000684 DOI: 10.1542/peds.2018-2800] [Citation(s) in RCA: 46] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/01/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Adolescents and young adults (AYAs) with cancer generally want to engage in decision-making but are not always able to do so. We evaluated cancer treatment decision-making among AYAs, including decisional engagement and regret. METHODS We surveyed 203 AYA patients with cancer aged 15 to 29 (response rate 74%) treated at a large academic center and their oncologists. Patients were approached within 6 weeks of diagnosis and asked to report decision-making preferences and experiences (Decisional Roles Scale) and the extent to which they regretted their initial treatment decision (Decisional Regret Scale) assessed at baseline and 4 and 12 months later. RESULTS A majority of AYAs (58%) wanted to share responsibility for decision-making with oncologists; half (51%) preferred limited involvement from parents. Although most AYAs held roles they preferred, those who did not reported holding more passive roles relative to oncologists (P < .0001) and parents (P = .002) than they desired. Nearly one-quarter of patients (24%; 47 of 195) experienced regret about initial cancer treatment decisions at baseline, with similar rates at 4 (23%) and 12 (19%) months. In a multivariable model adjusted for age, decisional roles were not associated with regret; instead, regret was less likely among patients who trusted oncologists completely (odds ratio 0.17 [95% confidence interval 0.06-0.46]; P < .001) and who reported that oncologists understood what was important to them when treatment started (odds ratio 0.13 [95% confidence interval 0.04-0.42]; P < .001). CONCLUSIONS Nearly one-fourth of AYA patients expressed regret about initial treatment decisions. Although some AYAs have unmet needs for decisional engagement, attributes of the patient-oncologist relationship, including trust and mutual understanding, may be most protective against regret.
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Affiliation(s)
- Jennifer W Mack
- Division of Population Sciences, Department of Pediatric Oncology, McGraw/Patterson Center for Outcomes and Policy Research and .,Division of Hematology and Oncology, Boston Children's Hospital, Boston, Massachusetts; and
| | - Karen M Fasciano
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Departments of Psychiatry and
| | - Susan D Block
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts.,Departments of Psychiatry and.,Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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Shaverdian N, Hegde JV, Felix C, Hsu S, Basehart V, Steinberg ML, Chen AM. Patient perspectives and treatment regret after de-escalated chemoradiation for human papillomavirus-positive oropharyngeal cancer: Findings from a phase II trial. Head Neck 2019; 41:2768-2776. [PMID: 30958605 DOI: 10.1002/hed.25760] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2018] [Revised: 03/03/2019] [Accepted: 03/18/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND We evaluated priorities, expectations, and regret among patients treated on a phase II trial of de-escalated chemoradiation for human papillomavirus (HPV)-positive oropharyngeal cancer. METHODS Eligibility included stage III/IV squamous cell carcinoma of the oropharynx, p16-positivity, age ≥18 years, and Zubrod score 0-1. Participants were surveyed with validated measures evaluating their treatment experience. RESULTS Twenty-four of 27 (89%) patients participated with a median follow-up of 24 months. Twenty-three subjects (96%) selected "being cured" or "living as long as possible" as top priority. No patient reported any regret about the decision to enroll on a de-escalation protocol. Sixteen participants (67%) found retrospectively reported long-term swallowing function to be either better than or as originally expected. CONCLUSIONS These data offer a baseline landscape of perspectives and priorities for patients treated with de-escalation for HPV-positive oropharyngeal carcinoma and provide support to the fundamental premise underlying ongoing efforts to establish a new standard of care.
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Affiliation(s)
- Narek Shaverdian
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - John V Hegde
- Department of Radiation Oncology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Carol Felix
- Department of Radiation Oncology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Sophia Hsu
- Department of Radiation Oncology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Vincent Basehart
- Department of Radiation Oncology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Michael L Steinberg
- Department of Radiation Oncology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
| | - Allen M Chen
- Department of Radiation Oncology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California.,Department of Radiation Oncology, University of California, Irvine, School of Medicine, Orange, California
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Exploring the perception of survivors on the bidirectional impact between cancer and their social contexts: A mixed-methods approach. Palliat Support Care 2019; 17:668-676. [DOI: 10.1017/s1478951519000038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
AbstractObjectiveThe purpose of the current study was to use a mixed-methods approach to assess the perspective of cancer survivors on the bidirectional impact between cancer and their social contexts.MethodA fixed concurrent triangulation mixed-methods survey design was used with open- and closed-ended questions that were predetermined and administered to participants. Quantitative items included demographic questions and the Life Impact Checklist. Qualitative questions were designed to explore the bidirectional impact between the patient and specific contexts including spirituality/faith, the spousal/partner relationship, and the family. A cross-sectional descriptive approach was used to evaluate the quantitative items and the constant comparative method guided the analysis of open-ended questions.ResultAmong 116 participants (mean age 58.4 years), the majority were female (66.7%) with breast cancer (27.9%). Nearly one-half the respondents endorsed a positive impact of cancer on their spirituality/faith, but qualitative results suggested less of a bidirectional impact. The importance of the spouse/partner during the cancer experience was emphasized, including the subthemes of instrumental and emotional support; however, there was often a negative impact of cancer on the spouse/partner relationship, including sexual functioning. Survivors indicated family members provided instrumental and emotional support, but not as regularly or directly as a spouse/partner.Significance of resultsSocial contexts are important among cancer survivors, with many cancer survivors relying more on their spouse/partner than other family members for support. The cancer experience is stressful not only for survivors, but also for individuals in their social contexts and relationships.
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47
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Cuypers M, Lamers RED, Kil PJM, van de Poll-Franse LV, de Vries M. Longitudinal regret and information satisfaction after deciding on treatment for localized prostate cancer with or without a decision aid. Results at one-year follow-up in the PCPCC trial. PATIENT EDUCATION AND COUNSELING 2019; 102:424-428. [PMID: 30314830 DOI: 10.1016/j.pec.2018.10.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Revised: 10/02/2018] [Accepted: 10/03/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE To investigate the effect of including an online decision aid (DA) during prostate cancer treatment counseling on decisional regret and information satisfaction in a one-year follow-up. METHODS Within a cluster RCT, 18 Dutch hospitals were randomized to DA counseling or care-as-usual, patients (n = 382) initially completed questionnaires directly after treatment decision making. Six and twelve months later regret (Decisional Regret Scale) and information satisfaction (SCIP-B) were assessed. Anxious and depressive symptoms (HADS) was included as possible covariate. RESULTS After 12 months, 43 participants (15%) regretted their treatment choice and 105 participants (36%) were dissatisfied with the information that was received at the time of decision-making, regardless of being exposed to the DA. Anxious and depressive symptoms at follow-up were associated with regret and information dissatisfaction. CONCLUSION No long-term benefical effects emerged from DA usage compared to patients who underwent standard counseling. PRACTICE IMPLICATIONS During PCa treatment counseling, healthcare providers should be aware of anxious and depressive symptoms.
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Affiliation(s)
- Maarten Cuypers
- Department of Social Psychology, Tilburg University, Tilburg, The Netherlands; Radboud Institute for Health Sciences, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Romy E D Lamers
- Department of Urology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.
| | - Paul J M Kil
- Department of Urology, Elisabeth-Tweesteden Hospital, Tilburg, The Netherlands.
| | - Lonneke V van de Poll-Franse
- CoRPS - Center of Research on Psychology in Somatic Diseases, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands; Department of Research, Comprehensive Cancer Organisation Netherlands, Eindhoven, The Netherlands; Department of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Marieke de Vries
- Institute for Computing and Information Sciences (iCIS) & Social and Cultural Psychology, Behavioural Science Institute, Radboud University, Nijmegen, The Netherlands.
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van Stam MA, Aaronson NK, Bosch JLHR, Kieffer JM, van der Voort van Zyp JRN, Tillier CN, Horenblas S, van der Poel HG. Patient-reported Outcomes Following Treatment of Localised Prostate Cancer and Their Association with Regret About Treatment Choices. Eur Urol Oncol 2018; 3:21-31. [PMID: 31411965 DOI: 10.1016/j.euo.2018.12.004] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 11/16/2018] [Accepted: 12/04/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Well-documented reports of patients' experiences with different treatments are important for helping localised prostate cancer (LPC) patients choose among the available treatment options. OBJECTIVE To document differences in patient-reported outcomes (PROs) following radical prostatectomy (RP), external beam radiotherapy (EBRT), brachytherapy (BT), and active surveillance (AS), and to evaluate how these PROs and other factors are associated with treatment decision regret. DESIGN, SETTING, AND PARTICIPANTS A prospective, observational, multicentre study of men diagnosed with LPC (stage cT1-2) during 2014-2016. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Patients completed validated PRO measures (Quality of Life Questionnaire Core 30 [QLQ-C30], Quality of Life Questionnaire prostate cancer-specific module [QLQ-PR25], Decision Regret Scale, and the Memorial Anxiety Scale for Prostate Cancer) before treatment and at 3, 6, and 12mo after treatment. Mixed-effect models were used to describe different PRO patterns. RESULTS AND LIMITATIONS The analytic cohort included 434 men (AS=32%; RP=45%; EBRT=12%; BT=10%). Follow-up response rates were above 90%. At 1-yr follow-up, (1) men who had received RP reported significantly (p<0.01) more urinary incontinence, sexual dysfunction, hormonal/masculinity-related symptoms, and less emotional distress; (2) those having received EBRT reported more sexual dysfunction, hormonal/masculinity-related symptoms, and physical distress; and (3) those having received BT reported more urinary obstruction and irritation symptoms, compared with patients under AS. Irrespective of the treatment modality, 23% of the patients reported clinically relevant treatment regret (99% confidence interval, 17-28%). Multivariate correlates of decision regret were hormonal/masculinity-related symptoms, educational level, and positive surgical margins. CONCLUSIONS Post-treatment physical and psychosocial functioning was significantly associated with specific treatment modalities and pretreatment functioning. Regret was relatively frequently reported by patients who experienced unwanted physical, psychosocial, and oncological outcomes. Greater efforts should be made to understand whether carefully educating patients about the possible consequences and effectiveness of treatments may help limit the feeling of treatment regret. PATIENT SUMMARY In men with localised prostate cancer, regret about the treatment choice was more common among those who experienced more treatment-related symptoms during the year after treatment.
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Affiliation(s)
- Marie-Anne van Stam
- Department of Urology, Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands; Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands; Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Neil K Aaronson
- Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - J L H Ruud Bosch
- Department of Urology, Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jacobien M Kieffer
- Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | | | - Corinne N Tillier
- Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Simon Horenblas
- Department of Urology, Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Henk G van der Poel
- Department of Urology, The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
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Nazim SM, Fawzy M, Bach C, Ather MH. Multi-disciplinary and shared decision-making approach in the management of organ-confined prostate cancer. Arab J Urol 2018; 16:367-377. [PMID: 30534434 PMCID: PMC6277278 DOI: 10.1016/j.aju.2018.06.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 06/12/2018] [Accepted: 06/18/2018] [Indexed: 01/24/2023] Open
Abstract
Decision-making in the management of organ-confined prostate cancer is complex as it is based on multi-factorial considerations. It is complicated by a multitude of issues, which are related to the patient, treatment, disease, availability of equipment(s), expertise, and physicians. Combination of all these factors play a major role in the decision-making process and provide for an interactive decision-making preferably in the multi-disciplinary team (MDT) meeting. MDT decisions are comprehensive and are often based on all factors including patients' biological status, disease and its aggressiveness, and physician and centres' expertise. However, one important and often under rated factor is patient-related factors. There is considerable evidence that patients and physicians have different goals for treatment and physicians' understanding of their own patients' preferences is not accurate. Several patient-related key factors have been identified such as age, religious beliefs, sexual health, educational background, and cognitive impairment. We have focused on these areas and highlight some key factors that need to be taken considered whilst counselling a patient and understanding his choice of treatment, which might not always be match with the clinicians' recommendation.
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Key Words
- (EB)RT, (external beam) radiotherapy
- ADT, androgen-deprivation therapy
- AS, active surveillance
- CCI, Charlson Comorbidity Index
- Decision-making
- ECE, extracapsular extension
- MDT, multi-disciplinary team
- Multi-disciplinary team (MDT)
- NCCN, National Comprehensive Cancer Network
- Patients’ preferences
- Prostate cancer
- QoL, quality of life
- RCT, randomised controlled trial
- RP, radical prostatectomy
- mpMRI, multiparametric MRI
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Affiliation(s)
- Syed M. Nazim
- Department of Urology, Aga Khan University, Karachi, Pakistan
| | - Mohamed Fawzy
- Department of Urology, University Hospital Aachen, Aachen, Germany
| | - Christian Bach
- Department of Urology, University Hospital Aachen, Aachen, Germany
| | - M. Hammad Ather
- Department of Urology, Aga Khan University, Karachi, Pakistan
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50
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Diefenbach MA, Benedict C, Miller SM, Stanton AL, Ropka ME, Wen KY, Fleisher LG, Mohamed NE, Hall SJ. Examining the impact of a multimedia intervention on treatment decision-making among newly diagnosed prostate cancer patients: results from a nationwide RCT. Transl Behav Med 2018; 8:876-886. [PMID: 29982747 PMCID: PMC6248862 DOI: 10.1093/tbm/iby066] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Men diagnosed with early stage prostate cancer face multiple treatment options, each with distinctive side effects that have significant implications for post-treatment quality of life. Healing Choices for Men with Prostate Cancer is a multimedia educational and decision aid program. This nation-wide randomized controlled trial evaluated the impact of Healing Choices on reducing decisional conflict and distress. Eligible prostate cancer patients who called the National Cancer Institute's Cancer Information Service (CIS) were invited to participate. After a baseline interview, participants were randomized to usual personalized consultation with a CIS specialist (comparison condition) or CIS personalized consultation plus the Healing Choices program (intervention condition). The Decision Conflict Scale and Impact of Event Scale assessed decisional conflict about prostate cancer treatment and cancer-related distress, respectively. Analyses evaluated group differences at 2 months postenrollment. Hypothesized moderation of intervention effects by demographic and clinical characteristics were evaluated. The final sample consisted of N = 349 participants (intervention: n = 181; comparison n = 168). Men were on average 64 years old, primarily White, and well educated. The difference in total decisional conflict was not significant (DCS total score; F[1,311] = .99, p = .32). The difference in cancer-related distress at 2 months between the intervention and the comparison groups was not significant (F[1,337] = .01, p = .93). Evaluation of specific decision processes indicated a significant effect on levels of perceived decisional support (intervention, M = 34.8, SD = 15.7; comparison, M = 38.3, SD = 16.1; F[1,337] = 3.74, p = .05). The intervention effect was greatest for nonwhite minority participants (b = -9.65, SE = 4.67) and those with lower educational attainment (b = 3.87, SE = 2.21). This interactive, comprehensive education and decision aid program may be most effective for a subset of prostate cancer patients in need of educational and decisional support.
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Affiliation(s)
- Michael A Diefenbach
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY
- Center for Health Innovations and Outcomes Research, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY
| | - Catherine Benedict
- Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Manhasset, NY
- Center for Health Innovations and Outcomes Research, The Feinstein Institute for Medical Research, Northwell Health, Manhasset, NY
| | - Suzanne M Miller
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA
| | - Annette L Stanton
- Departments of Psychology and Psychiatry/Biobehavioral Sciences, University of California, Los Angeles (UCLA), Los Angeles, CA
| | - Mary E Ropka
- Public Health Sciences, University of Virginia School of Medicine, Charlottesville, VA
| | - Kuang-Yi Wen
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, PA
| | - Linda G Fleisher
- Department of Biomedical and Health Informatics, The Center for Injury Research and Prevention, Office of Digital Health, Philadelphia, PA
| | - Nihal E Mohamed
- Department of Urology, Mount Sinai School of Medicine, New York, NY
| | - Simon J Hall
- The Arthur Smith Institute for Urology, Northwell Health, New York, NY
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