Treatment Decision Regret Among Long-Term Survivors of Localized Prostate Cancer: Results From the Prostate Cancer Outcomes Study

Abstract

Purpose To determine the demographic, clinical, decision-making, and quality-of-life factors that are associated with treatment decision regret among long-term survivors of localized prostate cancer. Patients and Methods We evaluated men who were age ≤ 75 years when diagnosed with localized prostate cancer between October 1994 and October 1995 in one of six SEER tumor registries and who completed a 15-year follow-up survey. The survey obtained demographic, socioeconomic, and clinical data and measured treatment decision regret, informed decision making, general- and disease-specific quality of life, health worry, prostate-specific antigen (PSA) concern, and outlook on life. We used multivariable logistic regression analyses to identify factors associated with regret. Results We surveyed 934 participants, 69.3% of known survivors. Among the cohort, 59.1% had low-risk tumor characteristics (PSA < 10 ng/mL and Gleason score < 7), and 89.2% underwent active treatment. Overall, 14.6% expressed treatment decision regret: 8.2% of those whose disease was managed conservatively, 15.0% of those who received surgery, and 16.6% of those who underwent radiotherapy. Factors associated with regret on multivariable analysis included reporting moderate or big sexual function bother (reported by 39.0%; OR, 2.77; 95% CI, 1.51 to 5.0), moderate or big bowel function bother (reported by 7.7%; OR, 2.32; 95% CI, 1.04 to 5.15), and PSA concern (mean score 52.8; OR, 1.01 per point change; 95% CI, 1.00 to 1.02). Increasing age at diagnosis and report of having made an informed treatment decision were inversely associated with regret. Conclusion Regret was a relatively infrequently reported outcome among long-term survivors of localized prostate cancer; however, our results suggest that better informing men about treatment options, in particular, conservative treatment, might help mitigate long-term regret. These findings are timely for men with low-risk cancers who are being encouraged to consider active surveillance.

Exploring pathways towards improving patient experience of robot‐assisted radical prostatectomy (RARP): assessing patient satisfaction and attitudes

“…In this Australian quantitative and qualitative study of patient outcomes after RARP, patients were overall very satisfied with the procedure and would likely recommend it to others. This is in contrast to previous international studies that have reported RARP as an independent predictor of greater dissatisfaction and regret when compared with open retropubic RP . This previous finding has been ascribed to higher expectations associated with a new and highly publicised procedure, as these studies were undertaken earlier in the popularisation of RARP .…”

“…Expectations of future health states have been shown to partially influence satisfaction and health‐related QoL . This supports the pivotal role that pre‐treatment patient education and counselling facilitates in setting realistic expectations of recovery after surgery .…”

Assessing decision regret in caregivers of deceased German people with cancer—A psychometric validation of the Decision Regret Scale for Caregivers

“…The DRS has been translated into seven languages and adapted for the application in various cultural contexts . The DRS has been applied in observational studies, for example, demonstrating that higher physician empathy predicts lower decision regret in people with cancer or patients with cancer . The DRS has also been used in randomized controlled trials of decision aids which recently have been shown to reduce decisional conflict .…”

“…2 The DRS has been applied in observational studies, for example, demonstrating that higher physician empathy predicts lower decision regret in people with cancer or patients with cancer. 5,6 The DRS has also been used in randomized controlled trials of decision aids which recently have been shown to reduce decisional conflict. [7][8][9] Indeed, decision regret often reaches high levels (increasing 6 months or more after a decision) due to very poor outcomes and definitive knowledge about the outcome.…”

Understanding Urinary Toxicity after Radiotherapy for Prostate Cancer: First Steps Forward

“…The increasing availability of information from huge databases, also coming from large international collaborations and including standardized patient-reported outcome measurements, will further boost this relevant field of research in the coming years. This will allow continuing reduction of urinary side effects and the consequent improvement of quality of life and reduced risk of patient regret about the choice of radiotherapy (83) in long-surviving prostate cancer patients.…”