Treatment-related regret is common among men with localized prostate cancer, especially among those who undergo surgery, new study findings suggest.
A disconnect between patient expectations and outcomes is a major contributor to regret, and appears to influence regret to a greater extent than factors such as disease characteristics, treatment modality, and patient-reported functional outcomes, according to investigators.
“Thus, improved counseling at the time of diagnosis and before treatment, including identification of patient values and priorities, may decrease regret among these patients,” a team led by Christopher J.D. Wallis, MD, PhD, of Mount Sinai Hospital in Toronto, Canada, concluded in a report published in JAMA Oncology.
Dr Wallis and colleagues conducted a population-based, prospective cohort study that included 2072 men with localized prostate cancer. Of these, 279 patients (13%) reported treatment-related regret at 5 years after their cancer diagnosis. The proportion of men who reported treatment-related regret was higher among those who underwent surgery (16%) and radiation therapy (11%) compared with those opted for active surveillance (7%) after adjusting for baseline differences.
Compared with active surveillance, surgery was significantly associated with 2.4-fold higher odds of regret, whereas radiation therapy was not significantly associated with higher odds of regret.
Results also showed that sexual dysfunction, and no other patient-reported functional outcomes, was significantly associated with regret, according to the investigators.
“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,” the authors concluded.
In an accompanying editorial, Randy A. Jones, PhD, RN, of the University of Virginia School of Nursing in Charlottesville, commented, “Considering multiple factors that are involved in providing patients with localized prostate cancer and the potential to enhance quality of life and decrease decisional regret, it is well worth the time for clinicians to assess and address patients’ treatment concerns.”
Wallis CJD, Zhao Z, Huang LC, et al. Association of treatment modality, functional outcomes, and baseline characteristics with treatment-related regret among men with localized prostate cancer. JAMA Oncol. Published online November 18, 2021.
Jones RA. Decisional regret among men with prostate cancer: What is involved? JAMA Oncol. Published online November 18, 2021. doi:10.1001/jamaoncol.2021.5137