PHILADELPHIA—Unfounded fears may influence a prostate cancer patient's decision to forgo external-beam radiation therapy, according to a study presented by Riccardo Valdagni, MD, of the Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, at the American Society for Therapeutic Radiation and Oncology Annual Meeting (poster 2320).
The availability of multiple treatments of equal efficacy makes the decision-making process difficult. Unfortunately, he said, "patients base their treatment choice not only on technical information but also on cultural and personal prejudices." Additional complicating factors are the involvement of multiple specialists, the fragmented approach that can result, and the terminology these experts use. As a result, men often decide against an effective treatment with the advantages of noninvasiveness, a short recovery period, and a good chance of preservation of sexual and urinary function.
Dr. Valdagni and his multidisciplinary team, including a psychologist, counseled 257 men with prostate cancer and recorded their fantasies and expectations about external-beam radiation therapy.
The most common worry was related to false beliefs about the action of x-rays. Some men believed they could become radioactive, that x-rays are difficult to control because they are invisible, or that family members could be injured by the rays. Some believed that radiation could not be curative, since the results are not visible and the cancer is not mechanically removed as with surgery.
Irrespective of their level of education, patients were confused by technical language, especially given the anxiety inherent in the clinical examination. Anxiety adversely affects patients' ability to understand new concepts, Dr. Valdagni said. He also advised against using anxiety-inducing military metaphors like "hit the target." An additional source of anxiety was the demonstration of the radiotherapy equipment. Only a minority of men were aware of advantages such as the potential to preserve sexual function and the avoidance of hospitalization.
