Treatment-Related Regret Varys by Approach in Prostate Cancer

Patients with prostate cancer who received surgery had the highest rate of treatment-related regret followed by radiotherapy and active surveillance.

Treatment-related regret was reported in 1 in 10 patients with localized prostate cancer, with rates of regret being dependent on the approach, according to results from a cohort study published in JAMA Oncology.

Five years following diagnosis, treatment-related regret was most common in patients who underwent surgery (16%) followed by radiotherapy (11%) and active surveillance (7%). Patients receiving active treatment vs active surveillance had an increase of regret among those underwent surgery (adjusted OR, 2.40; 95% CI, 1.44-4.01) and not radiotherapy (adjusted OR, 1.53; 95% CI, 0.88-2.66). In particular, change in sexual function from baseline was significantly associated with regret, although similar associations were not identified with regard to other patient-reported functional outcomes, (HR, 0.65; 95% CI, 0.52-0.81).

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

At 5 years, 13% (95% CI, 12%-15%) of patients said they had treatment regret. This was commonly seen among 71% of patients (95% CI, 55%-87%) who subjectively judged treatment effectiveness and 48% of patients (95% CI, 41%-55%) who thought treatment adverse effects were worse than expected.

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

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

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

With regard to characteristics that were evaluated at baseline including participatory decision-making tool (PDM-7) scores (adjusted OR, 0.80; 95% CI, 0.69-0.92), social support (adjusted OR, 0.78; 95% CI, 0.67-0.90), and age (adjusted OR, 0.78; 95% CI, 0.62-0.97) were independently inversely correlated with regret.

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

Reference

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. 2022;8(1):50-59. doi:10.1001/jamaoncol.2021.5160