Decisional Regret Among Men With Prostate Cancer: What Is Involved?
Menée à partir des données des registres américains des cancers portant sur 2 072 patients atteints d'un cancer localisé de la prostate (âge médian : 64 ans), cette étude de cohorte prospective analyse l'association entre les traitements reçus (chirurgie, radiothérapie, surveillance active), les effets de ces traitements sur leur état de santé et sur la survie, leurs attentes et leurs regrets vis-à-vis des décisions thérapeutiques
Prostate cancer remains the second most common cancer among men in the US, with 3 main options for treatment of localized prostate cancer: radical prostatectomy, radiotherapy, and active surveillance. A decision to have a particular treatment may cause decisional regret due to unwanted outcomes.Patients’ involvement in the treatment decision-making process involves assessing the treatment approach, weighing the functional outcomes, and having a clear understanding of the expectations after treatment. When a patient with localized prostate cancer and/or the treatment team do not have a shared understanding of at least 1 of these 3 components, treatment-related regret for the patient may occur. In this issue of JAMA Oncology, Wallis et al conducted a prospective population-based study from 5 population-based Surveillance, Epidemiology, and End Results (SEER) registries across the US. They assessed regret at 5 and 3 years after treatment by using a validated prostate cancer–oriented scale among 2072 participants who underwent radical prostatectomy, radiotherapy, or active surveillance. Of these, 279 men reported having treatment-related regret at 5 years. Those patients who underwent a radical prostatectomy or radiotherapy were more likely to report they had regret than men who chose active surveillance. Patients who were treated with surgery were more likely to report regret than men who had undergone radiotherapy or active surveillance. Wallis et al also found that a change in sexual function was significantly associated with regret, whereas other functional outcomes (eg, urinary incontinence and bowel symptoms) were not. The authors also stratified by D’Amico risk category and found that patients with low- and intermediate-risk disease who chose surgery were more likely to report regret than patients who underwent active surveillance; in addition, those who had high-risk disease and chose active surveillance or radiotherapy reported more regret.
JAMA Oncology , commentaire, 2020