Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Department of Statistics, University of Connecticut, Storrs, CT Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, University of North Carolina Lineberger Cancer Center, Chapel Hill, NC; Division of Urologic Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Harvard Medical School, Boston, MA; South Carolina College of Pharmacy and the Hollings Cancer Center, Charleston, SC; Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH; Departments of Medicine and Urology, Tulane University, New Orleans, LA Eisai Pharmaceuticals, Woodcliff Lake, NJ, USA.
Study Type - Therapy (case series) Level of Evidence 4.
What's known on the subject? and What does the study add? Treatment regret can have an adverse impact on a patient's overall outlook and has been associated with a poorer global quality of life. Understanding predictors of regret can help clinicians better counsel patients about their treatments so that later regret can be avoided. In previous studies, regret has been associated with lesser educational attainment, non-White race, greater post-treatment declines in sexual function and systemic symptoms. The present study found that, among men with recurrent prostate cancer, those with cardiovascular comorbidity were >50% more likely to regret their treatment choice than men without cardiovascular comorbidity. This study highlights the growing importance of considering comorbidity when counselling patients about prostate cancer treatment options, and provides a rationale for men with cardiovascular comorbidity to give additional consideration to active surveillance for their newly diagnosed prostate cancer.
To determine whether cardiovascular comorbidity is associated with increased treatment regret among men with recurrent prostate cancer.
The study cohort comprised 795 men in the Comprehensive, Observational, Multicenter, Prostate Adenocarcinoma (COMPARE) registry who experienced biochemical recurrence at a median (interquartile range) of 5.5 (2.8-9.1) years after prostatectomy (n= 410), external beam radiation therapy (n= 237), brachytherapy (n= 124) or primary androgen deprivation therapy (n= 24). Multivariable logistic regression analysis was used to determine whether cardiovascular comorbidity was associated with treatment regret. Cardiovascular comorbidity, which included myocardial infarction, congestive heart failure, angina, diabetes, stroke or circulation problems, was defined using a validated two-question screening process after adjusting for sociodemographic and treatment factors and post-treatment bladder and bowel toxicity.
Of 795 men, 14.8% reported regret. Men with cardiovascular comorbidity were more likely to experience post-therapy bowel toxicity (P= 0.022). In the adjusted multivariable model, the factors associated with increased treatment regret were: cardiovascular comorbidity (adjusted odds ratio [AOR]= 1.52 [95% CI:1.00-2.31], P= 0.048); younger age (AOR: 0.97 [95% CI 0.94-0.99] per year increase in age, P= 0.019); and bowel toxicity after treatment (AOR 1.58 [95% CI 1.03-2.43], P= 0.038).
Among men with recurrent prostate cancer, those with cardiovascular comorbidity were >50% more likely to experience treatment regret than men without cardiovascular comorbidity. These data provide a rationale for men with cardiovascular comorbidity to give additional consideration to active surveillance for their newly diagnosed prostate cancer.
Written by:
Nguyen PL, Chen MH, Hoffman KE, Chen RC, Hu JC, Bennett CL, Kattan MW, Sartor O, Stein K, D'Amico AV. Are you the author?
Reference: BJU Int. 2011 Nov 15. Epub ahead of print.
doi: 10.1111/j.1464-410X.2011.10709.x
PubMed Abstract
PMID: 22085233
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