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Living With Treatment Decisions: Regrets and Quality of Life Among Men Treated for Metastatic Prostate Cancer

From the Center for Health Quality, Outcomes and Economic Research, Edith Nourse Rogers Memorial Veterans Hospital, Bedford, MA; and Houston Center for Quality of Care and Utilization Studies, Department of Veterans Affairs Medical Center, Houston, TX.

Address reprint requests to Jack A. Clark, PhD, CHQOER, Edith Nourse Rogers Memorial Veterans Hospital, 200 Springs Rd, Bedford, MA 01730; email jaclark{at}bu.edu

PURPOSE: To examine variation in men’s long-term regret of treatment decisions, ie, surgical versus chemical castration, for metastatic prostate cancer and its associations with quality of life.

METHODS: Survey of previously treated patients to assess treatment decisions and quality of life, supplemented with focus groups. Two items addressing whether a patient wished he could change his mind and the belief that he would have been better off with the treatment not chosen were combined in classifying survey respondents as either satisfied or regretful. ² and t tests were used to test associations between regret and treatment history, complications, and quality of life.

RESULTS: Survey respondents included 201 men aged 45 to 93 years (median, 71 years), who had begun treatment (71% chemical castration, 29% orchiectomy) a median of 2 years previously. Most reported complications: hot flashes (70%), nausea (34%), and erectile dysfunction (81%). Most were satisfied with the treatment decision, but 23% expressed regret. Regretful men more frequently reported surgical (43%) versus chemical (36%) castration (P = .030) and nausea in the past week (54% v 32%; P = .010) but less frequently reported erectile dysfunction (56% v 72%; P = .048). Regretful men indicated poorer scores on every measure of generic and prostate cancer–related quality of life. Qualitative analyses revealed substantial uncertainty about the progress of their disease and the quality of the decisions in which patients participated.

CONCLUSION: Regret was substantial and associated with treatment choice and quality of life. It may derive from underlying psychosocial distress and problematic communication with physicians when decisions are being reached and over subsequent years.

The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

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