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Senior Citizen Health & Medicine
Men Found with Prostate Cancer Rush to Judgment on
Treatment
June 26, 2006 – Fear and uncertainty usually drive
the initial treatment decisions by men diagnosed with prostate cancer.
Seeking rapid results they make emotionally driven treatment decisions
influenced by anecdote and misconception rather than consideration of
clinical trial evidence, and they have no time for second opinions,
indicates the new study in the August issue of CANCER, journal of the
American Cancer Society.
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Furthermore, the study says, patient decisions were
influenced by misconceptions about disease management options, and men
often erroneously applied the anecdotal experiences of others with
prostate cancer to their own circumstances, even when the severity of
their own disease and available treatment options were significantly
different.
While there are several treatment options for men
with localized prostate cancer, clinical trials have failed to
demonstrate one optimal therapy. Each treatment option has benefits and
its own unique and significant adverse side effects. Radical
prostatectomy, for example, has only minimal survival benefits compared
to even observation, but is associated with complications, such as
impotence and urinary incontinence. With no clear-cut medical guidance,
patients must assume a greater role in deciding on treatment in the face
of disquieting statistics and risk-benefit information.
To characterize the factors that influence men's
treatment decisions, Thomas Denberg, M.D., Ph.D. of the University of
Colorado at Denver and Health Sciences Center and colleagues interviewed
20 men newly diagnosed with localized prostate cancer before and after
treatment.
Three factors characterized the patients'
decisions: fear and uncertainty; misconceptions about treatment efficacy
and risks; and anecdotal information about other's experiences with
prostate cancer. Even though most patients knew prostate cancer grows
slowly, such "abstract knowledge did little to dispel the vividly
frightening, yet unlikely prospect of prostate cancer suddenly
'blossoming,'" the researchers write.
After urologists reviewed the risks and benefits of
the treatment options, patients had poor recall of the information they
were provided, often confused side effects and treatments, and often
said that the side effects had no impact on their treatment decision.
Sixteen of 20 men did not intend to seek a second opinion, generally
because of misconceptions about its purpose.
Dr. Denberg and his colleagues report that "this
study illustrates that while attention to health information, outcome
preferences, and the framing of numerical risk is necessary, it is
hardly sufficient for achieving quality in patient-centered
decision-making." It is important to give greater attention to patients'
fears, misconceptions, and anecdotal influences.
About study:
Article: "Patient Treatment Preferences in
Localized Prostate Carcinoma: The Influence of Emotion, Misconception,
and Anecdote," Thomas D. Denberg, Trisha V. Melhado, John F. Steiner,
CANCER; Published Online: June 26, 2006 (DOI: 10.1002/cncr.22033); Print
Issue Date: August 1, 2006.
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