Treatment decision regret in long‐term survivors after radical prostatectomy: a longitudinal study

Abstract

To investigate prevalence, course, and predictors of longitudinal decision regret in long-term prostate cancer (PCa) survivors treated by radical prostatectomy (RP). Patients and MethodsA total of 1003 PCa survivors from the multicentre German Familial PCa Database completed questionnaires on average 7 years after RP in 2007 and at follow-up 13 years later in 2020. Patients completed standardised patient-reported outcome measures on decision regret, decision-making, health-related quality of life, and psychosocial factors. Hierarchical multivariable logistic regression was used to assess predictors of longitudinal decision regret. ResultsDecision regret increased significantly over time (9.0% after 6.9 years in 2007 and 12% after 19 years in 2020; P = 0.009). Favourable localised PCa (odds ratio [OR] 1.97, 95% confidence interval [CI] 1.05-3.68), decision regret in 2007 (OR 6.38,, and a higher depression score (OR 1.37, 95% CI 1.03-1.83) were associated with decision regret in 2020. Shared decision-making (OR 0.55, 95% CI 0.33-0.93) was associated with less decision regret. ConclusionThe findings of the present study underline the perseverance of decision regret in long-term PCa survivors and the definitive need for involving patients in the decision-making process to mitigate regret over the long term.

Trajectory of Depression among Prostate Cancer Patients: A Secondary Analysis of a Randomized Controlled Trial

“…Previous studies have also found that men who had a passive role in treatment decision-making had higher treatment regret than those who assumed an active or collaborative role, and that among those who participated in medical decision-making, 94% did not experience treatment regret [ 54 ]. Our results are in concordance with research that reported an association between treatment decision regret and depression [ 24 , 25 ]. While the evidence for the impact of treatment regret on depression among prostate cancer survivors is evolving, its contribution can be important.…”

“…Research has demonstrated that a large proportion of patients with prostate cancer experience some regret after treatment, and this regret tends to increase over time [ 21 , 22 , 23 , 24 , 51 , 52 ]. Diefenbach and Mohamed (2009) found that prostate cancer survivors who were regretful about their treatment choice(s) had a lower quality of life compared to those who were not regretful [ 53 ].…”

“…Decision regret is the undesirable emotion of distress following a decision, and can manifest when the outcome of a decision is compared with the likely outcome of an unchosen alternative [ 17 , 18 ]. Thus, when a treatment decision is made in an uncertain or preference-sensitive situation, such as prostate cancer, it may lead to decision regret [ 9 , 17 , 19 , 20 , 21 , 22 , 23 , 24 ].…”

Prevalence and determinants of decision regret in long-term prostate cancer survivors following radical prostatectomy

“…On multivariable logistic regression, biochemical recurrence, low HRQoL, clinical levels of depression and PSA anxiety (by single item cut-off) were associated with regret. Regarding the in uence of PC-related anxieties (PC/PSA anxiety) on regret, available data are ambiguous: some investigations indicate a clear association between PSA anxiety and regret [4] while others do not [10]. Also, the results typically rely on continuous scaling, rendering the interpretation and comparison of available ndings to the current study and between one another di cult.…”

“…Available data suggests that patients may experience decision regret not only during the early postoperative period [2,3,9], but also beyond ve years following primary treatment [4,5]. A recent longitudinal study from our group including 1003 PC survivors showed that decision regret does not naturally resolve, but remains stable or increases slightly even 20 years after RP [10]. Previous studies have shown poor post-treatment oncological and functional outcomes, early health-related quality of life (HRQoL) declines, and PC-related anxiety to be associated with later decision regret [2,3,5,9].…”