For men with prostate cancer, treatment information fails to address fears

Men with prostate cancer make emotionally driven treatment decisions influenced by anecdote and misconception rather than consideration of clinical trial evidence, according to a new study.

Published in the August 1, 2006 issue of CANCER, a peer-reviewed journal of the American Cancer Society, the study reveals that fear and uncertainty drove initial treatment decisions seeking rapid results, and that there was little interest in seeking second opinions. Furthermore, 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.

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.