Treating Prostate Cancer: How to Prevent ‘Decisional Regret’

如果您刚刚购买了昂贵的购买，那么与您是否做出正确的选择并不罕见。Should I have bought the car or house? Would another house or car have been a better choice?The phenomenon is often referred to as buyer’s remorse orcognitive dissonance.

同样的反应发生在医疗治疗。In this scenario, it’s known as decisional regret. And it can be particularly common among men being treated for前列腺cancer是美国男性中最常见的癌症说Paul Nguyen，MD, the vice chair for clinical research in the department of radiation oncology at the Dana-Farber Cancer Institute/Brigham and Women’s Cancer Center and an associate professor of radiation oncology at Harvard Medical School in Boston.

“与许多其他癌症不同，”Nguyen博士说，“前列腺cancer is a disease where patients have a wide range of accepted treatment options, from active surveillance to radiation of various forms, with or without androgen deprivation therapy, to open or robotic surgery.

“优先选择的是，患者有自由作出基于偏好的决定，”Nguyen继续。“不寻常的后果是，随着选择，可以有担心你做出了糟糕的选择，这导致了果断的遗憾。”

战争遗憾的主要原因：没有足够的信息

在2018年1月发布的一项研究中Urologia Internationalis，来自法国尼姆大学和蒙彼利埃大学泌尿外科和疾病部的研究人员，在具有前列腺癌的男性中寻找果断遗憾。

To evaluate the prevalence of urinary consequences and factors affecting patient satisfaction and decisional regret after treatment, the researchers distributed a survey to members of the National Association of Prostate Cancer Patients in France who had undergone prostate treatments.

Most of the 226 respondents fell into four groups: 110 patients who underwent surgery only, 29 who received radiotherapy plus hormone therapy, 28 who received radiotherapy only, and 49 who received other combination treatments. On average, they answered the questionnaire nearly five years after therapy.

研究人员发现“决策遗憾的主要原因是患者接受有关前列腺癌的不完整信息（40％）和[这种情况]治疗后果影响的泌尿系统（34％）。”

尿失禁occurred in 34.5 percent of patients treated by radical前列腺切除术, 10.3 percent in those treated by radiotherapy plus hormone therapy, 17.8 percent in those treated by radiotherapy only, and 38.7 percent in those treated by other combination therapies.

The information received about cancer was considered complete by 32.3 percent of the satisfied group and by 14.3 percent of the group that experienced decisional regret. With regard to urinary incontinence, the information received was considered complete by 41.4 percent and 17.4 percent of each group, respectively.

“Patients in the radiotherapy plus hormone therapy group considered themselves inadequately informed about the potential urinary complications [as compared with] the surgery-alone group,” the authors wrote. “This leads us to encourage radiotherapists to make more of an effort to explain the potential side effects to patients during the initial consultation.”

研究人员得出结论：“前列腺癌治疗的泌尿后果是常见的并且影响生活质量。患者需要清楚的信息能够参与治疗决策，并避免随后的决策遗憾。

“However,” they said, “the perception by patients that they did not receive complete information is not always related to poor communication on the part of the medical team. This is a multifactorial issue, and other factors should be taken into account, in particular patient recall, given the lengthy mean time of 4.5 years since patients received治疗前列腺癌in this study.”

What’s more, they added, “despite receiving high-quality care, decisional regret may eventuate if all options for prostatecancer treatments没有讨论。已经记录了在治疗决策过程中发挥积极作用的患者几乎总是报告对他们的决定感到满意。“

Nguyen says the new French research is consistent with other studies on decisional regret and prostate cancer. He says, “[Decisional regret] is often associated with feeling that you had incomplete information at the time you made the decision, or with having a complication or bad outcome with your chosen treatment.”

2017年7月，爱荷华州爱荷华大学的研究人员据报道，在近1000名男性的研究中，局部前列腺癌为15％，令人遗憾的是他们的治疗选择。最常见的后悔的原因是治疗相关的性功能障碍。

“Regret was a relatively infrequently reported outcome among long-term survivors of localized prostate cancer; however, our results suggest that better informing men about treatment options — in particular, conservative treatment — might help mitigate long-term regret,” concludedRichard Hoffman, MD和研究的共同主唱，发表在Journal of Clinical Oncology. “These findings are timely for men with low-risk cancers who are being encouraged to consider active surveillance.”

Preventing Decisional Regret: Next Steps

为了防止后悔，Nguyen建议治疗这些患者的医疗团队“必须确保患者与外科医生有足够的多学科咨询，辐射肿瘤学家, and medical oncologist and have heard all points of view and feel fully informed of all the options so that they are less likely to regret their choice later.”

他补充说，前列腺癌患者的遗憾问题特别明显。“乳腺癌，”Nguyen说，“[涉及]完全之间的选择mastectomyand乳房切除术plus radiation. It’s not so painful a choice usually as [those involved in] prostate, but there are still similar issues.”

John MacIntyre, MD, a general practitioner based in Waterdown, Ontario, who brought the French study to the attention of Everyday Health, finds it significant that “the study was initiated by a patient association, not urologists.” He says that research on decisional regrets is missing what patients were thinking at the time they made their original choice. According to Dr. MacIntyre, it’s not only prostate cancer patients who face these regrets but those undergoing treatment for高血压, dyslipidemia, breast cancer, and结直肠癌等等。

“凡常见的遗憾与进入治疗的个人期望之间的联系没有据说，”麦金塔尔说。“这是我过去40多年的经历，患者，患者，宽大，不知道要问的问题。我常常想知道患者不满意涉及他们只是不明白他们进入的东西的感觉，以及理解我的意思是他们根据个人生活价值观和期望和期望的个人思想，他们有能力地提出了询问了适当的问题。“知情同意”应建立在患者自己的一组问题上，而不是医生的概念和对问题的理解。“

底线：务必与您的医生交谈，并在开始任何推荐的前列腺癌症治疗方案之前对潜在治疗方案的任何问题进行答案。要求您的医生解释可能在可能的数字中的风险和福利。这应包括关于治疗（NNT）所需的数量的讨论，以防止前列腺癌中的一种类型的治疗方法与危害（NNH）所需的数量相比，导致一个副作用（如尿失禁或erectile dysfunction). Having this discussion with your doctor can help you realistically set your expectations.