Determinants of Treatment Regret in Low-Income, Uninsured Men With Prostate Cancer

Hu, Jim C.; Kwan, Lorna; Krupski, Tracey L.; Anger, Jennifer T.; Maliski, Sally L.; Connor, Sarah; Litwin, Mark S.

doi:10.1016/j.urology.2007.11.066

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Volume 72, Issue 6 , Pages 1274-1279, December 2008

Determinants of Treatment Regret in Low-Income, Uninsured Men With Prostate Cancer

Jim C. Hu
- Division of Urology, Brigham and Women's Hospital, Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts
- Reprint requests: Jim C. Hu, M.D., M.P.H., Division of Urology, Brigham and Women's Hospital, Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Harvard Medical School, 45 Francis Street, ASBII-3, Boston, MA 02115
Lorna Kwan
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California
Tracey L. Krupski
- Division of Urology, Duke University Medical School, Durham, North Carolina
Jennifer T. Anger
- Department of Urology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
- Department of and Health Services, University of California, Los Angeles, School of Public Health, Los Angeles, California
Sally L. Maliski
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California
Sarah Connor
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California
Mark S. Litwin
- Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, California
- Department of Urology, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, California
- Department of and Health Services, University of California, Los Angeles, School of Public Health, Los Angeles, California

Received 9 November 2006; accepted 12 November 2007. published online 29 February 2008.

Objectives

The regret of a prostate cancer treatment choice, a significant dimension of health-related quality of life, has not been well-characterized. Little is known about its association with the fear of cancer recurrence or spirituality.

Methods

We drew subjects from a men's health study composed of a clinically heterogeneous sample of subjects enrolled from a statewide, publicly funded assistance program that provided free prostate cancer treatment for uninsured, low-income men in California. We included men who completed a telephone interviews and self-administered questionnaires at study enrollment and at 6 months of follow-up. Using validated instruments, we measured regret, health-related quality of life, fear of cancer recurrence, and spirituality through telephone interviews and self-administered questionnaires.

Results

Of the 195 men, 90 underwent radical prostatectomy (46%), 50 underwent external beam radiotherapy (28%), and 51 underwent hormonal therapy (26%). Of these 195 men, 36 (18%) regretted their treatment choice. Multivariate analyses revealed that nonwhite men were more likely than white men to experience decisional regret (odds ratio [OR] range 7.27 to 12.26). Conversely, men confident of cancer cure (OR 0.19, 95% confident interval 0.04 to 0.86), men with greater spirituality (OR 0.91, 95% confidence interval 0.87 to 0.96), and men with acute treatment effects (OR 0.34, 95% confidence interval 0.12 to 0.93) were less likely to regret their treatment decisions.

Conclusions

In our study, a fear of cancer recurrence, less spirituality, a longer interval since treatment, and nonwhite race were associated with treatment regret in low-income, underserved men with prostate cancer. Attempts to decrease anxiety and enhance spirituality in men treated for prostate cancer might diminish treatment regret. Additional studies in racially diverse cohorts are needed to examine the association of regret with race.