Living with treatment decisions: Regrets and quality of life among men treated for metastatic prostate cancer

Purpose: To examine variation in men's long-term regret of treatment decisi ons, ie, surgical versus chemical castration, for metastatic prostate cance r and its associations with quality of life. Methods: Survey of previously treated patients to assess treatment decision s and quality of life, supplemented with focus groups. Two items addressing whether a patient wished he could change his mind and the belief that he w ould have been better off with the treatment not chosen were combined in cl assifying survey respondents as either satisfied or regretful. chi (2) and t tests were used to test associations between regret and treatment history , complications, and quality of life. Results: Survey respondents included 201 men aged 45 to 93 years (median, 7 1 years), who had begun treatment (71% chemical castration, 29% orchiectomy ) a median of 2 years previously, Most reported complications: hot flashes (70%), nausea (34%), and erectile dysfunction (81%). Most were satisfied wi th the treatment decision, but 23% expressed regret. Regretful men more fre quently reported surgical (43%) versus chemical (36%) castration (P = .030) and nausea in the past week (54% v 32%; P = .010) but less frequently repo rted erectile dysfunction (56% v 72%; P = .048). Regretful men indicated po orer scores on every measure of generic and prostate cancer-related quality of life. Qualitative analyses revealed substantial uncertainty about the p rogress of their disease and the quality of the decisions in which patients participated. Conclusion: Regret was substantial and associated with treatment choice and quality of life. It may derive from underlying psychosocial distress and p roblematic communication with physicians when decisions are being reached a nd over subsequent years. J Clin Oncol 19:72-80. (C) 2001 by American Socie ty of Clinical Oncology.