Comparability of health-related quality of life (HRQOL), treatment decision making, and treatment satisfaction after PSA recurrence among prostate cancer patients who receive hormone therapy (HT) versus observation (OBS): Results from the COMPARE registry

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 5131-5131
Author(s):  
T. Luu ◽  
O. Sartor ◽  
N. Dandade ◽  
S. Halabi ◽  
C. Bennett
Keyword(s):  
Decision Making ◽  
Sexual Dysfunction ◽  
Treatment Satisfaction ◽  
Hot Flashes ◽  
Treatment Decision ◽  
Treatment Choice ◽  
External Beam Radiation ◽  
Treatment Decision Making ◽  
Psa Failure ◽  
Patient Reported

5131 Background: HT may lower PSA, but it may also cause hot flashes and sexual dysfunction. OBS is not associated with hot flashes or lower testosterone production, but PSA may rise. Examining patient satisfaction with treatment decision making, treatment choice, and HRQOL may help improve disease management. We compared treatment satisfaction and HRQOL of patients who chose OBS over HT. Methods: The Comprehensive Multicenter Prostate Adenocarcinoma Registry (COMPARE) is an observational registry of men with PSA failure. Data from patient-reported questionnaires were analyzed for patients treated with OBS or HT. Results: 674 patients (82%) chose OBS; 147 (18%) chose HT. The median time between cancer diagnosis and registry enrollment was 6 years. Of men on OBS, 85%, 83%, and 71% were satisfied with treatment decision process, treatment choice, and treatment outcome, respectively. Men on HT had similar rates of satisfaction (82%, 75%, and 71%). Men initially treated with brachytherapy/surgery were less satisfied with OBS. Men initially treated with external beam radiation were less satisfied with HT. Patients reported similar problems with urinary, sexual, and bowel function. Conclusions: Men with PSA failure seem content with treatment choice and decision making and have low rates of urinary/bowel problems. Rates of sexual dysfunction in both groups are similar. Clinical trials may help determine if HT improves long-term outcomes (e.g. overall survival), since short-term patient reported satisfaction is similar between OBS and HT. The reported rate of sexual dysfunction is lower than expected. [Table: see text] [Table: see text]

The Significance of Patient-Reported Outcomes for Metastatic Breast Cancer Patients

2022 ◽  
Author(s):  
Larissa Elisabeth Hillebrand ◽  
Ulrike Söling ◽  
Norbert Marschner
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Metastatic Breast Cancer ◽  
Cancer Treatment ◽  
Patient Reported Outcomes ◽  
Metastatic Breast ◽  
Treatment Decision ◽  
Breast Cancer Patients ◽  
Treatment Decision Making ◽  
Patient Reported

Background: Breast cancer is still the most common malignancy in women worldwide. Once metastasized, breast cancer treatment primarily aims at reducing symptom burden, thereby trying to maintain and improve a patient´s quality of life (QoL), delaying disease progression, and prolonging survival. Curing the disease is not possible in the palliative setting. To better understand metastatic breast cancer patients, their symptoms and wishes, which are important for treatment-decision making and outcome, patient-reported outcomes (PROs) are of great importance, giving an impression of what really matters to and concerns a patient. Summary: Many advances have been made to implicate PROs in clinical trials, non-interventional studies, registries, and clinical routine care of metastatic breast cancer. For example, large phase III trials like PALOMA-3 (NCT01942135), MONALEESA-7 (NCT02278120), HER2CLIMB (NCT02614794), and KEYNOTE-119 (NCT02555657) trials implemented PROs in their trial design to assess the QoL of their trial patients. Also, non-interventional studies on metastatic breast cancer, like e.g., the NABUCCO study (IOM-02240), and prospective non-interventional, multicenter registries e.g., the tumor registry breast cancer (NCT01351584) or the breast cancer registry platform OPAL (NCT03417115), have implemented PROs to assess QoL during the anti-cancer treatment periods of the patients. Key Message: Using PROs in metastatic breast cancer can support shared treatment-decision making and management of symptoms, eventually leading to an improvement in QoL. Progressively, regulatory authorities take PROs into consideration for the approval of new drugs. Hence, the implication of PROs in cancer treatment, and especially in MBC, is of significant value.

Integrating touchscreen-based geriatric assessment and frailty screening for adults with acute myelogenous leukemia to drive personalized treatment decisions.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e24030-e24030
Author(s):  
Debra Wujcik ◽  
Nikolaos Papadantonakis ◽  
Sarah Allison Wall ◽  
Margaret T. Kasner ◽  
OMER HASSAN JAMY ◽  
...  
Keyword(s):  
Decision Making ◽  
Frailty Index ◽  
Treatment Decision ◽  
Treatment Decisions ◽  
Self Report ◽  
Myelogenous Leukemia ◽  
Valuable Insight ◽  
Nccn Guidelines ◽  
Treatment Decision Making ◽  
Patient Reported

e24030 Background: AML is a disease of older adults, with median age of 68 years at presentation. NCCN guidelines suggest comprehensive geriatric assessments (GA) be included in clinical practice to guide treatment decisions. Utility of GA in older AML patients in a real-world environment is not yet established. We tested the feasibility of using a modified GA (mGA), administered by patient self-report on a touchscreen computer, real-time use and utility by clinicians and the correlation of mGA results on treatment decision-making. Methods: Sixty-two patients were recruited from three sites to complete a tablet-based mGA screening at a treatment decision-making time point. The mGA consists of the Frailty Index (FI) that includes four domains: age, activities of daily living, instrumental ADLs, and comorbidities. Falls within the past 6 months and patient reported health interference with function are also assessed. Results are displayed for the clinician to inform the treatment discussion. Results: Participants were mean age 73 years (range 61-88), 63% male, and 90% white. Frailty Index result was 32% fit, 40% intermediate, and 28% frail. Providers were asked the fit/frailty status prior to seeing the results of the mGA. Of 53 provider responses, there was 57% (n=30) provider concordance with the mGA result; 9% (n=5) said fit when mGA said intermediate and 17% (n=9) said intermediate when mGA said frail. When asked their goals of care, nearly all (n=60, 97%) patients agreed with the statement “my cancer is curable”, yet 30% (n=19) disagreed the treatment goal was to get rid of all the cancer. Nearly half (n=30) indicated they want to make treatment decisions together with the provider rather than provider or patient making decision alone. 73% (45/62) of patients were satisfied with the ease of using the survey and took an average 16.3 minutes to complete. Patient self-reported presence/severity of eight symptoms at baseline (see Table). Conclusions: A simple electronic tool may provide valuable insight into patient understanding of disease to better tailor patient-provider discussion and treatment decision-making. Providers overestimated fitness 26% of the time. Final results will be presented to include the outcome at 3 months by Frailty Index. [Table: see text]

scholarly journals Influence of Men’s Personality and Social Support on Treatment Decision-Making for Localized Prostate Cancer

2017 ◽  
Vol 2017 ◽  
pp. 1-8 ◽  
Author(s):  
Elyse Reamer ◽  
Felix Yang ◽  
Margaret Holmes-Rovner ◽  
Joe Liu ◽  
Jinping Xu
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Treatment Decision ◽  
Population Based ◽  
Treatment Choice ◽  
Localized Prostate Cancer ◽  
Curative Treatment ◽  
Risk Level ◽  
Treatment Decision Making ◽  
Choice Decision

Background. Optimal treatment for localized prostate cancer (LPC) is controversial. We assessed the effects of personality, specialists seen, and involvement of spouse, family, or friends on treatment decision/decision-making qualities. Methods. We surveyed a population-based sample of men ≤ 75 years with newly diagnosed LPC about treatment choice, reasons for the choice, decision-making difficulty, satisfaction, and regret. Results. Of 160 men (71 black, 89 white), with a mean age of 61 (±7.3) years, 59% chose surgery, 31% chose radiation, and 10% chose active surveillance (AS)/watchful waiting (WW). Adjusting for age, race, comorbidity, tumor risk level, and treatment status, men who consulted friends during decision-making were more likely to choose curative treatment (radiation or surgery) than WW/AS (OR = 11.1, p<0.01; 8.7, p<0.01). Men who saw a radiation oncologist in addition to a urologist were more likely to choose radiation than surgery (OR = 6.0, p=0.04). Men who consulted family or friends (OR = 2.6, p<0.01; 3.7, p<0.01) experienced greater decision-making difficulty. No personality traits (pessimism, optimism, or faith) were associated with treatment choice/decision-making quality measures. Conclusions. In addition to specialist seen, consulting friends increased men’s likelihood of choosing curative treatment. Consulting family or friends increased decision-making difficulty.

scholarly journals Management of Early Laryngeal Cancer: The Role of Individualized Medicine

2016 ◽  
Vol 7 (1) ◽  
pp. 23-28
Author(s):  
Gady Har-El
Keyword(s):  
Decision Making ◽  
Radiation Therapy ◽  
Laryngeal Cancer ◽  
Treatment Modality ◽  
Individualized Medicine ◽  
Treatment Decision ◽  
External Beam Radiation ◽  
Decision Making Process ◽  
Treatment Decision Making

ABSTRACT Treatment options for early laryngeal cancer include radiation therapy or surgical resection. It is widely agreed upon that early laryngeal cancer should be managed with only one treatment modality. The debate on which treatment modality is best for early laryngeal cancer has essentially been going on for the last 65 years. Many new developments have impacted the treatment decision making process. These developments include the introduction of transoral endoscopic partial laryngeal surgery, such as transoral laser microsurgery (TLM) which is replacing external partial laryngectomy procedures; improvements in external beam radiation therapy (EBRT) delivery techniques and technology which result in enhanced accuracy and decreased extralaryngeal side effects and complications; and the introduction of quality of life measures and understanding their importance, in addition to survival rate, in defining successful outcome or failure. This review article concentrates on some of the important issues facing the patient, his/her family, and the treating physicians in the treatment decision making process. How to cite this article Har-El G. Management of Early Laryngeal Cancer: The Role of Individualized Medicine. Int J Head Neck Surg 2016;7(1):23-28.

Preferences, satisfaction and decision-making processes in osteoporosis treatment: a systematic review of the literature

2021 ◽  
Author(s):  
Laura Canals-Ruiz ◽  
Marta Comellas ◽  
Luís Lizán
Keyword(s):  
Decision Making ◽  
Treatment Satisfaction ◽  
Unmet Needs ◽  
Grey Literature ◽  
Treatment Decision ◽  
Osteoporosis Treatment ◽  
Decision Making Process ◽  
Treatment Decision Making ◽  
Decision Making Processes ◽  
Physician Patient

Aim: To synthesize information available in the literature on patients' preferences and satisfaction with osteoporosis treatment and their unmet needs on the treatment decision-making process. Materials & methods: Systematic literature review consulting international database and grey literature of articles published between January 1, 2009 and January 1, 2019. Results: Nineteen publications were reviewed, 79% of them focused on evaluating the importance that patients attached to the mode and frequency of administration, adverse events and treatment efficacy. 21% of them provided information about treatment satisfaction and 26% regarding unmet needs on treatment-decision making process. Conclusion: Aligning treatment with patients' preferences, promoting physician-patient communication and identifying patients' concerns with treatment may contribute to improve treatment satisfaction and adherence and ultimately achieve the treatment goal.

Investigating Preferences and Factors Associated with Involvement In Treatment Decision-Making In Newly Diagnosed Patients with High-Risk Myelodysplastic Syndromes: An International Multicenter Study

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 4953-4953
Author(s):  
Fabio Efficace ◽  
Gianluca Gaidano ◽  
Maria Teresa Voso ◽  
Giovanni Caocci ◽  
Massimo Breccia ◽  
...  
Keyword(s):  
Decision Making ◽  
High Risk ◽  
Treatment Option ◽  
Treatment Decision ◽  
Active Role ◽  
Risk Scores ◽  
Newly Diagnosed ◽  
Treatment Decision Making ◽  
Appropriate Treatment ◽  
Patient Reported

Abstract Abstract 4953 Background: Shared decision-making between patients and physicians is broadly advocated in medicine, however little research is available to understand whether this approach would be desirable to all patients regardless of disease type and severity or individual patient characteristics. While clinical decision-making in high-risk myelodysplastic syndromes (MDS) is critical for a number of reasons including: associated comorbidity, symptom burden, and limited life expectancy, no evidence-base data currently exist on patients' preferences. Aim: The objective of this study is twofold: 1) to investigate to what extent high-risk MDS patients prefer to be involved in treatment decision making during consultation just after diagnosis; 2) to identify possible clinical, socio-demographic and patient-reported health status factors associated with patients' preferences for involvement in treatment decisions. Patients and Methods: Data were gathered through an ongoing international prospective observational study involving 15 countries that recruits newly diagnosed patients with intermediate-2 or high-risk IPSS score. All patients were classified according to the WHO histology classification. During the first encounter with their treating physicians, discussing treatment options just after diagnosis, patients were administered a previously internationally validated “control preference scale”. This scale broadly categorizes patients into one of three roles depending on the extent of their preferred involvement in treatment decision-making: “active” (where the patient themselves prefer to decide on which would be the most appropriate treatment option for themselves); “collaborative/shared” (where the patient and the doctor jointly decided on the most appropriate treatment option); “passive” (where the patient prefer to leave decision on the most appropriate treatment option to the doctor). Associations with the following variables were investigated: performance status, comorbidity (“Hematopoietic Cell Transplantation”-“Comorbidity index”), living arrangements, age, gender, education, cultural group, IPSS risk category, evolution from lower IPSS risk scores and patient-reported symptoms (using symptom scales of the EORTC QLQ-C30). Descriptive statistics were used and Mann-Whitney U-test, Kruskall-Wallis test and Fisher's exact test were used as appropriate to test statistical significance of performed comparisons. Results: Study population included overall 121 patients (38% female and 62% male). Mean age of patients was 69 years (min:31.3 max: 87.9) and 80% were diagnosed with IPSS int-2 risk score and 20% with IPSS high risk score. Twenty-six percent evolved from lower IPSS risk scores, while 74% were newly diagnosed with higher-risk. Forty-nine percent favored a passive while only 13% preferred an active role in treatment decision-making; the remaining 38% favored a collaborative/shared decision-making approach. Investigation of factors possibly related to preferred roles, found that passive role was significantly associated with lower education levels (P=.04). Among lower educated patients, 62.5% preferred a passive role compared with only 5% preferring an active role. When investigating relationships with patient-reported symptoms, a general trend for patients preferring a passive role, showing worse outcomes, was also evident. Higher symptom mean scores were found for passive vs. active role groups, being respectively: 46 (sd.26.6) vs. 37 (sd.29.9) for fatigue; 20 (sd.31.8) vs. 2 (sd.8.6) for constipation; 34 (sd.33) vs. 24 (sd.29.5) for dyspnea. Exploratory analysis showed that overall mean symptom score was statistically significant worse in patients preferring a passive role vs. those preferring an active role (P=.01). While other trends of associations were noted, these were not statistically significant. Conclusion: This is the first evidence suggesting that a consistent percentage of high-risk MDS patients prefer a passive role when discussing treatment options with their treating physicians at the time of diagnosis. There is also an indication that these patients are those with lower education levels and presenting with a higher symptom burden. Results need to be confirmed in a larger sample size. Disclosures: No relevant conflicts of interest to declare.

Treatment decision making in metastatic prostate cancer (mPC).

2020 ◽  
Vol 38 (6_suppl) ◽  
pp. 224-224
Author(s):  
Alicia K. Morgans ◽  
Angela Fought ◽  
Benjamin Lee ◽  
David James VanderWeele ◽  
Maha H. A. Hussain ◽  
...  
Keyword(s):  
Decision Making ◽  
Treatment Decision ◽  
Good Health ◽  
Clinical Encounter ◽  
Treatment Choice ◽  
Categorical Variables ◽  
Exact Test ◽  
Treatment Decision Making ◽  
High Level ◽  
The Relationship

224 Background: Multiple treatments exist for mPC, and optimal treatment choice is not defined. Shared decision making (SDM) in which physicians communicate treatment purpose, risks, and benefits, and patients (pts) communicate values/preferences can be used to determine treatment. SDM is associated with superior health outcomes in non-cancer populations, but whether it is used in mPC is unknown. We assessed mPC pt and caregiver perceptions of decision locus of control (DLOC) (SDM vs physician (PD) or pt (PtD) directed decisions), and characteristics associated with DLOC. Methods: Between 12/16 and 11/17, mPC patients and caregivers completed surveys of decision making practices after a clinical encounter in which a decision occurred. To evaluate the relationship between pt perception of DLOC type and categorical variables we used Fisher’s exact test, and Kruskal-Wallis was used to evaluate the relationship between DLOC and age. Results: 50 pt/caregivers participated, with median pt age of 72 yo. Most pts were Caucasian (96%), married (90%), and reported good health or better (18% excellent, 58% good, 24% fair). 66% of pts reported SDM, 10% reported PD only, 12% reported PD considering patient’s preferences, and 12% reported PtD considering physician’s recommendation. Caregivers reported numerically lower rates of SDM (56%), PD only (6%), and PD considering patient’s preferences (8%), but greater PtD considering physician’s recommendation (30%), (p=0.28). Neither reported PtD without considering physician recommendations. There was no association between pt DLCO and age (p=0.70) or clinician type, (p=0.13). All pts reporting PtD considering physician’s recommendation saw medical oncologists rather than urologists. Conclusions: Both pts and caregivers perceived a majority of decisions as SDM, indicating a high level of patient engagement in mPC decision making, and clinician type and patient age were not associated with pt reported DLOC. Pts seen by medical oncology in this cohort reported directing treatment choice when considering physician’s recommendation. Efforts to assess and support decision making in more diverse patient populations and explore the association between SDM, pt satisfaction and quality of life are underway.

Treatment Decision Making in Early-Stage Breast Cancer: Should Surgeons Match Patients’ Desired Level of Involvement?

2002 ◽  
Vol 20 (6) ◽  
pp. 1473-1479 ◽  
Author(s):  
Nancy L. Keating ◽  
Edward Guadagnoli ◽  
Mary Beth Landrum ◽  
Catherine Borbas ◽  
Jane C. Weeks
Keyword(s):  
Breast Cancer ◽  
Decision Making ◽  
Early Stage ◽  
Treatment Decision ◽  
Active Role ◽  
Breast Conserving Surgery ◽  
Treatment Choice ◽  
Early Stage Breast Cancer ◽  
Treatment Decision Making ◽  
Actual Role

PURPOSE: To describe desired and actual roles in treatment decision making among patients with early-stage breast cancer, identify how often patients’ actual roles matched their desired roles, and examine whether matching of actual and desired roles was associated with type of treatment received and satisfaction. PATIENTS AND METHODS: We surveyed 1,081 women (response, 70%) diagnosed with early-stage breast cancer in Massachusetts or Minnesota about their desired and actual roles in treatment decision making with their surgeon and used logistic regression to assess whether matching of actual to desired roles was associated with type of surgery and satisfaction. RESULTS: Most patients (64%) desired a collaborative role in decision making, but only 33% reported actually having such a collaborative role when they discussed treatments with their surgeons. Overall, 49% of women reported an actual role that matched the desired role they reported, 25% had a less active role than desired, and 26% had a more active role than desired. In adjusted analyses, patients whose reported actual role matched their desired role were no more likely than others to undergo breast-conserving surgery (P > .2), but these women were more satisfied with their treatment choice (83.5% very satisfied; reference) than those whose role was less active than desired (72.9% very satisfied; P = .02) or more active than desired (72.2% very satisfied; P = .005). CONCLUSION: Only approximately half of patients reported an actual role in decision making that matched the desired role they reported. These patients were more satisfied with their treatment choice than other patients, suggesting that women with early-stage breast cancer may benefit from surgeons’ efforts to identify their preferences for participation in decisions and tailor the decision-making process to them.

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