Living with treatment decisions: Regrets and quality of life among men treated for metastatic prostate cancer
Living with treatment decisions: Regrets and quality of life among men treated for metastatic prostate cancer
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DOI：
10.1200/jco.2001.19.1.72
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发表时间：
2001-01-01
影响因子：
45.3
通讯作者：
Ashton, CM
中科院分区：
文献类型：
--
作者：
Clark, JA;Wray, NP;Ashton, CM
目的：研究男性对转移性前列腺癌治疗决定的长期后悔的变化，即手术与化学阉割，及其与生活质量的关系。方法：对既往治疗的患者进行调查，以评估治疗决策和生活质量，并辅以焦点小组。在将调查对象分为满意和后悔两类时，两类分别是：患者是否希望自己能改变主意，以及他是否相信如果不选择治疗方法，情况会更好。使用Chi(2)和t检验来检验后悔与治疗史、并发症和生活质量之间的关系。结果：调查对象包括201名年龄在45 - 93岁（中位71岁）的男性，他们中位2年前开始治疗（71%化学阉割，29%睾丸切除术），大多数报告的并发症：潮热（70%），恶心（34%）和勃起功能障碍（81%）。大多数人对治疗决定感到满意，但23%的人表示遗憾。后悔的男性在过去一周中更频繁地报告手术（43%）与化学（36%）阉割（P = 0.030）和恶心（54% vs 32%; P = 0.010），但较少报告勃起功能障碍（56% vs 72%; P = 0.048）。后悔的男性在一般和前列腺癌相关生活质量的各项指标上得分都较低。定性分析揭示了其疾病进展和患者参与决策质量的实质性不确定性。结论：后悔是实质性的，并与治疗选择和生活质量有关。它可能源于潜在的社会心理困扰，以及在做出决定时和随后几年里与医生沟通有问题。中华临床杂志（19）：72-80。(C) 2001年美国临床肿瘤学会。
Purpose: To examine variation in men's long-term regret of treatment decisions, ie, surgical versus chemical castration, for metastatic prostate cancer and its associations with quality of life.Methods: Survey of previously treated patients to assess treatment decisions 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 would have been better off with the treatment not chosen were combined in classifying 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, 71 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 with the treatment decision, but 23% expressed regret. Regretful men more frequently reported surgical (43%) versus chemical (36%) castration (P = .030) and nausea in the past week (54% v 32%; P = .010) but less frequently reported erectile dysfunction (56% v 72%; P = .048). Regretful men indicated poorer scores on every measure of generic and prostate cancer-related quality of life. Qualitative analyses revealed substantial uncertainty about the progress 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 problematic communication with physicians when decisions are being reached and over subsequent years. J Clin Oncol 19:72-80. (C) 2001 by American Society of Clinical Oncology.