What DID the doctor actually tell you about your prostate cancer ...

Posted on September 6, 2011 by Sitemaster

It is well understood that there can be big differences between what we are told and what we later say and think that we heard. It is also the case that what we are told may commonly reflect the beliefs of the person doing the telling (as opposed to actual, factual information).

Xu et al. have recently published data from a small series of semi-structured interviews with recently diagnosed prostate cancer patients. The interviews were conducted to investigate exactly how this series of 21 American men (14 black and 7 white) made their treatment decisions.

Here is a summary of the key findings:

• Physician recommendation was ?very important? to the final treatment decision.
• The patients? self-perceptions, their values and attitudes, and their beliefs about prostate cancer were ?influential.?
• Men who elected to have surgery apparently believed that
• It offered the best chance of cure .
• The cancer might spread if not surgically removed.
• Men who elected to have radiation therapy believed that
• It offered equal curative efficacy to surgery.
• It was associated with fewer side effects than surgery.
• Fear of future consequences was the most common reason to reject watchful waiting.
• Anecdotal experiences of family and friends were important, especially in deciding ?what not to do.?
• The technological ?wizardry? of robot-assisted laparoscopic prostatectomy gave increased optimism to men who wanted surgery but were concerned about the morbidity associated with traditional open surgery.
• Few men seemed to be aware that treatment did not guarantee improved survival.

The telling piece of information here, of course, is the fact that few of these 21 men apparently understood that invasive treatment for localized prostate cancer does not come with any guarantee of any improvement in survival compared to deferred treatment (particularly for low-risk patients of 65 years and older). This immediately raises the question of what men are actually told or hear when they discuss prostate cancer treatment with physicians. And it is closely linked to the recent data suggesting that men have unreasonable expectations of their individual outcomes following surgical treatment for localized disease (even after extensive explanation of their potential risks).

We know that the diagnosis of any form of cancer tends to be traumatic. We also know that many people given a diagnosis of cancer are unable to process with accuracy any information about expectations or treatment that are given to them in the short term.

How can we resolve this problem? Is there a set of minimal information that should be handed, in writing, to every newly diagnosed prostate cancer patient that addresses the facts about the risks associated with treatment and non-treatment? Does such information need to take account of whether they have low-, intermediate-, or high-risk disease? Should physicians be required to tell all patients that there is no guarantee that invasive therapy will affect either their cancer-specific or their overall survival? And even if we do things like this, how do we assure ourselves that patients actually hear and ?process? this information appropriately?

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Source: http://prostatecancerinfolink.net/2011/09/06/what-did-the-doctor-actually-tell-you-about-your-prostate-cancer/

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