Influential factors impacting treatment (tx) decision making (TDM) and decision regret (DR) in patients (pts) with localized or locally advanced prostate cancer (LPC/LAPC).

Abstract

294 Background: Pts newly diagnosed with LPC/LAPC must contemplate many factors to make tx decisions that may later lead to regret. We conducted literature reviews exploring factors associated with pt TDM and DR. Methods: Databases (Ovid Medline, Ovid Embase, Cochrane Library), select congress proceedings and gray literature were searched (12 Sept 2022). Publications (pubs) on pt TDM and tx DR in LPC/LAPC were included following systematic literature review methods and selected based on the following criteria: 2012 onward, ≥100 pts, journal article, and quantitative data. Study quality was assessed by risk of bias tools (NICE STA guidance; Newcastle-Ottawa). Influential factors were those with p<0.05; for TDM, factors described as “a decision driver,” “associated,” “influential,” or “significant” were also included. Key factors were determined under consideration of number of studies, consistency of evidence, and study quality. Results: 75 pubs (68 studies) reported TDM (12 countries; 68% North America [NA] 25% Europe [E]). Pt TDM participation was reported in 34 pubs; overall, pts preferred an active/shared role. Of 39 influential TDM factors, those related to baseline demographics, health and disease, external factors (doctor recommendation most common), and tx goals/attributes were key (Table). 49 pubs reported DR (12 countries; 59% NA, 29% E). DR was assessed at 2 weeks to 6 years post-tx. Not tx specific DR (23 studies), was felt by 8-48% of pts. Regret associated with specific tx (18 studies) was felt by 7-43% (active surveillance), 12-57% (radical prostatectomy), 1-49% (radiotherapy), 28-49% (androgen deprivation therapy), and 21-47% (combination therapy) of pts. Of 42 significant DR factors, tx toxicity (sexual/urinary/bowel dysfunction), pt role in TDM, and making an informed tx decision were key (Table). Conclusions: DR is common in pts with LPC/LAPC. To help pts navigate factors influencing TDM and limit risk of DR, a shared consensual TDM approach between pts, caregivers, and healthcare professionals is needed. [Table: see text]