Patient expectations from systemic treatment of metastatic prostate cancer (mPC).

Abstract

218 Background: Multiple systemic therapies prolong the survival of men with mPC, but the disease remains incurable. High-quality treatment decisions require an informed understanding of the purpose of treatment and expected risks and benefits, particularly because cancer patients may accept otherwise unacceptable treatment if they believe there is a ≥ 1% chance of cure. Reconciling patient expectations with expected outcomes of providers is necessary to prevent treatment with toxic therapies that patients would refuse if cure were not possible. We assessed patient expectations from treatment among men receiving systemic therapy for mPC. Methods: Between 6/1/15 and 9/29/16, men with mPC completed surveys defining expectations of cure from their current mPC treatment. We used frequencies and relative frequencies to describe expectations, and proportional odds models with robust standard errors to assess the association between expectations, optimism, clinical characteristics, and sociodemographic factors. Results: Among 96 men completing surveys, 32 (33%) reported that cure was at least a little likely (8% very likely, 14% somewhat likely, and 11% a little likely). Higher optimism scores were associated with higher expectations of cure (adjusted OR 2.5, 95% CI 1.3-4.8 for most versus least optimistic), and non-white race was associated with lower expectations of cure as compared with white patients (adjusted OR 0.08, 95% CI 0.02 – 0.3). Report of excellent or good overall health was associated with greater odds of expecting cure than report of fair or poor health (adjusted OR 13, 95% CI 1.3 – 125). Marital status and age were not associated with expectations. Conclusions: Up to 1/3 of men with mPC receive treatment with an expectation that it may cure their cancer. Men with greater optimism and better reported health status have greater odds of expecting cure. Actions to align patient and physician expectations are necessary to adequately counsel patients and avoid overtreatment with toxic therapies.