Treatment Regret Research Articles

2278: Decision aids and treatment regret in patients with localised prostate cancer: a systematic review

2278: Decision aids and treatment regret in patients with localised prostate cancer: a systematic review

(121) Acceptant and Commitment Therapy to Increase Compliance to Sexual Dysfunction Treatments in Men with Prostate Cancer: 6- and 12-Month Data from a Randomized Controlled Trial

Abstract Introduction For many men with prostate cancer, difficulty with sexual dysfunction, in particular erectile dysfunction (ED), can trigger a psychological process which leads to avoidance of utilizing sexual dysfunction treatments. Objective This study tests a novel psychological intervention based on Acceptance and Commitment Therapy (ACT) concepts to help men utilize these treatments. Methods This ongoing study recruited men with prostate cancer starting intracavernosal injection therapy (ICIT) for the treatment of ED. The recruitment goal is N=220. Subjects are randomized to ICIT + ACT (ACT), which focuses on reducing avoidance, or ICIT + Enhanced Monitoring and Education (EME), which includes enhanced follow-up. Both groups receive ICIT plus 3 sessions (30–45 min) and 10 booster sessions (10 min). The interventions are delivered over the course of a year. Subjects are assessed at entry and every 6 months (m) for two years. The primary outcomes are the number of penile injections/week (verified by syringe count), and compliance (defined as ≥2 injections/week). Secondary outcomes assess psychosexual variables. Preliminary 6m and 12m data is presented. Since these are preliminary analyses, effect sizes (d) are reported for secondary variables (d=0.2, small effect; d=0.5, medium effect; d=0.8, large effect). Results To date, 191 subjects have been randomized; 112 have completed the 6m assessment (ACT n=57, EME n=55) and 97 completed the 12m assessment (ACT n=48, EME n=49). Mean age at baseline was 60±7 years. At 6m and 12m, the ACT group utilized more injections/week vs. the EME group (6m: median 1.8 vs. 1.2, p=0.01; 12m: median 2.0 vs. 1.4, p=0.01) and were more compliant with ICI vs. the EME group (6m: 65% vs. 35%, p=0.01, RR=1.86; 12m: 79% vs. 41%, p=0.01, RR=1.93). At 6m and 12m, the ACT group reported greater: satisfaction with ED treatment (d=0.6) and overall sexual relationship (d=0.2). The ACT group also reported lower: sexual bother (d=0.2), prostate cancer treatment regret (d=0.3), negative psychological impact of cancer (d=0.3), and depressive symptoms (d=0.4). Conclusions Preliminary analysis suggests ACT significantly increases ICI use. Data also indicate that ACT helps increase men’s satisfaction with injections and sexual relationship, while reducing sexual bother, prostate cancer treatment regret, the psychological impact of cancer, and depressive symptoms. Disclosure No.

Patient-reported prostate cancer treatment regret following primary partial gland cryoablation

BackgroundProstate cancer treatment-related regret (TRR) incorporates the myriad effects of diagnosis and treatment with associated behavioral, emotional, and interpersonal changes within the context of patient values and expectations. We aimed to investigate TRR following primary partial gland cryoablation (PPGCA). MethodsMen with prostate cancer undergoing PPGCA since 3/2017 enrolled in a prospective outcome registry. Between June and August 2022, a validated prostate cancer related TRR decision scale was distributed. TRR score ≥40 was considered significant TRR. Men were considered potent if they reported ability to have penetration at least half the time sexual intercourse was initiated. Associations between significant TRR and baseline characteristics and longitudinal outcomes were assessed using logistic regressions. ResultsOf 245 men who met inclusion criteria, 163 (67%) completed the survey with median time since cryoablation 2.3 years (IQR: 1.3, 3.6). Overall, the mean composite TRR score was 12.4/100. Significant TRR was expressed by 14% of men. Among those who were potent/had erectile function at baseline, loss of potency and erectile function were associated with higher probability of significant TRR, respectively. No associations were identified between TRR and recurrence of clinically significant prostate cancer or salvage treatment. ConclusionsThe overwhelming majority of men do not express TRR following PPGCA. The loss of potency or development of erectile dysfunction predisposes to TRR. It is imperative to elucidate short-, intermediate- and long-term functional and oncological outcomes in order to define factors associated with TRR to improve counseling and reduce patient regret.

Treatment priorities and regret in older adults with head and neck cancer: A systematic review.

The majority of head and neck cancer (HNC) diagnoses are seen in people aged 70 and older; these numbers are set to increase. Greater understanding of treatment needs of older patients with HNC is essential. These older patients often have co-existing health conditions, are prone to frailty and may not prioritise survival when considering treatment options. This systematic review examines the current research with regard to priorities and factors influencing treatment regret in older people with HNC. Studies were eligible for inclusion if they (i) reported data from patients with a mean age of 65 years or older who had a confirmed diagnosis of HNC and had been treated using surgery, chemotherapy and/or radiotherapy with either palliative or curative intent, (ii) considered patient's priorities or preferences or examined treatment regret as one of the primary outcomes of the study (iii) were published in English. Pilot search identified n = 7222 articles; however, following screening, only four papers met the inclusion criteria. Narrative synthesis was indicated to analyse quantitative and qualitative evidence in parallel, as meta-analyses were not possible. There is a paucity in the literature examining older adults with HNC. There is an indication that older adults prioritise maintaining independence when making treatment decisions and treatment regret is seen in those with high levels of depression with level of frailty also a contributing factor. Clinicians should consider patient's social circumstances, premorbid status and priorities in maintaining independence and managing symptoms when making treatment decisions in this cohort.

What's New in Musculoskeletal Infection.

What's New in Musculoskeletal Infection.

MP73-10 PATIENT-REPORTED TREATMENT RELATED REGRET (TRR) FOLLOWING PRIMARY PARTIAL GLAND CRYOABLATION (PPGCA):A PROSPECTIVE COHORT STUDY OF MEN WITH LOCALIZED PROSTATE CANCER

You have accessJournal of UrologyCME1 Apr 2023MP73-10 PATIENT-REPORTED TREATMENT RELATED REGRET (TRR) FOLLOWING PRIMARY PARTIAL GLAND CRYOABLATION (PPGCA):A PROSPECTIVE COHORT STUDY OF MEN WITH LOCALIZED PROSTATE CANCER Herbert Lepor, Eli Rapoport, Rozalba Gogaj, Sameer Thakker, and James Wysock Herbert LeporHerbert Lepor More articles by this author , Eli RapoportEli Rapoport More articles by this author , Rozalba GogajRozalba Gogaj More articles by this author , Sameer ThakkerSameer Thakker More articles by this author , and James WysockJames Wysock More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003341.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: TRR captures the effect of treatment-related functional impairments, oncologic anxiety and outcomes, and behavioral, emotional, and interpersonal changes associated with diagnosis and treatment within the context of patient values and expectations. The objective is to determine the rate of TRR following PPGCA and characterize factors predisposing to TRR. METHODS: Men with prostate cancer undergoing PPGCA since 3/2017 were enrolled in a prospective outcome registry. Preoperative baseline characteristics (i.e., patient age, race, IPSS and SHIM, and Gleason Grade Group); post-operative outcomes (i.e., recurrence on surveillance biopsy, receipt of salvage treatment); and functional status (measured using the IPSS and SHIM) were recorded. Between June and August 2022, the Clark et al. validated prostate cancer-related treatment regret decision scale was distributed. A score≥40 on the regret scale was considered significant TRR. Men were considered potent at baseline or post-treatment if their response to Question #2 of the SHIM was>2. Associations between significant treatment regret and baseline characteristics (i.e., patient age, race, IPSS, SHIM and preoperative GGG) and longitudinal outcomes (i.e., recurrence on surveillance biopsy, receipt of salvage treatment, a clinically significant change in IPSS, decline in potency or erectile function, and loss of potency among those who were potent at baseline) were assessed using logistic regressions. RESULTS: 245 men met criteria for inclusion in the study, of whom 163 completed the survey (response rate: 66.5%). Significant TRR was expressed by 15.8% of men. Age, race, baseline erectile function, and Gleason Grade Group were not statistically significant predictors of TRR. Among those who were potent at baseline, loss of potency was associated with higher probability of significant TRR. Similarly, among those who had erectile function and severe LUTS at baseline, and loss of erectile function were associated with higher probabilities of significant TRR. No associations were identified between TRR and recurrence of csPCa or salvage treatment. CONCLUSIONS: The overwhelming majority of men do not express TRR following PPGCA. Baseline severe LUTS at baseline and the development of erectile dysfunction are factors predisposing to TRR. It is imperative to elucidate short, intermediate and long term functional and oncological outcomes predisposing to TRR in order to optimize outcomes. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e1038 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Herbert Lepor More articles by this author Eli Rapoport More articles by this author Rozalba Gogaj More articles by this author Sameer Thakker More articles by this author James Wysock More articles by this author Expand All Advertisement PDF downloadLoading ...

PD11-01 ACCEPTANT AND COMMITMENT THERAPY TO INCREASE COMPLIANCE TO SEXUAL DYSFUNCTION TREATMENTS IN MEN WITH PROSTATE CANCER: 6- AND 12-MONTH DATA FROM A RANDOMIZED CONTROLLED TRIAL

You have accessJournal of UrologyCME1 Apr 2023PD11-01 ACCEPTANT AND COMMITMENT THERAPY TO INCREASE COMPLIANCE TO SEXUAL DYSFUNCTION TREATMENTS IN MEN WITH PROSTATE CANCER: 6- AND 12-MONTH DATA FROM A RANDOMIZED CONTROLLED TRIAL Christian Nelson, Nassima Boukhalfa, Hayley Pessin, Nisha Mehta, Elizabeth Schofield, and John Mulhall Christian NelsonChristian Nelson More articles by this author , Nassima BoukhalfaNassima Boukhalfa More articles by this author , Hayley PessinHayley Pessin More articles by this author , Nisha MehtaNisha Mehta More articles by this author , Elizabeth SchofieldElizabeth Schofield More articles by this author , and John MulhallJohn Mulhall More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003251.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: For many men with prostate cancer, difficulty with sexual dysfunction, in particular erectile dysfunction (ED), can trigger a psychological process which leads to avoidance of utilizing sexual dysfunction treatments. This study tests a novel psychological intervention based on Acceptance and Commitment Therapy (ACT) concepts to help men utilize these treatments. METHODS: This ongoing study recruited men with prostate cancer starting intracavernosal injection therapy (ICIT) for the treatment of ED. The recruitment goal is N=220. Subjects are randomized to ICIT + ACT (ACT), which focuses on reducing avoidance, or ICIT + Enhanced Monitoring and Education (EME), which includes enhanced follow-up. Both groups receive ICIT plus 3 sessions (30-45 min) and 10 booster sessions (10 min). The interventions are delivered over the course of a year. Subjects are assessed at entry and every 6 months (m) for two years. The primary outcomes are the number of penile injections/week (verified by syringe count), and compliance (defined as ≥2 injections/week). Secondary outcomes assess psychosexual variables. Preliminary 6 m and 12 m data is presented. Since these are preliminary analyses, effect sizes (d) are reported for secondary variables (d=0.2, small effect; d=0.5, medium effect; d=0.8, large effect). RESULTS: To date, 191 subjects have been randomized; 112 have completed the 6m assessment (ACT n=57, EME n=55) and 97 completed the 12 m assessment (ACT n=48, EME n=49). Mean age at baseline was 60±7 years. At 6 m and 12 m, the ACT group utilized more injections/week vs. the EME group (6 m: median 1.8 vs. 1.2, p=0.01; 12 m: median 2.0 vs. 1.4, p=0.01) and were more compliant with ICI vs. the EME group (6 m: 65% vs. 35%, p=0.01, RR=1.86; 12 m: 79% vs. 41%, p=0.01, RR=1.93). At 6 m and 12 m, the ACT group reported greater: satisfaction with ED treatment (d=0.6) and overall sexual relationship (d=0.2). The ACT group also reported lower: sexual bother (d=0.2), prostate cancer treatment regret (d=0.3), negative psychological impact of cancer (d=0.3), and depressive symptoms (d=0.4). CONCLUSIONS: Preliminary analysis suggests ACT significantly increases ICI use. Data also indicate that ACT helps increase men’s satisfaction with injections and sexual relationship, while reducing sexual bother, prostate cancer treatment regret, the psychological impact of cancer, and depressive symptoms. Source of Funding: National Institutes of Health: R01 CA 190636 © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e332 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christian Nelson More articles by this author Nassima Boukhalfa More articles by this author Hayley Pessin More articles by this author Nisha Mehta More articles by this author Elizabeth Schofield More articles by this author John Mulhall More articles by this author Expand All Advertisement PDF downloadLoading ...

Patient-reported Satisfaction and Regret Following Focal Therapy for Prostate Cancer: A Prospective Multicenter Evaluation

BackgroundSeveral reports are available regarding the treatment decision regret of patients receiving conventional treatments for localized prostate cancer (PCa); yet data on patients undergoing focal therapy (FT) are sparse. ObjectiveTo evaluate the treatment decision satisfaction and regret among patients who underwent FT for PCa with high-intensity focused ultrasound (HIFU) or cryoablation (CRYO). Design, setting, and participantsWe identified consecutive patients who underwent HIFU or CRYO FT as the primary treatment for localized PCa at three US institutions. A survey with validated questionnaires, including the five-question Decision Regret Scale (DRS), International Prostate Symptom Score (IPSS), and International Index of Erectile Function (IIEF-5), was mailed to the patients. The regret score was calculated based on the five items of the DRS, and regret was defined as a DRS score of >25. Outcome measurements and statistical analysisMultivariable logistic regression models were applied to assess the predictors of treatment decision regret. Results and limitationsOf 236 patients, 143 (61%) responded to the survey. Baseline characteristics were similar between responders and nonresponders. During a median (interquartile range) follow-up of 43 (26–68) mo, the treatment decision regret rate was 19.6%. On a multivariable analysis, higher prostate-specific antigen (PSA) at nadir after FT (odds ratio [OR] 1.48, 95% confidence interval [CI] 1.1–2, p = 0.009), presence of PCa on follow-up biopsy (OR 3.98, 95% CI 1.5–10.6, p = 0.006), higher post-FT IPSS (OR 1.18, 95% CI 1.01–1.37, p = 0.03), and newly diagnosed impotence (OR 6.67, 95% CI 1.57–27, p = 0.03) were independent predictors of treatment regret. The type of energy treatment (HIFU/CRYO) was not a predictor of regret/satisfaction. Limitations include retrospective abstraction. ConclusionsFT for localized PCa is well accepted by the patients, with a low regret rate. Higher PSA at nadir, presence of cancer on follow-up biopsy, bothersome postoperative urinary symptoms, and impotence after FT were independent predictors of treatment decision regret. Patient summaryIn this report, we looked at the factors affecting satisfaction and regret in patients with prostate cancer undergoing focal therapy. We found that focal therapy is well accepted by the patients, while presence of cancer on follow-up biopsy as well as bothersome urinary symptoms and sexual dysfunction can predict treatment decision regret.

The Association Between Financial Toxicity and Treatment Regret in Men With Localized Prostate Cancer.

Financial toxicity is emerging as an important patient-centered outcome and is understudied in prostate cancer patients. We sought to understand the association between financial burden and treatment regret in men with localized prostate cancer to better evaluate the role of financial discussions in patient counseling. Utilizing the Comparative Effectiveness Analysis of Surgery and Radiation dataset, we identified all men accrued between 2011 and 2012 who underwent surgery, radiation, or active surveillance for localized prostate cancer. Financial burden and treatment regret were assessed at 3- and 5-year follow-up. The association between financial burden and regret was assessed using multivariable longitudinal logistic regression controlling for demographic and disease characteristics, treatment, functional outcomes, and patient expectations. Of the 2924 eligible patients, regret and financial burden assessments for 3- and/or 5-year follow-up were available for 81% (n = 2359). After adjustment for relevant covariates, financial burden from "finances in general" was associated with treatment regret at 3 years (odds ratio [OR] = 2.47, 95% confidence interval [CI] = 1.33 to 4.57; P = .004); however, this association was no longer statistically significant at 5-year follow-up (OR = 1.19, 95% CI = 0.56 to 2.54; P = .7). In this population-based sample of men with localized prostate cancer, we observed associations between financial burden and treatment regret. Our findings suggest indirect treatment costs, especially during the first 3 years after diagnosis, may impact patients more profoundly than direct costs and are important for inclusion in shared decision making.

Abstract 3220: Patient communication efficacy, information seeking, and treatment regret among early-stage prostate cancer survivors

Abstract Background: Most men with prostate cancer lack sufficient knowledge of their illness at the time they are diagnosed to make informed decisions about treatment. The ways patients interact with physicians can influence the quality of treatment-related information that is received and impact emotional well-being. Regret is a common negative affect that patients, providers, and care givers seek to avoid. This study investigated the relationship between patient communication efficacy, treatment information seeking behaviors, and decision regret within a sample of early-stage prostate cancer survivors. Methods: Sixty-three men diagnosed with early-stage prostate cancer (Stage T1 or T2) completed self-administered questionnaires. Men who were actively monitoring or undergoing definitive treatment were eligible for inclusion. The 67-item data collection tool captured patient demographics, cancer treatment information seeking behaviors, and psychosocial characteristics. Communication efficacy was measured using the validated Perceived Efficacy Patient Physicians Interaction (PEPPI-10, α=.94) scale. Decision regret was assessed using a validated 5-item measure (Brehaut et al., 2003). Descriptive and comparative analyses were conducted using SPSS Version 25. Results: A majority of participants were White (58.7%), married/partnered (79.4%), privately insured (54.2%) and graduated college (75.0%). More than two-thirds (77.8%) wanted to assume an active role during treatment decision-making. Most respondents (58.1%) fell within the high efficacy communication group (+/- 1/2 s.d. of the mean). A majority of men did not regret their initial treatment choice (82.5%). Men who regretted their initial treatment choice reported significantly more unmet treatment information needs (Mean= 5.63) than those who did not regret (Mean= 2.78) their treatment decision [t(60) = 2.084, p = .041]. Independent samples t-test results showed a statistically significant relationship between regret and communication efficacy [t(60) = -2.38, p =.021]. The two situations where men who regretted their decisions reported lower levels of communication efficacy were getting doctors to pay attention to what they have to say [t(60) = -3.39, p = .001] and making the most of their visit with the doctor [t(60) = -2.22, p = .030]. Perceived communication efficacy marginally differentiated men who regretted and did not regret their treatment decisions in two more clinical situations [t(60) = -1.92, p = .060; t(60) = -1.97, p = .054]. Conclusion: Communication efficacy appears to impact patient treatment information seeking behaviors and decision regret. Communication interventions need to be developed to increase early stage prostate cancer patients’ level of confidence when seeking treatment information to enhance their emotional well-being and quality of life. Citation Format: Levi Ross, Jordan S. Young, Jala Lockhart, Torhonda Lee, Ashley Bowers, Guleer Shabab, Michael A. Preston. Patient communication efficacy, information seeking, and treatment regret among early-stage prostate cancer survivors [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2022; 2022 Apr 8-13. Philadelphia (PA): AACR; Cancer Res 2022;82(12_Suppl):Abstract nr 3220.

Influence of decision support persons on breast cancer treatment decisions among Latinas.

12025 Background: Prior studies suggest that decision support persons (DSPs) involvement in breast cancer promotes greater deliberation and decision quality. Despite having the highest level of involvement, Latinx DSPs report the lowest satisfaction with their involvement. The reasons for this remain unknown. We examined the treatment decision-making experiences of Latinx DSPs, their influence on treatment deliberation, subjective decision quality (SDQ), and treatment received. Methods: Women with newly diagnosed early-stage breast cancer as reported to the Surveillance, Epidemiology, and End Results (SEER) registries of Georgia and Los Angeles County in 2014-2015 were surveyed. Participants identified the DSPs who played a key role in treatment decisions, who were also surveyed. We examined: (1) bivariate associations of DSP characteristics (e.g type, age, race/ethnicity, education, acculturation level) with DSP-reported level of engagement (informed about decisions, involvement (extent and satisfaction), and aware of patient preferences), (2) DSP engagement with patient-reported SDQ and treatment deliberation using multivariable linear regression with standardized scales (3), and treatment received by DSPs preferred treatment. Results: 2502 patients (68%) and 1203 eligible DSPs (70%) responded, resulting in 1,173 dyads, 292 where the patient identified as Latina, and 881 as non-Latina. Among Latina dyads, 78%, 17%, and 5% DSPs identified as Latinx, White, and Asian/Black/Other, respectively. Latinx DSPs within Latina/Latinx dyads were younger, had lower educational attainment and acculturation when compared to other dyads. The proportion of married/partnered status was not different across dyads, but the key DSP for the Latina-Latinx dyads was more often a daughter (37%), over a husband/partner (21%), compared to the other dyads. Latinx DSPs reported being more informed (adjusted mean 4.26, p = 0.058) compared to the other dyads, and being more informed was positively associated with higher patient SDQ (adjusted mean difference 0.176, p = 0.034), despite no difference in treatment deliberation. Overall, Latinx DSP had a higher preference for mastectomy, especially with reconstruction when compared to non-Latinx (40% vs 28%). Overall, 27% of Latinas (vs 13% non-Latina) underwent lumpectomy despite their DSP’s preference for mastectomy. Conclusions: These findings reveal that the key DSP for many married Latinas is often a daughter over spouse/partner. Our results suggest that including daughter/DSPs in treatment decisions and tailoring strategies to meet their information needs may positively impact Latina SDQ. Potential areas of improvement include surgical options preferences, where notable discrepancy was seen between Latinas and non-Latinas. Awareness of these differences can minimize treatment regret, improve decision quality, and ultimately outcomes in Latinas.

PD25-03 ASSOCIATION BETWEEN FINANCIAL BURDEN AND TREATMENT REGRET IN MEN WITH LOCALIZED PROSTATE CANCER

You have accessJournal of UrologyCME1 May 2022PD25-03 ASSOCIATION BETWEEN FINANCIAL BURDEN AND TREATMENT REGRET IN MEN WITH LOCALIZED PROSTATE CANCER Daniel D. Joyce, Christopher J. D. Wallis, Li-Ching Huang, Karen E. Hoffman, Zhiguo Zhao, Tatsuki Koyama, Ralph Conwill, David F. Penson, and Daniel A. Barocas Daniel D. JoyceDaniel D. Joyce More articles by this author , Christopher J. D. WallisChristopher J. D. Wallis More articles by this author , Li-Ching HuangLi-Ching Huang More articles by this author , Karen E. HoffmanKaren E. Hoffman More articles by this author , Zhiguo ZhaoZhiguo Zhao More articles by this author , Tatsuki KoyamaTatsuki Koyama More articles by this author , Ralph ConwillRalph Conwill More articles by this author , David F. PensonDavid F. Penson More articles by this author , and Daniel A. BarocasDaniel A. Barocas More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002567.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We sought to understand the association between financial burden and treatment regret in men with localized prostate cancer to better understand the importance of inclusion of financial discussions in patient counseling. METHODS: Utilizing the multicenter, population-based Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) dataset, we identified all men accrued between 2011 and 2012 who underwent surgery, radiation, or active surveillance as primary management for localized prostate cancer. Patient-reported functional outcomes were assessed at baseline and longitudinally through 5 years using the 26-item Expanded Prostate Index Composite questionnaire. Treatment regret was assessed at 3- and 5-year follow-up using Clark’s validated scale. Financial burden was similarly evaluated at 3 and 5 years using a previously published 4-item questionnaire. The association between financial burden and treatment regret was assessed using multivariable logistic regression controlling for demographics, disease characteristics, treatment, functional outcomes, and patient expectations. RESULTS: Of the 2,924 men who met inclusion criteria, both regret and financial burden assessments were available for 80.6% (n=2,359). Prostate cancer management included surgery (n=1,256, 53.2%), radiation (n=787, 33.4%), and active surveillance (n=316, 13.4%). Financial burden from “finances in general” was associated with treatment regret at 3 and 5 years, after adjusting for potential confounders (OR 2.47, 95% CI 1.33, 4.57). Similar associations with financial burden from direct costs, such as treatment (OR 1.02, 95% CI 0.47, 2.21), clinic visit (OR 1.85, 95% CI 0.92, 3.71), and health insurance costs (OR 1.71, 95% CI 0.89, 3.30) were not observed (see Table). CONCLUSIONS: In this representative, population-based sample of men with localized prostate cancer, we observed associations between overall financial burden and treatment regret. The lack of association between treatment regret and measures of financial burden due to direct treatment costs may indicate a more profound impact on patients from indirect costs and should guide future efforts to address financial toxicity in prostate cancer management. Source of Funding: This study was supported by the Agency for Healthcare Research and Quality (1R01HS019356, 1R01HS022640) and the Patient-Centered Outcomes Research Institute (CE-12-11-4667). Data management was facilitated by Vanderbilt University’s Research Electronic Data Capture (REDCap) system, which is supported by the Vanderbilt Institute for Clinical and Translational Research grant (UL1TR000011 from NCATS/NIH) © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e422 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel D. Joyce More articles by this author Christopher J. D. Wallis More articles by this author Li-Ching Huang More articles by this author Karen E. Hoffman More articles by this author Zhiguo Zhao More articles by this author Tatsuki Koyama More articles by this author Ralph Conwill More articles by this author David F. Penson More articles by this author Daniel A. Barocas More articles by this author Expand All Advertisement PDF DownloadLoading ...

Acceptance and commitment therapy to increase compliance to intracavernosal injection use (ICI) following radical prostatectomy (RP): Preliminary results from a randomized control trial

ABSTRACT Introduction ICI is the cornerstone of many erectile rehabilitation programs (ERP). However, compliance with ICI is historically low. This study tests a novel psychological intervention based on Acceptance and Commitment Therapy (ACT) concepts to help men reduce avoidance to ICI and commit to an ERP. Methods This ongoing study recruits men starting in our ERP. The recruitment goal is N=220. Subjects are randomized to ERP+ACT or ERP+Enhanced Monitoring and Education (EME). ERP+ACT receive ERP plus 3 ACT Sessions (30-45min) and 10 ACT Booster Sessions (10min). ERP+EME receive ERP plus 3 EME Sessions (30-45min) and 10 EME Booster Sessions (10min) delivered by a nurse practitioner who monitors ICI use, answers questions, and provides education. The interventions are delivered over a year. Eligibility includes: within 9m post RP; functional pre-RP erections (≥6/10). Subjects are assessed at entry and every 6m for two years. The primary outcomes are number of penile injections/week (verified by syringe count), and compliance (defined as ≥2 injections/week). Secondary outcomes are: ED treatment satisfaction, sexual self-esteem and relationship quality, sexual bother, prostate cancer treatment regret, the psychological impact of cancer, and depressive symptoms. Preliminary 6m data is presented. Groups are compared with ANCOVA. Since these are preliminary analyses, if differences were not statistically significant, effect sizes (d) are reported (d=0.2, small effect; d=0.5, medium effect; d=0.8, large effect). Results To date, 120 subjects have been randomized; 62 have completed the 6m assessment (ACT n=33, EME n=29). The mean age was 60±7 years and 81% were married. The mean erectile function grade pre-RP was 8.9±1 (0-10 scale). At 6m, the ACT group utilized more injections/week vs. the EM group (median: 2.06 vs. 1.17, p=0.01) and were more compliant with ICI vs. the EM group (70% vs. 45%, p=0.05, RR=1.55). The ACT group reported greater: satisfaction with ED treatment (d=0.6) and overall sexual relationship (d=0.2). The ACT group also reported lower: sexual bother (d=0.2), prostate cancer treatment regret (d=0.3), negative psychological impact of cancer (d=0.3), and depressive symptoms (d=0.2). Conclusion Preliminary analysis suggests ACT significantly increases ICI use. Data also indicate ACT helps increase men's satisfaction with injections and sexual relationship, while reducing sexual bother, prostate cancer treatment regret, the psychological impact of cancer, and depressive symptoms. Source of funding National Institutes of Health: R01 CA 190636 Disclosure Work supported by industry: no.

Acceptance and Commitment Therapy to Increase Compliance to Intracavernosal Injection Use (ICI) Following Radical Prostatectomy (RP): Preliminary Results from a Randomized Control Trial

ABSTRACT Introduction ICI is the cornerstone of many erectile rehabilitation programs (ERP). However, compliance with ICI is historically low. Objective This study tests a novel psychological intervention based on Acceptance and Commitment Therapy (ACT) concepts to help men reduce avoidance to ICI and commit to an ERP. Methods This ongoing study recruits men starting in our ERP. The recruitment goal is N=220. Subjects are randomized to ERP+ACT or ERP+Enhanced Monitoring and Education (EME). ERP+ACT receive ERP plus 3 ACT Sessions (30-45min) and 10 ACT Booster Sessions (10min). ERP+EME receive ERP plus 3 EME Sessions (30-45min) and 10 EME Booster Sessions (10min) delivered by a nurse practitioner who monitors ICI use, answers questions, and provides education. The interventions are delivered over a year. Eligibility includes: within 9m post RP; functional pre-RP erections (≥6/10). Subjects are assessed at entry and every 6m for two years. The primary outcomes are number of penile injections/week (verified by syringe count), and compliance (defined as ≥2 injections/week). Secondary outcomes are: ED treatment satisfaction, sexual self-esteem and relationship quality, sexual bother, prostate cancer treatment regret, the psychological impact of cancer, and depressive symptoms. Preliminary 6m data is presented. Groups are compared with ANCOVA. Since these are preliminary analyses, if differences were not statistically significant, effect sizes (d) are reported (d=0.2, small effect; d=0.5, medium effect; d=0.8, large effect). Results To date, 120 subjects have been randomized; 62 have completed the 6m assessment (ACT n=33, EME n=29). The mean age was 60±7 years and 81% were married. The mean erectile function grade pre-RP was 8.9±1 (0-10 scale). At 6m, the ACT group utilized more injections/week vs. the EM group (median: 2.06 vs. 1.17, p=0.01) and were more compliant with ICI vs. the EM group (70% vs. 45%, p=0.05, RR=1.55). The ACT group reported greater: satisfaction with ED treatment (d=0.6) and overall sexual relationship (d=0.2). The ACT group also reported lower: sexual bother (d=0.2), prostate cancer treatment regret (d=0.3), negative psychological impact of cancer (d=0.3), and depressive symptoms (d=0.2). Conclusions Preliminary analysis suggests ACT significantly increases ICI use. Data also indicate ACT helps increase men's satisfaction with injections and sexual relationship, while reducing sexual bother, prostate cancer treatment regret, the psychological impact of cancer, and depressive symptoms. Disclosure No

Treatment Regret, Mental and Physical Health Indicators of Psychosocial Well-Being among Prostate Cancer Survivors.

Prostate cancer (PCa) patients and survivors are at high risk of mental health illness. Here, we examined the contribution of treatment regret, mental and physical health indicators to the social/family, emotional, functional and spiritual well-being of PCa survivors. The study assessed 367 men with a history of PCa residing in the Maritimes Canada who were surveyed between 2017 and 2021. The outcomes were social/family, emotional, functional and spiritual well-being (FACT-P,FACIT-Sp). Predictor variables included urinary, bowel and sexual function (UCLA-PCI), physical and mental health (SF-12), and treatment regret. Logistic regression analyses were controlled for age, income, and survivorship time. Poor social/family, emotional, functional and spiritual well-being was identified among 54.4%, 26.5%, 49.9% and 63.8% of the men in the sample. Men who reported treatment regret had 3.62, 5.58, or 4.63 higher odds of poor social/family, emotional, and functional well-being, respectively. Men with low household income had 3.77 times higher odds for poor social/well-being. Good mental health was a protective factor for poor social/family, emotional, functional, or spiritual well-being. Better physical and sexual health were protective factors for poor functional well-being. Seeking to promote PCa patients’ autonomy in treatment decisions and recognizing this process’ vulnerability in health care contexts is warranted.

PD20-01 ACCEPTANCE AND COMMITMENT THERAPY TO INCREASE COMPLIANCE TO INTRACAVERNOSAL INJECTION USE (ICI) FOLLOWING RADICAL PROSTATECTOMY (RP): PRELIMINARY RESULTS FROM A RANDOMIZED CONTROL TRIAL

You have accessJournal of UrologySexual Function/Dysfunction: Medical, Hormonal & Non-surgical Therapy I (PD20)1 Sep 2021PD20-01 ACCEPTANCE AND COMMITMENT THERAPY TO INCREASE COMPLIANCE TO INTRACAVERNOSAL INJECTION USE (ICI) FOLLOWING RADICAL PROSTATECTOMY (RP): PRELIMINARY RESULTS FROM A RANDOMIZED CONTROL TRIAL Christian Nelson, Rebecca Tutino, Hayley Pessin, Nisha Joshi, Elizabeth Schofield, and John Mulhall Christian NelsonChristian Nelson More articles by this author , Rebecca TutinoRebecca Tutino More articles by this author , Hayley PessinHayley Pessin More articles by this author , Nisha JoshiNisha Joshi More articles by this author , Elizabeth SchofieldElizabeth Schofield More articles by this author , and John MulhallJohn Mulhall More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002009.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: ICI is the cornerstone of many erectile rehabilitation programs (ERP). However, compliance with ICI is historically low. This study tests a novel psychological intervention based on Acceptance and Commitment Therapy (ACT) concepts to help men reduce avoidance to ICI and commit to an ERP. METHODS: This ongoing study recruits men starting in our ERP. The recruitment goal is N=220. Subjects are randomized to ERP+ACT or ERP+Enhanced Monitoring and Education (EME). ERP+ACT receive ERP plus 3 ACT Sessions (30-45min) and 10 ACT Booster Sessions (10min). ERP+EME receive ERP plus 3 EME Sessions (30-45min) and 10 EME Booster Sessions (10min) delivered by a nurse practitioner who monitors ICI use, answers questions, and provides education. The interventions are delivered over a year. Eligibility includes: within 9m post RP; functional pre-RP erections (≥6/10). Subjects are assessed at entry and every 6m for two years. The primary outcomes are number of penile injections/week (verified by syringe count), and compliance (defined as ≥2 injections/week). Secondary outcomes are: ED treatment satisfaction, sexual self-esteem and relationship quality, sexual bother, prostate cancer treatment regret, the psychological impact of cancer, and depressive symptoms. Preliminary 6m data is presented. Groups are compared with ANCOVA. Since these are preliminary analyses, if differences were not statistically significant, effect sizes (d) are reported (d=0.2, small effect; d=0.5, medium effect; d=0.8, large effect). RESULTS: To date, 120 subjects have been randomized; 62 have completed the 6m assessment (ACT n=33, EME n=29). The mean age was 60±7 years and 81% were married. The mean erectile function grade pre-RP was 8.9±1 (0-10 scale). At 6m, the ACT group utilized more injections/week vs. the EM group (median: 2.06 vs. 1.17, p=0.01) and were more compliant with ICI vs. the EM group (70% vs. 45%, p=0.05, RR=1.55). The ACT group reported greater: satisfaction with ED treatment (d=0.6) and overall sexual relationship (d=0.2). The ACT group also reported lower: sexual bother (d=0.2), prostate cancer treatment regret (d=0.3), negative psychological impact of cancer (d=0.3), and depressive symptoms (d=0.2). CONCLUSIONS: Preliminary analysis suggests ACT significantly increases ICI use. Data also indicate ACT helps increase men’s satisfaction with injections and sexual relationship, while reducing sexual bother, prostate cancer treatment regret, the psychological impact of cancer, and depressive symptoms. Source of Funding: National Institutes of Health: R01 CA 190636 © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e367-e367 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christian Nelson More articles by this author Rebecca Tutino More articles by this author Hayley Pessin More articles by this author Nisha Joshi More articles by this author Elizabeth Schofield More articles by this author John Mulhall More articles by this author Expand All Advertisement Loading ...

Treatment decision satisfaction and regret after focal HIFU for localized prostate cancer

PurposeFocal therapies (FTs) are investigated within prospective studies on selected patients treated for localized prostate cancer (PCa). Benefits are preservation of genitourinary function and reduced complications, but follow-up is elaborate and is associated with uncertainty as cancer-free survival appears to be lower compared to standard radical treatments. The aim of this study was to analyse patient-reported acceptance of FT and evaluate factors associated with treatment decision regret.Methods52 patients who received focal high-intensity focused ultrasound for low- to intermediate-risk PCa between 2014 and 2019 within two prospective trials were eligible for a survey regarding PCa-related treatment regret and quality-of-life (Clark’s scale) and the following potential predictors: sociodemographic variables, Charlson Comorbidity Index, subjective aging (AARC-10 SF), and general health-related quality-of-life (SF-12). Cancer persistence/recurrence (multiparametric MRI and fusion biopsy after 12 months) and functional outcomes (EPIC-26 UI/UIO/S) data were also included in this study.ResultsThe overall survey response rate was 92.3% (48/52 patients). Median follow-up was 38 months (interquartile range = 25–50 months). In total, ten patients (20.8%) reported treatment decision regret. In univariable analyses, a clinically meaningful increase in urinary incontinence showed a significant association (OR 4.43; 95% CI 0.99–20.53; p = 0.049) with regret. Cancer recurrence (OR 12.31; 95% CI 1.78–159.26; p = 0.023) and general health worry as a domain of Clark’s scale (OR 1.07; 95% CI 1.03–1.14; p < 0.01) were predictors of regret in a multivariable logistic regression model (AUC = 0.892).ConclusionAcceptance of FT is comparable to standard treatments. Extensive follow-up including regular PSA testing does not cause additional regret but careful patient selection and information before FT is crucial.

Examining the association of health literacy and numeracy with prostate-related knowledge and prostate cancer treatment regret

Educational materials used in prostate cancer shared decision-making are often written above the health literacy levels of the patients that may benefit the most from such tools. Poor understanding the oncologic and functional outcomes of prostate cancer treatment may influence patient regret during this process. In this study, we assess the association between health literacy, numeracy, prostate-related knowledge and treatment regret in a diverse population. Patients obtaining care between June and August of 2016 at both community-based and academic tertiary care facilities were assessed for health literacy and numeracy using validated instruments. Prostate knowledge was tested in those patients without a history of prostate cancer using a 29-item questionnaire and patient-level predictors of knowledge were assessed. Prostate cancer treatment regret was assessed in those patients who had a history of prostate cancer. A total of 90 patients were enrolled, 38 (42%) of whom had a history of prostate cancer. African American race (I = 0.039), financial strain (P < 0.001), and educational attainment (P < 0.001) were all associated with lower health literacy on multivariable analysis. Possessing a professional degree (P = 0.021) and higher health literacy (P = 0.001) were associated with greater prostate-related knowledge. Of those with a history of prostate cancer, 9 (24%) expressed treatment regret. Patients with regret were more likely to be African American (n = 6, 66.7% vs. 5, 17.2%, P = 0.004), not married (P = 0.016), and score lower on the literacy (1.0 vs. 8.0, P = 0.009) and numeracy (10.0 vs. 16.0, P = 0.016) scales. We identified lower health literacy among African American men, and lower prostate-related knowledge in those with poor health literacy. To our knowledge, this is the first study to show an association between health literacy and prostate cancer treatment regret.

Trends in patient misperception and decisional regret during treatment for advanced cancer: A prospective study.

e24190 Background: Cancer patients receiving palliative therapy often misperceive the likelihood of benefits and toxicity. Change in misperception during treatment and decisional regret after has not been studied. We assessed shifts in perception of treatment outcomes and decisional regret after treatment in a single-center prospective study. Methods: We enrolled patients with advanced solid cancer starting palliative intent treatment. At baseline, both patients and their treating physicians were asked about their perceived likelihood of treatment response, symptom palliation, survival benefit, and treatment toxicity on scale of 0-100% at start of treatment and at follow-up. The Signed Rank tested whether patient perception changed significantly over time. After treatment, patients alive and not in hospice were asked about their decision to undergo treatment. Results: Of 122 patients with baseline estimates, 65% completed at least one follow-up survey while undergoing treatment. At enrollment, respondents’ mean age was 65 years (range: 32–89); 54% were male. Compared to baseline, there was no change in patients’ perceptions of treatment response, survival benefit, toxicity (all P≥0.52) at follow-up; a trend toward change in perceived curative potential (P = 0.06); an increase (of 7 points) of perceived likelihood of symptom relief (P = 0.04). Perceived likelihood of treatment response and symptom relief increased (both P &lt; 0.03) among patients whose baseline estimates of treatment response were lower than or similar to their physicians’ estimates. Conversely, perceived likelihood of treatment response (P = 0.01) and curative potential (P = 0.02) decreased among patients with more optimistic estimates than their physicians’. Of the surviving 63 patients, 33 (52%) completed the end of treatment survey, 24 were unreachable and 6 declined. Median time of survey response was at 41.2 weeks (IQR: 36.4 – 47.9). Nearly all (95%) agreed that treatment was the right decision. None regretted their choice; 79% agreed they would make the same choice if they had to do it again; 12% agreed that treatment did them a lot of harm. Conclusions: Patients’ perceptions of treatment response converged during therapy as compared to their physicians at baseline. Of surviving patients surveyed, none regretted their decision to receive palliative cancer treatment. Treatment expectations evolve over time, highlighting opportunities for enhanced communication and patient education beyond initial consent procedures.

PD26-04 ACCEPTANCE AND COMMITMENT THERAPY TO INCREASE COMPLIANCE WITH INTRACAVERNOSAL INJECTION USE (ICI) FOLLOWING RADICAL PROSTATECTOMY (RP)

INTRODUCTION AND OBJECTIVE: ICI is the cornerstone of many erectile rehabilitation programs (ERP). However, compliance with ICI is historically low. This study tests a novel psychological intervention based on Acceptance and Commitment Therapy (ACT) concepts to help men reduce avoidance to ICI and commit to an ERP. METHODS: This ongoing study recruits men starting in our ERP. The recruitment goal is N=220. Subjects are randomized to ERP+ACT or ERP+Enhanced Monitoring and Education (EME). ERP+ACT receive ERP plus 3 ACT Sessions (30-45min) and 10 ACT Booster Sessions (10min). ERP+EME receive ERP plus 3 EME Sessions (30-45min) and 10 EME Booster Sessions (10min) delivered by a nurse practitioner monitoring ICI use and providing education. The interventions are delivered over 1yr. Eligibility includes: within 9m post RP; functional pre-RP erections (≥6/10). Subjects are assessed at entry and every 6m for 2yrs. Primary outcomes: # of penile injections/wk (verified by syringe count), and compliance (defined as ≥2 injections/wk). Secondary outcomes: ED treatment satisfaction, sexual self-esteem and relationship quality, sexual bother, prostate cancer treatment regret, the psychological impact of cancer, and depressive symptoms. Preliminary 6m data is presented. Groups are compared with ANCOVA. Since these are preliminary analyses, if differences were not statistically significant, effect sizes (d) are reported (d=0.2, small effect; d=0.5, medium effect; d=0.8, large effect). RESULTS: To date, 120 subjects have been randomized; 62 have completed the 6m assessment (ACT n=33, EME n=29). Mean age 60±7 yrs and 81% were married. The mean erectile function grade pre-RP was 9±1 (0-10 scale). At 6m, the ACT group utilized more injections/wk vs. the EM group (1.8 vs. 1.4, p=0.01, d=0.7) and were more compliant with ICI vs. the EM group (70% vs. 45%, p=0.05, RR=1.55). The ACT group reported greater: satisfaction with ED treatment (d=0.6) and overall sexual relationship (d=0.2). The ACT group also reported lower: sexual bother (d=0.2), prostate cancer treatment regret (d=0.3), negative psychological impact of cancer (d=0.3), and depressive symptoms (d=0.2). CONCLUSIONS: Preliminary analysis suggests ACT significantly increases ICI use. Data also indicate ACT helps increase men’s satisfaction with injections and sexual relationship, while reducing sexual bother, prostate cancer treatment regret, the psychological impact of cancer, and depressive symptoms. Source of Funding: NIH: R01 CA 190636