TY - JOUR
T1 - Patients' survival expectations before localized prostate cancer treatment by treatment status
AU - Mohan, Ravinder
AU - Beydoun, Hind
AU - Barnes-Ely, Myra L.
AU - Lee, Lashonda
AU - Davis, John W.
AU - Lance, Raymond
AU - Schellhammer, Paul
PY - 2009/3
Y1 - 2009/3
N2 - Background: Cancer-specific mortality is projected to be only 1% in 15 years in approximately 75% of patients with screen-detected localized prostate cancer (LPC). Nearly 94% of patients choose treatment even though treatment damages health-related quality of life. No data are available regarding what survival benefit patients expected from treatment. Objectives: A self-administered mailed survey was sent to 184 men with newly diagnosed LPC to query patients about expected survival with treatment versus observation. Results: More than 90% of patients had at least a high school education and a ninth-grade health literacy. In addition, 68% patients had income of ≥$50,000. Mean cancer grade was 6.6. Twenty-three patients chose observation and 161 patients chose surgery or radiotherapy. Mean comorbidity adjusted life expectancy (CALE) without the cancer was 22.9 years. Without cancer treatment, 15.2% of patients expected to live <5 years, 48.8% 5 to 10 years, 33.5% 11 to 19 years, and 2.4% ≥20 years. With treatment, survival expectations were <5 years in 0.6%, 5 to 10 years in 6.5%, 11 to 19 years in 30.0%, and ≥20 years in 62.9% of patients. Age, prostate-specific antigen level, CALE, anxiety, depression, and social support were factors that predicted differences between CALE and patient survival expectations with and without treatment. Conclusion: LPC patients grossly underestimated their life expectancy without treatment and grossly overestimated the survival benefit of treatment.
AB - Background: Cancer-specific mortality is projected to be only 1% in 15 years in approximately 75% of patients with screen-detected localized prostate cancer (LPC). Nearly 94% of patients choose treatment even though treatment damages health-related quality of life. No data are available regarding what survival benefit patients expected from treatment. Objectives: A self-administered mailed survey was sent to 184 men with newly diagnosed LPC to query patients about expected survival with treatment versus observation. Results: More than 90% of patients had at least a high school education and a ninth-grade health literacy. In addition, 68% patients had income of ≥$50,000. Mean cancer grade was 6.6. Twenty-three patients chose observation and 161 patients chose surgery or radiotherapy. Mean comorbidity adjusted life expectancy (CALE) without the cancer was 22.9 years. Without cancer treatment, 15.2% of patients expected to live <5 years, 48.8% 5 to 10 years, 33.5% 11 to 19 years, and 2.4% ≥20 years. With treatment, survival expectations were <5 years in 0.6%, 5 to 10 years in 6.5%, 11 to 19 years in 30.0%, and ≥20 years in 62.9% of patients. Age, prostate-specific antigen level, CALE, anxiety, depression, and social support were factors that predicted differences between CALE and patient survival expectations with and without treatment. Conclusion: LPC patients grossly underestimated their life expectancy without treatment and grossly overestimated the survival benefit of treatment.
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U2 - 10.3122/jabfm.2009.03.080200
DO - 10.3122/jabfm.2009.03.080200
M3 - Article
C2 - 19429730
AN - SCOPUS:67049132651
SN - 1557-2625
VL - 22
SP - 247
EP - 256
JO - Journal of the American Board of Family Medicine
JF - Journal of the American Board of Family Medicine
IS - 2
ER -