PATIENT EXPECTATIONS FROM TREATMENT OF INCURABLE METASTATIC PROSTATE CANCER

Purpose: Multiple systemic therapies prolong the survival of men with metastatic prostate cancer (CaP), but the disease remains incurable.  Treatment options are varied (immunotherapy, chemotherapy, androgen receptor directed therapy, etc.), but all prolong overall survival by 3-4 months.  Because no medication is designated as “first-line”, patients and providers choose treatment based on expected response and distinct toxicities, cost, and administration requirements of each medication.  Therapeutic decisions are complicated for patients with cancer, and patients may agree to otherwise unacceptably toxic treatment if expecting ≥1% chance of cure.  Reconciling patient expectations with realistic expected outcomes is necessary for informed treatment decision making.  We assessed patient expectations from treatment among men receiving treatment for incurable metastatic CaP.

Method: Between 6/1/15 and 5/15/16, men with metastatic CaP completed surveys (online or telephone) describing their expectations of cure, symptom relief, and life extension from their current CaP treatment.  We used frequencies and relative frequencies to describe their expectations, and proportional odds models with robust standard errors to determine the associations between these expectations and optimism and sociodemographic factors.

Result: Among 63 men completing surveys, 25 (40%) reported that cure was at least a little likely (8% very likely, 16% somewhat likely, and 16% a little likely).  Conversely, three (5%) reported using treatment that was not likely to help with problems related to their cancer. A majority (60 men, 95%) expected that treatment was at least a little likely to help them live longer.  Higher optimism scores were associated with higher expectations of cure (adjusted OR 2.9, 95% CI 1.3-6.2 for every 4 points on Life Orientation Test-Revised), and non-white race was associated with lower expectations of cure as compared with Caucasians (adjusted OR 0.03, 95% CI 0.0060.2) in a regression model. Unmarried men were slightly less likely to expect to live longer (adjusted OR 0.19, 95% CI 0.03-0.96). 

Conclusion: Informed decisions require adequate understanding of realistic treatment risks and benefits. More than a third of men with metastatic CaP may receive treatment without this understanding, particularly among men with higher optimism. Methods to align patient expectations with historically expected outcomes are needed to ensure high-quality decision making and avoid overtreatment with toxic therapies in the setting of incurable prostate cancer.