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PCU 4|2002: Editor's
Note
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Editor’s Note |
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Perceptions
of treatment trade-offs in patients
with prostate and breast cancer |
Mark Soloway and I have had a friendly argument for more than a
year. The root of this disagreement stems from our differences in
opinion concerning prostate cancer patients’ perceptions of
the risk of recurrence and interventions to reduce that threat.
My hypothesis — based on a broad oncology experience, particularly
in breast cancer — is that cancer patients want as much information
as possible about their risk of recurrence and the potential options
to increase their likelihood of remaining cancer-free. Like all
experienced clinicians, Mark tailors his approach to the individual
patient, but his overall impression is that “men with prostate
cancer are very different from women with breast cancer.”
Even Mark’s wife, Cindy — who is working on a postdoctoral
thesis about the effect of prostate cancer on couples — tells
me that, unlike proactive breast cancer patients, men with prostate
cancer “just want to get on with their lives after radical
prostatectomy and don’t want to hear about further treatment.”
Peter Scardino made a similar point during his interview for this
program. With due respect to these experienced clinicians and others
interviewed for our audio series, I wanted to find out more about
the mindset of the prostate cancer patient and his spouse/partner.
To this end, Mark and I organized a “Prostate Cancer Town
Meeting,” held on September 22, 2002. We spent the day with
157 prostate cancer patients, 127 spouses/partners and 26 physicians
from South Florida. In front of our audience, I played the role
of a patient surrogate and closely questioned Mark about the risks
and benefits of various interventions. With electronic keypad polling,
we queried the audience about their experiences, perceptions and
the advice they would give to a friend or family member, based on
a variety of clinical scenarios.
The most striking overall impression Mark and I acquired, was
the dramatic heterogeneity in prostate cancer patients’ experiences
with the disease and perspectives on the trade-offs of various interventions.
Select examples of the data collected are presented below.
Clearly, our town meeting did not provide definitive data on the
complex mindset of the prostate cancer patient. However, my “argument”
with Mark seems likely to continue, because our town meeting did
provide me with more evidence that, while patients obviously wish
to avoid treatment-related morbidity, there is an almost universal
need in both men and women to take every reasonable action to avoid
cancer recurrence. Why else would a man choose to have a radical
prostatectomy?
On the enclosed program, I asked medical oncologist, Oliver Sartor,
what his thought process would be if he were facing a 50% risk of
distant progression after radical prostatectomy. He told me that
he would “lean towards” androgen deprivation, but that
he would assess his quality of life after a few months of treatment,
and then decide whether to continue. A similar approach is common
when utilizing adjuvant tamoxifen for breast cancer, and I predict
that, in the future, the gap between the treatment paradigms of
these two cancers will narrow considerably.
— Neil Love, MD
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