Presentation Authors: Ravishankar Jayadevappa*, Sumedha Chhatre, S. Bruce Malkowicz, Ruchika Talwar, Thomas Guzzo, Alan Wein, Philadelphia, PA
Introduction: Active surveillance (AS) is emerging as a viable option for low-risk prostate cancer. The objective of this novel study is to assess the association between value markers (utility levels) and AS among men with low-risk prostate cancer.
Methods: In this randomized controlled design study, patients with localized prostate cancer were randomized either to the preference assessment intervention or to the usual care group. Patient reported outcomes (satisfaction with care, satisfaction with decision, generic and prostate-specific health related quality of life, depression and anxiety) were assessed at baseline, and at 3, 6, 12 and 24-month follow-up. Clinical data such as stage of cancer, treatment, PSA, Gleason score and comorbidity were obtained from medical charts. Preference assessment was done using our web-based adaptive conjoint analysis tool, PreProCare, prior to treatment choice. For low-risk prostate cancer patients from the intervention group, logistic regression model was used to analyze the association between value markers of treatment attributes and AS treatment.
Results: Between January 2014 and March 2015, 743 localized prostate cancer patients were recruited and randomized to the PreProCare intervention (n=371) or to a control group (n=372). The sample demographics and clinical characteristics were comparable by intervention status. Among 117 low-risk prostate cancer patients from the intervention group, older age (OR=1.2, CI=1.09, 1.31), sexual function (OR=1.5, CI=1.1, 2.1), fear of surgery (OR=1.5, CI=1.1, 2.2), recovery time (OR=1.1, CI=1.02, 1.9) were associated with higher odds of being on AS. Survival (OR=0.68, CI=0.49, 0.96) was associated with lower odds of being on AS.
Conclusions: Preference assessment is a key component of patient-centered care and is feasible among localized prostate cancer patients. Results of our novel study showed that patient treatment choice aligned with their values. Value markers (or utility levels) of treatment such as survival, recovery time and sexual function were associated with AS among low-risk prostate cancer patients. Preference assessment intervention can help prostate cancer patients reveal their preferences, leading to better alignment with treatment decision. Future research should identify strategies to ensure diagnosis and treatment options are communicated to patients accurately, therefore reducing overtreatment and the resulting burden on healthcare systems.
Source of Funding: Patient-centered Outcomes Research Institute, CE-12-11-497