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HSR&D 2004 National Meeting Abstracts

1010. Decisions & Cancer Control: Perceptions of Early Prostate Cancer Survivors
Jack A Clark, PhD, CHQOER, Bedford VAMC and Boston University School od Public Health, JA Talcott, Massachusetts General Hospital and Havard Medical School

Objectives: Early prostate cancer compels men to make difficult treatment choices amidst uncertainty. The possibility of cancer recurrence, side effects, and uncertain survival benefit accompany each treatment approach over the long term. Yet, how long-term survivors view cancer control and the choices they made is virtually unknown.

Methods: Survey of patients who completed pre- and 3 annual post-treatment assessments of health status. Patients reporting "good" or "poor" perceived Cancer Control and Confidence in Treatment Decision, were compared with respect to tumor characteristics, side-effects of treatment, and quality of life, using univariable tests and hierarchical logistic models.

Results: 235 respondents (87% response), treated 4--8 (med 5) years previously; 65% reported good cancer control and 57% good confidence in treatment decisions. Control and decision confidence were modestly correlated (r=.32). Cancer control was associated with lower pre-treatment Gleason scores, low post-treatment PSA, but diminished with bowel side-effects. Confidence in decisions was greater among younger, married men, who received surgery rather than external radiation. Lack of confidence was associated with survival more than five years and bowel and sexual dysfunction. Both control and confidence declined with quality of life decrements, especially dimished confidence in sexual capability.

Conclusions: Perceived cancer control and confidence in one’s treatment decisions among long term survivors overlap but have distinctive correlates. Cancer control varies with clinical indicators of severity and biochemical control, while decision confidence increases with social support and preserved sexual function and well-being.

Impact: Findings highlight complex psychosocial outcomes of treatment and suggest points where we can supportively intervene.