What Prostate Cancer Patients Should Know About Post-operative Radiotherapy for Prostate Cancer

Merrylee McGuffin1, Deb Feldman-Stewart2, Margaret Fitch3, Arlene Court3, Lisa Di Prospero1,

Alex Kiss5, Kaitlin Koo6, Laura D’Alimonte1, Ewa Szumacher6

Introduction

Methods

Results

Conclusion

1Department of Radiation Therapy, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, 2Dept of Oncology and Division of Cancer Care and Epidemiology, Cancer Research Institute, Queen’s University 3Department of Nursing, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto 5Department of Biostatistics, Institute of Clinically Evaluative Sciences, University of Toronto 6Department of Radiation Oncology,

Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto

Prostatectomy is a well-known treatment for non-metastatic prostate cancer

Radiotherapy (RT) post prostatectomy can be delivered as an adjuvant treatment or after biochemical failure (salvage treatment)

A similar study was conducted among the health care providers (radiation oncologists, urologists, nurses and radiation therapists) who treat patients with prostate cancer (D’Alimonte et al., 2013)

Patients are often encouraged to actively participate in the decision-making process when considering post-operative radiotherapy post-prostatectomy

After investigating the health-care providers opinions (D’Alimonte et al., 2013) in this study, we focused on patients’ views about important questions they would like to discuss with their health care team about post-prostatectomy RT

30 patients were accrued in follow-up clinics

Patient demographic information was collected (Table 1)

The survey was comprised of a list of questions that may be considered important by post-prostatectomy patients (D’Alimonte et al., 2013)

The survey consisted of six domains:

Understanding My Situation and Prostate Cancer

Diagnosis Making a Decision Radiotherapy: Procedures Involved Potential Benefits Side Effects My Supportive Network During Radiation Therapy

A four category response was used: Essential, Important, No opinion, and Avoid.

Descriptive statistics were calculated for all variables of interest; categorical measures were summarized using counts and percentages

There were no significant differences among patients’ responses and demographic characteristics

Most of the items important to patients were related to “Understanding My Situation and Prostate Cancer Diagnosis” sections.

Over 90% of patients rated these questions as “Essential” or “Important”

However, low rated questions were also essential or important for >50% of patients

No items were ranked essential from the “Side Effects” and “My Supportive Network for Radiation Therapy” domains

Limitations: There was a relatively small sample size Only English speaking patients were eligible Patients were accrued from academic centres

The information from these two studies will help to develop a decision aid which will benefit the patient, their families and the health care professionals

Questions Rated as “Essential” or ”Important” by Most Patients

1. Has my cancer spread?

2. What is my prognosis?

3. What are my chances for cure?

4. Should I have any tests done to know exactly where the cancer is located?

5. Why was my treatment not entirely effective following prostate surgery? Why has my cancer come back?

6. What tests should I have done before radiation to know if this cancer has not spread?

7. Do I have to be treated with radiation?

8. What will happen if I do not go for radiation?

9. What will happen to me if radiation treatment is not successful?

10. Will radiation treatment cure me?

11. Should I be treated sooner or later when PSA is more elevated?

12. How long should I wait before making the decision about radiation?

13. If I wait with my decision regarding radiation after surgery, do I compromise my chances for cure or/and progression of the disease?

Top Questions Rated Essential by Patients (%)

Demographics Questions

1 2 3 4 5 6 7 8 9 10 11 12 13

Age

≤ 60 years 87.5 75.0 87.5 75.0 62.5 62.5 75 75 62.5 50 75 50 62.5

> 60 years 90.0 81.8 7.3 81.8 81.8 81.8 77.3 77.3 81.8 81.8 72.7 81.8 77.3

Ethnicity

Nonwhite 85.7 71.4 71.4 71.4 71.4 71.4 71.4 71.4 71.4 57.1 71.4 85.7 71.4

White 90. 82.6 82.6 82.6 78.3 78.3 78.3 78.3 78.3 78.3 73.9 69.6 73.9

Education

High school or less 90.0 80.0 80.0 90.0 90.0 80 70 80 90 90 90 70 80

More than high school

88.9 80.0 80.0 75.0 70.0 75.0 80 75 70 65 65 75 70

Distance from the centre

≤ 10 km 75.0 62.5 75.0 75.0 62.5 75.0 75 62.5 75 62.5 62.5 75 62.5

> 10 km 95.0 86.4 81.8 81.8 81.8 77.3 77.3 81.8 77.3 77.3 77.3 72.7 77.3

Demographic N (%) Demographic

N (%)

Age in years (range: 49-87) Education

≤60 years 8 (26.7) High school or less 10 (33.3)

>60 years 22 (73.3) More than high school 20 (66.7)

Ethnicity Distance to the centre

Nonwhite 7 (23.3) ≤10 km 8 (26.7)

White 23 (76.7) >10 km 22 (73.3)

Table 1. Patient Demographics

Questions Rated as “Essential” or “Important” by Fewest Patients

1. Will I pay for parking and lodging if necessary?

2. Will my body become radioactive?

3. What is a ProstaScint scan?

4. Should I have a protective coat placed on my body during radiation, the same as is put on me when I have my chest x-ray done?

5. Is it safe to be around small children and other family members?

6. Can I be treated with radiation seeds after the removal of my prostate?

7. May I seek a second opinion before I make a decision about radiation?

8. Do you see the cancer cells?

9. Are there any other organs that produce PSA than the prostate?

10. Do I have to be treated with hormones?

11. Will I be able to exercise?

Patients want information that will help them to better understand their diagnoses and personalize their treatment choices when considering post-operative radiotherapy for prostate cancer

Future analysis will compare the questions rated “essential” by the patient versus the health care professionals

Table 2. Percentage of Patients that Rated the Question as “Essential” Categorized by Demographic Information