title: Determinants of treatment regret in low-income, uninsured men with prostate cancer.
abstract: OBJECTIVE
  The regret of a prostate cancer treatment choice, a significant dimension of health-related quality of life, has not been well-characterized. Little is known about its association with the fear of cancer recurrence or spirituality.
  
  
  METHODS
  We drew subjects from a men's health study composed of a clinically heterogeneous sample of subjects enrolled from a statewide, publicly funded assistance program that provided free prostate cancer treatment for uninsured, low-income men in California. We included men who completed a telephone interviews and self-administered questionnaires at study enrollment and at 6 months of follow-up. Using validated instruments, we measured regret, health-related quality of life, fear of cancer recurrence, and spirituality through telephone interviews and self-administered questionnaires.
  
  
  RESULTS
  Of the 195 men, 90 underwent radical prostatectomy (46%), 50 underwent external beam radiotherapy (28%), and 51 underwent hormonal therapy (26%). Of these 195 men, 36 (18%) regretted their treatment choice. Multivariate analyses revealed that nonwhite men were more likely than white men to experience decisional regret (odds ratio [OR] range 7.27 to 12.26). Conversely, men confident of cancer cure (OR 0.19, 95% confident interval 0.04 to 0.86), men with greater spirituality (OR 0.91, 95% confidence interval 0.87 to 0.96), and men with acute treatment effects (OR 0.34, 95% confidence interval 0.12 to 0.93) were less likely to regret their treatment decisions.
  
  
  CONCLUSIONS
  In our study, a fear of cancer recurrence, less spirituality, a longer interval since treatment, and nonwhite race were associated with treatment regret in low-income, underserved men with prostate cancer. Attempts to decrease anxiety and enhance spirituality in men treated for prostate cancer might diminish treatment regret. Additional studies in racially diverse cohorts are needed to examine the association of regret with race.
authors.affiliation: Division of Urology, Brigham and Women's Hospital, Lank Center for Genitourinary Oncology, Dana Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts 02115, USA. jhu2@partners.org
authors.forename: Jim C
authors.initials: JC
authors.lastname: Hu
authors.forename: Lorna
authors.initials: L
authors.lastname: Kwan
authors.forename: Tracey L
authors.initials: TL
authors.lastname: Krupski
authors.forename: Jennifer T
authors.initials: JT
authors.lastname: Anger
authors.forename: Sally L
authors.initials: SL
authors.lastname: Maliski
authors.forename: Sarah
authors.initials: S
authors.lastname: Connor
authors.forename: Mark S
authors.initials: MS
authors.lastname: Litwin
mesh_terms: D000368:Aged; D015897:Comorbidity; D004470:Economics, Medical; D004644:Emotions; D006801:Humans; D008297:Male; D017057:Medically Uninsured; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011203:Poverty; D011471:Prostatic Neoplasms / Q000191:economics* / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life; D012008:Recurrence; D016896:Treatment Outcome