与强烈保留性功能偏好和接受主动监测相关的前列腺癌患者特征。
Prostate Cancer Patient Characteristics Associated With a Strong Preference to Preserve Sexual Function and Receipt of Active Surveillance.
机构信息
Department of Radiation, Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC.
School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC.
出版信息
J Natl Cancer Inst. 2018 Apr 1;110(4):420-425. doi: 10.1093/jnci/djx218.
BACKGROUND
Men with early-stage prostate cancer have multiple options that have similar oncologic efficacy but vary in terms of their impact on quality of life. In low-risk cancer, active surveillance is the option that best preserves patients' sexual function, but it is unknown if patient preference affects treatment selection. Our objectives were to identify patient characteristics associated with a strong preference to preserve sexual function and to determine whether patient preference and baseline sexual function level are associated with receipt of active surveillance in low-risk cancer.
METHODS
In this population-based cohort of men with localized prostate cancer, baseline patient-reported sexual function was assessed using a validated instrument. Patients were also asked whether preservation of sexual function was very, somewhat, or not important. Prostate cancer disease characteristics and treatments received were abstracted from medical records. A modified Poisson regression model with robust standard errors was used to compute adjusted risk ratio (aRR) estimates. All statistical tests were two-sided.
RESULTS
Among 1194 men, 52.6% indicated a strong preference for preserving sexual function. Older men were less likely to have a strong preference (aRR = 0.98 per year, 95% confidence interval [CI] = 0.97 to 0.99), while men with normal sexual function were more likely (vs poor function, aRR = 1.59, 95% CI = 1.39 to 1.82). Among 568 men with low-risk cancer, there was no clear association between baseline sexual function or strong preference to preserve function with receipt of active surveillance. However, strong preference may differnetially impact those with intermediate baseline function vs poor function (Pinteraction = .02).
CONCLUSIONS
Treatment choice may not always align with patients' preferences. These findings demonstrate opportunities to improve delivery of patient-centered care in early prostate cancer.
背景
早期前列腺癌患者有多种治疗方案可供选择，这些方案在肿瘤疗效方面相似，但对生活质量的影响却有所不同。在低危癌症中，主动监测是保留患者性功能的最佳选择，但尚不清楚患者偏好是否会影响治疗选择。我们的目的是确定与强烈保留性功能偏好相关的患者特征，并确定患者偏好和基线性功能水平是否与低危癌症中接受主动监测相关。
方法
在这项基于人群的局限性前列腺癌患者队列研究中，使用经过验证的工具评估了基线患者报告的性功能。患者还被问到保留性功能是否非常、有些或不重要。从病历中提取前列腺癌疾病特征和治疗方法。使用稳健标准误差的修正泊松回归模型计算调整后的风险比(aRR)估计值。所有统计检验均为双侧检验。
结果
在 1194 名男性中，52.6%的人表示强烈希望保留性功能。年龄较大的男性不太可能有强烈的偏好(aRR=0.98/年，95%置信区间[CI]为 0.97 至 0.99)，而性功能正常的男性比性功能较差的男性更有可能(aRR=1.59，95%CI=1.39 至 1.82)。在 568 名低危癌症患者中，基线性功能或强烈保留性功能的偏好与接受主动监测之间没有明确的关联。然而，强烈的偏好可能会对那些基线功能处于中间水平和较差的功能的人产生不同的影响(P 交互=0.02)。
结论
治疗选择可能并不总是与患者的偏好一致。这些发现表明，在早期前列腺癌中，有机会改善以患者为中心的护理服务。
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