El-Haouly Abir, Dragomir Alice, El-Rami Hares, Liandier Frédéric, Lacasse Anaïs
Département des sciences de la santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, QC, Canada.
Department of Surgery, Division of Urology, McGill University, Montreal, QC, Canada.
Can Urol Assoc J. 2021 Mar;15(3):E160-E168. doi: 10.5489/cuaj.6521.
For the management of localized prostate cancer, patient treatment choice is poorly documented among people living in remote areas, where access to certain treatments offered in large centers involves travelling several hundred kilometres. This study aimed to describe and identify the determinants of treatment decision-making in men with localized prostate cancer living in remote areas.
In this cross-sectional study, patients with prostate cancer were recruited from Rouyn-Noranda's urology clinic (Quebec, Canada) between 2017 and 2019.
A total of 127 men (mean age 68.34±7.23 years) constituted the study sample. Radiotherapy, a treatment not available locally, was chosen most frequently (67.7%), followed by options available locally, such as surgery (22.8%) and active surveillance (9.4%). Most patients preferred to play an active role in this choice (53.5%) and agreed with the statement, "I chose that treatment because it gives the best chance for a cure" (86.6%). Multiple logistic regression analysis revealed that cancer stage (odds ratio [OR] 10.15; 95% confidence interval [CI] 3.18-32.40) was the only factor associated with radiotherapy choice (patients with lower stage cancer were more likely to choose radiotherapy). The socioeconomic status was not associated with treatment choice.
While radiotherapy was not available locally, it was the most frequently chosen treatment, even though the available literature suggests that no one treatment option is superior in terms of cancer control. The choice of radiotherapy is not associated with patient income, but rather the cancer stage. This result could be explained by the patients' desire to avoid surgery and its adverse effects.
对于局限性前列腺癌的治疗管理，居住在偏远地区的人群中患者的治疗选择记录较少，在这些地区，要获得大型中心提供的某些治疗需要跋涉数百公里。本研究旨在描述和确定居住在偏远地区的局限性前列腺癌男性患者治疗决策的决定因素。
在这项横断面研究中，2017年至2019年期间从鲁安 - 诺兰达的泌尿外科诊所（加拿大魁北克）招募了前列腺癌患者。
共有127名男性（平均年龄68.34±7.23岁）构成研究样本。最常被选择的治疗是当地无法提供的放射治疗（67.7%），其次是当地可提供的选择，如手术（22.8%）和主动监测（9.4%）。大多数患者希望在这一选择中发挥积极作用（53.5%），并同意“我选择那种治疗是因为它提供了治愈的最佳机会”这一说法（86.6%）。多因素逻辑回归分析显示，癌症分期（比值比[OR]10.15；95%置信区间[CI]3.18 - 32.40）是与放射治疗选择相关的唯一因素（癌症分期较低的患者更有可能选择放射治疗）。社会经济地位与治疗选择无关。
虽然当地无法提供放射治疗，但它却是最常被选择的治疗方法，尽管现有文献表明在癌症控制方面没有一种治疗选择具有优越性。放射治疗的选择与患者收入无关，而是与癌症分期有关。这一结果可以通过患者避免手术及其不良反应的愿望来解释。
