Streck Brennan P, Vo Jacqueline B, Brandt Carolyn, Klein William M P, Han Paul, Ferrer Rebecca A, Gillman Arielle S
Basic Biobehavioral and Psychological Sciences Branch, Behavioral Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland, USA.
Radiation Epidemiology Branch, Division of Cancer Epidemiology & Genetics, National Cancer Institute, Rockville, Maryland, USA.
Psychooncology. 2025 Jan;34(1):e70061. doi: 10.1002/pon.70061.
Nearly 20% of US cancer survivors develop cardiovascular disease (CVD) from cardiotoxic cancer treatments. Patients and providers may consider alternative treatments to lower cardiotoxicity risk, but these may be less effective at preventing relapse/recurrence, presenting a difficult tradeoff.
This study explored survivors' cancer treatment decision-making when weighing this tradeoff.
Using adjusted multivariable logistic regression, we examined 443 US survivors' risk perceptions (deliberative, affective, and intuitive) about cancer and CVD and associations of these with their selection between two hypothetical cancer treatments: Treatment A: 5% chance of cancer recurrence and 10% chance of CVD; Treatment B: 10% chance of recurrence and 5% chance of CVD. We explored the effects of delay discounting by randomizing to a condition describing cancer recurrence/CVD as either immediate or delayed.
More survivors (Mage = 48, range = 18-93; M = 10.8 years post-diagnosis) selected Treatment A than Treatment B (72% v. 28%). Timing of onset was not associated with treatment selection. Greater affective risk perception (worry) about cancer was associated with increased odds of choosing Treatment A, whereas greater CVD worry was associated with decreased odds (OR-cancer = 1.33, p = 0.006; OR-CVD = 0.72, p = 0.007). Neither deliberative nor experiential risk perceptions were associated with treatment choice.
Survivors were more likely to select the treatment that minimized recurrence rather than CVD-regardless of the timing of onset. Treatment decision was linked to both cancer- and CVD-related worry but not deliberative or experiential risk perceptions. During treatment discussions, clinicians should open conversations about the risks of treatment-associated cardiotoxicity, the probabilities, and patients' relative worries about cancer and cardiotoxicity.
近20%的美国癌症幸存者因具有心脏毒性的癌症治疗而患上心血管疾病（CVD）。患者和医疗服务提供者可能会考虑采用替代治疗方法以降低心脏毒性风险，但这些方法在预防复发/再发方面可能效果较差，这就形成了一个艰难的权衡。
本研究探讨了幸存者在权衡这种利弊时的癌症治疗决策。
我们使用调整后的多变量逻辑回归，研究了443名美国幸存者对癌症和心血管疾病的风险认知（深思熟虑型、情感型和直觉型），以及这些认知与他们在两种假设的癌症治疗方法之间的选择的关联：治疗A：癌症复发几率为5%，心血管疾病几率为10%；治疗B：复发几率为10%，心血管疾病几率为5%。我们通过随机分配到将癌症复发/心血管疾病描述为即时或延迟的条件来探讨延迟折扣的影响。
选择治疗A的幸存者（年龄中位数 = 48岁，范围 = 18 - 93岁；诊断后中位数 = 10.8年）比选择治疗B的更多（72%对28%）。发病时间与治疗选择无关。对癌症更高的情感风险认知（担忧）与选择治疗A的几率增加相关，而对心血管疾病更高的担忧则与几率降低相关（癌症的比值比 = 1.33，p = 0.006；心血管疾病的比值比 = 0.72，p = 0.007）。深思熟虑型和经验型风险认知均与治疗选择无关。
幸存者更有可能选择将复发风险降至最低而非心血管疾病风险的治疗方法——无论发病时间如何。治疗决策与癌症和心血管疾病相关的担忧有关，但与深思熟虑型或经验型风险认知无关。在治疗讨论期间，临床医生应开启关于治疗相关心脏毒性风险、概率以及患者对癌症和心脏毒性的相对担忧的对话。
