Life-prolonging therapies for metastatic castration-resistant prostate cancer (mCRPC) aim to extend survival and reduce symptom burden. Rapid development of new treatments has increased the complexity of treatment decision-making (TDM), forcing patients and clinicians to balance potential survival benefits against side effects and effects on quality of life. The studied manuscript sought to describe patient-reported satisfaction with TDM at the start of successive lines of life-prolonging treatment and to characterize long-term patient experiences when receiving one or multiple treatment lines in a real-world setting.
The study used a longitudinal observational design. Participants were enrolled at the start of any first line of life-prolonging treatment after an mCRPC diagnosis and completed a study-specific questionnaire every three months for up to two years. Satisfaction with TDM was assessed at the start of each new treatment line. Treatment experiences were derived from responses on the first and the last questionnaire completed by each participant.
Medical information was collected from clinical records to complement questionnaire data. Descriptive statistics summarized participant characteristics and responses. Inferential statistics were applied to compare groups and to test changes over time; p-values reported in the abstract reflect these analyses.
A total of 122 participants were included. The mean age was 75.3 years. The average follow-up duration across participants was 18.3 months. The cohort was followed with repeated three-monthly questionnaires for up to 24 months from the start of their first life-prolonging treatment after developing mCRPC. Specific inclusion or exclusion criteria, recruitment details, and the full content or psychometric properties of the study-specific questionnaire were not reported in the abstract and therefore are not available from the source provided.
At the initiation of the first, second and third lines of life-prolonging treatment, overall satisfaction with aspects of treatment decision-making was generally high. However, the study identified that participants reported lower satisfaction specifically with discussions concerning how treatments might affect their broader life situation. In other words, while many logistical or clinical aspects of decision-making may have been perceived positively, conversations about the personal, daily-life consequences of treatment received comparatively less attention or were less satisfactory to patients.
Treatment experiences reported at the first completed questionnaire were largely positive. Despite this, there was a statistically significant decline from the first to the last follow-up in two specific endorsement measures: whether participants would choose the same treatment again (p = 0.04) and whether they would recommend the same treatment to others (p = 0.01). The observed decline indicates a modest reduction in treatment satisfaction or endorsement as time progressed within the follow-up period.
The authors compared participants who received a single line of life-prolonging treatment to those who received two or more lines. Among participants who received only one line of treatment, there was a significant decrease between the first and last follow-up in endorsement of the treatment (p = 0.02). For those who underwent two or more lines of treatment, no statistically significant differences between first and last follow-up were reported in the abstract. The abstract does not provide granular subgroup sizes, time-to-event details, or effect sizes beyond the p-values noted, so exact magnitudes and distributions are not available from the source provided.
The study concludes that satisfaction with many aspects of TDM and with the treatments themselves was high at initiation, but that there is an important unmet need to discuss how treatments may impact patients’ life situations. The modest but significant decrease in willingness to choose or recommend the same treatment over time could indicate that ongoing communication and follow-up discussions between patients and healthcare professionals need strengthening.
Authors suggest that care for patients with mCRPC could benefit from a shift from a primarily disease-centered model toward a more person-centered and palliative care approach. Such a shift would emphasize regular discussion of life impact, daily functioning, symptom burden and patient priorities throughout the course of treatment decision-making and follow-up.
The study received ethical approval from the Swedish Ethical Review Authority (Dnr 2014/341-21/2, Dnr 2016/851-32 and Dnr 2016/2230-32) and was conducted in accordance with the Declaration of Helsinki. Written informed consent was obtained from all participants. The authors declared no competing interests. Detailed study protocols, questionnaires, recruitment procedures and full statistical output were not included in the abstract provided and therefore are not reported here.