Satisfaction with treatment decision-making and long-term experiences of life-prolonging treatments for metastatic castration-resistant prostate cancer

BACKGROUND: Treatments in the phase of metastatic castration-resistant prostate cancer (mCRPC) aim to prolong survival and reduce the symptom burden. The fast development of life-prolonging therapies makes treatment decision-making (TDM) complex, weighting survival against possible side-effects and quality of life, especially in a real-world context. This study aimed to describe satisfaction with TDM at start of the first, second and third line of life-prolonging treatment and to describe and compare long-term treatment experiences when receiving one or several lines of treatment in patients with mCRPC. METHODS: A longitudinal observational study. Participants completed a study-specific questionnaire every three months for up to two years from the start of any first line of life-prolonging treatment after mCRPC. Satisfaction with TDM was measured at the start of each new treatment line while treatment experiences were measured using the first and last completed questionnaire of each participant. Medical data was obtained from medical records. Descriptive statistics were used to present data while inferential statistics were used for analysis of group comparisons and over time changes. RESULTS: A total of 122 participants (mean age 75.3 years) with an average follow-up time of 18.3 months were included. Satisfaction with TDM was generally high at the start of the first, second and third line of treatment, but lower regarding discussions on how treatment could affect their life situation. Treatment experiences were positive, yet there was a significant decrease from the first to the last follow-up in whether they would choose (p = 0.04) and recommend (p = 0.01) the same treatment to others. For participants who received one line of treatment, a significant decrease was found between the first and the last follow-up (p = 0.02), while no differences were found for those who received two or more lines. CONCLUSIONS: Despite high satisfaction with aspects of TDM and the treatment given it is important to discuss how the treatment can impact the patient's life situation. The slightly decreased satisfaction over time on the treatment received could reflect a possible need to strengthen communication between patients and healthcare professionals, shifting from a disease-centered perspective towards a more person-centered and palliative care approach.