Understanding Cancer Treatment Decision Making Among Cancer Survivors: Weighing Cancer Recurrence Versus Cardiotoxicity.

IF 3.3 2区医学 Q2 ONCOLOGY

Psycho‐Oncology Pub Date : 2025-01-01 DOI:10.1002/pon.70061

Brennan P Streck, Jacqueline B Vo, Carolyn Brandt, William M P Klein, Paul Han, Rebecca A Ferrer, Arielle S Gillman

{"title":"Understanding Cancer Treatment Decision Making Among Cancer Survivors: Weighing Cancer Recurrence Versus Cardiotoxicity.","authors":"Brennan P Streck, Jacqueline B Vo, Carolyn Brandt, William M P Klein, Paul Han, Rebecca A Ferrer, Arielle S Gillman","doi":"10.1002/pon.70061","DOIUrl":null,"url":null,"abstract":"Background: 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.Aims: This study explored survivors' cancer treatment decision-making when weighing this tradeoff.Methods: 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.Results: 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.Conclusions: 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.","PeriodicalId":20779,"journal":{"name":"Psycho‐Oncology","volume":"34 1","pages":"e70061"},"PeriodicalIF":3.3000,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11739822/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Psycho‐Oncology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1002/pon.70061","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"ONCOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: 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.

Aims: This study explored survivors' cancer treatment decision-making when weighing this tradeoff.

Methods: 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.

Results: 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.

Conclusions: 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.

查看原文本刊更多论文

了解癌症幸存者的癌症治疗决策：权衡癌症复发与心脏毒性。

背景：近20%的美国癌症幸存者因心脏毒性癌症治疗而患上心血管疾病（CVD）。患者和提供者可能会考虑替代治疗来降低心脏毒性风险，但这些治疗在预防复发方面可能效果较差，这是一个困难的权衡。目的：本研究探讨幸存者在权衡这一权衡时的癌症治疗决策。方法：采用调整后的多变量logistic回归，我们检查了443名美国幸存者对癌症和心血管疾病的风险感知（深思熟虑的、情感的和直觉的），以及这些感知与他们在两种假设的癌症治疗方案之间的选择之间的关系：治疗A: 5%的癌症复发机会和10%的心血管疾病机会；治疗B: 10%的复发率和5%的CVD发生率。我们通过随机分配描述癌症复发/心血管疾病为立即或延迟的条件来探索延迟折扣的影响。结果：更多的幸存者(法师= 48，射程= 18-93；M =诊断后10.8年)选择A治疗比B治疗（72% vs 28%）。发病时间与治疗选择无关。对癌症更大的情感风险感知（担忧）与选择A治疗的几率增加相关，而对心血管疾病更大的担忧与选择A治疗的几率降低相关(OR-cancer = 1.33, p = 0.006；OR-CVD = 0.72, p = 0.007)。慎重的或经验的风险感知与治疗选择无关。结论：无论发病时间如何，幸存者更倾向于选择最小化复发的治疗，而不是cvd。治疗决定与癌症和心血管疾病相关的担忧有关，但与慎重或经验风险感知无关。在治疗讨论中，临床医生应该公开讨论治疗相关心脏毒性的风险、可能性以及患者对癌症和心脏毒性的相对担忧。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Psycho‐Oncology 医学-心理学

CiteScore

6.30

自引率

8.30%

发文量

220

审稿时长

3-8 weeks

期刊介绍： Psycho-Oncology is concerned with the psychological, social, behavioral, and ethical aspects of cancer. This subspeciality addresses the two major psychological dimensions of cancer: the psychological responses of patients to cancer at all stages of the disease, and that of their families and caretakers; and the psychological, behavioral and social factors that may influence the disease process. Psycho-oncology is an area of multi-disciplinary interest and has boundaries with the major specialities in oncology: the clinical disciplines (surgery, medicine, pediatrics, radiotherapy), epidemiology, immunology, endocrinology, biology, pathology, bioethics, palliative care, rehabilitation medicine, clinical trials research and decision making, as well as psychiatry and psychology. This international journal is published twelve times a year and will consider contributions to research of clinical and theoretical interest. Topics covered are wide-ranging and relate to the psychosocial aspects of cancer and AIDS-related tumors, including: epidemiology, quality of life, palliative and supportive care, psychiatry, psychology, sociology, social work, nursing and educational issues. Special reviews are offered from time to time. There is a section reviewing recently published books. A society news section is available for the dissemination of information relating to meetings, conferences and other society-related topics. Summary proceedings of important national and international symposia falling within the aims of the journal are presented.