What Do Men with Metastatic Prostate Cancer Consider When Making Treatment Decisions? A Mixed-methods Study

Figures & data

Table 1 Sociodemographic and Clinical Characteristics of Men Who Participated in the Focus Groups and Survey

Variables	Focus Group 1 (n=5)	Focus Group 2 (n=3)	Focus Group 3 (n=6)	Survey (n=100)
Age, years; median	71	62	72	68
Race/ethnicity; n (%)
White	5 (100)	3 (100)	5 (83)	88 (88)
Black/African American	0	0	0	10 (10)
Other	0	0	1 (17)	2 (2)
Marital status; n (%)
Married or partnered	5 (100)	2 (67)	4 (67)	80 (80)
Not married or partnered	0	1 (33)	2 (33)	19 (19)
Employment status; n (%)
Working				35 (35)
Retired				63 (63)
Health insurance status; n (%)
Insured				99 (99)
Not insured				1 (1)
Self-reported health; n (%)
Excellent or good				68 (68)
Fair or poor				30 (30)
Disease status; n (%)
Biomedical recurrence	1 (20)	1 (33)	1 (17)	0
Metastatic	4 (80)	2 (67)	5 (83)	100 (100)
Most recent PSA, ng/mL; M (SD)				12.33 (23.66)
Site of metastasis; n (%)
Bone				79 (79)
Lymph node				27 (27)
Liver				2 (2)
Lung				3 (3)
Other				3 (3)
Do not know				7 (7)
Total number of metastases; n (%)
1				77 (77)
2				11 (11)
3				5 (5)
Do not know				7 (7)

Notes: Only brief sociodemographic information was collected from focus group participants. Among survey participants, variables with missing data are age (n=96), marital status (n=99), employment status (n=98), self-reported health (n=98), and most recent PSA (n=97).

Abbreviations: M, mean; PSA, prostate-specific antigen.

Table 2 Proportion of Participants Who Strongly Agreed with Statements About Treatment Decision-making Considerations

Treatment Decision-making Consideration	Survey Item	Percent of Participants Responding “Strongly Agree”
Confidence in physician’s expertise
	I rely on my doctor to tell me how to treat my prostate cancer.	79
Eliminating cancer
	When I choose a cancer treatment, I am hoping for one that will eliminate the cancer completely.	68
Prolonging survival
	Above all, living as long as I can is my most important goal.	53
	I need to live as long as possible, no matter how I feel, so I can continue to take care of my loved ones.	32
Quality of life
	I am more interested in having a good quality of life rather than the longest life possible.	59
	If I am going to die from cancer, the most important thing for me is to die with dignity.	70
	It is very important to me that I do not end my life so sick I am stuck in bed.	63
	I want a treatment that lets me keep working or doing the things I enjoy even if it means I will not live as long.	51
	Feeling well enough to spend as much quality time as possible with my loved ones is the most important thing.	72
	I would choose to die sooner rather than be a burden to my loved ones.	52
Side effects
	I am willing to put up with uncomfortable side effects as long as the treatment is slowing the growth of my cancer.	39
	I would put up with severe side effects to avoid needing to be in a wheelchair.	34
	I would put up with severe side effects to make sure I have time to organize my affairs for my loved ones.	56
Pain relief
	The most important thing is finding a treatment that minimizes pain.	25
Treatment efficacy
	I try to choose treatments that will not close any doors to future treatments.	65
Financial toxicity
	Avoiding financial trouble due to treatment of my prostate cancer is very important to me.	54
Treatment accessibility
	I am willing to travel as far as necessary to get the best treatment.	53
Fastest treatment
	I am not in a hurry to treat my cancer, I would rather take my time and make the best choices.	39
	I would choose a treatment that is available now rather than wait for a treatment that might work better, but requires waiting.	20
Decision regret
	I choose my treatment so I will not look back with regret.	62

Table 3 P-values Indicating the Significance of Fisher’s Exact Test Assessing the Relationships Between Participants’ Sociodemographic Characteristics and Likelihood of Strongly Endorsing Each Survey Item

Survey Item	Age	Race	Marital Status	Employment Status	Health Status
I rely on my doctor to tell me how to treat my prostate cancer	1.000	0.712	0.356	0.799	0.431
When I choose a cancer treatment, I am hoping for one that will eliminate the cancer completely	1.000	0.747	0.285	0.074*	0.001***
Above all, living as long as I can is my most important goal	0.540	0.130	0.317	0.675	0.279
I need to live as long as possible, no matter how I feel, so I can continue to take care of my loved ones	0.272	0.001***	1.000	0.823	0.489
I am more interested in having a good quality of life rather than the longest life possible	0.013**	0.760	1.000	0.213	0.118
If I am going to die from cancer, the most important thing for me is to die with dignity	0.027**	0.749	0.287	0.117	0.477
It is very important to me that I do not end my life so sick I am stuck in bed	0.292	1.000	0.445	0.393	1.000
I want a treatment that lets me keep working or doing the things I enjoy even if it means I will not live as long	0.675	0.543	0.617	0.671	0.825
Feeling well enough to spend as much quality time as possible with my loved ones is the most important thing	0.656	1.000	0.092*	0.817	0.628
I would choose to die sooner rather than be a burden to my loved ones	0.303	0.223	0.132	1.000	0.827
I am willing to put up with uncomfortable side effects as long as the treatment is slowing the growth of my cancer	0.683	0.219	0.210	1.000	0.017**
I would put up with severe side effects to avoid needing to be in a wheelchair	1.000	0.329	0.036**	1.000	0.021**
I would put up with severe side effects to make sure I have time to organize my affairs for my loved ones	0.834	0.530	1.000	0.198	0.120
The most important thing is finding a treatment that minimizes pain	0.345	0.068*	0.576	0.473	0.801
I try to choose treatments that will not close any doors to future treatments	0.515	0.533	0.794	0.512	0.067*
Avoiding financial trouble due to treatment of my prostate cancer is very important to me	0.063*	0.137	0.803	0.293	0.666
I am willing to travel as far as necessary to get the best treatment	0.148	0.368	0.618	0.675	0.129
I am not in a hurry to treat my cancer, I would rather take my time and make the best choices	0.217	1.000	0.114	1.000	0.108
I would choose a treatment that is available now rather than wait for a treatment that might work better, but requires waiting	0.201	1.000	0.127	0.832	0.268
I choose my treatment so I will not look back with regret	1.000	0.527	0.607	1.000	0.071*

Notes: Sociodemographic variables were dichotomized as follows: age, median split <68 vs ≥68 years old; race, nonwhite vs white; marital status, married/partnered vs not married/partnered; employment status, working vs retired; self-reported health, poor/fair vs good/excellent. *p<0.10, **p<0.05, ***p<0.01.