A study published in the Journal of Clinical Oncology in July suggests that as many as 15 percent of patients who undergo treatment for prostate cancer later regret the treatment they choose. Dr. Christopher Saigal, vice chair of urology at UCLA, is trying to fix that.
Prostate cancer is one of the more curable cancers — it has a 96 percent survival rate 15 years after diagnosis, according to the American Cancer Society. Even so, men face some daunting decisions after diagnosis because of a perplexing set of treatment options with different side effects and trade-offs. So choosing, for example, between radiation therapy or surgery can be complicated for a person.
Such difficulties led Saigal to develop a tool to simplify the choices for men and reduce what he calls “decisional conflict,” when patients experience stress about which treatment — and the associated risks — to choose.
The tool, an online computer program called WiserCare, asks men with prostate cancer to answer questions about personal values and goals. Based on those answers, the program ranks the suggested treatments.
The program uses algorithms that incorporate medical evidence and modeling to quantify the relative strengths of what a patient says he values. For example, a man might answer that he values living as long as possible more than lessening the likelihood of a side effect, such as decreased sexual function. The software then suggests treatment options, which the men can weigh to decide which treatment option is best for them.
“As doctors, we want to offer a patient-centered plan that gives patients the power to leverage all the clinical evidence we have and choose a treatment that fits with their personal preferences,” Saigal said.
Bill Pickett is one of the more than 300 men at UCLA who have used the tool. It's currently available to all prostate cancer patients at UCLA and is being adopted at a growing number of institutions, including Johns Hopkins University and NorthShore University. After completing the questionnaire online, Pickett decided that enrolling in a clinical trial was the right choice for him.
"When you’re diagnosed with prostate cancer, you realize that each treatment can have very different side effects," said Pickett. "By the time I was done using the tool, I knew which treatment I wanted to have."
The trial involved treatment with oral drugs and subcutaneous injections in hopes of making the surgery to remove the prostate gland — known as a prostatectomy — more successful. Pickett, who underwent surgery in January and now has no signs of cancer in his body, continues to be regularly monitored for signs the disease may have returned.
“With my treatment, I just wanted the best chance at success,” Pickett said. “I've been doing well post-surgery, and my side effects have been getting better each day.”
Prostate cancer is one of many diagnoses that highlights the benefits of personalized medicine.
“There is so much data out there now on this diagnosis that patients can be overwhelmed,” Saigal said. “Software programs like these help patients to unlock the power of those data and apply them to their personal situation.”
Saigal is measuring the impact of the software on patient decision quality and said his team has found improvements in patient satisfaction, increased knowledge about prostate cancer and reductions in feelings of uncertainty after making a treatment decision.
“As doctors, we need to put a greater emphasis on patient preferences when guiding them through their treatment,” he said. “It's important for patients to be as involved as they can be when it comes to decisions about their own health.”