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

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Cancer survivors often choose treatments prioritizing cancer recurrence over cardiovascular disease (CVD) risk. Patient worry significantly influences this decision, not perceived timing of risks.

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Area of Science:

  • Oncology
  • Cardiology
  • Behavioral Science

Background:

  • Cardiotoxicity from cancer treatments affects nearly 20% of US cancer survivors, leading to cardiovascular disease (CVD).
  • Alternative cancer treatments may reduce cardiotoxicity but can be less effective against cancer relapse, creating a complex treatment tradeoff.
  • Understanding patient decision-making in this context is crucial for optimizing survivorship care.

Purpose of the Study:

  • To explore how cancer survivors make treatment decisions when faced with a tradeoff between cancer recurrence risk and cardiotoxicity risk.
  • To investigate the association between survivors' risk perceptions (deliberative, affective, intuitive) and their treatment choices.

Main Methods:

  • A multivariable logistic regression analysis was conducted on 443 US cancer survivors.
  • Survivors evaluated two hypothetical cancer treatments with differing recurrence and CVD probabilities.
  • Risk perceptions and the effect of immediate versus delayed onset of risks were examined.

Main Results:

  • A majority of survivors (72%) selected the treatment with a lower cancer recurrence risk (Treatment A) over the one with lower CVD risk (Treatment B).
  • Affective risk perception (worry) about cancer increased the likelihood of choosing Treatment A, while CVD worry decreased it.
  • The timing of risk onset (immediate vs. delayed) did not significantly influence treatment selection.

Conclusions:

  • Cancer survivors prioritize minimizing cancer recurrence over CVD risk when selecting treatments, irrespective of risk timing.
  • Treatment choices are influenced by emotional responses (worry) to cancer and CVD risks, not by deliberative or intuitive risk assessments.
  • Clinicians should discuss cardiotoxicity risks, probabilities, and patient-specific worries during treatment consultations.