To find the extent of treatment mismatches, Talcott's team collected data on 438 prostate cancer patients. Patients were asked to complete questionnaires that included questions about urinary incontinence and other urinary problems, and bowel and sexual dysfunction.
The researchers found that 89 percent of the patients had some level of urinary, bowel or sexual problem before starting treatment. Among these patients, 34 percent of those with one serious symptom had a mismatched treatment, as did 37 percent who had a less serious symptom. Moreover, 40 percent of those who had several symptoms also received contraindicated therapy.
In addition, among patients with significant dysfunction in all three areas for whom no treatment would be recommended, only 5 percent chose watchful waiting. In this strategy, patients are not treated but are followed closely.
These mismatches appear to occur because doctors and patients don't communicate well. Patients are often reluctant to talk about urinary, bowel and sexual problems, Talcott said. "And, sometimes patients override their doctor's recommendation," he added.
Talcott also thinks that physicians can be wedded to a particular treatment at the exclusion of others. "Surgeons believe in surgery, and radiation oncologists believe in radiation," he said. "That may be part of the problem."
To counterbalance physician bias, patients should get another opinion, Talcott said. "Patients should always get a second consult," he said. "It's a good idea to talk with a surgeon, a radiation oncologist and possible a medical oncologist."
One expert thinks that patients need to make an informed decision about which treatment is best.
"The kind of doctor that you see often predetermines the treatment you receive," said Dr. Durado Brooks, director of prostate an
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