Age, communication, and access to appropriate prostate cancer services/options


Newly reported data from the German HAROW study suggests that older men diagnosed with prostate cancer are less informed that younger men about access to things like patient support groups, post-treatment rehabilitation services, and second medical opinions.

The HAROW study is a”real world,” prospective, observational study that has been collecting clinical and patient-reported outcomes data associated with varied treatment options from men newly diagnosed with localized prostate cancer. Every 6 months, the researchers have collected general clinical data, data on quality of life and quality of physician-patient interactions, and individual patient costs. “HAROW” is an abbreviation that stands for “hormonal therapy, active surveillance, radiation, operation and watchful waiting” (which clearly encompasses all of the most common treatment options).

Ernstmann et al. report that the HAROW study had collected data on 2,482 patients over four time points (T0 to T4) at the time of the current study.

Here are the core findings:

  • There appeared to be no significant differences in terms of shared decision-making and information regarding the application of different treatment options between patients aged > 75 years old and the rest of the sample.
  • There were significant differences in terms of information about access to self-help (support) groups, rehabilitation services, and second medical opinions between patients in all age groups
    • Patients aged > 75 years old received less information on these aspects at all points in time.

The authors conclude that “there is room for improvement”  (at least in Germany) in the provision of information to elderly prostate cancer patients about rehabilitation services, second medical opinions, and support groups. They also suggest that “special information tools and decision aids” should be developed and implemented to meet the specific information needs of men > 75 years of age.

The “New” Prostate Cancer InfoLink is less confident of the value of “special information tools and decisions aids” for men > 75, but we do concur that older men may well need more time to absorb the available information and greater care on the part of health professionals and care-givers to be sure that the patient has really understood and appreciates all his options.

3 Responses

  1. Everyone needs “special information tools and decision aids.” I often wonder how many urologists actually have had prostate cancer that they treat patients for and had the procedures done on them. Does it affect how they now treat patients?

  2. Dear elucidated1:

    My “educated guesses” would be as follows:

    (1) The incidence of diagnosis of prostate cancer among urologists and radiation oncologists is probably similar to that among the general population among men 70 years of age because of a greater appreciation for the risk of harms related to treatment relative to the potential benefits. Most urologists and radiation oncologists > 75 probably don’t get regular PSA tests.

    (2) The application of first-line treatment for localized prostate cancer is probably significantly lower in urologists and radiation oncologists > 70 years of age because of the same appreciation for the risk of harms related to treatment relative to the potential benefits. Equally, the application of active surveillance and watchful waiting as management strategies by physicians is probably higher than in the non-physician male population.

    What I can certainly tell you is that a diagnosis and treatment for prostate cancer is a profound educational experience for some urologists (see, for example, this link). On the other hand, I have attended a lecture by one relatively recent president of the AUA to members of the advocacy community who saw his personal diagnosis and surgical treatment for localized prostate cancer (in his early 60s) as some sort of badge of honor that only confirmed his belief that such treatment was highly appropriate for anyone with a diagnosis of localized disease (and that surgery was definitely the way to go).

  3. INTERNET COMMUNICATION CLEARLY A CHALLENGE FOR MANY WHO ARE 75 OR OLDER

    I was an able typist from the time I took a course in high school, but many of my peers were not. I’m now 69, and many of us relied on secretarial services to get our typing done. While the fruits of the Internet have no doubt enticed many older men to acquire the skill needed to participate, I suspect many others never acquired the skill. That lack would make it challenging to benefit from several key modes of modern communication.

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