"The assessment we used includes scales that ask patients how bothered or distressed they are by each symptom," Talcott explains. "In earlier work, Wwe matched reported the symptom levels they reported to how much those symptoms had bothered other patients we surveyed before or soon after treatment in previous studies. If no symptoms were at a level that caused distress, that function would be considered normal. If a patient reported one symptom that usually caused high levels of distress, that function would be ranked as poor. Everyone else - those who reported any moderately distressing symptoms but no highly distressing ones - was ranked as intermediate."

More than half of the participants in the current study whose function would be categorized as intermediate actually ranked that function as normal. Similarly about 20 percent of those who would be categorized as poor in terms of urinary irritation or obstruction ranked that function as normal, as did around 40 percent of those rated poor for bowel problems.

"Symptoms that seem to bother other patients early in the course of their prostate cancer were regarded as normal by these patients nearly a decade after treatment," Talcott says. "As clinicians, we know that patients adapt to their situation and accept physical changes as the 'new normal.' When talking with prostate cancer patients, I've been surprised when, for example, a patient in his late 60s who became impotent two or three years after treatment would comment, 'Well, it would have happened anyway to a man my age.'

"While these results need to be confirmed, since this is just one study," he continues, "it's looking as if we should tell patients that treatment side effects probably will bother them less than they originally fear because they are likely to adjust and experience less distress over time. We also may need to rethink our standard measures of treatment outcomes, which assume that the impact of symptoms on patients' quality of life does not change over time. While that may be true for pain, it doesn't seem to be true for these sorts of symptoms." Talcott is an associate professor of Medicine at Harvard Medical School.

Source: Massachusetts General Hospital