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

Background: Nearly 20% of US cancer survivors develop cardiovascular disease (CVD) from cardiotoxic cancer treatments. Patients and providers may consider alternative treatments to lower cardiotoxicity risk, but these may be less effective at preventing relapse/recurrence, presenting a difficult tradeoff.

Aims: This study explored survivors' cancer treatment decision-making when weighing this tradeoff.

Methods: Using adjusted multivariable logistic regression, we examined 443 US survivors' risk perceptions (deliberative, affective, and intuitive) about cancer and CVD and associations of these with their selection between two hypothetical cancer treatments: Treatment A: 5% chance of cancer recurrence and 10% chance of CVD; Treatment B: 10% chance of recurrence and 5% chance of CVD. We explored the effects of delay discounting by randomizing to a condition describing cancer recurrence/CVD as either immediate or delayed.

Results: More survivors (Mage = 48, range = 18-93; M = 10.8 years post-diagnosis) selected Treatment A than Treatment B (72% v. 28%). Timing of onset was not associated with treatment selection. Greater affective risk perception (worry) about cancer was associated with increased odds of choosing Treatment A, whereas greater CVD worry was associated with decreased odds (OR-cancer = 1.33, p = 0.006; OR-CVD = 0.72, p = 0.007). Neither deliberative nor experiential risk perceptions were associated with treatment choice.

Conclusions: Survivors were more likely to select the treatment that minimized recurrence rather than CVD-regardless of the timing of onset. Treatment decision was linked to both cancer- and CVD-related worry but not deliberative or experiential risk perceptions. During treatment discussions, clinicians should open conversations about the risks of treatment-associated cardiotoxicity, the probabilities, and patients' relative worries about cancer and cardiotoxicity.