{{globalize, date=March 2015 The trade-off dilemma, or ''patient trade-off'', refers to the choice between the expected beneficial and harmful effects in terms of patient survival and quality of life for a particular medical treatment. The choice involves a

trade-off A trade-off (or tradeoff) is a situational decision that involves diminishing or losing one quality, quantity, or property of a set or design in return for gains in other aspects. In simple terms, a tradeoff is where one thing increases, and anot ...

so it is of central importance for the patient and the physician to have access to empirical information on established treatment benefits and side effects. Research on this issue has been done upon prostate cancer.

Example of prostate cancer

An example of such trade-off is

prostate cancer Prostate cancer is cancer of the prostate. Prostate cancer is the second most common cancerous tumor worldwide and is the fifth leading cause of cancer-related mortality among men. The prostate is a gland in the male reproductive system that sur ...

treatment. Distress of this treatment includes urinary and bowel symptoms and waning

sexual function Sexual function is how the body reacts in different stages of the sexual response cycle, or as a result of sexual dysfunction. Relevant aspects of sexual function are defined on the basis of a modified version of Masters and Johnson's work. The aspe ...

Helgason ÁR Helgason is a surname of Icelandic origin, meaning ''son of Helgi''. In Icelandic names, the name is not strictly a surname, but a patronymic. The name may refer to: *Agnar Helgason (born 1968), Icelandic scientist; researcher in genetic anthropolo ...

, Adolfsson J, Dickman P, Fredrikson M, Arver S, Steineck G. Waning sexual function - the most important disease-specific distress for patients with prostate cancer. Br. J. Cancer. 1996: 73: 1417-1421. An important factor here is that prevalence of these symptoms and the distress they cause varies between types of treatment and individual patients. Patient trade-off shows the importance in collecting information needed to make such decisions.

Life expectancy and sexual function trade off

One option is to trade off an intact

for the possibility of a prolonged life expectancy by not having curative treatment. A Swedish study found that the willingness to do this kind of trade-off varied considerably among the men included in the study. While six out of ten were willing to consider a trade-off between life expectancy and intact sexual function, given the present knowledge of treatment benefits for clinically localized prostate cancer, four out of ten stated that they would under all circumstances choose treatment irrespective of the risk for waning sexual function. Access to valid empirical information is crucial for such decision making. Key factors here are an individual's feeling towards the illness, their emotional values and religious beliefs.

Stress of making trade-off decisions

A substantial proportion of patients and physicians, experience stress in judging the trade-off between different treatment options and treatment side-effects which adds to the stress of cancer diagnosed, a situation made worse in that eight out of ten prostate cancer patients have no one to confide in except their spouse and one out of five live in total

emotional isolation Emotional isolation is a state of isolation where one may have a well-functioning social network but still feels emotionally separated from others. Population-based research indicates that one in five middle-aged and elderly men (50–80 years) ...

.Helgason ÁR, Dickman PW, Adolfsson J, Steineck G. Emotional isolation : Prevalence and the effect on well-being among 50- to 80-year-old prostate cancer patients. Scandinavian Journal of Urology and Nephrology 2001 :35;97-101.

Issues needing research

It has not yet been empirically documented how far an individual may decide or not to select a treatment if in theory some positive treatment effects to counteract its negative effects.

References

Oncology