Factors Influencing Men's Choice of and Adherence to Active Surveillance for Low-risk Prostate Cancer: A Mixed-method Systematic Review

Kinsella, Netty; Stattin, Pär; Cahill, Declan; Brown, Christian; Bill‐Axelson, Anna; Bratt, Ola; Carlsson, Sigrid; Hemelrijck, Mieke Van

doi:10.1016/j.eururo.2018.02.026

Cited by 95 publications

(139 citation statements)

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“…Research suggests that AS poses no greater threat to patient mortality or well-being than active treatments [9][10][11][12] when recommended and adhered to correctly. However, there is some concern men on AS experience psychological burdens [13][14][15][16] , which may contribute to AS nonadherence 17 . Emerging research suggests approximately 10% to 20% of men transition from AS to treatment without evidence of disease progression [18][19][20] .…”

Section: Introductionmentioning

confidence: 99%

A systematic review of the unmet supportive care needs of men on active surveillance for prostate cancer

et al. 2019

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Objective Understanding the unmet supportive care needs of men on active surveillance for prostate cancer may enable researchers and health professionals to better support men and prevent discontinuation when there is no evidence of disease progression. This review aimed to identify the specific unmet supportive care needs of men on active surveillance. Methods A systematic review following PRISMA guidelines was conducted. Databases (Pubmed, Embase, PsycINFO, and CINAHL) were searched to identify qualitative and/or quantitative studies that reported unmet needs specific to men on active surveillance. Quality appraisals were conducted before results were narratively synthesised. Results Of the 3613 unique records identified, only eight articles were eligible (five qualitative and three cross‐sectional studies). Unmet Informational, Emotional/Psychological, Social, and “Other” needs were identified. Only three studies had a primary aim of investigating unmet supportive care needs. Small active surveillance samples, use of nonvalidated measures, and minimal reporting of author reflexivity in qualitative studies were the main quality issues identified. Conclusions The unmet needs of men on active surveillance is an underresearched area. Preliminary evidence suggests the information available and provided to men during active surveillance is perceived as inadequate and inconsistent. Men may also be experiencing unmet psychological/emotional, social, and other needs; however, further representative, high‐quality research is required to understand the magnitude of this issue. Reporting results specific to treatment type and utilising relevant theories/models (such as the social ecological model [SEM]) is recommended to ensure factors that may facilitate unmet needs are appropriately considered and reported.

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Section: Introductionmentioning

confidence: 99%

A systematic review of the unmet supportive care needs of men on active surveillance for prostate cancer

et al. 2019

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“…The findings from this study add to previous research in PCa care that has investigated patient decision making in PCa diagnosis and treatment, 16 such as men's understanding of benefits and harms You're also 73. The side effects of radiotherapy are less likely to affect you, versus a 53 or 63-year-old".…”

Section: Discussionmentioning

confidence: 56%

“…The findings from this study add to previous research in PCa care that has investigated patient decision making in PCa diagnosis and treatment, such as men's understanding of benefits and harms associated with PSA testing; and their decision‐making and treatment preferences . However, in this study, we have concentrated on risk, through qualitative interviews, observations and surveys.…”

Section: Discussionmentioning

confidence: 85%

“…Even though risk is expressed in terms that are clinical (impacting on a person's physical health) patients can also experience risk in ways that are non-clinical (impacting on their quality of life) or in terms of psychosocial implications (impacting on their relationship and mental health). 16 Risk communication in this study builds on our previous work in understanding how risk is discussed with patients, and expressed, in breast cancer. 17,19 2 | ME THOD…”

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confidence: 98%

“…12,13 Moreover, as it does not involve the eradication of the cancer, AS may be associated with anxiety and uncertainty. 14,15 Patients' perceptions of risk and their certainty of the effectiveness of treatments for PCa are influenced by their understanding of clinical outcomes, 15,16 in turn affected by a number of psychosocial factors, such as family support, clinician communication and attitude, 16 and anxiety and distress. 7 In this study, we sought to uncover the experiences of men with low-risk PCa responding to the risks associated with their cancer.. We aimed to identify risk from the perspective of men with localized PCa, who were considering or using an AS protocol to manage their risk of cancer metastasizing, and from the perspectives of their treating clinicians.…”

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confidence: 99%

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Appraising risk in active surveillance of localized prostate cancer

Hogden

Churruca

Rapport

et al. 2019

Health Expectations

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ObjectivesMen diagnosed with low‐risk prostate cancer are typically eligible for active surveillance of their cancer, involving monitoring for cancer progression and making judgements about the risks of prostate cancer against those of active intervention. Our study examined how risk for prostate cancer is perceived and experienced by patients undergoing active surveillance with their clinicians, how risk is communicated in clinical consultations, and the implications for treatment and care.MethodParticipants were nine patients and three clinicians from a university hospital urology clinic. A staged, qualitative, multi‐method data collection approach was undertaken, comprising: observations of consultations; patient and clinician interviews; and patient surveys. The three data sets were analysed separately using thematic analysis and then integrated to give a comprehensive view of patient and clinician views.ResultsThirty data points (eight patient surveys; 10 observations of consultations between patients and clinicians; 10 patient interviews; and two clinician interviews) combined to create a detailed picture of how patients perceived and appraised risk, in three themes of “Making sense of risk”, “Talking about risk” and “Responding to risk”.ConclusionEffective risk communication needs to be finely tuned and timed to individual patient's priorities and information requirements. A structured information exchange process that identifies patients' priorities, and details key moments in risk assessment, so that complexities of risk are discussed in ways that are meaningful to patients, may benefit patient care. These findings could inform the development of patient‐centric risk assessment procedures and service delivery models in prostate cancer care more broadly.

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Patient and Context Factors in the Adoption of Active Surveillance for Low-Risk Prostate Cancer

Ciccone,

De Luca,

Oderda

et al. 2023

JAMA Netw Open

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ImportanceAlthough active surveillance for patients with low-risk prostate cancer (LRPC) has been recommended for years, its adoption at the population level is often limited.ObjectiveTo make active surveillance available for patients with LRPC using a research framework and to compare patient characteristics and clinical outcomes between those who receive active surveillance vs radical treatments at diagnosis.Design, Setting, and ParticipantsThis population-based, prospective cohort study was designed by a large multidisciplinary group of specialists and patients’ representatives. The study was conducted within all 18 urology centers and 7 radiation oncology centers in the Piemonte and Valle d’Aosta Regional Oncology Network in Northwest Italy (approximate population, 4.5 million). Participants included patients with a new diagnosis of LRPC from June 2015 to December 2021. Data were analyzed from January to May 2023.ExposureAt diagnosis, all patients were informed of the available treatment options by the urologist and received an information leaflet describing the benefits and risks of active surveillance compared with active treatments, either radical prostatectomy (RP) or radiation treatment (RT). Patients choosing active surveillance were actively monitored with regular prostate-specific antigen testing, clinical examinations, and a rebiopsy at 12 months.Main Outcomes and MeasuresOutcomes of interest were proportion of patients choosing active surveillance or radical treatments, overall survival, and, for patients in active surveillance, treatment-free survival. Comparisons were analyzed with multivariable logistic or Cox models, considering centers as clusters.ResultsA total of 852 male patients (median [IQR] age, 70 [64-74] years) were included, and 706 patients (82.9%) chose active surveillance, with an increasing trend over time; 109 patients (12.8%) chose RP, and 37 patients (4.3%) chose RT. Median (IQR) follow-up was 57 (41-76) months. Worse prostate cancer prognostic factors were negatively associated with choosing active surveillance (eg, stage T2a vs T1c: odds ratio [OR], 0.51; 95% CI, 0.28-0.93), while patients who were older (eg, age ≥75 vs &lt;65 years: OR, 4.27; 95% CI, 1.98-9.22), had higher comorbidity (Charlson Comorbidity Index ≥2 vs 0: OR, 1.98; 95% CI, 1.02-3.85), underwent an independent revision of the first prostate biopsy (OR, 2.35; 95% CI, 1.26-4.38) or underwent a multidisciplinary assessment (OR, 2.65; 95% CI, 1.38-5.11) were more likely to choose active surveillance vs active treatment. After adjustment, center at which a patient was treated continued to be an important factor in the choice of treatment (intraclass correlation coefficient, 18.6%). No differences were detected in overall survival between active treatment and active surveillance. Treatment-free survival in the active surveillance cohort was 59.0% (95% CI, 54.8%-62.9%) at 24 months, 54.5% (95% CI, 50.2%-58.6%) at 36 months, and 47.0% (95% CI, 42.2%-51.7%) at 48 months.Conclusions and RelevanceIn this population-based cohort study of patients with LRPC, a research framework at system level as well as favorable prognostic factors, a multidisciplinary approach, and an independent review of the first prostate biopsy at patient-level were positively associated with high uptake of active surveillance, a practice largely underused before this study.

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Factors Influencing Men's Choice of and Adherence to Active Surveillance for Low-risk Prostate Cancer: A Mixed-method Systematic Review

Cited by 95 publications

References 113 publications

A systematic review of the unmet supportive care needs of men on active surveillance for prostate cancer

A systematic review of the unmet supportive care needs of men on active surveillance for prostate cancer

Appraising risk in active surveillance of localized prostate cancer

Patient and Context Factors in the Adoption of Active Surveillance for Low-Risk Prostate Cancer

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