Long-term follow-up after active surveillance or curative treatment: quality-of-life outcomes of men with low-risk prostate cancer

Venderbos, Lionne D.F.; Aluwini, S.; Roobol, Monique J.; Bokhorst, Leonard P.; Oomens, Eric H. G. M.; Bangma, Chris H.; Korfage, Ida J.

doi:10.1007/s11136-017-1507-7

Cited by 31 publications

(44 citation statements)

References 37 publications

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“…Our findings are broadly consistent with previous quantitative studies but appear to differ from some previous qualitative research that reports persistent worry, altered social activities, and greater psychological needs in men on AS/WW . These studies were, however, based on much smaller samples of men on WW (less than 10 participants), those who switched from AS to AT or focused on men closer to diagnosis.…”

Section: Discussionsupporting

confidence: 83%

“…Concerns have been raised over the psychological impact of being on an AS/WW regime. Systematic reviews of quantitative studies suggest that quality of life and psychological well‐being in men on AS/WW are generally good and comparable with, or better than, men who received AT. However, evidence from qualitative studies suggests that men on AS/WW may struggle with anxiety .…”

Section: Introductionmentioning

confidence: 99%

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The psychological impact of being on a monitoring pathway for localised prostate cancer: A UK‐wide mixed methods study

et al. 2019

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Objective To address concerns over the psychological impact of being on a monitoring pathway following prostate cancer (PCa) diagnosis, this study compared the psychological status of men on active surveillance (AS) or watchful waiting (WW) with men on active treatment (AT) and explored psychological adjustment in men on AS/WW. Methods Cross‐sectional survey of UK men diagnosed with PCa 18 to 42 months previously (n = 16 726, localised disease at diagnosis) and telephone interviews with 24 men on AS/WW. Psychological outcomes were measured using two validated scales (Short Warwick‐Edinburgh Mental Well‐being Scale [SWEMWBS] and Kessler Psychological Distress Scale). Univariable and multivariable analyses compared outcomes between men on AS/WW and AT. Thematic analysis of interviews was undertaken, informed by a previously developed theory of adjustment to cancer. Results A total of 3986 (23.8%) respondents were on AS/WW. Overall, psychological outcomes were similar or better in men on AS/WW compared with those receiving AT (SWEMWBS: Poor well‐being; 12.3% AS/WW vs 13.9% AT, adjusted OR = 0.86, 95% CI, 0.76‐0.97; K6: severe psychological distress; 4.6% vs 5.4%, adjusted OR = 0.90, 95% CI, 0.74‐1.08). Interviews indicated that most men on AS/WW had adjusted positively. Men with poorer well‐being were less able to accept, reframe positively and normalise their diagnosis, described receiving insufficient information and support, and reported a lack of confidence in their health care professionals. Conclusions Most men on AS/WW cope well psychologically. Men making treatment decisions should be given this information. Psychological health should be assessed to determine suitability for AS/WW, and at monitoring appointments. A clear action plan and support from health care professionals is important.

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Section: Discussionsupporting

confidence: 83%

Section: Introductionmentioning

confidence: 99%

The psychological impact of being on a monitoring pathway for localised prostate cancer: A UK‐wide mixed methods study

et al. 2019

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“…The increase in AS patients' generalized anxiety symptoms over time contradicts previous research that reported declining anxiety in this group . Much of international AS research has been conducted on men being managed in centers with a strong focus on AS who have been refining and perfecting the diagnosis experience for almost two decades, and therefore AS is more widely accepted by clinicians and patients . This study demonstrates that men's experience of diagnosis in a nonspecialist AS center appears to be different.…”

Section: Discussioncontrasting

confidence: 59%

“…The sample size was calculated using GPower software (2007); effect size and sample size were calculated based on mean score and standard deviation on the State‐Trait Anxiety Inventory short form (STAI‐6) in two populations; data from a population of men diagnosed with low‐to‐intermediate risk PCa, prior to treatment, and men of a similar age group from the general population . At 0.8 power, P value 0.05, and an effect size of 0.503, the required sample size was 50 participants per group; 10% was added to this, resulting in a final sample size of 55 PCa patients and 55 non‐cancer controls.…”

Section: Methodsmentioning

confidence: 99%

Investigating the psychological impact of active surveillance or active treatment in newly diagnosed favorable‐risk prostate cancer patients: A 9‐month longitudinal study

et al. 2019

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Objective This study aimed to explore the psychological impact of favorable‐risk prostate cancer (PCa) and associated treatment (active surveillance [AS] or active treatment [AT]), comparing prevalence and temporal variability of generalized anxiety, PCa‐specific anxiety, and depression symptoms. Methods PCa patients were recruited at diagnosis prior to treatment decision‐making and completed questionnaires assessing anxiety (State‐Trait Anxiety Inventory short form [STAI‐6] and Memorial Anxiety Scale for Prostate Cancer [MAX‐PC]) and depression symptoms (Centre for Epidemiologic Studies Depression Scale [CES‐D]) at four timepoints for 9 months. Non‐cancer controls were recruited via university staff lists and community groups. Results were analyzed using analysis of variance. Results Fifty‐four PCa (AS n = 11, AT n = 43) and 53 non‐cancer participants were recruited. The main effect of time or treatment group were not statistically significant for CES‐D scores (P > .05). The main effect of treatment on STAI‐6 scores was significant (F2,73 = 4.678, .012) with AS patients reporting highest STAI‐6 scores (T1 M = 36.56; T2 M = 36.89, T3 M = 38.46; T4 M = 38.89). There was a significant main effect for time since diagnosis on MAX‐PC (F3,123 = 3.68, .01); AS patient scored higher than AT at all timepoints (T1 M = 10.33 vs 10.78; T2 M = 11.11 vs 11.30; T3 M = 13.44 vs 10.55; T4 M = 11.33 vs 8.88); however, both groups declined overall with time. Conclusions Men undergoing AS had significantly higher anxiety symptoms than AT and non‐cancer participants, contradicting previous literature. This may be due to perceived inactivity of AS relative to traditional narratives of cancer treatment. Participant experiences appear to be less favorable relative to other international centers. Recommendations for future research and clinical practice include the need to improve diagnosis and treatment information provision particularly for lower risk patients.

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“…The International Consortium for Health Outcomes Measurement (ICHOM (45)) proposed the Expanded Prostate Cancer Index Composite 26-question short form (EPIC-26 (46)), which is already widely used (14,37,39,(47)(48)(49)(50) and addresses all pertinent domains of prostate cancer treatment side effects including urinary obstructive symptoms, urinary incontinence and hematuria. ICHOM recognized that recommending a single instrument for comprehensive evaluation of side effects was a contentious decision, because centers of excellence already had well-established prospective programs including different patient-reported outcomes and there was no convincing indication for the superiority of one tool over another (45).…”

Section: Is the Patient's Point Of View Of Interest? Challenges In Mementioning

confidence: 99%

Understanding Urinary Toxicity after Radiotherapy for Prostate Cancer: First Steps Forward

Rancati

Palorini

Cozzarini

et al. 2017

Tumori

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Tumori 2017; 103(5): [395][396][397][398][399][400][401][402][403][404] REVIEW -BONADONNA LECTURE SERIES may be differently related to the absorbed dose. For example, rectal bleeding arises as a serial effect and is mainly related to the absorption of high doses in small rectal mucosa volumes, whilst fecal incontinence is related to intermediate doses absorbed by large rectal volumes.The development of reliable models of radiation-induced toxicities along with the available level of technology has determined an efficient improvement of the treatment plans, even in dose-escalated or hypofractionated regimens. This is particularly true for moderate and severe rectal toxicities, which had an incidence close to 20% in the 1990s while in the most recent publications they have fallen below 7%-10%.However, an analogous result has not yet been reached in urinary symptoms. This is mainly due to the difficulty in sparing the bladder, which is partially but unavoidably included in the target volume, as well as to the clear lack of knowledge concerning the predictors of urinary toxicity. The main reason for this deficiency is probably the difficulty in following for a sufficiently long time a large number of patients whose clinical and dosimetry data need to be individually and prospectively collected with proper evaluation of urinary symptoms. Some important symptoms (e.g., incontinence) may indeed continuously arise after radiation therapy and their incidence reaches a plateau only many years (typically 5-8) after treatment. The fulfilment of reliable models of radiation-induced urinary sequelae is therefore made particularly challenging by the complexity of symptoms, their evolution over time, and the strong dependence on the baseline situation.It is widely acknowledged that radiation-induced toxicity is a multifactorial problem, depending not only on the delivered

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Long-term follow-up after active surveillance or curative treatment: quality-of-life outcomes of men with low-risk prostate cancer

Cited by 31 publications

References 37 publications

The psychological impact of being on a monitoring pathway for localised prostate cancer: A UK‐wide mixed methods study

The psychological impact of being on a monitoring pathway for localised prostate cancer: A UK‐wide mixed methods study

Investigating the psychological impact of active surveillance or active treatment in newly diagnosed favorable‐risk prostate cancer patients: A 9‐month longitudinal study

Understanding Urinary Toxicity after Radiotherapy for Prostate Cancer: First Steps Forward

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