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

Abstract

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.

Examining anxiety and depression in haematology cancer patients in ongoing treatment and under watchful waiting: A systematic review and meta‐analysis

“…Across studies, prevalence rates of anxiety and depression in patients under watchful waiting were estimated to be higher than in the general population. This discovery contradicts findings in prostate cancer research where patients are reported to cope well under watchful waiting (Matheson et al, 2019 ). Psychological theories of needs, where psychological distress is thought to indicate unmet psychosocial needs, can be considered to understand why such a difference has been observed.…”

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

“…Information regarding PCa, AS, treatment options, and health care recommendations was perceived as confusing, inconsistent between providers/resources, and/or inadequately available or provided to men. Similar informational needs were also reported as unmet in systematic reviews for PCa survivors across treatments and in a recent mixed‐methods paper investigating psychological impact of AS.…”

Why men with a low-risk prostate cancer select and stay on active surveillance: A qualitative study

“…This is consistent with literature reports, including several systematic reviews, showing that anxiety is generally low among men on AS and decreases over time. [33–36] The randomized Prostate Testing for Cancer and Treatment (ProtecT) trial[37] and observational large observational studies with long-term follow-up, including the Prostate cancer Research International Active Surveillance protocol (PRIAS),[38] the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE)[39], and a population-based study in the United Kingdom[40] found that anxiety is similar between men choosing AS or AT. However, Ruane-McAteer’s systematic review concluded that quantitative observational studies often have important methodological flaws that limit the ability to validly assess the psychological impact of AS.…”