The psychological impact of active surveillance in men with prostate cancer: implications for nursing care

2021 ◽  
Vol 30 (10) ◽  
pp. S30-S37
Author(s):  
Sophie Biddle
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Negative Impact ◽  
Psychological Impact ◽  
Future Research ◽  
Management Approach ◽  
Close Monitoring ◽  
Illness Uncertainty ◽  
Quantitative Studies ◽  
Positive Treatment

Introduction: Active surveillance is a conservative management approach to treating prostate cancer involving regular testing and close monitoring by the health professional. The aim of this literature review is to establish whether men experience a psychological impact of active surveillance and what the prevalent effects might be. Method: The search was carried out in three databases: CINAHL, Medline and PsycINFO. Articles published in English, from October 2015 to March 2018, which focused on the psychological impact of active surveillance, were included. Findings: A total of eight quantitative studies were included in this report. The review identified key psychological impacts of active surveillance, including anxiety, sub-clinical depression, illness uncertainty and hopelessness. Active surveillance was seen by some patients as a positive treatment approach that limited the side effects associated with active treatment. Conclusion: The evidence found a negative impact of active surveillance might be felt by men at any stage during treatment and at differing levels of severity. The article highlights key demographic areas, including ethnicity and age, for future research and recommends more qualitative studies are conducted.

Out of the Black Box: Expansion of a Theory-Based Intervention to Self-Manage the Uncertainty Associated With Active Surveillance (AS) for Prostate Cancer

2010 ◽  
Vol 24 (2) ◽  
pp. 101-112 ◽  
Author(s):  
Meredith Wallace Kazer ◽  
Donald E. Bailey ◽  
Robin Whittemore
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Management Approach ◽  
Cancer Treatments ◽  
Illness Uncertainty ◽  
Management Intervention ◽  
Alternative Approach ◽  
Cancer Intervention ◽  
Prostate Cancer Treatments

Active surveillance (AS) (sometimes referred to as watchful waiting) is an alternative approach to managing low-risk forms of prostate cancer. This management approach allows men to avoid expensive prostate cancer treatments and their well-documented adverse events of erectile dysfunction and incontinence. However, AS is associated with illness uncertainty and reduced quality of life (QOL; Wallace, 2003). An uncertainty management intervention (UMI) was developed by Mishel et al. (2002) to manage uncertainty in women treated for breast cancer and men treated for prostate cancer. However, the UMI was not developed for men undergoing AS for prostate cancer and has not been adequately tested in this population. This article reports on the expansion of a theory-based intervention to manage the uncertainty associated with AS for prostate cancer. Intervention Theory (Sidani & Braden, 1998) is discussed as a framework for revising the UMI intervention for men undergoing AS for prostate cancer (UMI-AS). The article concludes with plans for testing of the expanded intervention and implications for the extended theory.

Careful Selection and Close Monitoring of Low-Risk Prostate Cancer Patients on Active Surveillance Minimizes the Need for Treatment

2010 ◽  
Vol 58 (6) ◽  
pp. 831-835 ◽  
Author(s):  
Mark S. Soloway ◽  
Cynthia T. Soloway ◽  
Ahmed Eldefrawy ◽  
Kristell Acosta ◽  
Bruce Kava ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Patients ◽  
Active Surveillance ◽  
Low Risk ◽  
Close Monitoring ◽  
Careful Selection ◽  
Need For Treatment ◽  
Risk Prostate Cancer ◽  
Low Risk Prostate Cancer

Associations between uncertainty, anxiety, and quality of life in men with favorable-risk prostate cancer on active surveillance: Two-and-a-half years' follow-up.

2014 ◽  
Vol 32 (4_suppl) ◽  
pp. 135-135
Author(s):  
Patricia A. Parker ◽  
John W. Davis ◽  
David Latini ◽  
George Baum ◽  
Xuemei Wang ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Prostate Cancer ◽  
Active Surveillance ◽  
Specific Antigen ◽  
Digital Rectal Examination ◽  
Study Entry ◽  
Illness Uncertainty ◽  
Disease Specific

135 Background: Active surveillance (AS) has emerged as a viable option for many men with early stage prostate cancer (PC). This approach of careful monitoring with prostate-specific antigen (PSA) level, digital rectal examination, and prostate biopsy may allow men to avoid or delay the potentially debilitating side effects of such aggressive treatments as surgery or radiation; however, AS may create uncertainty and anxiety for men with PC. We examined the associations between illness uncertainty and anxiety and general and PC-specific quality of life (QOL) of 191 men with favorable-risk PC participating in the AS program at MD Anderson Cancer Center. Methods: Men completed measures of uncertainty (Mishel Uncertainty in Illness Scale), anxiety (State-Trait Anxiety Inventory), and general (SF-12, Physical Health [PCS] and Mental Health Component Score [MCS]) and disease-specific (Expanded Prostate Index Composite [EPIC]) QOL questionnaires upon study entry and every 6 months. These results are through a 2.5 year follow-up. Results: Men were primarily (86%) white and an average age of 67.2 (SD=8.9). Average baseline PSA was 3.3 ng/mL (SD=1.6), 98% had a Gleason score of 6, and 85% had cT1c disease. Both general and PC-specific QOL were relatively unchanged across the 2.5 year study period, except for statistically significant declines in the EPIC Sexual score (p<0.05). Controlling for demographic (age, ethnicity) and clinical characteristics (study entry PSA, PSA density, testosterone, BMI, baseline number of biopsies, family history of cancer, whether patients were taking a 5-alpha-reductase inhibitor, and whether the tumor was reclassified during the study), illness uncertainty was a significant predictor of all EPIC summary scores, PCS, and MCS (all, p<0.05). Anxiety was also a significant predictor of all EPIC summary scores and MCS (all, p<0.05), but not PCS (p=0.08). Conclusions: Both increased anxiety and increased illness uncertainty were associated with poorer general and disease specific QOL. Interventions that focus on reducing uncertainty and anxiety may enhance the QOL of men on AS for PC.

Perspectives of prostate cancer patients about active surveillance.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 82-82
Author(s):  
Fred Saad ◽  
Margaret Fitch ◽  
Kittie Pang ◽  
Veronique Ouellet ◽  
Carmen Loiselle ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Active Surveillance ◽  
Health Care Professionals ◽  
Treatment Options ◽  
Low Risk ◽  
Close Monitoring ◽  
Focus Group Interviews ◽  
Group Interviews

82 Background: In prostate cancer (PC), men diagnosed with low risk disease may be monitored through an active surveillance (AS) approach that runs counter to the traditional message of undergoing treatment as soon as possible following a cancer diagnosis. This research explored the perspectives of men with PC regarding their decision-making process for AS to identify the factors that influenced their decision and assisted health care professionals in discussing AS as an option. Methods: Focus group interviews (n = 7) were held in several Canadian cities with men (n = 52) diagnosed with PC and eligible for AS. The men’s viewpoints were captured regarding their understanding of AS, the factors that influenced their decision to engage in AS, and their experience with the approach. A content and theme analysis was performed on the verbatim transcripts from the interviews. Results: All patients described the perception that their disease was not “large enough” to require treatment. They understood that the waiting process avoided the side effects associated with treatments, and they were comfortable about postponing treatment while undergoing close monitoring. Conversations with their doctor and how AS was described were cited as key influences in their decision. Other influences included availability of information on treatment options, distrust in the health system, personality, experiences and opinions of others, and personal perspectives on quality of life. Conclusions: AS is a relatively new approach for the care of men with low risk PC. Men require a thorough explanation on AS as a safe and valid option, as well as guidance towards supportive resources in their decision-making.

Patient experiences of care in localized prostate cancer.

2019 ◽  
Vol 37 (27_suppl) ◽  
pp. 215-215 ◽  
Author(s):  
Michelle Mollica ◽  
Lisa M Lines ◽  
Timothy S. McNeel ◽  
Serban Negoita ◽  
Sarah Gaillot ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Cancer Survivors ◽  
Patient Care ◽  
Active Surveillance ◽  
Watchful Waiting ◽  
Patient Experiences ◽  
Localized Prostate Cancer ◽  
Outcome Variable ◽  
Future Research ◽  
Prostate Cancer Survivors

215 Background: Over 161,000 new prostate cancer patients diagnosed annually, with 75% diagnosed at early stages. Limited evidence exists supporting choice of treatment (including radical prostatectomy, radiation therapy, hormonal therapy, active surveillance or watchful waiting) for localized prostate cancer. Treatments have varying side effects associated with impaired functional status and health-related quality of life. Patient care experiences are important quality indicators, but research examining patient experiences by prostate cancer treatment is limited. The purpose of this study was to examine the association between treatment received (surgery, radiation, or no treatment) and CAHPS ratings of overall care over the prior six months. Methods: This study used data from SEER-CAHPS, which links Surveillance, Epidemiology, and End Results (SEER) data with Medicare Consumer Assessment of Healthcare Providers and Systems (CAHPS) patient experience survey and Medicare claims data. Medicare Fee-for-Service beneficiaries ≥65 years with a National Comprehensive Cancer Network (NCCN) low- or intermediate-risk prostate cancer diagnosis were assigned to surgery only, radiation only, and no treatment received groups for analysis. The outcome variable was a CAHPS rating of overall care (0 = worst; 10 = best). The analysis adjusted for case mix and other cancer-specific variables. Results: The final cohort included 507 prostate cancer survivors (surgery n = 109 [21%]; radiation n = 197 [39%]; no treatment n = 201 [40%]). Respondents who received radiation rated their overall care higher than those not receiving treatment (adjusted mean 8.9 vs 8.3; p= 0.02). Ratings did not differ significantly between the surgery and no treatment groups. Conclusions: This study represents a first look at patient experiences among localized prostate cancer survivors receiving surgery, radiation, or no treatment. It is not clear whether those who did not receive treatment chose active surveillance or watchful waiting, or whether they did not have access to care, which could have affected results. Future research should explore associations between receipt of treatment and patient care experiences in an adequately powered sample to inform future interventions.

scholarly journals MRI-derived PRECISE scores for predicting pathologically-confirmed radiological progression in prostate cancer patients on active surveillance

2020 ◽  
Author(s):  
Iztok Caglic ◽  
Nikita Sushentsev ◽  
Vincent J. Gnanapragasam ◽  
Evis Sala ◽  
Nadeem Shaida ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Predictive Value ◽  
Scoring System ◽  
Lesion Size ◽  
Receiver Operating Curve ◽  
Close Monitoring ◽  
Targeted Mri ◽  
Sensitivity Specificity

Abstract Objectives To assess the predictive value and correlation to pathological progression of the Prostate Cancer Radiological Estimation of Change in Sequential Evaluation (PRECISE) scoring system in the follow-up of prostate cancer (PCa) patients on active surveillance (AS). Methods A total of 295 men enrolled on an AS programme between 2011 and 2018 were included. Baseline multiparametric magnetic resonance imaging (mpMRI) was performed at AS entry to guide biopsy. The follow-up mpMRI studies were prospectively reported by two sub-specialist uroradiologists with 10 years and 13 years of experience. PRECISE scores were dichotomized at the cut-off value of 4, and the sensitivity, specificity, positive predictive value and negative predictive value were calculated. Diagnostic performance was further quantified by using area under the receiver operating curve (AUC) which was based on the results of targeted MRI-US fusion biopsy. Univariate analysis using Cox regression was performed to assess which baseline clinical and mpMRI parameters were related to disease progression on AS. Results Progression rate of the cohort was 13.9% (41/295) over a median follow-up of 52 months. With a cut-off value of category ≥ 4, the PRECISE scoring system showed sensitivity, specificity, PPV and NPV for predicting progression on AS of 0.76, 0.89, 0.52 and 0.96, respectively. The AUC was 0.82 (95% CI = 0.74–0.90). Prostate-specific antigen density (PSA-D), Likert lesion score and index lesion size were the only significant baseline predictors of progression (each p < 0.05). Conclusion The PRECISE scoring system showed good overall performance, and the high NPV may help limit the number of follow-up biopsies required in patients on AS. Key Points • PRECISE scores 1–3 have high NPV which could reduce the need for re-biopsy during active surveillance. • PRECISE scores 4–5 have moderate PPV and should trigger either close monitoring or re-biopsy. • Three baseline predictors (PSA density, lesion size and Likert score) have a significant impact on the progression-free survival (PFS) time.

scholarly journals Comparing Perspectives of Canadian Men Diagnosed With Prostate Cancer and Health Care Professionals About Active Surveillance

2020 ◽  
Vol 7 (6) ◽  
pp. 1122-1129
Author(s):  
Margaret Fitch ◽  
Veronique Ouellet ◽  
Kittie Pang ◽  
Simone Chevalier ◽  
Darrel E Drachenberg ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Health Care ◽  
Decision Making ◽  
Active Surveillance ◽  
Health Care Professionals ◽  
Critical Factor ◽  
Disease Status ◽  
Low Risk ◽  
Management Approach ◽  
Low Grade

Active surveillance (AS) has gained acceptance as a primary management approach for patients diagnosed with low-risk prostate cancer (PC). In this qualitative study, we compared perspectives between patients and health care professionals (HCP) to identify what may contribute to patient–provider discordance, influence patient decision-making, and interfere with the uptake of AS. We performed a systematic comparison of perspectives about AS reported from focus groups with men eligible for AS (7 groups, N = 52) and HCP (5 groups, N = 48) who engaged in conversations about AS with patient. We used conventional content analysis to scrutinize separately focus group transcripts and reached a consensus on similar or divergent viewpoints between them. Patients and clinicians agreed that AS was appropriate for low grade PC and understood the low-risk nature of the disease. They shared the perspective that disease status was a critical factor to pursue or discontinue AS. However, men expressed a greater emphasis on quality of life in their decisions related to AS. Patients and clinicians differed in their perspectives on the clarity, availability, and volume of information needed and offered; clinicians acknowledged variations between HCP when presenting AS, while patients were often compelled to seek additional information beyond what was provided by physicians and experienced difficulty in finding or interpreting information applicable to their situation. A greater understanding of discordant perspectives about AS between patients and HCP can help improve patient engagement and education, inform development of knowledge-based tools or aids for decision-making, and identify areas that require standardization across the clinical practice.

scholarly journals Measuring illness uncertainty in men undergoing active surveillance for prostate cancer

2011 ◽  
Vol 24 (4) ◽  
pp. 193-199 ◽  
Author(s):  
Donald E. Bailey ◽  
Meredith Wallace ◽  
David M. Latini ◽  
Josephine Hegarty ◽  
Peter R. Carroll ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Active Surveillance ◽  
Illness Uncertainty
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