Patient's choice of observational strategy for early-stage prostate cancer

Published on Nov 1, 2012
· DOI :10.7358/NEUR-2012-012-BELL
Lara Bellardita10
Estimated H-index: 10
Guendalina Graffigna29
Estimated H-index: 29
(UCSC: Catholic University of the Sacred Heart)
+ 6 AuthorsRiccardo Valdagni51
Estimated H-index: 51
Active Surveillance (AS) may represent for selected patients with low risk, potentially indolent prostate cancer (PCa) a viable alternative to radical therapies, thus reducing the risk of over-treatment. Researchers and clinicians emphasized that the choice of AS may be a controversial one as patients have the chance to avoid the side effects of radical therapies but also the burden of living with an untreated PCa. The aim of our study is to focus on the decision-making process leading patients to elect AS amongst different therapeutic options. An observational, qualitative study was conducted. Between 2007 and 2009, 46 patients (mean age 67 years) were administered a semi-structured interview at enrolment in the Prostate Cancer Research International: Active Surveillance protocol. The focus of the interview was on the first question, i.e. “Why did you choose AS?”. Interviews were audio-recorded and verbatim transcriptions were made. Content analyses were performed by using a text-driven, automatic software (T-lab). Four clusters of themes emerged. In cluster 1, the most meaningful theme was the ambivalence in front of different therapeutic options. In cluster 2, the focus was on patients’ assessment of the aggressiveness of their PCa. In cluster 3, the topic was the collection of information from specialists. In cluster 4, the main theme was the collection of data through informal sources. Patients are motivated to opt for AS based on the subjective evaluation of medical information as well as characteristics of their psycho-social context. Understanding motivation for AS will help clinicians support patients in making the best choice for them. Lara Bellardita et al. Neuropsychological Trends – 12/2012 108
#1Dawn Stacey (Ottawa Hospital Research Institute)H-Index: 56
#1Annette M. O'Connor (U of O: University of Ottawa)H-Index: 77
Last. David R. RovnerH-Index: 37
view all 10 authors...
Background Decision aids are intended to help people participate in decisions that involve weighing the benefits and harms of treatment options often with scientific uncertainty. Objectives To assess the effects of decision aids for people facing treatment or screening decisions. Search methods For this update, we searched from 2009 to June 2012 in MEDLINE; CENTRAL; EMBASE; PsycINFO; and grey literature. Cumulatively, we have searched each database since its start date including CINAHL (to Septe...
4,169 CitationsSource
#1Tiziana MagnaniH-Index: 10
#2Riccardo ValdagniH-Index: 51
Last. Nadia ZaffaroniH-Index: 66
view all 11 authors...
Study Type – Therapy (decision analysis) Level of Evidence 2b What's known on the subject? and What does the study add? The benefits of the multidisciplinary approach in oncology are widely recognised. In particular, managing patients with prostate cancer within a multidisciplinarity and multiprofessional context is of paramount importance, to address the complexity of a disease where patients may be offered multiple therapeutic and observational options handled by different specialists and havi...
36 CitationsSource
#1Alvin Goh (BCM: Baylor College of Medicine)H-Index: 24
#2Marc A. Kowalkowski (BCM: Baylor College of Medicine)H-Index: 15
Last. David M. LatiniH-Index: 35
view all 6 authors...
UNLABELLED: Men with prostate cancer who choose active surveillance may experience anxiety and depression. Higher anxiety related to uncertainty surrounding cancer has been shown to increase the likelihood of choosing active treatment in the absence of a clinical indication. Certain characteristics, including physician influence and a neurotic personality, may also increase the risk of psychological distress. Our study identified particular areas that may affect the degree of satisfaction or unc...
37 CitationsSource
#1Hanna Vasarainen (HYKS: Helsinki University Central Hospital)H-Index: 9
#2Utku Lokman (Turkish Ministry of Health)H-Index: 1
Last. Antti Rannikko (HYKS: Helsinki University Central Hospital)H-Index: 30
view all 5 authors...
54 CitationsSource
#1Roderick C.N. van den Bergh (EUR: Erasmus University Rotterdam)H-Index: 37
#2Ida J. KorfageH-Index: 36
Last. Chris H. BangmaH-Index: 78
view all 3 authors...
Purpose of reviewActive surveillance is emerging as a serious alternative to radical therapy for low-risk prostate cancer. In a situation in which the difference in effects on disease morbidity and mortality of different treatment options for these malignancies is likely to be small, the quality of
56 CitationsSource
#1Laurence Klotz (U of T: University of Toronto)H-Index: 85
With the advent of increasingly sensitive and widely used diagnostic testing, cancer overdiagnosis in particular has emerged as a problem in multiple organ sites. This has the greatest ramifications in the case of prostate cancer because of the very high incidence of latent prostate cancer in aging men, the availability of the prostate-specific antigen (PSA) test, and the long-term effects of definitive therapy. The condition of most men with favorable-risk prostate cancer is far removed from th...
29 CitationsSource
#1Meelan Bul (EUR: Erasmus University Rotterdam)H-Index: 11
#2Roderick C.N. van den Bergh (EUR: Erasmus University Rotterdam)H-Index: 37
Last. Monique J. Roobol (EUR: Erasmus University Rotterdam)H-Index: 76
view all 7 authors...
Abstract Background Active surveillance (AS) protocols for low-risk prostate cancer (PCa) generally include repeat prostate biopsies at predefined follow-up intervals. Objective To study the outcome of routinely obtained 1-yr repeat biopsies and factors predicting reclassification to higher risk, to contribute to risk stratification for men on AS. Design, setting, and participants We analysed men with low-risk PCa (clinical stage ≤T2, prostate-specific antigen (PSA) ≤10 ng/ml, PSA density Interv...
64 CitationsSource
8 CitationsSource
#1Matthew R. Cooperberg (UCSF: University of California, San Francisco)H-Index: 74
#2Peter R. CarrollH-Index: 141
Last. Laurence KlotzH-Index: 85
view all 3 authors...
Widespread prostate-specific antigen (PSA) –based screening and aggressive treatment of prostate cancer have reduced mortality rates substantially, but both remain controversial in large part because of high rates of overdiagnosis and overtreatment of otherwise indolent tumors. Active surveillance—or close monitoring of PSA levels combined with periodic imaging and repeat biopsies—is gaining acceptance as an alternative initial management strategy for men with low-risk prostate cancer. In report...
251 CitationsSource
#1Freddie C. Hamdy (John Radcliffe Hospital)H-Index: 94
2 CitationsSource
Cited By12
#1Massimo Miglioretti (University of Milano-Bicocca)H-Index: 13
#2Claudia Meroni (University of Milano-Bicocca)H-Index: 2
Last. Veronica Velasco (University of Milano-Bicocca)H-Index: 5
view all 5 authors...
Objective: This study verifies whether the open-ended question of the B-IPQ can collect causal attributions of patients with cardiac diseases, define the more frequent causal attributions reported, classify them and describe the relation between the classification of the causes and patients’ characteristics.Design: A group of 2011 patients with cardiac diseases was recruited during the first week of cardiac rehabilitation.Primary outcome measures: Every participant filled in the B-IPQ and the HA...
3 CitationsSource
#1Guendalina Graffigna (UCSC: Catholic University of the Sacred Heart)H-Index: 29
#2I. Cecchini (GfK)H-Index: 1
Last. Matteo PacilliH-Index: 4
view all 20 authors...
Purpose The main objective of this study is to gain a deeper understanding of how patients suffering from chronic myeloid leukemia (CML) cope with their illness. The study aims to reconstruct the subjective meaning-making process related to CML in order to gain insights into the impact the disease has on patients’ emotions and everyday lives, as well as to explore the psychological impact of their being presented with the chance to suspend their therapy and recover from the disease.
7 CitationsSource
#1Emanuela Saita (UCSC: Catholic University of the Sacred Heart)H-Index: 13
#2Susanna ZaniniH-Index: 1
Last. Chiara Acquati (UH: University of Houston)H-Index: 9
view all 4 authors...
1 CitationsSource
#1Emanuela Saita (UCSC: Catholic University of the Sacred Heart)H-Index: 13
#2Chiara Acquati (UH: University of Houston)H-Index: 9
Last. Sara Molgora (UCSC: Catholic University of the Sacred Heart)H-Index: 10
view all 3 authors...
The positive outcomes associated with Patient Engagement (PE) have been strongly supported by the recent literature. However, this concept has been marginally addressed in the context of cancer. Limited attention has also received the role of informal caregivers in promoting physical and psychological well-being of patients, as well as the interdependence of dyads. The Cancer Dyads Group Intervention (CDGI) is a couple-based psychosocial intervention developed to promote engagement in management...
6 CitationsSource
#1Guendalina Graffigna (UCSC: Catholic University of the Sacred Heart)H-Index: 29
#2Serena Barello (UCSC: Catholic University of the Sacred Heart)H-Index: 26
Last. Julia Menichetti (UCSC: Catholic University of the Sacred Heart)H-Index: 9
view all 4 authors...
eHealth and mHealth interventions for type 2 diabetes are emerging as useful strategies to accomplish the goal of a high functioning integrated care system. However, mHealth and eHealth interventions in order to be successful need the clear endorsement from the healthcare professionals. This cross-sectional study included a sample of 93 Italian-speaking type 2 diabetes patients and demonstrated the role of the perceived ability of healthcare professionals to motivate patients' initiative in impr...
35 CitationsSource
#1Guendalina Graffigna (UCSC: Catholic University of the Sacred Heart)H-Index: 29
#2Serena Barello (UCSC: Catholic University of the Sacred Heart)H-Index: 26
Last. Edoardo Lozza (UCSC: Catholic University of the Sacred Heart)H-Index: 10
view all 4 authors...
Beyond the rhetorical call for increasing patients’ engagement, policy makers recognize the urgency to have an evidence-based measure of patients’ engagement and capture its effect when planning and implementing initiatives aimed at sustaining the engagement of consumers in their health. In this paper, authors describe the Patient Health Engagement Scale (PHE-scale), a measure of patient engagement that is grounded in rigorous conceptualization and appropriate psychometric methods. The scale was...
112 CitationsSource
#1Lionne D. F. Venderbos (EUR: Erasmus University Rotterdam)H-Index: 10
#2Roderick C.N. van den Bergh (EUR: Erasmus University Rotterdam)H-Index: 37
Last. Ida J. Korfage (EUR: Erasmus University Rotterdam)H-Index: 36
view all 8 authors...
textabstractObjective: Patients with potentially indolent prostate cancer (PC) can be managed with active surveillance (AS). Our objective was to analyse how anxiety and distress develop in men with untreated PC and whether highly anxious men quit AS. Methods: One hundred and fifty Dutch patients who opted for AS in the Prostate cancer Research International: Active Surveillance Study were invited to participate in an additional prospective, longitudinal quality of life (QoL) study within 6month...
53 CitationsSource
#1Guendalina Graffigna (UCSC: Catholic University of the Sacred Heart)H-Index: 29
#2Caterina Bosio (GfK)H-Index: 1
Last. Isabella Cecchini (GfK)H-Index: 2
view all 3 authors...
Objective This study was aimed to explore parents’ experience of assisting children affected by tuberous sclerosis complex (TSC) with subependymal giant-cell astrocytoma (SEGA) manifestation, in order to understand their caring needs and expectation of support. Setting and procedure The study was designed according to the qualitative method of interpretative description and implied two sequential phases of data collection. The first phase was based on in-depth interviews with 18 Italian caregive...
12 CitationsSource
#1Lara BellarditaH-Index: 10
#2Tiziana RancatiH-Index: 27
Last. Riccardo ValdagniH-Index: 51
view all 11 authors...
Abstract Background Active surveillance (AS) is emerging as an alternative approach to limit the risk of overtreatment and impairment of quality of life (QoL) in patients with low-risk localised prostate cancer. Although most patients report high levels of QoL, some men may be distressed by the idea of living with untreated cancer. Objective To identify factors associated with poor QoL during AS. Design, setting, and participants Between September 2007 and March 2012, 103 patients participated i...
78 CitationsSource
#1Guendalina Graffigna (UCSC: Catholic University of the Sacred Heart)H-Index: 29
#2Serena Barello (UCSC: Catholic University of the Sacred Heart)H-Index: 26
Last. Giuseppe Riva (UCSC: Catholic University of the Sacred Heart)H-Index: 88
view all 3 authors...
47 CitationsSource