Supporting Patients With Untreated Prostate Cancer on Active Surveillance: What Causes an Increase in Anxiety During the First 10 Months?

Published on Nov 19, 2020in Frontiers in Psychology
· DOI :10.3389/FPSYG.2020.576459
Maria Francesca Alvisi4
Estimated H-index: 4
,
Paola Dordoni6
Estimated H-index: 6
+ 12 AuthorsBellardita Lara
Sources
Abstract
Background The psychological burden possibly deriving from not immediately undergoing radical treatment for prostate cancer (PCa) could be a potential disadvantage of active surveillance (AS), especially in the eve of some relevant clinical exams [i.e., re-biopsy, prostate-specific antigen (PSA) test, and medical examination]. Even if it is known from the literature that the majority of PCa men in AS do not report heightened anxiety, there is a minority of patients who show clinically significant levels of anxiety after diagnosis. The present study aimed to investigate if demographic, clinical, and psychological variables at the entrance in AS (T0) were associated with the risk of developing clinically significant PCa-related anxiety 2 months before the first re-biopsy (T1) and to offer psychological support to improve quality of life (QoL). Materials and methods A total of 236 patients participated in the PCa Research International: AS (PRIAS) protocol and in PRIAS-QoL study. Demographic/clinical features, health-related QoL domains, coping with cancer, PCa-related anxiety [Memorial Anxiety Scale for PCa (MAX-PC)], personality traits, and decision-making-related factors were assessed at T0. MAX-PC was also administered at T1. PCa-related anxiety at T1 was considered to be of clinical significance if the MAX-PC score was ≥1.5. Multivariable logistic regression coupled to bootstrap was used to detect factors associated with high levels of anxiety. Results The median age was 64.4 years. Fifty-six patients (24%) reported MAX-PC total score above the cutoff. Three factors were associated with a high level of PCa anxiety at T1: anxious preoccupation [odds ratio (OR) = 4.36], extraversion (OR = 1.9), and prostate-related symptoms (median OR = 0.46). Physical well-being was associated with a low PCa anxiety subscale (median OR = 0.15); neuroticism and functional well-being were associated with PSA anxiety (median OR = 7.05 and 0.73, respectively). Neuroticism and helplessness/hopelessness were associated with fear of progression (median OR = 18.1 and 5.8, respectively). Conclusion Only a partial portion of the sample experienced significant levels of anxiety after 10 months. Psychological assessment should be routinely conducted to detect risk factors (i.e., anxious preoccupation, extraversion) for increased anxiety, offering tailored psychological interventions aimed at promoting interpersonal awareness and emotional well-being.
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#1Paola DordoniH-Index: 2
Last. Lara BellarditaH-Index: 10
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OBJECTIVE: To investigate whether prostate cancer (PCa) patients' coping strategies (i.e., fighting spirit, anxious preoccupation, fatalism, helplessness/hopelessness, and avoidance) significantly change during the first 3-year follow-up period of active surveillance (AS). MATERIALS AND METHODS: Altogether, 104 patients on AS completed the Mini-Mental Adjustment to Cancer (Mini-MAC) at baseline (T0), at 10 and 12 months after diagnostic biopsy (T1 and T2, respectively) and then at 24- (T3) and 3...
2 CitationsSource
#1Karim Marzouk (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 5
#2Melissa Assel (MSK: Memorial Sloan Kettering Cancer Center)H-Index: 19
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Purpose: Active surveillance is the preferred management of low risk prostate cancer. Cancer specific anxiety during active surveillance remains under studied. We evaluated long-term anxiety in men on active surveillance to determine whether interventions must be tailored to improve adherence.Materials and Methods: A total of 413 men enrolled in active surveillance at a single tertiary care center completed quality of life surveys as part of routine care. A modified version of the MAX-PC (Memori...
17 CitationsSource
#2Claudia RepettoH-Index: 17
Last. Lara BellarditaH-Index: 10
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Purpose:The Memorial Anxiety Scale for Prostate Cancer (MAX-PC) is a self-report questionnaire that was developed in English to assess prostate cancer (PCa)-related anxiety. The aim of this study w...
3 CitationsSource
#1Lara BellarditaH-Index: 10
#2Paola DordoniH-Index: 2
Last. Riccardo Valdagni (University of Milan)H-Index: 50
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The journey of men diagnosed with low-volume, potentially non-aggressive prostate cancer may be a multifaceted one. In fact, from the moment of diagnosis, patients deal with the opportunity and burden of choosing among multiple therapeutic/observational strategies that differ in terms of clinical and personal costs and benefits. The treatment/active surveillance decision can be an initially counterintuitive one and feelings of disorientation could emerge. Based on existing literature and our exp...
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PurposeTo evaluate the outcomes of active surveillance (AS) on patients with low-risk prostate cancer (PCa) and to identify predictors of disease reclassification.MethodsIn 2005, we defined an inst...
9 CitationsSource
#1Silvia VillaH-Index: 6
#2Friederike KendelH-Index: 15
Last. Lara BellarditaH-Index: 10
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Abstract Background Literature on the health-related quality of life (HRQoL) for men with localized prostate cancer (PCa) on active surveillance (AS) shows a need for methodological guidance regarding HRQoL issues and how to address them. Objective The European School of Oncology Task Force (ESO TF) aimed to identify a core set of research questions and related measures to include in AS HRQoL studies. Design, setting, and participants A modified Delphi study was used to reach consensus on AS HRQ...
8 CitationsSource
#1Gary T. Deimling (Case Western Reserve University)H-Index: 24
#2Casey Albitz (Case Western Reserve University)H-Index: 2
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ABSTRACTThis research examines a model of how personality (Five-Factor Model) is related to adjustment to cancer in later life in terms of the presence of continuing cancer-related worry and depression among older adult, long-term cancer survivors. Data from an NCI-funded study with 275 older adult (age 60+), long-term (5+ years) survivors of breast, prostate, and colorectal cancer were examined. Regression analyses identified neuroticism as the strongest predictor of cancer-related worry along ...
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#1Leonard P. Bokhorst (Erasmus University Medical Center)H-Index: 12
#2Riccardo ValdagniH-Index: 50
Last. Monique J. Roobol (Erasmus University Medical Center)H-Index: 76
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Abstract Background The Prostate Cancer Research International Active Surveillance (PRIAS) study was initiated a decade ago to study the most optimal selection and follow-up of men on active surveillance (AS). Objective We report on 10 yr of follow-up of men on AS in the PRIAS study and evaluate if criteria used to recommend a switch to active treatment truly predict unfavorable outcome on subsequent radical prostatectomy (RP). Design, setting, and participants Men with low-risk prostate cancer ...
181 CitationsSource
#1Hung-Jui Tan (UCLA: University of California, Los Angeles)H-Index: 20
#2Leonard S. Marks (UCLA: University of California, Los Angeles)H-Index: 58
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Purpose: Anxiety may serve as a major barrier to participation in active surveillance. Intolerance of uncertainty, that is the tendency to perceive the potential for negative events as threatening, has been linked to cancer related worry. Accordingly we explored prospectively the relationship of intolerance of uncertainty with anxiety along with other clinical factors among men treated with active surveillance for prostate cancer.Materials and Methods: A total of 119 men with D’Amico low risk pr...
40 CitationsSource
#1Patricia A. Parker (University of Texas MD Anderson Cancer Center)H-Index: 31
#2John W. Davis (University of Texas MD Anderson Cancer Center)H-Index: 55
Last. Jeri Kim (University of Texas MD Anderson Cancer Center)H-Index: 19
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Objectives To evaluate prospectively the associations between illness uncertainty, anxiety, fear of progression and general and disease-specific quality of life (QoL) in men with favourable-risk prostate cancer undergoing active surveillance (AS). Patients and Methods After meeting stringent enrollment criteria for an AS cohort study at a single tertiary care cancer centre, 180 men with favourable-risk prostate cancer completed questionnaires at the time of enrollment and every 6 months for up t...
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