Advertisement

The Influence of Psychosocial Constructs on the Adherence to Active Surveillance for Localized Prostate Cancer in a Prospective, Population-based Cohort

Published:February 10, 2017DOI:https://doi.org/10.1016/j.urology.2016.12.063

      Objective

      To evaluate the influence of psychosocial factors such as prostate cancer (PCa) anxiety, social support, participation in medical decision-making (PDM), and educational level on patient decisions to discontinue PCa active surveillance (AS) in the absence of disease progression.

      Methods

      The Comparative Effectiveness Analysis of Surgery and Radiation study is a prospective, population-based cohort study of men with localized PCa diagnosed in 2011-2012. PCa anxiety, social support, PDM, educational level, and patient reasons for discontinuing AS were assessed through patient surveys. A Cox proportional hazards model examined the relationship between psychosocial variables and time to discontinuation of AS.

      Results

      Of 531 patients on AS, 165 (30.9%) underwent treatment after median follow-up of 37 months. Whereas 69% of patients cited only medical reasons for discontinuing AS, 31% cited at least 1 personal reason, and 8% cited personal reasons only. Patients with some college education discontinued AS significantly earlier (hazard ratio: 2.0, 95% confidence interval: 1.2, 3.2) than patients with less education. PCa anxiety, social support, and PDM were not associated with seeking treatment.

      Conclusion

      We found that 31% of men who choose AS for PCa discontinue AS within 3 years. Eight percent of men who sought treatment did so in the absence of disease progression. Education, but not psychosocial factors, seems to influence definitive treatment-seeking. Future research is needed to understand how factors unrelated to disease severity influence treatment decisions among patients on AS to identify opportunities to improve adherence to AS.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Albertsen P.C.
        • Hanley J.A.
        • Fine J.
        20-year outcomes following conservative management of clinically localized prostate cancer.
        JAMA. 2005; 293: 2095-2101
        • Ritch C.R.
        • Graves A.J.
        • Keegan K.A.
        • et al.
        Increasing use of observation among men at low risk for prostate cancer mortality.
        J Urol. 2015; 193: 801-806
        • Eggener S.E.
        • Mueller A.
        • Berglund R.K.
        • et al.
        A multi-institutional evaluation of active surveillance for low risk prostate cancer.
        J Urol. 2013; 189 (discussion S25): S19-S25
        • Newcomb L.F.
        • Thompson I.M.
        • Boyer H.D.
        • et al.
        Outcomes of active surveillance for clinically localized prostate cancer in the prospective, multi-institutional Canary PASS cohort.
        J Urol. 2015; 195: 313-320
        • Dall'Era M.A.
        • Konety B.R.
        • Cowan J.E.
        • et al.
        Active surveillance for the management of prostate cancer in a contemporary cohort.
        Cancer. 2008; 112: 2664-2670
        • van den Bergh R.C.N.
        • Essink-Bot M.-L.
        • Roobol M.J.
        • et al.
        Anxiety and distress during active surveillance for early prostate cancer.
        Cancer. 2009; 115: 3868-3878
        • Latini D.M.
        • Hart S.L.
        • Knight S.J.
        • et al.
        The relationship between anxiety and time to treatment for patients with prostate cancer on surveillance.
        J Urol. 2007; 178 (discussion 831-2): 826-831
        • Loeb S.
        • Folkvaljon Y.
        • Makarov V, D.
        • et al.
        Five-year nationwide follow-up study of active surveillance for prostate cancer.
        Eur Urol. 2015; 67: 233-238
        • Dall'Era M.A.
        • Albertsen P.C.
        • Bangma C.
        • et al.
        Active surveillance for prostate cancer: a systematic review of the literature.
        Eur Urol. 2012; 62: 976-983
        • Dall'Era M.A.
        • Cooperberg M.R.
        • Chan J.M.
        • et al.
        Active surveillance for early-stage prostate cancer: review of the current literature.
        Cancer. 2008; 112: 1650-1659
        • Resnick M.J.
        • Koyama T.
        • Fan K.-H.
        • et al.
        Long-term functional outcomes after treatment for localized prostate cancer.
        N Engl J Med. 2013; 368: 436-445
        • Barocas D.A.
        • Chen V.
        • Cooperberg M.
        • et al.
        Using a population-based observational cohort study to address difficult comparative effectiveness research questions: the CEASAR study.
        J Comp Eff Res. 2013; 2: 445-460
        • Lubeck D.P.
        • Litwin M.S.
        • Henning J.M.
        • et al.
        The CaPSURE database: a methodology for clinical practice and research in prostate cancer.
        Urology. 1996; 48: 773-777
        • Sherbourne C.D.
        • Stewart A.L.
        The MOS social support survey.
        Soc Sci Med. 1991; 32: 705-714
        • Clark J.A.
        • Bokhour B.G.
        • Inui T.S.
        • et al.
        Measuring patients' perceptions of the outcomes of treatment for early prostate cancer.
        Med Care. 2003; 41: 923-936
        • Kaplan S.H.
        • Gandek B.
        • Greenfield S.
        • et al.
        Patient and visit characteristics related to physicians' participatory decision-making style. Results from the Medical Outcomes Study.
        Med Care. 1995; 33: 1176-1187
        • Stier D.M.
        • Greenfield S.
        • Lubeck D.P.
        • et al.
        Quantifying comorbidity in a disease-specific cohort: adaptation of the total illness burden index to prostate cancer.
        Urology. 1999; 54: 424-429
        • Chang P.
        • Szymanski K.M.
        • Dunn R.L.
        • et al.
        Expanded prostate cancer index composite for clinical practice: development and validation of a practical health related quality of life instrument for use in the routine clinical care of patients with prostate cancer.
        J Urol. 2011; 186: 865-872
        • R Core Team
        R: A Language and Environment for Statistical Computing.
        3-900051-07-0 R, Foundation for Statistical Computing, Vienna, Austria2016 (U and; No Title)
        • Venderbos L.D.F.
        • van den Bergh R.C.N.
        • Roobol M.J.
        • et al.
        A longitudinal study on the impact of active surveillance for prostate cancer on anxiety and distress levels.
        Psychooncology. 2015; 24: 348-354
        • Bul M.
        • Zhu X.
        • Valdagni R.
        • et al.
        Active surveillance for low-risk prostate cancer worldwide: the PRIAS study.
        Eur Urol. 2013; 63: 597-603
        • Patel M.I.
        • DeConcini D.T.
        • Lopez-Corona E.
        • et al.
        An analysis of men with clinically localized prostate cancer who deferred definitive therapy.
        J Urol. 2004; 171: 1520-1524
        • Klotz L.
        • Zhang L.
        • Lam A.
        • et al.
        Clinical results of long-term follow-up of a large, active surveillance cohort with localized prostate cancer.
        J Clin Oncol. 2010; 28: 126-131
        • Berger Z.D.
        • Yeh J.C.
        • Carter H.B.
        • et al.
        Characteristics and experiences of patients with localized prostate cancer who left an active surveillance program.
        Patient. 2014; 7: 427-436
        • Barocas D.A.
        • Mallin K.
        • Graves A.J.
        • et al.
        Effect of the USPSTF grade D recommendation against screening for prostate cancer on incident prostate cancer diagnoses in the United States.
        J Urol. 2015; 194: 1587-1593
        • Cooperberg M.R.
        • Carroll P.R.
        • Klotz L.
        Active surveillance for prostate cancer: progress and promise.
        J Clin Oncol. 2011; 29: 3669-3676
        • Womble P.R.
        • Montie J.E.
        • Ye Z.
        • et al.
        Contemporary use of initial active surveillance among men in Michigan with low-risk prostate cancer.
        Eur Urol. 2015; 67: 44-50
        • Ross A.E.
        • Loeb S.
        • Landis P.
        • et al.
        Prostate-specific antigen kinetics during follow-up are an unreliable trigger for intervention in a prostate cancer surveillance program.
        J Clin Oncol. 2010; 28: 2810-2816
        • Vasarainen H.
        • Lokman U.
        • Ruutu M.
        • et al.
        Prostate cancer active surveillance and health-related quality of life: results of the Finnish arm of the prospective trial.
        BJU Int. 2012; 109: 1614-1619
        • Kronenwetter C.
        • Weidner G.
        • Pettengill E.
        • et al.
        A qualitative analysis of interviews of men with early stage prostate cancer: the Prostate Cancer Lifestyle Trial.
        Cancer Nurs. 2005; 28: 99-107