The psychological impact of being on a monitoring pathway for early stage prostate cancer: a UK-wide mixed methods study.


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Eila Watson1,Lauren Matheson1,Sarah Wilding2,Johanna Nayoan3,Amy Downing2,Carol Rivas3,Jo Brett1,Penny Wright2,Therese Kearney4,William Cross5,Anna Gavin4,Adam Glaser2,Richard Wagland6
1Oxford Brookes University,2University of Leeds,3University College London,4Queens University Belfast,5Leeds Teaching Hospitals NHS Trust,6University of Southampton

Abstract

Background

As increasing numbers of men diagnosed with prostate cancer (PCa) go on an Active Surveillance (AS) or Watchful Waiting (WW) pathway, it is important to understand the psychological impact of not receiving active treatment.  As part of the UK-wide Life After Prostate Cancer Diagnosis study, the psychological status of men with PCa on AS/WW was explored, and compared with that of men who underwent active treatment.

Method

Cross-sectional postal survey of UK men diagnosed with PCa 18-42 months previously (n=16,726 with localised disease at diagnosis).  Twenty-five survey respondents on AS/WW were interviewed to explore their experiences in depth.   Psychological status was measured using two validated scales (SWEMWEBS, well-being; K6, distress). Univariable and multi-variable analyses compared outcomes between men on AS/WW and those who received active treatment.  Interviews were analysed using Framework analysis.

Results

3,986 (23.8%) respondents were on AS/WW.  Overall, psychological scores were positive.  Men on AS/WW had similar or better scores than those who received active treatment (SWEMWBS:  Poor well-being; 6.9% AS/WW vs 8.1% active treatment, p=0.02; K6: severe psychological distress; 4.4% vs 5.1%, p=0.05). Multivariable analysis indicated no difference in outcomes between men on AS/WW and active treatment.  Interviews indicated most participants on AS/WW had adjusted well.  Men with poorer well-being were less able to accept and normalise the diagnosis, and described receiving insufficient information and support, and a lack of confidence in their health-care team. 

Conclusion

Most men on a monitoring pathway cope well psychologically, and this information should be helpful to men making treatment decisions.  Factors associated with how men adjust indicate ways in which health professionals can improve the support they provide.

The Life After Prosate Cancer Diagnosis study was funded by the Movember Foundation, in partnership with Prostate Cancer UK.