Anxiety and distress during active surveillance for early prostate cancer

Authors

  • Roderick C. N. van den Bergh MD,

    Corresponding author
    1. Department of Urology, Erasmus University Medical Center, Rotterdam, the Netherlands
    2. Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
    • Department of Urology, Erasmus University Medical Center, Room NH-227; P.O. Box 2040, 3000 CA Rotterdam, the Netherlands===

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    • Fax: (011) 31-10-703-5315

  • Marie-Louise Essink-Bot MD, PhD,

    1. Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
    2. Institute of Social Medicine, Academic Medical Center, Amsterdam, the Netherlands
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  • Monique J. Roobol MSc PhD,

    1. Department of Urology, Erasmus University Medical Center, Rotterdam, the Netherlands
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  • Tineke Wolters MD,

    1. Department of Urology, Erasmus University Medical Center, Rotterdam, the Netherlands
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  • Fritz H. Schröder MD, PhD,

    1. Department of Urology, Erasmus University Medical Center, Rotterdam, the Netherlands
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  • Chris H. Bangma MD, PhD,

    1. Department of Urology, Erasmus University Medical Center, Rotterdam, the Netherlands
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  • Ewout W. Steyerberg MSc, PhD

    1. Department of Public Health, Erasmus University Medical Center, Rotterdam, the Netherlands
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Abstract

BACKGROUND:

Patients on active surveillance (AS) for early prostate cancer (PC) may experience feelings of anxiety and distress while living with “untreated” cancer. In this study, these feelings were quantified, and their associations with various psychologic, medical, demographic, and decision-related factors were assessed.

METHODS:

Men with recently diagnosed PC who participated in a prospective protocol-based AS program (the Prostate Cancer Research International: Active Surveillance study [PRAIS]) received a questionnaire (N = 150). Scores concerning decisional conflict (the Decisional Conflict Scale), depression (the Center for Epidemiologic Studies Depression Scale), generic anxiety (the abridged State-Trait Anxiety Inventory), and PC-specific anxiety (the Memorial Anxiety Scale for Prostate Cancer) were compared with reference values and the literature. Associations with scores on physical health (the Medical Outcomes Study 12-item short-form Physical Component Summary), personality (the Eysenck Personality Questionnaire), shared decision-making, knowledge of PC, and demographic and medical parameters were determined with univariate and multivariate linear regression analyses.

RESULTS:

The questionnaire response rate was 86% (129 of 150 men). Of all respondents, 81%, 92%, 83%, and 93% scored better than reference values for clinically significant uncertainty regarding the treatment decision, depression, generic anxiety, and PC-specific anxiety, respectively. Scores were comparable to or more favorable than those of men (reported in literature) who underwent other treatments for localized PC. In multivariate analysis, the following associations emerged: a perceived important role of the physician in shared decision-making was associated with higher decisional conflict, better physical health was associated with lower depression, neurotic personality was associated with higher depression and with generic and PC-specific anxiety, and higher prostate-specific antigen level was associated with higher PC-specific anxiety.

CONCLUSIONS:

Men on protocol-based AS mainly reported favorable levels of anxiety and distress. A neurotic personality score was associated with unfavorable effects. These findings may help to optimize patient selection for AS or to select men for supportive measures. Cancer 2009. © 2009 American Cancer Society.

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