Psychosocial barriers to active surveillance for the management of early prostate cancer and a strategy for increased acceptance

Authors

  • Tom Pickles,

    1. Radiation Program, BC Cancer Agency, Vancouver, and Faculty of Medicine, University of Calgary, Tom Baker Cancer Centre, Calgary, Canada
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  • J. Dean Ruether,

    1. Radiation Program, BC Cancer Agency, Vancouver, and Faculty of Medicine, University of Calgary, Tom Baker Cancer Centre, Calgary, Canada
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  • Lorna Weir,

    1. Radiation Program, BC Cancer Agency, Vancouver, and Faculty of Medicine, University of Calgary, Tom Baker Cancer Centre, Calgary, Canada
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  • Linda Carlson,

    1. Radiation Program, BC Cancer Agency, Vancouver, and Faculty of Medicine, University of Calgary, Tom Baker Cancer Centre, Calgary, Canada
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  • Fabijana Jakulj,

    1. Radiation Program, BC Cancer Agency, Vancouver, and Faculty of Medicine, University of Calgary, Tom Baker Cancer Centre, Calgary, Canada
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  • the SCRN Communication Team

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    • Members of the Communication Team of the Sociobehavioural Cancer Research Network of the National Cancer Institute of Canada: Thomas F. Hack (Faculty of Nursing, University of Manitoba), Tom Pickles, Linda Carlson, Lorna Butler (School of Nursing, Dalhousie University), J. Dean Ruether, Lorna M. Weir, Lesley F. Degner (Faculty of Nursing, University of Manitoba).


Tom Pickles, Radiation Oncology Program, BC Cancer Agency, 600 West 10th Ave., Vancouver BC, Canada V5Z 4E6.
e-mail: tpickles@bccancer.bc.ca

Abstract

OBJECTIVES

To review the psychosocial needs of men undergoing active surveillance (AS, the monitoring of early prostate cancer, with curative intervention only if the disease significantly progresses) for prostate cancer, and barriers to its uptake.

METHODS

The introduction of screening for prostate-specific antigen (PSA) has led to more men diagnosed with early and nonlife-threatening forms of prostate cancer; about half of men diagnosed as a result of PSA testing have cancers that would never cause symptoms if left untreated and yet up to 90% of such men receive curative therapy, then living with the toxicity of treatment but with no benefit. Thus AS is increasingly being promoted, but if such a strategy is to succeed, the psychosocial barriers that discourage men from adopting AS must be addressed. We reviewed and assessed reports on this topic, published in English since 1994.

RESULTS

There is relatively little research on AS, as most published reports refer to watchful waiting (which is a palliative management approach). Men with prostate cancer generally have lower levels of psychological disturbance than for other cancers, but the psychosocial issues identified include anxiety in response to no intervention, uncertainty related to loss of control, and lack of patient education and support, particularly around the time of initial treatment planning. Approaches that were identified to improve uptake of AS include increased education and improved communication, interventions to reduce anxiety and uncertainty, and the empowerment of patients by the development of a sense of control and meaning. Physicians attitudes are influential and the education of physicians about AS as an appropriate option is to be encouraged. Peer-support groups were also identified as being of particular value.

CONCLUSIONS

There are several strategies that should be developed if AS is to become more widely adopted. Increased education and good communication can alleviate anxiety and uncertainty, as can interventions for cognitive re-framing. Inviting patients to become active participants in their management might enhance the patients’ sense of control, and the involvement of peer-support groups might be beneficial.

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