It is well understood that some (perhaps even many) men diagnosed with low-risk disease have difficulty accepting active monitoring of any type as an effective and safe management strategy for deferring immediate, unnecessary treatment — and perhaps being able to avoid treatment at all. What is less well understood is exactly what the key factors are that may make it more difficult for men to accept active surveillance as an appropriate management strategy in their individual cases.
Bellardita et al. have used data from the Prostate Cancer Research International Active Surveillance (PRIAS) quality of life study to try and identify factors associated with low quality of life during active surveillance that may then lead to distress at the idea of living with “untreated” prostate cancer.
Their paper is based on data from 103 men participating in the PRIAS study and enrolled between September 2007 and March 2012. These patients’ mental health, along with demographic, clinical, and decisional data, were assessed at entrance onto the active surveillance protocol. Their health-related QoL (HRQoL) mental adjustment to cancer outcomes were re-assessed after 10 months on active surveillance.
Here are the key study findings:
- The average (mean) age of the study participants was 67 ± 7 years.
- Lack of a partner (odds ratio [OR] = 0.08; p = 0.009) and impaired mental health (OR = 1.2, p = 0.1) were associated with low HRQoL (p = 0.006).
- Poor mental adjustment to living with cancer (p = 0.047) could be predicted by recent diagnosis (OR = 3.3; p = 0.072).
- Poor overall (global) QoL (p = 0.02) was predicted by impaired mental health (OR = 1.16; p = 0.070) and time from diagnosis to enrollment in the active surveillance protocol of < 5 months (OR = 5.52; p = 0.009).
- Influence of different physicians on the choice of active surveillance (OR = 0.17; p = 0.044), presence of a partner (OR = 0.22; p = 0.065), and diagnostic biopsy with > 18 core specimens (OR = 0.89; p = 0.029) were all predictors of better QoL.
- Limitations of this study were the small sample size and the lack of a control group.
The authors conclude — perhaps not surprisingly – that factors predicting poor QoL were lack of a partner, impaired mental health, recent diagnosis, influence of clinicians and lower number of core samples taken at diagnostic biopsy. The note that, “Educational support from physicians and emotional/social support should be promoted in some cases to prevent poor QoL.”
Without wish to insult anyone, it really does seem extraordinarily obvious to The “New” Prostate Cancer InfoLink that men diagnosed with low-risk prostate cancer and advised that active surveillance is a highly appropriate management strategy are highly likely to need counseling and support during the early stages of this process (as may their spouses and other family members too). One of the current problems with uptake of active surveillance as a management strategy (at least here in the USA) is that physicians may be paid thousands of dollars in the short-term to carry out a radical prostatectomy or give radiation treatment. By comparison, they will receive almost no compensation at all for spending sufficient time with a new patient (and that patient’s spouse/partner if necessary) to reassure him that active monitoring is a completely valid strategy in his case.