An exploration of wellbeing in men diagnosed with prostate cancer undergoing active surveillance: a qualitative study

Abstract

Purpose There is a growing emphasis on improving quality of life of people with prostate cancer. However, those undergoing active surveillance remain underrepresented in the literature with less known about their unique challenges. Therefore, we aimed to explore their lived experiences post diagnosis and its effect on their mental, social, and physical wellbeing. Methods Qualitative semi-structured interviews were conducted with 13 men undergoing active surveillance for low-risk disease. Thematic analysis was used to inductively co-construct themes through the lens of the biopsychosocial model. Results Mental wellbeing was strongly affected in our participants due to the overwhelming emotional impact of their diagnosis resulting in an ‘Emotional Diagnostic Disequilibrium’. Informational awareness and education about prostate cancer helped patients with ‘Recognition of the Impact’. Patients experienced an ‘Unsettling Monitoring Cycle’ due to the increased fear and anxiety around PSA monitoring appointments, with some men ignoring their mental wellbeing needs as their disease is ‘A Future Problem’. ‘Concealment of Diagnosis’ left many feeling isolated and highlighted an important coping mechanisms in the ‘Importance of a Social Support Network’ theme. Finally, physical health mostly changed through alterations in health behaviour, leading to ‘A Healthier Lifestyle’ with increasing attribution of physical symptoms to age through ‘Symptomatic Overshadowing’. Conclusion The greatest disease impact on men’s wellbeing was at the time of diagnosis, with a subsequent cyclical anxiety and fear of disease progression prominent around monitoring appointments. Future research should explore ways to better support patients with these issues and at these times, improving their quality of life.

Cross-cultural differences in men on active surveillance’ anxiety: a longitudinal comparison between Italian and Dutch patients from the Prostate cancer Research International Active Surveillance study

“…The difference in PSA anxiety was however small, and seems to be in the opposite direction of the total MAX-PC and fear of recurrence scores. Eymech et al studied the biopsychosocial and holistic impact of living with untreated PCa while following an AS strategy through qualitative interviews [ 30 ]. It was recognized that men may experience cyclical anxiety around monitoring appointments.…”

“…It was recognized that men may experience cyclical anxiety around monitoring appointments. So while men after the diagnosis and recognition of the potential impact of low-risk PCa return to a normal state of mind and they do not worry about their PCa on a day-to-day or month-to-month basis, monitoring appointments may still cause a peak-anxiety moment [ 30 ].…”

Prognostic factors for mental wellbeing in prostate cancer: A systematic review and meta‐analysis

“…8 Therefore, multiple separate reviews and qualitative patient interviews were conducted, with a triangulation approach of these in combination used to better define this, selecting outcomes seen to be prevalent, severe and of importance to patients leading to five outcomes being selected as set out in this review. 7,11,18,25,26 No restrictions were set on post-diagnosis timing with any clinical setting included. Studies had to utilise either a previously validated psychometric tool to assess the outcome of interest, or diagnostic coding data following clinical diagnosis for depression and anxiety outcomes.…”

Patients’ self-reported overall wellbeing correlates with concurrent reported symptoms: analysis of the Edmonton Symptom Assessment System

“…Our results are in agreement with other studies 17,23,32,37,45,59 that have studied the psychological symptoms most predictive of patient wellbeing and have reported depression followed by anxiety. ESAS-PHY scores are stratified as low (0-5), mild (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23), moderate (24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41) and severe (42)(43)(44)(45)(46)(47)(48)(49)(50)…”

“…16,22,43 McKenzie et al 16 used the ESAS responses to characterise the relationship between dyspnoea (i.e., shortness of breath), and concurrent symptoms experienced by advanced cancer patients. Other studies 17,[44][45][46][47][48][49] have also investigated factors associated with wellbeing among cancer patients. A patient's ESAS overall wellbeing score can be interpreted as their perceived state of overall health 8 and may be related to the experience and severity of specific symptoms.…”