Optimizing psychosocial support in prostate cancer patients during active surveillance

Abstract

What are the psychosocial support needs of prostate cancer (PCa) patients undergoing active surveillance (AS)? The preferred management strategy for low-risk PCa (LR-PCa) is AS. Patients remain under close surveillance to monitor disease progression. However, living with untreated disease has psychosocial implications. The objective of this study was to investigate the psychosocial support needs in PCa patients undergoing AS. According to Marzouk (2018) 30% of patients risk developing anxiety during the first year of AS. Parker (2015) and Tan (2016) suggest approximately 10% of AS-patients request a change to active treatment, often based on anxiety. Pickles (2007) states that psychosocial support can effectively reduce anxiety and uncertainty. A literature based interview guide was used to conduct 17 semi-structured interviews following an explorative qualitative approach. LR-PCa patients, eligible for AS, were enrolled from two participating Dutch urology clinics experienced with AS. Written informed consent was obtained. Inclusion ended after attaining data saturation. The interviews were transcribed verbatim. NVIVO 10 was used for open coding. Participants expressed recurring uncertainty and anxiety caused by medical examinations, lower urinary tract symptoms and erectile dysfunction. Various effective and ineffective coping strategies were adopted by participants. The use of specific strategies was associated with patient-physician relationship, locus-of-control and disease-acceptation. Ineffective coping strategies seemed to impede resilience during stressful situations. Satisfactory decision-making and diseaseacceptation were promoted by immediate availability of relevant, reliable information regarding disease characteristics and treatment options. Early-stage reliable and relevant information, assessment and encouragement of effective coping strategies appear to be important psychosocial support needs during AS. Most participants in this study had spousal support and completed higher education. Future research should determine the generalizability of these findings in a more heterogeneous population.

Experiences of interaction between people with cancer and their healthcare professionals: A systematic review and meta-synthesis of qualitative studies

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Selecting interventions for a psychosocial support program for prostate cancer patients undergoing active surveillance: A modified Delphi study

“…Presence thereof negatively impacts physical and psychosocial wellbeing 29 . Standardized screening and adequate support upon detection need improvement 10–13 . Distress is often not expressed by PCa patients 30 .…”

“…Approximately 5%–10% of men discontinue AS and pursue active treatment despite a lack of disease progression 12 . Research indicates men undergoing AS need psychosocial support to promote psychological adaptability during AS 9,13,14 . To prevent psychosocial problems, assessment of psychosocial support needs is important amongst all men undergoing AS and not merely those already experiencing problems.…”

What interventions affect the psychosocial burden experienced by prostate cancer patients undergoing active surveillance? A scoping review

“…This scoping review aims to identify interventions with the potential to alleviate the psychosocial burden experienced by PCa patients undergoing AS. These interventions include coping strategies, information and psychoeducation, symptom management, lifestyle, complementary and alternative medicine (CAM), self-management, mindfulness, and (peer) support [18]. This research may contribute to developing a psychosocial support program for AS patients that increases psychosocial well-being and patient engagement.…”