Relationship between illness uncertainty, anxiety, fear of progression and quality of life in men with favourable‐risk prostate cancer undergoing active surveillance

Abstract

Objectives To evaluate prospectively the associations between illness uncertainty, anxiety, fear of progression, and general and disease-specific quality of life (QOL) in men with favorable risk prostate cancer undergoing active surveillance (AS). Patients and Methods After meeting stringent enrollment criteria for an AS cohort study at a single tertiary care cancer center, 180 men with favorable-risk prostate cancer completed questionnaires at enrollment and every 6 months for up to 30 months. Questionnaires assessed illness uncertainty, anxiety, prostate-specific (Expanded Prostate Cancer Index Composite; EPIC) and general QOL (Short Form 12; SF-12) and fear of progression. We used linear mixed model analyses and multilevel mediation analyses. Results EPIC sexual scores significantly declined over time (P <0.05). Illness uncertainty was a significant predictor of all EPIC summary, SF12 physical component summary (PCS), mental component summary (MCS), and fear of progression scores (all P values, <0.05), despite controlling for demographic and clinicopathologic factors. Anxiety predicted all EPIC summary, MCS, and fear of progression scores (all P values, <0.05) but not PCS scores (P = 0.08). Scores on PCS, MCS, EPIC summary scales (except sexual scale), and fear of progression did not change significantly over the study period (all P values, >0.10). Conclusion Over the 2.5-year follow-up, QOL remained stable; only sexual function scores significantly declined. Illness uncertainty and anxiety were significant predictors of general and prostate-specific QOL and fear of progression. Interventions to reduce uncertainty and anxiety may enhance QOL for men with prostate cancer on AS.

Cancer and quality of life in spousal dyads: spillover in couples with and without cancer-related health problems

“…In the current study, a 10 point increase in the mental or physical HRQoL of one spouse was associated with an increase in HRQoL ranging from 0.7 to 1.2 points in the other spouse, while reporting depressed mood was associated with a 2.4 to 4.3 point change in spousal HRQoL. Although these effects are objectively small (with effect sizes ranging from <0.10 to 0.39 [29]), they are akin to the associations with HRQoL (measured, as in this study, with the SF-12 or SF-36) reported for illness uncertainty (Betas≈0.1 [30]), having a greater number cancer-related symptoms (Betas ranging from −0.34 to −0.51 [31]), increasing physical activity after diagnosis (Beta=3.28 [32]), and the longitudinal effect of cancer treatment on HRQoL (Beta=−2.26 [33]). This supports the clinical relevance of change in HRQoL related to spillover from the spouse.…”

Feasibility, acceptability and preliminary psychological benefits of mindfulness meditation training in a sample of men diagnosed with prostate cancer on active surveillance: results from a randomized controlled pilot trial

“…While evidence is still accumulating regarding the association between anxiety/distress and placement onto active surveillance for prostate cancer and what specific factors ultimately lead to a stronger relationship, there is a good deal of research that supports this association and suggests next steps are to implement behavioral and psychosocial interventions. Based on these pilot findings, future studies should examine the efficacy of mindfulness training on both positive and negative psychological responses to active surveillance, as well as its potential association with adherence to active surveillance, especially within larger, more geographically representative samples of men.…”

Symptomatic and quality‐of‐life outcomes after treatment for clinically localised prostate cancer: a systematic review

“…A study published since we conducted the searches for our present review used EPIC and SF-12 data for USA men with low-risk prostate cancer undergoing active surveillance [77]; more such studies are required. Although there have been claims that robot-assisted or laparoscopic RP might have reduced impact on symptomatic outcomes, the overall summary of results in the present review did not show this, and this was further confirmed in a recent review of best practice in RP, which revealed that incontinence and erectile dysfunction remained significant factors [78], with urinary incontinence still an important issue 60 months after robotassisted RP, and rates of sexual dysfunction remaining comparable to open RP [57].…”