The Relationship between Intolerance of Uncertainty and Anxiety in Men on Active Surveillance for Prostate Cancer

Abstract

Purpose Anxiety may serve as a major barrier to participation in AS. Intolerance of uncertainty—the tendency to perceive the potential for negative events as threatening—has been linked to cancer-related worry. Accordingly, we explored prospectively the relationship of intolerance of uncertainty with anxiety along with other clinical factors among men managed with AS for prostate cancer. Materials and Methods From 2011–2014, 119 men with D’Amico low-risk prostate cancer participating in active surveillance completed the HADS, MAX-PC, IUS, and IPSS surveys. We evaluated the relationship between anxiety and IUS score after adjusting for patient characteristics, cancer information, and IPSS score using bivariable and multivariable analyses. Results A number of men reported clinically significant anxiety on the generalized (n=18, 15.1%) and prostate-cancer-specific (n=17, 14.3%) scales. In bivariable analyses, men with moderate/severe urinary symptoms and higher IUS scores reported more generalized and prostate-cancer-specific anxiety than men with mild urinary symptoms and lower IUS scores, respectively (p≤0.008). Men with depressive symptoms (p=0.024) or family history of prostate cancer (p=0.006) experienced greater generalized anxiety. In multivariable analysis, IUS score was significantly associated with generalized (OR 1.22, 95% CI 1.09–1.38) and prostate-cancerspecific anxiety (OR 1.29, 95% CI 1.13–1.49) while moderate/severe urinary symptoms were associated with prostate-cancer-specific anxiety (OR 6.89, 95% CI 1.33–35.68). Conclusions Intolerance of uncertainty and urinary symptoms may promote anxiety among men on AS for prostate cancer. Patient education, management of lower urinary tract symptoms, and behavioral interventions may lessen anxiety related to uncertainty intolerance and help maintain patient engagement in AS.

Towards the validation of a new, blended theoretical model of fear of cancer recurrence

“…Survivors who held more positive beliefs about the benefits of worrying and were intolerant of uncertainty resorted to greater use of maladaptive coping strategies. However, contrary to previous studies, we did not find that these predicted FCR . One possible explanation is that (1) other meta‐cognitions such as negative beliefs about worrying have more impact on FCR than positive beliefs and (2) that these variables have an indirect effect on FCR (ie, are mediated by the use of maladaptive coping strategies) that needs to be tested in a larger sample.…”

“…Intolerance of uncertainty is defined as a predisposition to react negatively to an uncertain event or situation, independent of its probability of occurrence and its associated consequences . In the context of cancer—an illness fraught with uncertainty—we can expect that patients with lower tolerance for uncertainty will experience greater FCR . Furthermore, these theories suggest that one of the functions of worry is to avoid feared outcomes by interfering with emotional processing .…”

Intolerance of uncertainty, social support, and loneliness in relation to anxiety and depressive symptoms among women diagnosed with ovarian cancer

“…IU has also been linked to depressive symptoms, health anxiety, and anxiety sensitivity among women with breast cancer. Additionally, it has also been linked to cancer‐related distress and both generalized and disease‐specific anxiety among men with prostate cancer. Therefore, IU appears to be associated with various forms of distress among individuals with cancer.…”

Exercise training as a novel primary treatment for localised prostate cancer: a multi-site randomised controlled phase II study

“…The evidence in favour of radical treatments such prostatectomy and radiation therapy is disputed, with large randomised studies such as PIVOT and ProtecT demonstrating minimal overall survival advantage 1 , 2 . Nevertheless, living with an untreated cancer can be a source of anxiety for men 3 and active monitoring is associated with a higher rate of disease progression and development of metastatic cancer 1 , 2 . Active surveillance has long been suggested as a primary management strategy for localised prostate cancer, particularly in men thought to be at low risk of progression, however reliably identifying such men is associated with a degree of uncertainly that men and their partners often find difficult to accept 4 , particularly as they perceive no active role in such treatment 5 .…”