Fear and Anxiety on Active Surveillance for Low Risk Prostate Cancer

(UroToday.com) On this presentation, Dr. Chris Bagma, Professor of Urology at Erasmus MC, centered on nervousness and quality-of-life for males on energetic surveillance for prostate most cancers.

First, he began by reviewing energetic surveillance. Energetic surveillance (AS) is a therapy possibility for low-risk prostate most cancers per the EAU and AUA tips. It goals to keep away from the unwanted effects of pointless invasive remedy whereas sustaining the chance for remedy if there may be subsequent development. Sadly, screening for prostate most cancers contributes to an unavoidable detection of low-risk prostate most cancers (overdiagnosis), leading to a big proportion of males being on energetic surveillance. Concern of prostate most cancers and uncertainty are the first drivers for prostate most cancers screening.

As soon as identified with low-risk prostate most cancers and placed on energetic surveillance, males can carry a heavy burden. The main target of the presentation is on nervousness and high quality of life. Nervousness is a sense of unease, resembling fear or concern, that may be delicate or extreme. It could vary from regular stress to pathologic situation and in addition from incidental to steady – to the purpose it could actually have an effect on each day life.

It’s the predominant symptom of many circumstances, together with panic dysfunction, phobias, PTSD, social nervousness dysfunction

Why is measuring nervousness related?

• It has a direct influence on sufferers high quality of life (reduces QOL measures)
• It influences shared decision-making and outcomes of ailments 25% of urologic sufferers expertise nervousness, enhancing decisional battle
• It reduces therapy compliance ~50% therapy dropout in sufferers with nervousness problems
• It induces undesirable interventions (medical, different) ~26% of people with nervousness obtained further medicines

When wanting particularly at AS, within the PRIAS examine, ~10% of sufferers present process delayed intervention is because of affected person/doctor nervousness – and will lead to overtreatment.

How can we quantify QoL and nervousness?

There are quite a few validated metrics together with:

1. EQ-5D-5L (generic well being)
2. EORTC-QLQ-30 (most cancers associated QoL)
3. EPIC 26 (expanded Prostate most cancers index)
4. RAND-36 (features a area on emotional wellbeing)

He then famous that there are quite a few controversial opinions in AS:

1. Dwelling with untreated most cancers results in nervousness (on one finish of the spectrum) — however on the opposite finish, AS could also be related to decrease ranges of hysteria in comparison with healing therapy because of lack of bodily capabilities
2. Diagnostic testing can both induce OR lower stress, relying on the affected person

There are a couple of research which have addressed these questions, which he then summarizes briefly:

1. Cross-sectional snap shot research – EUPROMS (2020)
2. Longitidunal research: REDEEM (2021), HAROW (2020), Finnish PRIAS (2021), ProtecT (2016)
3. Psychological Character Research: PRIAS cohorts
4. Interventional research – there aren’t any!

EUPROMS¹

On this cross-sectional survey amongst PCa sufferers at present receiving or having obtained therapy, once they particularly assessed nervousness primarily based on remedy sort, AS was no totally different than the opposite therapy modalities:

REDEEM²

Of their retrospective evaluation of all 302 topics from the Discount by Dutasteride of medical development Occasions in Expectant Administration (REDEEM) examine, Naha et al. discovered that prime degree of hysteria was ~5% and nervousness was not correlated with therapy shift.

PRIAS³
PRIAS

Within the PRIAS examine itself, generic nervousness and concern of illness development decreased considerably over time. Solely 5% of sufferers discontinued because of AS (of 32% whole)

In comparable PRIAS analysis of subpopulations for particular person international locations, they discovered:

1. Japan PRIAS – Males on AS have higher QOL than the matched normal inhabitants
2. Finnish PRIAS – 3.5% of males discontinued AS because of nervousness throughout the first 3-6 months. No distinction in sufferers on continued AS vs. RALP.

What are some potential strategies of figuring out nervousness upfront?

• Neuroticism and introversion are related to elevated threat for melancholy and nervousness in sufferers
• Signs of hysteria and melancholy are extra frequent in people with a decrease degree of training and people dwelling alone

How do sufferers address nervousness?

• Coping mechanisms embrace preventing spirit, anxious preoccupation, fatalism, helplessness, avoidance

Lastly, what are some potential interventions to cut back nervousness?

• Even a really transient compassionate intervention could assist to cut back the persistence nervousness
• Use of determination aids to make sure a excessive customary of affected person info or referring somebody to a web-based help group has been proven to successfully cut back nervousness and melancholy
• The implementation of nurse navigators who may also help sufferers navigate the healthcare system

He concluded with the next remarks:

1. In energetic surveillance nervousness considerably influences decision-making and end result
2. 3.5-7% shift in the direction of invasive therapy perhaps because of nervousness
3. Emotional misery is perhaps routinely assessed with validated devices earlier than medical session
4. Care suppliers ought to acknowledge persistence with much less training and people who dwell alone as the principle expertise extra misery
5. Easy interventions and helps that match coping mechanisms can be found and needs to be provided early on.

Offered by: Chris H. Bangma, MD, PhD, Professor of Urology, Erasmus Medical Heart

Written by: Thenappan (Thenu) Chandrasekar, MD – Urologic Oncologist, Assistant Professor of Urology, Sidney Kimmel Most cancers Heart, Thomas Jefferson College, @tchandra_uromd on Twitter throughout the 2021 American Urological Association, (AUA) Annual Meeting, Fri, Sep 10, 2021 – Mon, Sep 13, 2021.

References:

1. Venderbos LDF, Deschamps A, Dowling J, Carl EG, Remmers S, van Poppel H, Roobol MJ. Europa Uomo Affected person Reported Consequence Examine (EUPROMS): Descriptive Statistics of a Prostate Most cancers Survey from Sufferers for Sufferers. Eur Urol Focus. 2020 Dec 3:S2405-4569(20)30297-2. doi: 10.1016/j.euf.2020.11.002. Epub forward of print. PMID: 33281109.
2. Naha U, Freedland SJ, Abern MR, Moreira DM. The association of cancer-specific anxiety with disease aggressiveness in men on active surveillance of prostate cancer. Prostate Cancer Prostatic Dis. 2021 Jun;24(2):335-340. doi: 10.1038/s41391-020-00279-z. Epub 2020 Sep 8. PMID: 32901094.
3. Venderbos LD, van den Bergh RC, Roobol MJ, Schröder FH, Essink-Bot ML, Bangma CH, Steyerberg EW, Korfage IJ. A longitudinal study on the impact of active surveillance for prostate cancer on anxiety and distress levels. Psychooncology. 2015 Mar;24(3):348-54. doi: 10.1002/pon.3657. Epub 2014 Aug 20. PMID: 25138075.