Background
A diagnosis of prostate cancer is often a stressful experience for men and their families but responses will differ depending on a range of factors.
Treatment options are offered to patients in the context of their individual feelings about the diagnosis and the threat posed by cancer.
As overtreatment is one of the issues associated with PSA testing for prostate cancer, active surveillance (AS) is emerging as an alternative approach to limit the risk of overtreatment and associated impairment of quality of life (QoL) in patients with low-risk localised prostate cancer.
Although most patients on AS come to terms with the uncertainties of this approach, some men are distressed by living with untreated cancer and in most reported series of patients, 5-10% elect to have active treatment rather than continuing on AS without a clear clinical reason.
The factors that predict a poorer QoL or higher anxiety in men on AS are not well described but are helpful to know when providing support for men who are either making decisions about, or undergoing AS for low risk prostate cancer.
Aim
To identify factors associated with poor quality of life during AS
Methods
Between September 2007 and March 2012, 103 Italian patients participated in the Prostate Cancer Research International Active Surveillance (PRIAS) QoL study.
Mental health (Symptom Checklist-90), demographic, clinical, and decisional data were assessed at the beginning of AS.
Health-related QoL (HRQoL) was assessed using the Functional Assessment of Cancer Therapy – prostate version (FACT-P), and style of coping with cancer was measured using the Mini-Mental Adjustment to Cancer (Mini-MAC). Outcomes were assessed after 10 months of AS.
Multivariable logistic regression models were used to identify predictors of low (<25th percentile) HRQoL, adjustment to cancer, and a global QoL index (combination of 2 sub-scales of the FACT-P with the Mini-MAC) 10 months after enrolment.
Results
Mean age of patients was 67 years (standard deviation: ±7 years). Having a partner was protective for (odds ratio [OR]: 0.08; p = 0.009,) and impaired mental health (OR: 1.2, p = 0.1) was associated with (p = 0.006; area under the curve [AUC]: 0.72), low HRQoL.
The maladaptive adjustment to cancer (p = 0.047; AUC: 0.60) was associated with recent diagnosis of cancer (OR: 3.3; p = 0.072). Poor global QoL (overall p = 0.02; AUC: 0.85) was predicted by impaired mental health (OR: 1.16; p = 0.070) and time from diagnosis to enrolment in AS <5 months (OR: 5.52; p = 0.009).
The influence of several different physicians on the choice of AS (OR: 0.17; p = 0.044), the presence of a partner (OR: 0.22; p = 0.065), and diagnostic biopsy with >18 core specimens (OR: 0.89; p = 0.029) were inversely associated with low QoL and thus were predictors of better QoL.
Limitations of this study were the small sample size, the lack of a control group and short follow up time.
Conclusion
Factors predicting poor QoL were lack of a partner, impaired mental health, recent diagnosis, influence of fewer clinicians and lower number of core samples taken at diagnostic biopsy.
Educational and emotional support programs based on findings from this and other studies identifying risk factors for poor QoL could help to alleviate anxiety and consequent effects on QoL of men on AS.
