Ruane-McAteer Eimear, Porter Sam, O'Sullivan Joe M, Santin Olinda, Prue Gillian
School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Belfast, UK.
Department of Social Sciences and Social Work, Bournemouth University, Bournemouth, UK.
Psychooncology. 2017 Oct;26(10):1411-1421. doi: 10.1002/pon.4311. Epub 2016 Dec 7.
Active surveillance (AS) allows men with favorable-risk prostate cancer to avoid or postpone active treatment and hence spares potential adverse effects for a significant proportion of these patients. Active surveillance may create an additional emotional burden for these patients. The aim of the review was to determine the psychological impact of AS to inform future study in this area and to provide recommendations for clinical practice.
Studies were identified through database searching from inception to September 2015. Quantitative or qualitative noninterventional studies published in English that assessed the psychological impact of AS were included. The Mixed Methods Appraisal Tool was used to assess methodological quality.
Twenty-three papers were included (20 quantitative and 3 qualitative). Quantitatively, the majority of patients do not report psychological difficulties; however, when appropriateness of study design is considered, the conclusion that AS has minimal impact on well-being may not be accurate. This is due to small sample sizes, inappropriately timed baseline, and inappropriate/lack of comparison groups. In addition, a mismatch in outcome was noted between the outcome of quantitative and qualitative studies in uncertainty, with qualitative studies indicating a greater psychological impact.
Because of methodological concerns, many quantitative studies may not provide a true account of the burden of AS. Further mixed-methods studies are necessary to address the limitations highlighted and to provide clarity on the impact of AS. Practitioners should be aware that despite findings of previous reviews, patients may require additional emotional support.
主动监测（AS）使低危前列腺癌男性能够避免或推迟积极治疗，从而使这些患者中的很大一部分免受潜在的不良反应。主动监测可能会给这些患者带来额外的情感负担。本综述的目的是确定主动监测的心理影响，为该领域的未来研究提供信息，并为临床实践提供建议。
通过数据库检索确定从开始到2015年9月的研究。纳入以英文发表的评估主动监测心理影响的定量或定性非干预性研究。使用混合方法评估工具评估方法学质量。
纳入23篇论文（20篇定量研究和3篇定性研究）。从数量上看，大多数患者未报告心理问题；然而，考虑到研究设计的适当性，主动监测对幸福感影响最小这一结论可能并不准确。这是由于样本量小、基线时间不合适以及对照组不合适/缺乏对照组。此外，在不确定性方面，定量和定性研究的结果存在不匹配，定性研究表明心理影响更大。
由于方法学方面的问题，许多定量研究可能无法真实反映主动监测的负担。有必要进行进一步的混合方法研究，以解决所强调的局限性，并明确主动监测的影响。从业者应意识到，尽管先前的综述有相关发现，但患者可能仍需要额外的情感支持。
