Oxford Institute of Nursing, Midwifery and Allied Health Research, Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK.
Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK.
Psychooncology. 2019 Jul;28(7):1567-1575. doi: 10.1002/pon.5133. Epub 2019 Jun 10.
To address concerns over the psychological impact of being on a monitoring pathway following prostate cancer (PCa) diagnosis, this study compared the psychological status of men on active surveillance (AS) or watchful waiting (WW) with men on active treatment (AT) and explored psychological adjustment in men on AS/WW.
Cross-sectional survey of UK men diagnosed with PCa 18 to 42 months previously (n = 16 726, localised disease at diagnosis) and telephone interviews with 24 men on AS/WW. Psychological outcomes were measured using two validated scales (Short Warwick-Edinburgh Mental Well-being Scale [SWEMWBS] and Kessler Psychological Distress Scale). Univariable and multivariable analyses compared outcomes between men on AS/WW and AT. Thematic analysis of interviews was undertaken, informed by a previously developed theory of adjustment to cancer.
A total of 3986 (23.8%) respondents were on AS/WW. Overall, psychological outcomes were similar or better in men on AS/WW compared with those receiving AT (SWEMWBS: Poor well-being; 12.3% AS/WW vs 13.9% AT, adjusted OR = 0.86, 95% CI, 0.76-0.97; K6: severe psychological distress; 4.6% vs 5.4%, adjusted OR = 0.90, 95% CI, 0.74-1.08). Interviews indicated that most men on AS/WW had adjusted positively. Men with poorer well-being were less able to accept, reframe positively and normalise their diagnosis, described receiving insufficient information and support, and reported a lack of confidence in their health care professionals.
Most men on AS/WW cope well psychologically. Men making treatment decisions should be given this information. Psychological health should be assessed to determine suitability for AS/WW, and at monitoring appointments. A clear action plan and support from health care professionals is important.
针对前列腺癌（PCa）诊断后进行监测路径可能对心理产生的影响，本研究比较了主动监测（AS）或观察等待（WW）与积极治疗（AT）的男性的心理状态，并探讨了 AS/WW 男性的心理调整情况。
对英国 18 至 42 个月前被诊断为 PCa 的男性（n = 16726，诊断时有局限性疾病）进行了横断面调查，并对 24 名 AS/WW 男性进行了电话访谈。使用两个经过验证的量表（Short Warwick-Edinburgh Mental Well-being Scale [SWEMWBS] 和 Kessler Psychological Distress Scale）测量心理结果。对 AS/WW 和 AT 男性的结果进行单变量和多变量分析。对访谈进行了主题分析，该分析受先前开发的癌症适应理论的指导。
共有 3986 名（23.8%）受访者接受 AS/WW 治疗。总体而言，与接受 AT 的男性相比，AS/WW 男性的心理结果相似或更好（SWEMWBS：幸福感差；12.3% AS/WW 与 13.9% AT，调整后的 OR = 0.86，95%CI，0.76-0.97；K6：严重心理困扰；4.6% AS/WW 与 5.4% AT，调整后的 OR = 0.90，95%CI，0.74-1.08）。访谈表明，大多数接受 AS/WW 的男性都进行了积极的调整。自我报告幸福感较差的男性无法接受、积极重塑或使他们的诊断正常化，他们表示自己获得的信息和支持不足，并对他们的医疗保健专业人员缺乏信心。
大多数接受 AS/WW 的男性心理状况良好。在做出治疗决策时，应向男性提供这些信息。应评估心理健康状况，以确定是否适合 AS/WW，并在监测预约时进行评估。清晰的行动计划和医疗保健专业人员的支持非常重要。
