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. 2019 Aug;28(8):1743-1752. doi: 10.1002/pon.5161. Epub 2019 Jul 8.
This study aimed to explore the psychological impact of favorable-risk prostate cancer (PCa) and associated treatment (active surveillance [AS] or active treatment [AT]), comparing prevalence and temporal variability of generalized anxiety, PCa-specific anxiety, and depression symptoms.
PCa patients were recruited at diagnosis prior to treatment decision-making and completed questionnaires assessing anxiety (State-Trait Anxiety Inventory short form [STAI-6] and Memorial Anxiety Scale for Prostate Cancer [MAX-PC]) and depression symptoms (Centre for Epidemiologic Studies Depression Scale [CES-D]) at four timepoints for 9 months. Non-cancer controls were recruited via university staff lists and community groups. Results were analyzed using analysis of variance.
Fifty-four PCa (AS n = 11, AT n = 43) and 53 non-cancer participants were recruited. The main effect of time or treatment group were not statistically significant for CES-D scores (P > .05). The main effect of treatment on STAI-6 scores was significant (F = 4.678, .012) with AS patients reporting highest STAI-6 scores (T1 M = 36.56; T2 M = 36.89, T3 M = 38.46; T4 M = 38.89). There was a significant main effect for time since diagnosis on MAX-PC (F = 3.68, .01); AS patient scored higher than AT at all timepoints (T1 M = 10.33 vs 10.78; T2 M = 11.11 vs 11.30; T3 M = 13.44 vs 10.55; T4 M = 11.33 vs 8.88); however, both groups declined overall with time.
Men undergoing AS had significantly higher anxiety symptoms than AT and non-cancer participants, contradicting previous literature. This may be due to perceived inactivity of AS relative to traditional narratives of cancer treatment. Participant experiences appear to be less favorable relative to other international centers. Recommendations for future research and clinical practice include the need to improve diagnosis and treatment information provision particularly for lower risk patients.
本研究旨在探讨有利风险前列腺癌（PCa）及其相关治疗（主动监测[AS]或主动治疗[AT]）对患者心理的影响，比较广泛性焦虑、PCa 特异性焦虑和抑郁症状的流行率和时变。
在治疗决策前，招募 PCa 患者并完成焦虑症评估问卷（状态特质焦虑量表短表[STAI-6]和前列腺癌焦虑量表[MAX-PC]）和抑郁症评估问卷（流行病学研究中心抑郁量表[CES-D]），共 4 次，时间跨度为 9 个月。非癌症对照组通过大学员工名单和社区团体招募。使用方差分析进行分析。
共招募了 54 名 PCa（AS 组 n = 11，AT 组 n = 43）和 53 名非癌症对照组。CES-D 评分的时间或治疗组的主要效应不具有统计学意义（P >.05）。STAI-6 评分的治疗主效应显著（F = 4.678，.012），AS 患者报告的 STAI-6 评分最高（T1 M = 36.56；T2 M = 36.89，T3 M = 38.46；T4 M = 38.89）。自诊断以来，MAX-PC 的时间主效应显著（F = 3.68，.01）；AS 患者在所有时间点的评分均高于 AT 患者（T1 M = 10.33 比 10.78；T2 M = 11.11 比 11.30；T3 M = 13.44 比 10.55；T4 M = 11.33 比 8.88）；然而，两组的分数随时间整体呈下降趋势。
与接受传统癌症治疗的患者相比，接受 AS 的男性焦虑症状显著高于 AT 和非癌症对照组，这与先前的文献相矛盾。这可能是由于与传统癌症治疗观念相比，AS 被认为缺乏治疗行动。与其他国际中心相比，患者的体验似乎不太理想。对未来研究和临床实践的建议包括需要改善诊断和治疗信息的提供，特别是对于低风险患者。
