University of Adelaide, Adelaide Medical School, Adelaide, South Australia, Australia.
South Australian Health and Medical Research Institute and The University of Adelaide, Freemasons Centre for Male Health and Wellbeing, Adelaide, South Australia, Australia.
Psychooncology. 2022 Aug;31(8):1420-1430. doi: 10.1002/pon.5947. Epub 2022 May 18.
To explore the personal and/or medical reasons patients on active surveillance (AS) have, or consider having, further definitive treatment for their prostate cancer. Research suggests up to 50% of patients on AS will discontinue within 5 years, though reasons for discontinuation from the patient's perspective is under-explored.
Prostate cancer patients who were or had been on AS for at least 6 months were recruited. A questionnaire assessed reasons for receiving/considering definitive treatment and the extent to which reasons were personal or medical. Clinical information was extracted from a state-level population registry. A subset of participants were interviewed to further explore questionnaire responses.
One-hundred and-three individuals completed the survey; 33 were also interviewed. Fifty-four survey participants (52%) had discontinued AS for definitive treatment. Common reasons for discontinuation were evidence of disease progression, doctor recommendation, desire to act, and fear of progression. Many participants who considered or had treatment reported weighing medical and personal factors equally in their decision. Interview participants described strongly considering any amount of disease progression and personal factors such as fear of progression, family concerns, and adverse vicarious experiences when deciding whether to pursue treatment.
Both medical and personal factors are considered when deciding whether to discontinue AS. Identifying predictors of discontinuation is essential for informing supportive care services to improve AS management.
探讨主动监测（AS）患者存在或考虑进一步进行确定性治疗的个人和/或医学原因。研究表明，多达 50%的 AS 患者在 5 年内会停止治疗，尽管从患者角度来看，停止治疗的原因尚未得到充分探讨。
招募了至少接受或曾接受过 6 个月 AS 治疗的前列腺癌患者。一份问卷评估了接受/考虑确定性治疗的原因，以及原因在多大程度上是个人的还是医学的。临床信息从州级人口登记处提取。一小部分参与者接受了访谈，以进一步探讨问卷的回应。
共有 103 人完成了调查；其中 33 人接受了访谈。54 名调查参与者（52%）因确定性治疗而停止了 AS。停止 AS 的常见原因是疾病进展的证据、医生的建议、渴望采取行动和对进展的恐惧。许多考虑或接受治疗的参与者报告称，在决定是否进行治疗时，他们平等地权衡了医学和个人因素。接受访谈的参与者描述了当决定是否进行治疗时，他们会认真考虑任何程度的疾病进展以及个人因素，如对进展的恐惧、家庭关注和不利的间接经验。
在决定是否停止 AS 时，会考虑医学和个人因素。确定停止治疗的预测因素对于提供支持性护理服务以改善 AS 管理至关重要。
