Cross-cultural differences in men on active surveillance’ anxiety: a longitudinal comparison between Italian and Dutch patients from the Prostate cancer Research International Active Surveillance study

Background: Men diagnosed with localized prostate cancer (PCa) on active surveillance (AS) have shown to cope with anxiety caused by living with an ‘untreated cancer’ and different factors can influence the tolerance level for anxiety in these patients. The present study analyzes Italian (Milan) and Dutch (Rotterdam) men prospectively included in the Prostate cancer International Active Surveillance (PRIAS) trial, aiming to explore whether socio-demographic factors (i.e. age, relationship status, education, nationality) may be relevant factors in conditioning the level of anxiety at AS entry and over time. Methods: Italian and Dutch men participating in the IRB-approved PRIAS study, after signing an informed consent, filled in the Memorial Anxiety Scale for PCa (MAX-PC) at multiple time points after diagnosis. A linear mixed model was used to assess the relationship between the level of patient’s anxiety and time spent on AS, country of origin, the interaction between country and time on AS, patients’ relationship status and education, on PCa anxiety during AS. Results: 823 MAX-PC questionnaires were available for Italian and 307 for Dutch men, respectively. Median age at diagnosis was 64 years (IQR 60–70 years) and did not differ between countries. On average, Dutch men had a higher total MAX-PC score than Italian men. However, the level of their anxiety decreased over time. Dutch men on average had a higher score on the PCa anxiety sub-domain, which did not decrease over time. Minimal differences were observed in the sub-domains PSA anxiety and fear of recurrence. Conclusion: Significant differences in PCa anxiety between the Italian and Dutch cohorts were observed, the latter group of men showing higher overall levels of anxiety. These differences were not related to the socio-demographic factors we studied. Although both PRIAS-centers are dedicated AS-centers, differences in PCa-care organization (e.g. having a multidisciplinary team) may have contributed to the observed different level of anxiety at the start and during AS. Trial registration This study is registered in the Dutch Trial Registry (www.trialregister.nl) under NL1622 (registration date 11-03-2009), ‘PRIAS: Prostate cancer Research International: Active Surveillance—guideline and study for the expectant management of localized prostate cancer with curative intent’

Prostate cancer patients on active surveillance: is physical activity associated with health-related quality of life?

The benefits of physical activity (PA), even of low intensity, on disease progression, urinary symptoms, psychological wellbeing, and health-related quality of life (HRQoL) of prostate cancer (PCa) patients have been documented by several studies (Richman 2011; Chipperfield 2014; Thorsen 2008). To our knowledge, there are no studies investigating the effects of PA on HRQoL among PCa patients in Active Surveillance (AS). The present research aimed to study the relationship between the level of PA performed by patients in AS and their HRQoL

ASSOCIATION BETWEEN PHYSICAL ACTIVITY AND QUALITY OF LIFE IN PROSTATE CANCER PATIENTS FOLLOWING ACTIVE SURVEILLANCE

Introduction Active surveillance (AS) can be an attractive and feasible management option for patients with low-grade, low-volume prostate cancer (PCa) (Dall’Era et al., 2008). It is still unclear if living with an untreated cancer can lower the quality of life (QoL) of these patients (Daubenmier et al., 2006). Few studies investigated those aspects and explored the factors that are able to hinder or improve the QoL in these patients (Bellardita et al., 2014). In particular, there is a paucity of studies investigating the potential of health-promoting behaviors, such as engaging in greater physical exercise, in improving QoL and wellbeing of men with PCa in AS (Daubenmier et al., 2006). The purpose of the present study was to investigate the association between physical activity and QoL in patients with PCa in AS. Methods Pca patients enrolled in the Prostate cancer Research International: AS (PRIAS) protocol and accepting to participate in an ancillary study on QoL were invited to participate. At 10 month after the diagnosis, patients were asked to complete self-reported validated questionnaires assessing physical activity (through the International Physical Activity Questionnaire - IPAQ) and generic and disease-specific health-related QoL (through the Short Form 36 - SF-36 – and the Functional Assessment of Cancer Therapy scale Prostate Version - FACT-P). Descriptive analyses were conducted and stepwise multiple regression analyses were performed to examine the impact of exercise type and activity on QoL scores. Statistical significance was established at p < .05. Results 81 patients with a mean age of 64 years (SD=7; 42-79 years) accepted to participate. Analyses showed that patients engaging in more physical activity experience greater physical wellbeing (FACT-P) (p=0.018; R2=0.085; F=5.294; ß=0.291) and higher mental health scores (SF-36) (p=0.025; R2=0.071; F=5.268; ß=0.266). In particular, patients doing greater vigorous activity reported greater FACT-P functional wellbeing (p=0.025; R2=0.08; F=5.253; ß =0.273). Conclusion The present study indicated that almost the 10% of variance of physical, mental, and functional QoL of Pca men in AS can be explained by changes in physical exercise. Our results, although preliminary and limited by small sample and effect size, highlight the importance to recommend lifestyle change in AS clinical practice and to focus upon strategies to support maintenance of exercise activity to sustain QoL of Pca patients in AS

Quality of Life Longitudinal Evaluation in Prostate Cancer Patients from Radiotherapy Start to 5 Years after IMRT-IGRT

Purpose: The purpose of this study is to study the evolution of quality of life (QoL) in the first 5 years following Intensity-modulated radiation therapy (IMRT) for prostate cancer (PCa) and to determine possible associations with clinical/treatment data. Material and methods: Patients were enrolled in a prospective multicentre observational trial in 2010-2014 and treated with conventional (74–80 Gy, 1.8–2 Gy/fr) or moderately hypofractionated IMRT (65–75.2 Gy, 2.2–2.7 Gy/fr). QoL was evaluated by means of EORTC QLQ-C30 at baseline, at radiation therapy (RT) end, and every 6 months up to 5 years after IMRT end. Fourteen QoL dimensions were investigated separately. The longitudinal evaluation of QoL was analysed by means of Analysis of variances (ANOVA) for multiple measures. Results: A total of 391 patients with complete sets of questionnaires across 5 years were available. The longitudinal analysis showed a trend toward the significant worsening of QoL at RT end for global health, physical and role functioning, fatigue, appetite loss, diarrhoea, and pain. QoL worsening was recovered within 6 months from RT end, with the only exception being physical functioning. Based on ANOVA, the most impaired time point was RT end. QoL dimension analysis at this time indicated that acute Grade ≥ 2 gastrointestinal (GI) toxicity significantly impacted global health, physical and role functioning, fatigue, appetite loss, diarrhoea, and pain. Acute Grade ≥ 2 genitourinary (GU) toxicity resulted in lower role functioning and higher pain. Prophylactic lymph-nodal irradiation (WPRT) resulted in significantly lower QoL for global health, fatigue, appetite loss, and diarrhoea; lower pain with the use of neoadjuvant/concomitant hormonal therapy; and lower fatigue with the use of an anti-androgen. Conclusions: In this prospective, longitudinal, observational study, high radiation IMRT doses delivered for PCa led to a temporary worsening of QoL, which tended to be completely resolved at six months. Such transient worsening was mostly associated with acute GI/GU toxicity, WPRT, and higher prescription doses