Active surveillance for favorable-risk prostate cancer: Is there a greater psychological impact than previously thought? A systematic, mixed studies literature review.

OBJECTIVE: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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

Investigating the Psychological Impact of Active Surveillance or Active Treatment in Newly Diagnosed Favorable-Risk Prostate Cancer Patients: A 9 month Longitudinal Study

Objective This study aimed to explorethe 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. Methods PCa patients were recruited at diagnosis prior to treatment decision-making and completed questionnaires assessing anxiety (STAI-6; MAX-PC) and depression symptoms (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. Results Fifty-four PCa (AS n=11, AT n=43) and fifty-three non-cancer participants were recruited. The main effect of time or treatment group were not statistically significant for CES-D scores (p>0.05). The main effect of treatment on STAI-6 scores was significant (F(2,73)=4.678, p=0.012) 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(3,123)=3.68, p=0.01), AS patient scored higher than AT at all timepoints (T1 M=10.33 v 10.78; T2 M=11.11 v 11.30; T3 M=13.44 v 10.55; T4 M=11.33 v 8.88), however both groups declined overall with time. Conclusions 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

Mixed-methods study in England and Northern Ireland to understand young men who have sex with men’s knowledge and attitudes towards human papillomavirus vaccination

Objectives: Men-who-have-sex-with-men (MSM) are at greater risk for HPV-associated cancers. Since 2016, MSM have been offered the HPV vaccination, which is most effective when received prior to sexual debut, at Genitourinary Medicine clinics in the United Kingdom. In September 2019, the national HPV vaccination programme will be extended to boys. This study aimed to understand young MSM’s (YMSM) knowledge and attitudes towards human papillomavirus (HPV) vaccination. Design: Questionnaires assessed YMSM demographics, sexual behaviour, culture, knowledge and attitudes towards HPV vaccination, and stage of vaccine decision-making using the Precaution Adoption Process Model. Focus groups explored sexual health information sources, attitudes, barriers and facilitators to vaccination, and strategies to support vaccination uptake. Questionnaire data were analysed using descriptive statistics and focus group data were analysed thematically. Setting: Questionnaires were also completed online. Focus groups were conducted within Lesbian Gay Bisexual Trans Queer (LGBTQ) organisational settings and a university student’s union in England and Northern Ireland. Participants: Seventeen YMSM (M=20.5 years) participated in four focus groups and 51 (M=21.1 years) completed questionnaires. Results: Over half of YMSM were aware of HPV (54.9%), yet few (21.6%) had previously discussed vaccination with a Healthcare Professional (HCP). Thematic analyses found YMSM were willing to receive the HPV vaccine. Vaccination programmes requiring YMSM to request the vaccine, particularly prior to sexual orientation disclosure to family and friends, were viewed as unfeasible. Educational campaigns explaining vaccine benefits were indicated as a way to encourage uptake. Conclusions: This study suggests that to effectively implement HPV vaccination for YMSM, this population requires clearer information and greater discussion with their HCP. In support of the decision made by the JCVI, universal vaccination is the most feasible and equitable option. However, the absence of a catch-up programme will leave a significant number of YMSM at risk of HPV infection