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Johnson MJ, Huang C, Chen H, Jones L, Twiddy M. Prostate cancer: unmet supportive and palliative care needs: national survey of patients and family carers. BMJ Support Palliat Care 2024; 14:317-325. [PMID: 34969695 DOI: 10.1136/bmjspcare-2021-003438] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2021] [Accepted: 12/10/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Men living with prostate cancer have supportive and palliative needs. However, few studies detail unmet needs (vs quality of life measurement) or include data from those with advanced disease. We aimed to identify unmet needs of people living with prostate cancer (men, family carers), including those with advanced disease. METHODS Mixed-methods national survey (patient Supportive Care Needs Survey; Carer Support Needs Assessment Tool) and health status (EuroQol Visual Analogue Scale). Quantitative data were explored using regression analysis. Free text data were subjected to thematic analysis. RESULTS 216 men (mean age 65±8.5 years; active cancer 136 [63%]) and 97 carers (68 (70%) spouse/partner) provided data. 133 men (62%) reported moderate-to-high need which was more likely in advanced disease. Men's health status was worse with active vs remitted disease (mean difference -11; 95% CI -17 to -5; p<0.001). 85 (88%) carers reported at least one unmet need relating to 'enabling them to care' and 83 (86%) relating to 'their own well-being'. Carers with chronic illnesses had more unmet needs (p=0.01 to p=0.04) and patient receipt of palliative care independently predicted higher unmet carer needs (p=0.02).Free text data demonstrated widespread burden with: (1) poor communication/information, including about palliative care; (2) poorly managed symptoms/concerns and (3) poor care co-ordination. Incontinence, sexual dysfunction and hormone side-effects were serious problems, often left unaddressed. CONCLUSIONS Many living with prostate cancer continue with wide-ranging concerns. Lack of systematic, ongoing needs assessment and poor communication compound inadequate clinical pathways. Person-centred care, interdisciplinary working and integrated palliative care should be resourced.
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Affiliation(s)
- Miriam J Johnson
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Chao Huang
- Institute of Clinical and Applied Health Research, Hull York Medical School, University of Hull, Hull, UK
| | - Hong Chen
- Institute of Clinical and Applied Health Research, Hull York Medical School, University of Hull, Hull, UK
| | - Lesley Jones
- Wolfson Palliative Care Research Centre, Hull York Medical School, University of Hull, Hull, UK
| | - Maureen Twiddy
- Institute of Clinical and Applied Health Research, Hull York Medical School, University of Hull, Hull, UK
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Hughes S, Everitt H, Stuart B, Band R. The experiences of men on active surveillance for prostate cancer and their significant others: A qualitative synthesis. Psychooncology 2024; 33:e6324. [PMID: 38570198 DOI: 10.1002/pon.6324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Revised: 02/26/2024] [Accepted: 03/03/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND Active surveillance (AS) for prostate cancer (PCa) is a monitoring pathway for men with low-grade, slow growing PCa and aims to delay or avoid active treatment by treating only in the case of disease progression. Experiences of this pathway vary but living with an untreated cancer can have a negative psychological impact on both the patient and their significant other (SO). Literature suggests partners are the primary source of support for men on AS, and therefore it is important to consider SO experiences alongside those of the patient. To the best of our knowledge this is the first UK-based qualitative review looking specifically at experiences of AS for both men with PCa and their SOs. METHODS MEDLINE (Ovid), EMBASE, PsychINFO, CINAHL and Cochrane Library were searched for literature reporting qualitative experiences of AS for PCa for either men on AS or SOs (or both). 2769 records were identified and screened, with 28 meeting the eligibility criteria. Qualitative data were synthesised and included men on AS (n = 428), and SOs (n = 51). RESULTS Experiences of the AS pathway vary but reports of uncertainty and anxiety were present in the accounts of both men on AS and SOs. SOs are intertwined throughout every part of the PCa journey, and couples presented as a unit that were on AS together. Both patients and SOs expressed a need for more support, and highly valued peer support. Despite this finding, men expressed a dislike towards 'support groups'. CONCLUSIONS Increased recognition in clinical practice of SO involvement in AS is needed. Further research is required to explore the specific types of support that would be most acceptable to this population to address the unmet support needs uncovered in this review.
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Affiliation(s)
- Stephanie Hughes
- Primary Care Research Centre, School of Primary Care, Population Sciences & Medical Education, University of Southampton, Southampton, Hants, UK
| | - Hazel Everitt
- Primary Care Research Centre, School of Primary Care, Population Sciences & Medical Education, University of Southampton, Southampton, Hants, UK
| | - Beth Stuart
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Rebecca Band
- Health Sciences, University of Southampton, Southampton, Hants, UK
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Russell K, Moghaddam N, Tickle A. Examining anxiety and depression in haematology cancer patients in ongoing treatment and under watchful waiting: A systematic review and meta-analysis. Eur J Cancer Care (Engl) 2022; 31:e13678. [PMID: 35977801 PMCID: PMC9787612 DOI: 10.1111/ecc.13678] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 06/21/2022] [Accepted: 08/02/2022] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The present review aimed to establish prevalence rates of anxiety and depression in adults with haematology cancer, with a focus on the differences between patients under treatment and patients under watchful waiting. METHOD Five databases (Scopus, Medline, PsycINFO, EThOS, CINAHL) were searched throughout June 2021. Key search terms included haematology cancer, anxiety, depression, in treatment and watchful waiting. Study and sample characteristics, prevalence rates and mean self-reported scores of anxiety and depression data were extracted. RESULTS A total of 18 eligible papers were included in the review. Quality appraisal indicated papers were of adequate standard. Depression data from 2720 participants (14.5% under watchful waiting) and anxiety data from 2520 participants (15.9% under watchful waiting) were analysed through subgroup meta-analyses. The prevalence of anxiety was 34% amongst adults receiving treatment and 24.5% amongst those under watchful waiting. The prevalence of depression amongst adults receiving treatment was 31.3%, significantly higher than 16.1% of adults under watchful waiting. CONCLUSION Overall, adults with haematology cancer were at greater risk of experiencing anxiety and depression than the general population, with greatest risk in those under treatment. The findings indicate the need for future research to examine availability and effectiveness of targeted psychological interventions.
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Affiliation(s)
- Katie Russell
- Division of Psychiatry and Applied Psychology, School of MedicineUniversity of NottinghamNottinghamUK
| | - Nima Moghaddam
- Division of Psychiatry and Applied Psychology, School of MedicineUniversity of LincolnLincolnUK
| | - Anna Tickle
- Division of Psychiatry and Applied Psychology, School of MedicineUniversity of NottinghamNottinghamUK
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Prashar J, Schartau P, Murray E. Supportive care needs of men with prostate cancer: A systematic review update. Eur J Cancer Care (Engl) 2022; 31:e13541. [PMID: 35038783 PMCID: PMC9285340 DOI: 10.1111/ecc.13541] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 11/05/2021] [Accepted: 12/02/2021] [Indexed: 01/16/2023]
Abstract
BACKGROUND Prostate cancer is highly prevalent and impacts profoundly on patients' quality of life, leading to a range of supportive care needs. METHODS An updated systematic review and thematic synthesis of qualitative data using the Preferred Reporting Items for Systematic Reviews (PRISMA) reporting guidelines, to explore prostate cancer patients' experience of, and need for, supportive care. Five databases (Medline, Embase, PsycInfo, Emcare and ASSIA) were searched; extracted data were synthesised using Corbin and Strauss's 'Three Lines of Work' framework. RESULTS Searches identified 2091 citations, of which 105 were included. Overarching themes emerged under the headings of illness, everyday life and biographical work. Illness work needs include consistency and continuity of information, tailored to ethnicity, age and sexual orientation. Biographical work focused on a desire to preserve identity in the context of damaging sexual side effects. Everyday life needs centred around exercise and diet support and supportive relationships with partners and peers. Work-related issues were highlighted specifically by younger patients, whereas gay and bisexual men emphasised a lack of specialised support. CONCLUSION While demonstrating some overarching needs common to most patients with prostate cancer, this review offers novel insight into the unique experiences and needs of men of different demographic backgrounds, which will enable clinicians to deliver individually tailored supportive care.
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Affiliation(s)
- Jai Prashar
- Research Department of Primary Care and Population Health, Royal Free Hospital, University College London, London, UK
| | - Patricia Schartau
- Research Department of Primary Care and Population Health, Royal Free Hospital, University College London, London, UK
| | - Elizabeth Murray
- Research Department of Primary Care and Population Health, Royal Free Hospital, University College London, London, UK
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Wade J, Donovan J, Lane A, Davis M, Walsh E, Neal D, Turner E, Martin R, Metcalfe C, Peters T, Hamdy F, Kockelbergh R, Catto J, Paul A, Holding P, Rosario D, Kynaston H, Rowe E, Hughes O, Bollina P, Gillatt D, Doherty A, Gnanapragasam VJ, Paez E. Strategies adopted by men to deal with uncertainty and anxiety when following an active surveillance/monitoring protocol for localised prostate cancer and implications for care: a longitudinal qualitative study embedded within the ProtecT trial. BMJ Open 2020; 10:e036024. [PMID: 32907896 PMCID: PMC7482454 DOI: 10.1136/bmjopen-2019-036024] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 04/20/2020] [Accepted: 07/14/2020] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVES Active surveillance (AS) enables men with low risk, localised prostate cancer (PCa) to avoid radical treatment unless progression occurs; lack of reliable AS protocols to determine progression leaves uncertainties for men and clinicians. This study investigated men's strategies for coping with the uncertainties of active monitoring (AM, a surveillance strategy within the Prostate testing for cancer and Treatment, ProtecT trial) over the longer term and implications for optimising supportive care. DESIGN Longitudinal serial in-depth qualitative interviews every 2-3 years for a median 7 (range 6-14) years following diagnosis. SETTING Four centres within the UK Protect trial. PARTICIPANTS Purposive sample of 20 men with localised PCa: median age at diagnosis 64 years (range 52-68); 15 (75%) had low-risk PCa; 12 randomly allocated to, 8 choosing AM. Eleven men continued with AM throughout the study period (median 7 years). Nine received radical treatment after a median 4 years (range 0.8-13.8 years). INTERVENTION AM: 3-monthly serum prostate-specific antigen (PSA)-level assessment (year 1), 6-12 monthly thereafter; increase in PSA ≥50% during previous 12 months or patient/clinician concern triggered review. MAIN OUTCOMES Thematic analysis of 73 interviews identified strategies to accommodate uncertainty and anxiety of living with untreated cancer; implications for patient care. RESULTS Men sought clarity, control or reassurance, with contextual factors mediating individual responses. Trust in the clinical team was critical for men in balancing anxiety and facilitating successful management change/continued monitoring. Only men from ProtecT were included; men outside ProtecT may have different experiences. CONCLUSION Men looked to clinicians for clarity, control and reassurance. Where provided, men felt comfortable continuing AM or having radical treatments when indicated. Clinicians build patient trust by clearly describing uncertainties, allowing patients control wherever possible and being aware of how context influences individual responses. Insights indicate need for supportive services to build trust and patient engagement over the long term. TRIAL REGISTRATION NUMBER ISRCTN20141297; Pre-results.
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Affiliation(s)
- Julia Wade
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jenny Donovan
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Athene Lane
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael Davis
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Eleanor Walsh
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - David Neal
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Emma Turner
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Richard Martin
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Chris Metcalfe
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Tim Peters
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Freddie Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Roger Kockelbergh
- Department of Urology, University Hospitals of Leicester NHS Trust, Leicester, UK
| | - James Catto
- Department of Oncology and Metabolism, University of Sheffield Medical School, Sheffield, UK
| | - Alan Paul
- Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Peter Holding
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Derek Rosario
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | | | - Edward Rowe
- Department of Urology, North Bristol NHS Trust, Bristol, UK
| | - Owen Hughes
- Department of Urology, Cardiff and Vale University Health Board, Cardiff, UK
| | | | - David Gillatt
- Faculty of Medicine, Health and Human Science, Macquarie University, Sydney, New South Wales, Australia
| | - Alan Doherty
- Department of Urology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | - Vincent J Gnanapragasam
- Department of Surgery, University of Cambridge, Cambridge, UK
- Department of Urology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Edgar Paez
- Department of Urology, Newcastle Upon Tyne Hospitals NHS Trust, Newcastle Upon Tyne, UK
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Why men with a low-risk prostate cancer select and stay on active surveillance: A qualitative study. PLoS One 2019; 14:e0225134. [PMID: 31747396 PMCID: PMC6867634 DOI: 10.1371/journal.pone.0225134] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Accepted: 10/29/2019] [Indexed: 12/05/2022] Open
Abstract
Objective Active surveillance (AS) is an increasingly utilized strategy for monitoring men with low-risk prostate cancer (PCa) that allows them to defer active treatment (AT) in the absence of cancer progression. Studies have explored reasons for selecting AS and for then switching to AT, but less is known about men’s experiences being on AS. We interviewed men to determine the clinical and psychological factors associated with selecting and adhering to AS protocols. Methods We conducted semi-structured interviews with men with a low-risk PCa at two academic medical centers. Subjects had either been on AS for ≥ 1 year or had opted for AT after a period of AS. We used an iterative, content-driven approach to analyze the interviews and to identify themes. Results We enrolled 21 subjects, mean age 70.4 years, 3 racial/ethnic minorities, and 16 still on AS. Men recognized the favorable prognosis of their cancer (some had sought second opinions when initially offered AT), valued avoiding treatment complications, were reassured that close monitoring would identify progression early enough to be successfully treated, and trusted their urologists. Although men reported feeling anxious around the time of surveillance testing, those who switched to AT did so based only on evidence of cancer progression. Conclusions Our selected sample was comfortable being on AS because they understood and valued the rationale for this approach. However, this highlights the importance of ensuring that men newly diagnosed with a low-risk PCa are provided sufficient information about prognosis and treatment options to make informed decisions.
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McIntosh M, Opozda MJ, Evans H, Finlay A, Galvão DA, Chambers SK, Short CE. A systematic review of the unmet supportive care needs of men on active surveillance for prostate cancer. Psychooncology 2019; 28:2307-2322. [PMID: 31663180 DOI: 10.1002/pon.5262] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 09/19/2019] [Accepted: 10/14/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Understanding the unmet supportive care needs of men on active surveillance for prostate cancer may enable researchers and health professionals to better support men and prevent discontinuation when there is no evidence of disease progression. This review aimed to identify the specific unmet supportive care needs of men on active surveillance. METHODS A systematic review following PRISMA guidelines was conducted. Databases (Pubmed, Embase, PsycINFO, and CINAHL) were searched to identify qualitative and/or quantitative studies that reported unmet needs specific to men on active surveillance. Quality appraisals were conducted before results were narratively synthesised. RESULTS Of the 3613 unique records identified, only eight articles were eligible (five qualitative and three cross-sectional studies). Unmet Informational, Emotional/Psychological, Social, and "Other" needs were identified. Only three studies had a primary aim of investigating unmet supportive care needs. Small active surveillance samples, use of nonvalidated measures, and minimal reporting of author reflexivity in qualitative studies were the main quality issues identified. CONCLUSIONS The unmet needs of men on active surveillance is an underresearched area. Preliminary evidence suggests the information available and provided to men during active surveillance is perceived as inadequate and inconsistent. Men may also be experiencing unmet psychological/emotional, social, and other needs; however, further representative, high-quality research is required to understand the magnitude of this issue. Reporting results specific to treatment type and utilising relevant theories/models (such as the social ecological model [SEM]) is recommended to ensure factors that may facilitate unmet needs are appropriately considered and reported.
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Affiliation(s)
- Megan McIntosh
- Freemasons Foundation Centre for Men's Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Melissa J Opozda
- Freemasons Foundation Centre for Men's Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Holly Evans
- Freemasons Foundation Centre for Men's Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Amy Finlay
- Freemasons Foundation Centre for Men's Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
| | - Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Suzanne K Chambers
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
- University of Technology Sydney, Sydney, New South Wales, Australia
- University of Southern Queensland, Toowoomba, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
| | - Camille E Short
- Freemasons Foundation Centre for Men's Health, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA, Australia
- Melbourne School of Psychological Sciences and Melbourne School of Health Sciences (jointly appointed), The University of Melbourne, Melbourne, VIC, Australia
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