PCa: Emotional distress influences treatment decision

Researchers have found that the anxiety men often experience after being diagnosed with prostate cancer could lead to potentially unnecessary treatment options.

Researchers from the University at Buffalo and Roswell Park Cancer Institute, Buffalo, NY have found that the anxiety men often experience after being diagnosed with prostate cancer could lead to potentially unnecessary treatment options.

“We have spent the past 6 years studying a cohort of men diagnosed with clinically localized prostate cancer from shortly after diagnosis to, in some cases, as long as 4 years after treatment,” co-author Willie Underwood, III, MD, MS, MPH, of Roswell Park Cancer Institute told Urology Times. “This study is part of a larger study, called the Live Well and Live Long Study, in which we set out to study treatment decision-making and quality of life in survivorship.”

There were just over 2,000 men in the larger study who were recruited at three community clinics and two comprehensive cancer centers. The men joined the study shortly after they were diagnosed and they all had clinically localized prostate cancer.

“For these analyses we included responses from 1,531 men who had responded to surveys both when they first enrolled in the study as well as after they made the decision about how to treat their cancer, and for whom we had abstracted clinical information from their medical records,” lead author Heather Orom, PhD, of the University at Buffalo told Urology Times. “We asked men to indicate their level of emotional distress using a visual analogue distress scale both when they joined the study shortly after diagnosis and at the time they completed the survey about their treatment decision.”

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From there, the authors identified how men were treated based on information from their medical records. When they examined whether emotional distress was related to their treatment choice, they statistically controlled for the aggressiveness of their disease, whether they had comorbidities that typically affect the kind of treatment men receive, where they were treated, and their demographic characteristics.

Next: What the authors found

The results, published in the Journal of Urology (2017; 197:350-5), revealed that among men with low-risk disease for whom active surveillance may be a viable treatment option, men who are more emotionally distressed shortly after diagnosis as well as just after they made the treatment decision are more likely to choose surgery over active surveillance.

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“The latter are also more likely to choose radiation over surgery. Thus, men’s emotional states when they make a treatment decision could increase the likelihood of overtreatment,” Dr. Orom said. “Our data support an argument that emotional distress should be assessed early on during the decision-making process so we can identify men who may need additional emotional support during this process. They may need some extra time with a social worker or psychologist or even just some extra time with the doctor to talk about their uncertainty about disease prognosis.”

These results represent just one component from data from the more comprehensive study, and while it has implications for prostate cancer care, it reflects a more widespread dynamic with consequences for treatment adherence in general.

“In other papers, we have identified characteristics and beliefs of men who are more distressed shortly after diagnosis; we have also reported on the fact that physician recommendations are quite influential in men’s treatment decisions but physicians’ degree of influence does depend on the quality of relationship they have with their patients,” Dr. Orom said.

Dr. Underwood added, “When patients trust their physician more, feel closer to their physician and the physician is perceived as sharing decision-making control, patients are more likely to follow their physician’s recommendations.”