Effect of Treatment Status on Affective Status of Patients with Prostate Cancer: A Pilot Study
William C. Daly, BS1, Madeline C. Rutan, BS1, Paul KJ Han, MD, MA, MPH1, Christina Gentile, MPH1, Matthew Hayn, MD2, Moritz H. Hansen, MD2, Jesse D. Sammon, DO2.
1Maine Medical Center Research Institute, Center for Outcomes Research and Evaluation, Portland, ME, USA, 2Maine Medical Center Department of Urology, Portland, ME, USA.
BACKGROUND: Active surveillance (AS) has increasingly become the preferred option in the management of low-risk prostate cancer (PCa). This option potentially involves greater uncertainty and worry for patients, although little is known about the extent of this uncertainty. The goal of this exploratory study was to measure uncertainty, as well as anxiety and worry, among AS patients and in patients pursuing other treatment strategies. METHODS: We developed a patient survey consisting of 17 items designed to assess PCa patients' level of anxiety, uncertainty and of worry, which were measured using a 4-point Likert scale. We piloted the survey among all PCa patients seen at a multi-physician urology clinic between September and December 2018. For this initial study, we limited our analysis to the 6 items that focused on cancer specific worry and anxiety (Figure 1.). We combined these items into a 24-point summary score. We used descriptive statistics, ANOVA, and Mann-Whitney U tests to compare the survey responses of AS patients vs. patients receiving treatment as well as patients in other treatment groups.
RESULTS: Cronbach's alpha for the six items was 0.90. A total of 253 patients returned complete surveys: 50 AS patients, 144 RP patients, and 59 patients in the process of deciding or who opted for another active treatment (Other). When compared to patients undergoing active treatment, patients undergoing AS had did not differ significantly in regards to worry about cancer progression or recurrence. Patients at a decision point and patients who were prior to treatment had significantly higher cancer worry scores than those not at a decision point or those post-treatment (p<0.001 in both cases). Patients with no evidence of disease (NED) trended towards lower worry scores, but not to a significant degree (p=0.123).
CONCLUSIONS:
Patients undergoing AS did not have significantly more worry about cancer progression or recurrence. Patients prior to treatment or at decision points in their treatment were more worried that those that were not, which presents an opportunity for psychosocial intervention or further counseling to improve patient quality of life at these times. 
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