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Godtman RA, Pettersson C, Svensson L, Kohestani K, Stinesen Bratt K, Wallström J, Månsson M, Hellström M, Hugosson J. Men's Acceptance of Screening for Prostate Cancer with Prostate-specific Antigen, Magnetic Resonance Imaging, and Prostate Biopsy. Eur Urol Oncol 2024; 7:553-562. [PMID: 37993370 DOI: 10.1016/j.euo.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/07/2023] [Accepted: 11/02/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND A prerequisite before introducing a screening program is that the screening examinations are acceptable to participants. OBJECTIVE To evaluate the acceptance and bother of prostate cancer screening examinations. DESIGN, SETTING, AND PARTICIPANTS The randomized population-based GÖTEBORG-2 prostate cancer screening trial invited >37 000 men for prostate-specific antigen (PSA) testing followed by magnetic resonance imaging (MRI) in case of elevated PSA and prostate biopsy (targeted and/or systematic) if indicated. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Participants were asked to fill out a questionnaire and rate the level of bother associated with each examination (PSA, MRI, and prostate biopsy) on a categorical scale ranging from 1 to 5 (1 = "not at all bothersome" and 5 = "very bothersome"), and to rate their willingness to repeat the examinations, by marking an X on a continuous scale ranging from 0 to 10 (0 = "yes, without any hesitation" and 10 = "no, absolutely not"). Wilcoxon signed rank test was used. RESULTS AND LIMITATIONS Compliance with MRI was 96% (1790/1872), compliance with biopsy was 89% (810/907), and the response rate to the questionnaire was 75% (608/810). Men who underwent all examinations (n = 577) responded that biopsy was more bothersome than PSA test (p < 0.001) and MRI (p < 0.001). High levels of bother (≥4 out of 5) were reported by 2% (12/577) for PSA test, 8% (46/577) for MRI, and 43% (247/577) for biopsy. Men were more willing to repeat MRI than biopsy (p < 0.001), but the difference was small (median 0.2 [interquartile range 0.1-0.6] vs 0.5 [0.1-2.0]). CONCLUSIONS Biopsies are more bothersome than MRI, but a large majority of men accept to repeat both examinations if necessary. Omitting biopsy for MRI-negative men and shifting to targeted biopsies only will reduce bother for men participating in prostate cancer screening. PATIENT SUMMARY We asked men how bothersome they found the prostate-specific antigen (PSA) test, magnetic resonance imaging (MRI), and prostate biopsies. Biopsies were more bothersome than PSA and MRI, but most men were willing to repeat all procedures if necessary.
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Affiliation(s)
- Rebecka Arnsrud Godtman
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Urology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
| | - Christina Pettersson
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Radiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Linda Svensson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Urology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Kimia Kohestani
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Urology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Karin Stinesen Bratt
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jonas Wallström
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Radiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Marianne Månsson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Mikael Hellström
- Department of Radiology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Radiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Jonas Hugosson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Urology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
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Søndergaard MEJ, Lode K, Husebø SE, Dalen I, Kjosavik SR. Men's perception of information and psychological distress in the diagnostic phase of prostate cancer: a comparative mixed methods study. BMC Nurs 2022; 21:266. [PMID: 36180907 PMCID: PMC9526317 DOI: 10.1186/s12912-022-01047-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 09/19/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Previous studies indicate that men experience frustration and uncertainty when confronted with an elevated prostate specific antigen (PSA) test and during further diagnostics for prostate cancer. The novel Stockholm3 test is an algorithm-based test that combines plasma protein biomarkers, genetic markers and clinical variables in predicting the risk of PCa. The test was introduced in a western part of Norway as a new tool for detecting prostate cancer. This study aimed to explore and compare men's perception of information and possible experience of distress between a PSA group and a Stockholm3 group during the diagnostic phase of prostate cancer. METHODS This study is a part of the trailing research evaluating the impact of the change from PSA to Stockholm3. It is a multicenter study using a comparative mixed method design. Data were collected in a PSA group (n = 130) and a Stockholm3 group (n = 120) between 2017 and 2019. Quantitative data were collected using questionnaires and qualitative data were collected using semi-structured interviews (n = 20). The quantitative and qualitative data were analysed and compared separately and then merged in a side-by-side discussion. The study adheres to the GRAMMS guidelines for reporting mixed-methods research. RESULTS Compared with the PSA group, men in the Stockholm3 group reported that the information from the general practitioners was better. Similarly, men in the Stockholm3 group were more likely to indicate that they had received sufficient information regarding how examinations would be conducted. No differences were found between the groups regarding waiting time and distress. Three themes emerged from the qualitative analysis of the two groups: "Information affects the experience of comprehension", "Stepping into the world of the healthcare system", and "Periodically feelings of distress". CONCLUSION The Stockholm3 test may facilitate the provision of information to patients. However, some patients in both groups experienced distress and would benefit from more information and additional support from healthcare professionals. Routines that ensure sufficient information from the interdisciplinary healthcare team should be of priority during the diagnostic phase of prostate cancer in order to provide patients with predictability and to avoid unnecessary distress.
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Affiliation(s)
- Maja Elisabeth Juul Søndergaard
- Department of Surgery, Stavanger University Hospital, Postboks 8100, 4068, Stavanger, Norway. .,Research Group of Nursing and Healthcare Sciences, Stavanger University Hospital, Postboks 8100, 4068, Stavanger, Norway. .,Faculty of Health Sciences, University of Stavanger, Kjell Arholms Hus, postboks 8600, 4036, Stavanger, Norway.
| | - Kirsten Lode
- Research Group of Nursing and Healthcare Sciences, Stavanger University Hospital, Postboks 8100, 4068, Stavanger, Norway.,Faculty of Health Sciences, University of Stavanger, Kjell Arholms Hus, postboks 8600, 4036, Stavanger, Norway
| | - Sissel Eikeland Husebø
- Department of Surgery, Stavanger University Hospital, Postboks 8100, 4068, Stavanger, Norway.,Research Group of Nursing and Healthcare Sciences, Stavanger University Hospital, Postboks 8100, 4068, Stavanger, Norway.,Faculty of Health Sciences, University of Stavanger, Kjell Arholms Hus, postboks 8600, 4036, Stavanger, Norway
| | - Ingvild Dalen
- Department of Research, Section of Biostatistics, Stavanger University Hospital, Postboks 8100, 4068, Stavanger, Norway
| | - Svein Reidar Kjosavik
- Faculty of Health Sciences, University of Stavanger, Kjell Arholms Hus, postboks 8600, 4036, Stavanger, Norway.,The General Practice and Care Coordination Research Group, Stavanger University Hospital, Postboks 8100, 4068, Stavanger, Norway
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3
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Pitt SC, Saucke MC, Roman BR, Alexander SC, Voils CI. The Influence of Emotions on Treatment Decisions About Low-Risk Thyroid Cancer: A Qualitative Study. Thyroid 2021; 31:1800-1807. [PMID: 34641715 PMCID: PMC8721509 DOI: 10.1089/thy.2021.0323] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Background: Little is known about the role of emotions in treatment decisions for thyroid cancer. We aimed to characterize the emotional content of patient-surgeon communication during decision-making about low-risk thyroid cancer treatment. Methods: We audio-recorded conversations about treatment for clinically low-risk thyroid cancer or biopsy suspicious for thyroid cancer between patients (n = 30) and surgeons (n = 9) in two diverse, academic hospitals in the United States. Inductive and deductive content analyses were used to characterize the emotional content in verbatim transcripts. Results: Patients' expression of emotion focused on primarily on their diagnosis and treatment outcomes. Patients commonly expressed negative emotions like fear and anxiety about "the C-word" and worried about the cancer growing or spreading. In response, most surgeons used education, as opposed to empathy or validation, to reassure patients, often highlighting low probabilities of adverse events. Surgeons emphasized the "slow-growing" nature and excellent prognosis of thyroid cancer compared with other malignancies. When discussing treatment options, surgeons often described alternatives in terms of their emotional outcomes. Some described total thyroidectomy as providing "peace of mind" or a "sense of completeness," warning that cancer or thyroid tissue remaining in the body with active surveillance or lobectomy might "worry" or "bother" patients. Surgeons supported deliberation by reassuring patients that there are "two right answers" and "no rush" to decide. Conclusions: Patients express negative emotions during treatment decision-making. In response, surgeons often miss opportunities to provide empathy in addition to education. Surgeons and patients both acknowledge patient fear and anxiety as a reason to choose thyroidectomy instead of active surveillance. Peace of mind gained by patients and surgeons as a result of thyroidectomy may lead to overtreatment of patients with low-risk thyroid cancer.
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Affiliation(s)
- Susan C. Pitt
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Address correspondence to: Susan C. Pitt, MD, MPHS, Department of Surgery, University of Michigan, 1500 E. Medical Center Dr., Tubman 2920F, Ann Arbor, MI 48109, USA
| | - Megan C. Saucke
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Benjamin R. Roman
- Division of Head and Neck, Department of Surgery, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | | | - Corrine I. Voils
- Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Research Service, William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin, USA
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Sarchi L, Eissa A, Puliatti S, Amato M, Assumma S, Calcagnile T, Ticonosco M, Iseppi A, Toso S, Sighinolfi MC, Bianchi G, Micali S, Rocco B. Psychological distress among patients awaiting histopathologic results after prostate biopsy: An unaddressed concern. Urologia 2021; 89:382-387. [PMID: 34612746 DOI: 10.1177/03915603211049889] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Prostate cancer is the most commonly diagnosed neoplasm in men. From the introduction of PSA testing, an increasing number of men undergoes prostate biopsy (PBX). While the physical side effects of PBx have been well investigated, its psychological impact has been under-evaluated. AIM The aim of our study is to investigate the presence of psychological distress (anxiety and depression) in patients waiting for histopathological results after prostate biopsy (PBx). METHODS From February to April 2019, 51 consecutive patients undergoing prostate biopsies at our institution were included. Age, PSA, DRE, familiarity for prostate cancer, number of previous biopsies, type of anesthesia, number of cores were recorded. All patients filled the Hospital Anxiety and Depression Scale (HADS), a psychometric Likert-scale questionnaire, before receiving the histopathological results of their PBx. RESULTS The prevalence of psychological distress among patients awaiting histopathologic results is 41% (21/51 patients), with anxiety being the main component of their distress. On multivariate analysis, PSA, family history, and repeat biopsy were significantly associated with anxiety and depression. CONCLUSION Patients undergoing PBx experience a burden of psychological distress waiting for histopathologic results, especially anxiety. Appropriate counseling should be offered to patients at high risk of developing psychological distress after PBx. Future goals would include technological improvements to shorten the time between biopsy and definitive results.
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Affiliation(s)
- Luca Sarchi
- Urology Department, University of Modena & Reggio Emilia, Modena, Italy
| | - Ahmed Eissa
- Urology Department, University of Modena & Reggio Emilia, Modena, Italy.,Urology Department, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Stefano Puliatti
- Urology Department, University of Modena & Reggio Emilia, Modena, Italy.,ORSI Academy, Gent, Belgium.,Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Marco Amato
- Urology Department, University of Modena & Reggio Emilia, Modena, Italy.,ORSI Academy, Gent, Belgium.,Department of Urology, Onze Lieve Vrouw Hospital, Aalst, Belgium
| | - Simone Assumma
- Urology Department, University of Modena & Reggio Emilia, Modena, Italy
| | | | - Marco Ticonosco
- Urology Department, University of Modena & Reggio Emilia, Modena, Italy
| | - Andrea Iseppi
- Urology Department, University of Modena & Reggio Emilia, Modena, Italy
| | - Stefano Toso
- Urology Department, University of Modena & Reggio Emilia, Modena, Italy
| | | | - Giampaolo Bianchi
- Urology Department, University of Modena & Reggio Emilia, Modena, Italy
| | - Salvatore Micali
- Urology Department, University of Modena & Reggio Emilia, Modena, Italy
| | - Bernardo Rocco
- Urology Department, University of Modena & Reggio Emilia, Modena, Italy
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5
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Hayes L, Adams J, McCallum I, Forrest L, Hidajat M, White M, Sharp L. Age-related and socioeconomic inequalities in timeliness of referral and start of treatment in colorectal cancer: a population-based analysis. J Epidemiol Community Health 2021; 75:1-9. [PMID: 33055178 DOI: 10.1136/jech-2020-214232] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 06/11/2020] [Accepted: 06/20/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Poorer colorectal cancer survival in the UK than in similar countries may be partly due to delays in the care pathway. To address this, cancer waiting time targets were established. We investigated if socio-demographic inequalities exist in meeting cancer waiting times for colorectal cancer. METHODS We identified primary colorectal cancers (International Classification of Diseases, Tenth Revision C18-C20; n=35 142) diagnosed in the period 2001-2010 in the Northern and Yorkshire Cancer Registry area. Using multivariable logistic regression, we calculated likelihood of referral and treatment within target by age group and deprivation quintile. RESULTS 48% of the patients were referred to hospital within target (≤14 days from general practitioner (GP) referral to first hospital appointment); 52% started treatment within 31 days of diagnosis; and 44% started treatment within 62 days of GP referral. Individuals aged 60-69, 70-79 and 80+ years were significantly more likely to attend a first hospital appointment within 14 days than those aged <60 years (adjusted OR=1.23, 95% CI 1.12 to 1.34; adjusted OR=1.19, 95% CI 1.09 to 1.29; adjusted OR=1.30, 95% CI 1.18 to 1.42, respectively). Older age was significantly associated with lower likelihood of starting treatment within 31 days of diagnosis and 62 days of referral. Deprivation was not related to referral within target but was associated with lower likelihood of starting treatment within 31 days of diagnosis or 62 days of referral (most vs least: adjusted OR=0.82, 95% CI 0.74 to 0.91). CONCLUSIONS Older patients with colorectal cancer were less likely to experience referral delays but more likely to experience treatment delays. More deprived patients were more likely to experience treatment delays. Investigation of patient pathways, treatment decision-making and treatment planning would improve understanding of these inequalities.
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Affiliation(s)
- Louise Hayes
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Jean Adams
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Iain McCallum
- Northumbria Healthcare NHS Foundation Trust, North Shields, UK
| | - Lynne Forrest
- University of Edinburgh School of GeoSciences, Edinburgh, UK
| | - Mira Hidajat
- University of Bristol School of Social and Community Medicine, Bristol, UK
| | - Martin White
- MRC Epidemiology Unit, University of Cambridge, Cambridge, UK
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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Xie W, Glaser AK, Vakar-Lopez F, Wright JL, Reder NP, Liu JTC, True LD. Diagnosing 12 prostate needle cores within an hour of biopsy via open-top light-sheet microscopy. JOURNAL OF BIOMEDICAL OPTICS 2020; 25:JBO-200249LR. [PMID: 33325186 PMCID: PMC7744172 DOI: 10.1117/1.jbo.25.12.126502] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Accepted: 11/24/2020] [Indexed: 06/01/2023]
Abstract
SIGNIFICANCE Processing and diagnosing a set of 12 prostate biopsies using conventional histology methods typically take at least one day. A rapid and accurate process performed while the patient is still on-site could significantly improve the patient's quality of life. AIM We develop and assess the feasibility of a one-hour-to-diagnosis (1Hr2Dx) method for processing and providing a preliminary diagnosis of a set of 12 prostate biopsies. APPROACH We developed a fluorescence staining, optical clearing, and 3D open-top light-sheet microscopy workflow to enable 12 prostate needle core biopsies to be processed and diagnosed within an hour of receipt. We analyzed 44 biopsies by the 1Hr2Dx method, which does not consume tissue. The biopsies were then processed for routine, slide-based 2D histology. Three pathologists independently evaluated the 3D 1Hr2Dx and 2D slide-based datasets in a blinded, randomized fashion. Turnaround times were recorded, and the accuracy of our method was compared with gold-standard slide-based histology. RESULTS The average turnaround time for tissue processing, imaging, and diagnosis was 44.5 min. The sensitivity and specificity of 1Hr2Dx in diagnosing cancer were both >90 % . CONCLUSIONS The 1Hr2Dx method has the potential to improve patient care by providing an accurate preliminary diagnosis within an hour of biopsy.
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Affiliation(s)
- Weisi Xie
- University of Washington, Department of Mechanical Engineering, Seattle, Washington, United States
| | - Adam K. Glaser
- University of Washington, Department of Mechanical Engineering, Seattle, Washington, United States
| | - Funda Vakar-Lopez
- University of Washington, Department of Laboratory Medicine and Pathology, Seattle, Washington, United States
| | - Jonathan L. Wright
- University of Washington, Department of Urology, Seattle, Washington, United States
| | - Nicholas P. Reder
- University of Washington, Department of Mechanical Engineering, Seattle, Washington, United States
- University of Washington, Department of Laboratory Medicine and Pathology, Seattle, Washington, United States
| | - Jonathan T. C. Liu
- University of Washington, Department of Mechanical Engineering, Seattle, Washington, United States
- University of Washington, Department of Laboratory Medicine and Pathology, Seattle, Washington, United States
- University of Washington, Department of Bioengineering, Seattle, Washington, United States
| | - Lawrence D. True
- University of Washington, Department of Laboratory Medicine and Pathology, Seattle, Washington, United States
- University of Washington, Department of Urology, Seattle, Washington, United States
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7
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The association of cancer-specific anxiety with disease aggressiveness in men on active surveillance of prostate cancer. Prostate Cancer Prostatic Dis 2020; 24:335-340. [PMID: 32901094 DOI: 10.1038/s41391-020-00279-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Revised: 08/13/2020] [Accepted: 08/27/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND Active surveillance (AS) provides appropriate prostate cancer (PCa)-specific survival while minimizing morbidity, but underlying worry of PCa can generate anxiety. The aim of the study is to evaluate anxiety levels in men on AS and how anxiety relates to disease characteristics and treatment decision-making. METHODS A retrospective analysis was conducted using all 302 subjects from the Reduction by Dutasteride of clinical progression Events in Expectant Management (REDEEM) study. Prostate biopsies were obtained at 18 and 36 months. Anxiety was measured at baseline and 3, 6, 12, 18, and 36 months post-randomization using the MAX-PC (Memorial general anxiety scale for PCa) questionnaire. Univariable and multivariable analysis of the association of disease aggressiveness (PSA levels, percentage of positive cores, and maximum core involvement) and anxiety levels were performed. Cox regression was used to analyze time to progression to discontinuation of active surveillance as a function of baseline anxiety. RESULTS Overall, MAX-PC scores decreased from moderate at baseline with slight increases after receiving PSA results at 18 months, followed by more decline. Percentage of positive cores was associated with baseline anxiety (P = 0.02). The association remained when controlling for age, race, number of cores sampled, body mass index, prostate volume, and maximum core length (P = 0.003). In univariable and multivariable analysis, baseline anxiety was not significantly associated with time to progression to discontinuation of active surveillance. CONCLUSIONS In evaluating the natural history of anxiety levels among patients with prostate cancer undergoing active surveillance, there was a decline of anxiety levels over time, with increases after receiving PSA results. Moreover, we found that disease aggressiveness measured by percentage of positive biopsy cores was associated with baseline levels of anxiety. However, anxiety had no impact on clinical or therapeutic progression.
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Cuevas AG, Trudel-Fitzgerald C, Cofie L, Zaitsu M, Allen J, Williams DR. Placing prostate cancer disparities within a psychosocial context: challenges and opportunities for future research. Cancer Causes Control 2019; 30:443-456. [PMID: 30903484 DOI: 10.1007/s10552-019-01159-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2018] [Accepted: 03/12/2019] [Indexed: 01/13/2023]
Abstract
Black men are more likely to be diagnosed with prostate cancer compared with White men. Despite advances in prevention and treatment strategies, disparities in prostate cancer among Black men persist. While research on the causes of higher incidence and mortality is ongoing, there is limited evidence in the existing literature that clearly speaks to the potential psychological or social factors that may contribute to disparities in prostate cancer incidence. Given the lack of attention to this issue, we review scientific evidence of the ways in which social factors, including socioeconomic status and racial segregation, as well as psychological factors, like depression and anxiety, are related to subsequent prostate cancer risk, which could occur through behavioral and biological processes. Our objective is to illuminate psychosocial factors and their context, using a racial disparity lens, which suggests opportunities for future research on the determinants of prostate cancer. Ultimately, we aim to contribute to a robust research agenda for the development of new prostate cancer prevention measures to reduce racial disparities.
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Affiliation(s)
- Adolfo G Cuevas
- Department of Community Health, Tufts University, Medford, MA, 02155, USA. .,Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.
| | - Claudia Trudel-Fitzgerald
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Leslie Cofie
- Health Education and Promotion, East Carolina University, Greenville, NC, 27858, USA
| | - Masayoshi Zaitsu
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA
| | - Jennifer Allen
- Department of Community Health, Tufts University, Medford, MA, 02155, USA
| | - David R Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, 02115, USA.,Department of African and African American Studies, Harvard University, Cambridge, MA, 02138, USA
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9
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Nguyen MH, Smets EMA, Bol N, Bronner MB, Tytgat KMAJ, Loos EF, van Weert JCM. Fear and forget: how anxiety impacts information recall in newly diagnosed cancer patients visiting a fast-track clinic. Acta Oncol 2019; 58:182-188. [PMID: 30264632 DOI: 10.1080/0284186x.2018.1512156] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
INTRODUCTION One-day fast track programs for cancer diagnostics and treatment planning are increasingly being implemented in health care. Fast-track programs are highly effective at reducing waiting times, and thus well received by patients and healthcare providers. However, these programs may also burden patients, as patients generally receive a lot of information from multiple healthcare providers within a short time span. This might increase anxiety and negatively impact recall of medical information in newly diagnosed patients. This study examines whether anxiety influences information recall at the moment of diagnosis, and whether this relation differs for younger and older patients. METHODS Data were collected from 78 colorectal cancer patients visiting a one-day fast-track multidisciplinary outpatient clinic. All consultations that took place were recorded on a video. Anxiety was measured at baseline (T1) and immediately after consultations (T2) with the STAI-6. Information recall was assessed by telephone within 36-48 hours after patients' visit (T3) using open questions. RESULTS After consultations (T2), 32% of patients experienced clinical anxiety levels. Patients recalled ∼60% of medical information (T3). Information recall was negatively impacted by anxiety (β = -.28, p = .011), and negatively related to higher age (β = -.23, p = .031), and lower education level (β = .27, p = .013). Although older patients (M = 53.99) recalled 11% less information than younger patients (M = 64.84), age was not related to anxiety and did not moderate the anxiety-recall relationship. CONCLUSION High levels of anxiety after receiving a cancer diagnosis negatively influence how much information patients remember after visiting a one-day fast-track clinic. This calls for interventions that may reduce patients' anxiety as much as reasonably possible and support patients' information recall. Researchers, practitioners, and hospitals are encouraged to continue exploring ways to optimize information provision to cancer patients in current modern healthcare.
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Affiliation(s)
- Minh Hao Nguyen
- Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, Netherlands
| | - Ellen M. A. Smets
- Department of Medical Psychology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Nadine Bol
- Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, Netherlands
| | - Madelon B. Bronner
- Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, Netherlands
| | - Kristien M. A. J. Tytgat
- Department of Gastroenterology, Academic Medical Center, University of Amsterdam, Amsterdam, Netherlands
| | - Eugène F. Loos
- Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, Netherlands
| | - Julia C. M. van Weert
- Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, Netherlands
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10
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Feldman-Stewart D, Tong C, Brundage M, Bender J, Robinson J. Prostate cancer patients' experience and preferences for acquiring information early in their care. Can Urol Assoc J 2018; 12:E219-E225. [PMID: 29405903 DOI: 10.5489/cuaj.4754] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Prostate cancer patients' information needs are well-described, but little is known about their preferred sources and media for obtaining information. We sought to determine prostate cancer patients' experiences and preferences for acquiring information after diagnosis, a time of high information need. METHODS Population surveys were conducted in four Canadian provinces in 2014-2015. Each provincial cancer registry surveyed a random sample of prostate cancer patients diagnosed in late 2012. RESULTS A total of 1366 patients responded across provinces. Respondents most frequently tried to obtain information from their urologist; 86% found that easy and 9% found it difficult. Seventy-nine percent of respondents who saw only a urologist felt well-informed compared to 86% of those who saw both a urologist and a radiation oncologist. Eighty-five percent of respondents wanted printed information; 68% wanted it electronically. Respondents' most frequent barriers to obtaining information from physicians were: not actually having enough time (31%), worrying about having enough time (23%), and worrying about asking too many questions (18%). Their most frequent barriers related to internet/printed information, respectively, were uncertainty about quality (63%/49%) and unclear if personally applicable (56%/49%). Recommended facilitators were having a navigator (85%), providing printed information (85%), and someone to answer questions: in person (90%), by phone (66%), or via email (58%). CONCLUSIONS Prostate cancer patients want urologists to provide them with information and are more likely to report being informed if they see both a urologist and a radiation oncologist. Optimal information provision requires that it be provided both on the internet and in print.
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