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Active surveillance for favorable‐risk prostate cancer: Is there a greater psychological impact than previously thought? A systematic, mixed studies literature review
Author(s) -
RuaneMcAteer Eimear,
Porter Sam,
O'Sullivan Joe M.,
Santin Olinda,
Prue Gillian
Publication year - 2017
Publication title -
psycho‐oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.41
H-Index - 137
eISSN - 1099-1611
pISSN - 1057-9249
DOI - 10.1002/pon.4311
Subject(s) - clarity , prostate cancer , medicine , qualitative research , qualitative property , psychological intervention , clinical psychology , psychology , cancer , psychiatry , computer science , social science , biochemistry , chemistry , machine learning , sociology
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.