Illness representations, coping and anxiety among men with localized prostate cancer over an 18-months period: A parallel vs. level-contrast mediation approach.

OBJECTIVE: Men diagnosed with localized prostate cancer (lPCa) are confronted with the decision for a treatment strategy, potentially experiencing treatment side effects and psychological distress. The Common Sense Model proposes that coping with such challenges is related to illness representations: Beliefs regarding consequences, coherence, timeline, and controllability of the illness. We analyzed the interplay of illness representations, coping and anxiety over an 18-month period among men with lPCa undergoing different treatment options (Active Surveillance, curative treatment). METHODS: In this longitudinal study, 183 men (age M = 66.83) answered a questionnaire before starting treatment, and 6, 12, and 18 months later. We analyzed time trajectories with growth curve modeling and conducted mediation analyses to evaluate the influence of coping on the association of illness representations and anxiety. Using a novel methodological approach, we compared a classic parallel mediation model with a level-contrast approach for the correlated mediators problem- and emotion-focused coping. RESULTS: Independent of treatment (b = 1.31, p = 0.200) men reported an elevated level of anxiety after diagnosis which declined considerably within the following 6 months (b = -1.87, p = 0.009). The perceived seriousness of consequences was significantly associated with greater anxiety, at baseline (ß = 0.471) and over time (all ß ≥ 0.204). This association was mediated by coping: Using more emotion-than problem-focused coping was associated with higher anxiety. CONCLUSIONS: Receiving a lPCa diagnosis is associated with a phase of increased anxiety. In order to reduce anxiety, information provision should be accompanied by developing concrete action plans to enable problem-focused coping strategies.

Time pressure predicts decisional regret in men with localized prostate cancer: data from a longitudinal multicenter study.

PURPOSE: A substantial proportion of men with localized prostate cancer (lPCa) later regret their treatment decision. We aimed to identify factors contributing to decisional regret. METHODS: We conducted a longitudinal study, in which men with lPCa were surveyed at four measurement points: T0 (baseline) = prior to treatment; T1 = 6; T2 = 12; T3 = 18 months after baseline. χ2-tests and independent t-tests were used to compare men undergoing different treatments [Active Surveillance (AS) vs. local treatment]. Logistic regression models were fitted to investigate the associations between predictors (time pressure, information provided by the urologist, impairment of erectile functioning, satisfaction with sexual life) and the criterion decisional regret. RESULTS: At baseline, the sample included N = 176 men (AS: n = 100; local treatment: n = 76). At T2 and T3, men after local therapies reported higher regret than men under AS. Decisional regret at T3 was predicted by time pressure at baseline (OR 2.28; CI 1.04-4.99; p < 0.05), erectile dysfunction at T2 and T3 (OR 3.40; CI 1.56-7.42; p < 0.01), and satisfaction with sexual life at T1-T3 (OR 0.44; CI 0.20-0.96; p < 0.05). CONCLUSIONS: Time pressure, erectile dysfunction, and satisfaction with sexual life predict decisional regret in men with lPCa. Mitigating time pressure and realistic expectations concerning treatment side effects may help to prevent decisional regret in PCa survivors. TRIAL REGISTRATION NUMBER: DRKS00009510; date of registration: 2015/10/28.

[Living with Localized Prostate Cancer - Decision-Making and Coping with the Illness]. / Leben mit einem lokal begrenzten Prostatakarzinom ­ Entscheidungsfindung und Krankheitsverarbeitung.

BACKGROUND: Men diagnosed with localized prostate cancer must make a choice between treatment strategies that differ considerably in their side effects and have different long-term requirements for coping with the disease. The aim of this study was to describe how men perceive their treatment decision retrospectively and which coping strategies they use. MATERIAL & METHODS: Fifteen men (age mean=67.13±9.38 years) diagnosed with localized prostate cancer participated in three focus groups, grouped according to the treatment strategies radical prostatectomy, radiotherapy, and active surveillance. An interview guide structured the focus group discussions. In analogy to the structured interview, the material was deductively sorted in a first step; in a second step, sub-categories were developed inductively from the material. RESULTS: The content analysis revealed four particularly relevant topics: (1) The communication of the diagnosis and the associated reactions. (2) The decision-making process and the perceived time pressure. (3) The coping strategies, which showed a broad spectrum ranging from distraction and information search to lifestyle changes. (4) The perception of the disease over time. In particular men under active surveillance highlighted the importance of deceleration in their decision making and the role of lifestyle changes. DISCUSSION: The time of the diagnosis is still very much present even a long time after the diagnosis has been communicated. It is possible that a decrease in time pressure and deceleration would lead to more men deciding in favor of an observational strategy. Lifestyle changes could especially help men who choose active surveillance to overcome the feeling of "doing nothing" and gain a sense of control. CONCLUSION: In view of the variety of possible treatment strategies, an ethic of action is required that meets the need for an individual and preference-sensitive decision.

Health-related quality of life and rates of toxicity after high-dose-rate brachytherapy in combination with external beam radiation therapy for high-risk prostate cancer.

Purpose: High-dose-rate brachytherapy (HDR-BT) with external beam radiation therapy (EBRT) is a common treatment option for locally advanced prostate cancer. Quality of life is an important factor when discussing therapy options for high-risk prostate cancer. This study evaluated adverse effects and health-related quality of life (HRQOL). Materials and Methods: Ninety male patients (median age, 71 years; range, 50 to 79 years) with high-risk prostate cancer underwent HDR-BT after EBRT between December 2009 and January 2017 with a median follow-up of 43 months. A total of 57 patients (69.5%) answered the European Organisation for Research and Treatment of Cancer (EORTC) Quality of Life of Cancer Patients questionnaire (QLQ-C30; ver. 3.0), and 8 patients died during follow-up. In order to put the results of this study in context, we compared the results with reference data from the EORTC QLQ-C30 Scoring Manual. Correlations of prostate-specific antigen (PSA) values, International Prostate Symptom Score, and HRQOL measures were calculated. Results: The study participants reported better physical functioning and better global health compared with the reference data, but worse social, role, and cognitive functioning. We found negative statistically significant correlations between the last-measured PSA value and social functioning (p>0.01), cognitive functioning, pain, and constipation (all p<0.05). Toxicity rates were 10.0% for gastrointestinal and 12.2% for genitourinary adverse effects. All reported complications for toxicity were Grade I. Conclusions: The described therapy results in high biochemical control rates with minimal adverse effects. Compared with reference groups, the HRQOL of this study cohort was acceptable. PSA values during follow-up seem to be a possible indicator to influence HRQOL.

Patients' preferences for selective versus complete excavation: A mixed-methods study.

OBJECTIVES: Despite increasing evidence supporting selective caries tissue removal, the technique is not adopted by most dentists, one possible reason being that patients might reject it. We aimed to assess patients' preferences for selective versus complete excavation, and to identify predictors of this preference. METHODS: A sequential mixed-methods approach was taken. First, semi-structured focus group discussions on two convenience samples were performed. Verbatim transcripts were evaluated using content-analysis to inform quantitative study design. The subsequent survey employed convenience, snow-ball and deviant-case sampling, yielding 150 respondents. The relevance of treatment attributes (risks of nerve damage, root-canal treatment, recurrent caries, restorative complications, treatment costs, aesthetic consequences) on patients' treatment preferences was measured using case-vignettes. Dental experience and anxiety as well as patients' personality and socio-demographic details were recorded. Association of predictor variables (age, gender, education, partnership status, personality items, dental experience, anxiety) with treatment preference was assessed using regression analysis. RESULTS: Focus group participants perceived complete excavation as reliable, but feared endodontic treatment. The vast majority of survey respondents (82.7%) preferred complete over selective excavation. The preference for selective excavation was significantly increased in patients with an emotionally stable personality (p<0.001), university entrance degree (p<0.001), none or little dental anxiety (p=0.044), few dentist changes in the past (p=0.025), and who accepted that sealed lesions could progress (p<0.002). CONCLUSION: Treatment attributes, socio-demographic characteristics, personality and dental experiences shape patients' preference towards caries excavation. CLINICAL SIGNIFICANCE: Clinical decision-making regarding carious tissue removal might be affected by dentists on both an informative and an empathic level.