Predictors of health-related quality of life and adjustment to prostate cancer during active surveillance.
BACKGROUND
Active surveillance (AS) is emerging as an alternative approach to limit the risk of overtreatment and impairment of quality of life (QoL) in patients with low-risk localised prostate cancer. Although most patients report high levels of QoL, some men may be distressed by the idea of living with untreated cancer.


OBJECTIVE
To identify factors associated with poor QoL during AS.


METHODS
Between September 2007 and March 2012, 103 patients participated in the Prostate Cancer Research International Active Surveillance (PRIAS) QoL study. Mental health (Symptom Checklist-90), demographic, clinical, and decisional data were assessed at entrance in AS. Health-related QoL (HRQoL) Functional Assessment of Cancer Therapy-Prostate version and Mini-Mental Adjustment to Cancer outcomes were assessed after 10 mo of AS.


METHODS
Multivariate logistic regression models were used to identify predictors of low (<25th percentile) HRQoL, adjustment to cancer, and a global QoL index at 10 mo after enrollment.


CONCLUSIONS
The mean age of the study patients was 67 yr (standard deviation: ±7 yr). Lack of partner (odds ratio [OR]: 0.08; p=0.009) and impaired mental health (OR: 1.2, p=0.1) were associated with low HRQoL (p=0.006; area under the curve [AUC]: 0.72). The maladaptive adjustment to cancer (p=0.047; AUC: 0.60) could be predicted by recent diagnosis (OR: 3.3; p=0.072). Poor global QoL (overall p=0.02; AUC: 0.85) was predicted by impaired mental health (OR: 1.16; p=0.070) and time from diagnosis to enrollment in AS <5 mo (OR: 5.52; p=0.009). Influence of different physicians on the choice of AS (OR: 0.17; p=0.044), presence of a partner (OR: 0.22; p=0.065), and diagnostic biopsy with >18 core specimens (OR: 0.89; p=0.029) were predictors of better QoL. Limitations of this study were the small sample size and the lack of a control group.


CONCLUSIONS
Factors predicting poor QoL were lack of a partner, impaired mental health, recent diagnosis, influence of clinicians and lower number of core samples taken at diagnostic biopsy. Educational support from physicians and emotional/social support should be promoted in some cases to prevent poor QoL.
Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Lara.bellardita@istitutotumori.mi.it
Lara
L
Bellardita
Tiziana
T
Rancati
Maria Francesca
MF
Alvisi
Daniela
D
Villani
Tiziana
T
Magnani
Cristina
C
Marenghi
Nicola
N
Nicolai
Giuseppe
G
Procopio
Sergio
S
Villa
Roberto
R
Salvioni
Riccardo
R
Valdagni
D000223:Adaptation, Psychological; D000368:Aged; D001706:Biopsy; D017281:Cost of Illness; D006801:Humans; D016015:Logistic Models; D008297:Male; D017533:Marital Status; D008603:Mental Health; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011471:Prostatic Neoplasms / Q000473:pathology / Q000523:psychology / Q000628:therapy*; D011788:Quality of Life; D012307:Risk Factors; D012944:Social Support; D013315:Stress, Psychological / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology; D011795:Surveys and Questionnaires; D013997:Time Factors; D057832:Watchful Waiting