title: The Relationship between Intolerance of Uncertainty and Anxiety in Men on Active Surveillance for Prostate Cancer.
abstract: Anxiety may serve as a major barrier to participation in active surveillance. Intolerance of uncertainty, that is the tendency to perceive the potential for negative events as threatening, has been linked to cancer related worry. Accordingly we explored prospectively the relationship of intolerance of uncertainty with anxiety along with other clinical factors among men treated with active surveillance for prostate cancer.
  
  
  
  A total of 119 men with D'Amico low risk prostate cancer participating in active surveillance completed the HADS (Hospital Anxiety and Depression Scale), MAX-PC (Memorial Anxiety Scale for Prostate Cancer), IUS (Intolerance of Uncertainty Scale) and I-PSS (International Prostate Symptom Score) surveys from 2011 to 2014. We evaluated the relationship between anxiety and IUS score after adjusting for patient characteristics, cancer information and I-PSS using bivariable and multivariable analyses.
  
  
  
  Of the men 18 (15.1%) and 17 (14.3%) reported clinically significant anxiety on the generalized and prostate cancer specific scales, respectively. On bivariable analysis men with moderate/severe urinary symptoms and higher IUS scores reported more generalized and prostate cancer specific anxiety than men with mild urinary symptoms and lower IUS scores, respectively (p ≤0.008). Men with depressive symptoms (p = 0.024) or a family history of prostate cancer (p = 0.006) experienced greater generalized anxiety. On multivariable analysis IUS score was significantly associated with generalized and prostate cancer specific anxiety (OR 1.22, 95% CI 1.09-1.38 and OR 1.29, 95% CI 1.13-1.49, respectively) while moderate/severe urinary symptoms were associated with prostate cancer specific anxiety (OR 6.89, 95% CI 1.33-35.68).
  
  
  
  Intolerance of uncertainty and urinary symptoms may promote anxiety in men on active surveillance for prostate cancer. Patient education, management of lower urinary tract symptoms and behavioral interventions may lessen anxiety related to uncertainty intolerance and help maintain patient engagement in active surveillance.
authors.affiliation: Veterans Affairs/UCLA Robert Wood Johnson Clinical Scholars Program, University of California-Los Angeles, Los Angeles, California; Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California. Electronic address: htan@mednet.ucla.edu.
authors.forename: Hung-Jui
authors.initials: HJ
authors.lastname: Tan
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California.
authors.forename: Leonard S
authors.initials: LS
authors.lastname: Marks
authors.affiliation: Department of Psychology, Hunter College, City University of New York, New York, New York.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Hoyt
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California.
authors.forename: Lorna
authors.initials: L
authors.lastname: Kwan
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Filson
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California.
authors.forename: Malu
authors.initials: M
authors.lastname: Macairan
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California.
authors.forename: Patricia
authors.initials: P
authors.lastname: Lieu
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California; Department of Health Policy and Management, Fielding School of Public Health, University of California-Los Angeles, Los Angeles, California.
authors.forename: Mark S
authors.initials: MS
authors.lastname: Litwin
authors.affiliation: Departments of Psychology and Psychiatry/Biobehavioral Sciences, University of California-Los Angeles, Los Angeles, California; Jonsson Comprehensive Cancer Center, University of California-Los Angeles, Los Angeles, California.
authors.forename: Annette L
authors.initials: AL
authors.lastname: Stanton
mesh_terms: D000368:Aged; D001007:Anxiety / Q000453:epidemiology* / Q000209:etiology; D015331:Cohort Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000523:psychology* / Q000628:therapy; D011594:Psychometrics / Q000379:methods; D012042:Registries; D012307:Risk Factors; D011795:Surveys and Questionnaires; D035501:Uncertainty
keywords: anxiety; prostatic neoplasms; questionnaires; uncertainty; watchful waiting