title: Active surveillance for favorable-risk prostate cancer: Is there a greater psychological impact than previously thought? A systematic, mixed studies literature review.
abstract: 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.
authors.affiliation: School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Belfast, UK.
authors.forename: Eimear
authors.identifier: http://orcid.org/0000-0003-1669-218X
authors.initials: E
authors.lastname: Ruane-McAteer
authors.affiliation: Department of Social Sciences and Social Work, Bournemouth University, Bournemouth, UK.
authors.forename: Sam
authors.initials: S
authors.lastname: Porter
authors.affiliation: Centre for Cancer Research and Cell Biology (CCRCB), Queen's University Belfast, Belfast, UK.|The Northern Ireland Cancer Centre (NICC), Belfast City Hospital, Belfast, UK.
authors.forename: Joe M
authors.initials: JM
authors.lastname: O'Sullivan
authors.affiliation: School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Belfast, UK.
authors.forename: Olinda
authors.initials: O
authors.lastname: Santin
authors.affiliation: School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Belfast, UK.
authors.forename: Gillian
authors.identifier: http://orcid.org/0000-0003-2198-3731
authors.initials: G
authors.lastname: Prue
mesh_terms: D001007:Anxiety / Q000523:psychology*; D003863:Depression / Q000523:psychology*; D006801:Humans; D008297:Male; D011159:Population Surveillance / Q000379:methods*; D011471:Prostatic Neoplasms / Q000523:psychology*; D011788:Quality of Life; D035501:Uncertainty
keywords: active surveillance; anxiety; cancer; depression; oncology; prostatic neoplasms; uncertainty