title: The Influence of Psychosocial Constructs on the Adherence to Active Surveillance for Localized Prostate Cancer in a Prospective, Population-based Cohort.
abstract: To evaluate the influence of psychosocial factors such as prostate cancer (PCa) anxiety, social support, participation in medical decision-making (PDM), and educational level on patient decisions to discontinue PCa active surveillance (AS) in the absence of disease progression.
  
  
  
  The Comparative Effectiveness Analysis of Surgery and Radiation study is a prospective, population-based cohort study of men with localized PCa diagnosed in 2011-2012. PCa anxiety, social support, PDM, educational level, and patient reasons for discontinuing AS were assessed through patient surveys. A Cox proportional hazards model examined the relationship between psychosocial variables and time to discontinuation of AS.
  
  
  
  Of 531 patients on AS, 165 (30.9%) underwent treatment after median follow-up of 37 months. Whereas 69% of patients cited only medical reasons for discontinuing AS, 31% cited at least 1 personal reason, and 8% cited personal reasons only. Patients with some college education discontinued AS significantly earlier (hazard ratio: 2.0, 95% confidence interval: 1.2, 3.2) than patients with less education. PCa anxiety, social support, and PDM were not associated with seeking treatment.
  
  
  
  We found that 31% of men who choose AS for PCa discontinue AS within 3 years. Eight percent of men who sought treatment did so in the absence of disease progression. Education, but not psychosocial factors, seems to influence definitive treatment-seeking. Future research is needed to understand how factors unrelated to disease severity influence treatment decisions among patients on AS to identify opportunities to improve adherence to AS.
authors.affiliation: Vanderbilt University School of Medicine, Nashville, TN. Electronic address: maximilian.f.lang@vanderbilt.edu.
authors.forename: Maximilian F
authors.initials: MF
authors.lastname: Lang
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Tyson
authors.affiliation: Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: JoAnn Rudd
authors.initials: JR
authors.lastname: Alvarez
authors.affiliation: Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, TN.
authors.forename: Tatsuki
authors.initials: T
authors.lastname: Koyama
authors.affiliation: Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Karen E
authors.initials: KE
authors.lastname: Hoffman
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN; Department of Health Policy, Vanderbilt University School of Medicine, Nashville, TN; The Geriatric Research, Education, and Clinical Center, Tennessee Valley Veterans Affairs Health Care System, Nashville, TN.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Resnick
authors.affiliation: Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA; Epidemiology and Biostatistics, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, CA.
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Cooperberg
authors.affiliation: School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA.
authors.forename: Xiao-Cheng
authors.initials: XC
authors.lastname: Wu
authors.affiliation: School of Public Health, Louisiana State University Health Sciences Center, New Orleans, LA.
authors.forename: Vivien
authors.initials: V
authors.lastname: Chen
authors.affiliation: Rutgers Cancer Institute of New Jersey, Cancer Surveillance Research Program, New Brunswick, NJ.
authors.forename: Lisa E
authors.initials: LE
authors.lastname: Paddock
authors.affiliation: Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, CA.
authors.forename: Ann S
authors.initials: AS
authors.lastname: Hamilton
authors.affiliation: Department of Family and Preventive Medicine and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT.
authors.forename: Mia
authors.initials: M
authors.lastname: Hashibe
authors.affiliation: Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA.
authors.forename: Michael
authors.initials: M
authors.lastname: Goodman
authors.affiliation: Center for Health Policy Research and Department of Medicine, University of California Irvine, Irvine, CA.
authors.forename: Sheldon
authors.initials: S
authors.lastname: Greenfield
authors.affiliation: Health Policy Research Institute, University of California Irvine, Irvine, CA.
authors.forename: Sherrie H
authors.initials: SH
authors.lastname: Kaplan
authors.affiliation: Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ.
authors.forename: Antoinette
authors.initials: A
authors.lastname: Stroup
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN; The Geriatric Research, Education, and Clinical Center, Tennessee Valley Veterans Affairs Health Care System, Nashville, TN.
authors.forename: David F
authors.initials: DF
authors.lastname: Penson
authors.affiliation: Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, TN.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Barocas
mesh_terms: D000368:Aged; D001007:Anxiety / Q000503:physiopathology*; D003657:Decision Making; D004522:Educational Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D016016:Proportional Hazards Models; D011471:Prostatic Neoplasms / Q000473:pathology / Q000523:psychology; D011584:Psychology; D018570:Risk Assessment / Q000379:methods; D018571:Sentinel Surveillance; D012944:Social Support; D014481:United States; D057832:Watchful Waiting / Q000379:methods