The psychological impact of being on a monitoring pathway for localised prostate cancer: a UK-wide mixed methods study

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    Early online date
    • Lauren Matheson
    • Sarah Wilding
    • Richard Wagland
    • Johana Nayoan
    • Carol Rivas
    • Amy Downing
    • Penny Wright
    • Jo Brett
    • Therese Kearney
    • William Cross
    • Adam W Glaser
    • Anna Gavin
    • Eila Watson

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    Objective: To address concerns over the psychological impact of being on a monitoring pathway following prostate cancer (PCa) diagnosis, this study compared the psychological status of men on active surveillance (AS) or watchful waiting (WW) with men on active treatment (AT), and explored psychological adjustment in men on AS/WW.

    Methods: Cross-sectional survey of UK men diagnosed with PCa 18-42 months previously (n=16,726, localised disease at diagnosis) and telephone interviews with 24 men on AS/WW. Psychological outcomes were measured using two validated scales (Short Warwick-Edinburgh Mental-Well-being Scale; Kessler Psychological Distress Scale). Univariable and multivariable analyses compared outcomes between men on AS/WW and AT. Thematic analysis of interviews was undertaken, informed by a previously developed theory of adjustment to cancer.

    Results: 3,986 (23.8%) respondents were on AS/WW. Overall, psychological outcomes were similar or better in men on AS/WW compared to those receiving AT (SWEMWBS: Poor well-being; 12.3% AS/WW vs 13.9% AT, adjusted OR=0.86, 95% CI 0.76-0.97; K6: severe psychological distress; 4.6% vs 5.4%, adjusted OR=0.90, 95% CI 0.74-1.08). Interviews indicated most men on AS/WW had adjusted positively. Men with poorer well-being were less able to accept, reframe positively and normalise the diagnosis, described receiving insufficient information and support, and a lack of confidence in their health-care professionals.

    Conclusions: Most men on AS/WW cope well psychologically. Men making treatment decisions should be given this information. Psychological health should be assessed to determine suitability for AS/WW, and at monitoring appointments. A clear action plan and support from healthcare professionals is important.


    • The psychological impact of being on a monitoring pathway for localised prostate cancer: a UK-wide mixed methods study

      Rights statement: © 2019 John Wiley & Sons, Ltd. This work is made available online in accordance with the publisher’s policies. Please refer to any applicable terms of use of the publisher.

      Accepted author manuscript, 1003 KB, PDF-document

      Embargo ends: 10/06/2020


    Original languageEnglish
    Journal publication date10 Jun 2019
    Early online date10 Jun 2019
    Publication statusEarly online date - 10 Jun 2019

    ID: 169957700