Oral Presentation Clinical Oncology Society of Australia 2014 Annual Scientific Meeting

Men’s and partners’ reactions to localised prostate cancer: Medical and community education on treatment options is needed (#100)

Clare O'Callaghan 1 2 3 4 , Tracey Dryden 5 6 , Amelia Hyatt 1 , Brooker Joanne 7 8 , Sue Burney 8 9 , Addie C Wootten 10 11 , Alan I White 12 , Mark Frydenberg 13 , Declan Murphy 11 14 , Scott Williams 6 15 , Penny Schofield 1 14 16
  1. Department of Cancer Experiences Research, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
  2. Palliative Care Service, Cabrini Health, Melbourne, Victoria, Australia
  3. Department of Medicine, St Vincent’s Hospital, Faculty of Medicine, Dentistry and Health Sciences, and The Conservatorium of Music, The University of Melbourne, Melbourne, Victoria, Australia
  4. Caritas Christi Hospice, St Vincent’s Hospital, Melbourne, Victoria, Australia
  5. Leukaemia Foundation, Melbourne, Victoria, Australia
  6. Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
  7. Department of Psychiatry, Southern Clinical School, Monash University, Melbourne, Victoria, Australia
  8. Cabrini Monash Psycho-oncology, Cabrini Health, Melbourne, Victoria, Australia
  9. School of Psychological Sciences, Monash University, Melbourne, Victoria, Clayton
  10. Department of Urology, Royal Melbourne Hospital, Melbourne, Victoria, Australia
  11. Epworth Prostate Centre, Epworth Healthcare, Melbourne, Victoria, Australia
  12. Prostate Cancer Foundation Australia, Sydney, Victoria, Australia
  13. Department of Surgery and Urology, Monash Unversity, Melbourne, Victoria, Australia
  14. Division of Cancer Surgery, The University of Melbourne, Melbourne, Victoria, Australia
  15. Sir Peter MacCallum Department of Oncology, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia
  16. School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, Australia

Abstract

Aims. The shift in localized prostate cancer (LPC) management to include active surveillance (AS), alongside radical treatment options (radical prostatectomy, external beam radiotherapy, brachytherapy),1 has added complexity to treatment decision-making.2 This study examined men with LPC and partners’ experiences of choosing between AS and radical treatments when AS was recommended. It also examined men’s and partners’ experiences of AS when selected. Method. Qualitative descriptive research design.3 Sampling was purposive. Interviewed participants were men, and partners of men who had either chosen radical treatment immediately following diagnosis, or had been on AS for ≥ 3 months. Clinical eligibility criteria for AS recommendation were: T1-2a tumours, Gleason score ≤6, and PSA <10 ng/mL. Additionally, one urologist included men with one of: T2b-T2c tumour, PSA 10–20 ng/mL, or Gleason score 7. Audio-recorded and transcribed interviews were thematically analysed using grounded theory techniques, i.e., inductive, cyclic, and constant comparative analysis.4 Results. Twenty-one men and 14 partners participated. Prostate cancer information used to inform treatment decisions was regularly described as contradictory, confusing, and stressful. Some preferred doctors to select treatments. Radical treatment could be selected when cancer progression was feared. AS was commonly misunderstood but all described monitoring procedures. Men and partners usually coped with AS but were sometimes encumbered by memories of treatment decision-making, painful biopsies, and ongoing conflicting information. Partners often implied they were also on AS. Men who immediately chose radical treatment were difficult to recruit, preventing data saturation. Conclusion. To reduce distress, frequently experienced by men diagnosed with LPC and their partners during treatment decision-making and AS monitoring, there is a need for improved community and medical education about AS eligibility, and availability of consistent, unbiased information about LPC prognoses, treatment options, and side effects. Discussion about inconsistent information and how recommendation to cease AS is made could be useful.5 

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  3. Sandelowski M. Whatever happened to qualitative description? Res Nurs Health 2000;23(4):334–340.
  4. Corbin J, Strauss A. Basics of qualitative research 3e: Techniques and procedures for developing grounded theory. Thousand Oaks, California: Sage, 2008.
  5. O’Callaghan C, Dryden T, Hyatt A, Brooker J, Burney S, Wootten A, White A, Frydenberg M, Murphy D, Williams S, Schofield P. (2014; Epub ahead of print). “What is this active surveillance thing?” Men's and partners’ reactions to treatment decision-making for prostate cancer when active surveillance is the recommended treatment option. Psycho-Oncology. DOI: 10.1002/pon.3576.