PURPOSE - Anxiety may serve as a major barrier to participation in AS. Intolerance of uncertainty-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 managed with AS for prostate cancer.
MATERIALS AND METHODS - From 2011-2014, 119 men with D'Amico low-risk prostate cancer participating in active surveillance completed the HADS, MAX-PC, IUS, and IPSS surveys. We evaluated the relationship between anxiety and IUS score after adjusting for patient characteristics, cancer information, and IPSS score using bivariable and multivariable analyses.
RESULTS - A number of men reported clinically significant anxiety on the generalized (n=18, 15. 1%) and prostate-cancer-specific (n=17, 14. 3%) scales. In bivariable analyses, 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 family history of prostate cancer (p=0. 006) experienced greater generalized anxiety. In multivariable analysis, IUS score was significantly associated with generalized (OR 1. 22, 95% CI 1. 09-1. 38) and prostate-cancer-specific anxiety (OR 1. 29, 95% CI 1. 13-1. 49) while moderate/severe urinary symptoms were associated with prostate-cancer-specific anxiety (OR 6. 89, 95% CI 1. 33-35. 68).
CONCLUSIONS - Intolerance of uncertainty and urinary symptoms may promote anxiety among men on AS 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 AS.
The Journal of urology. 2016 Feb 09 [Epub ahead of print]
Hung-Jui Tan, Leonard S Marks, Michael A Hoyt, Lorna Kwan, Christopher P Filson, Malu Macairan, Patricia Lieu, Mark S Litwin, Annette L Stanton
VA/UCLA Robert Wood Johnson Clinical Scholars Program, Los Angeles, CA; Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA. Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA. , Department of Psychology, Hunter College, City University of New York, New York. , Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA. , Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA. , Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA. , Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA. , Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, CA; Department of Health Policy & Management, Fielding School of Public Health, University of California, Los Angeles, CA. , Departments of Psychology and Psychiatry/Biobehavioral Sciences; Jonsson Comprehensive Cancer Center, University of California, Los Angeles, CA.