Abstract: PD28-04
Sources of Funding: This work was supported by NIH/NCI Grant 1R03CA173812 (DAB). It was also supported by NIH/NCI Grant 5T32CA106183 (MDT); American Cancer Society MSRG-15-103-01-CPHPS (MJR); the US Agency for Healthcare Research and Quality (grants 1R01HS019356 and 1R01HS022640-01); the National Cancer Institute, National Institutes of Health (grant R01-CA114524), and the following contracts to each of the participating institutions: N01-PC-67007, N01-PC-67009, N01-PC-67010, N01-PC-67006, N01-PC-67005, and N01-PC-67000, and through a contract from the Patient-Centered Outcomes Research Institute

Introduction

Disease-related factors influence men on active surveillance (AS) for localized prostate cancer (PCa) to discontinue AS and seek treatment, but so too may psychosocial factors. This study sought to evaluate the influence of psychosocial factors such as PCa anxiety, social support, participation in medical decision-making (PDM), and education level on patient decisions to discontinue PCa AS in the absence of disease progression.

Methods

The Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study is a prospective, population-based cohort study of men with localized PCa diagnosed in 2011-2012. PCa anxiety, social support, PDM, education 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 discontinuing AS.

Results

Of 531 AS patients, 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 one personal reason, and 8% cited personal reasons only. Patients with some college education discontinued AS significantly earlier (HR: 2.0, 95% CI: 1.2, 3.2) than patients with less education. PCa anxiety, social support, and PDM were not associated with seeking treatment.

Conclusions

We found that 31 percent 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 seeking definitive treatment. Future research is needed to understand how factors unrelated to disease severity influence treatment decisions among AS patients in order to identify opportunities to improve adherence to AS.

Funding

This work was supported by NIH/NCI Grant 1R03CA173812 (DAB). It was also supported by NIH/NCI Grant 5T32CA106183 (MDT); American Cancer Society MSRG-15-103-01-CPHPS (MJR); the US Agency for Healthcare Research and Quality (grants 1R01HS019356 and 1R01HS022640-01); the National Cancer Institute, National Institutes of Health (grant R01-CA114524), and the following contracts to each of the participating institutions: N01-PC-67007, N01-PC-67009, N01-PC-67010, N01-PC-67006, N01-PC-67005, and N01-PC-67000, and through a contract from the Patient-Centered Outcomes Research Institute