Eur Urol. v74(3), p261-280 September 2018; doi: 10.1016/j.eururo.2018.02.026.
- The recent ProtecT trial demonstrated that there was no difference in 10-year survival rates between men with low risk localised prostate cancer who were allocated to active surveillance and those who chose radical treatment.
- However, patient uptake of and adherence to active surveillance is generally low in clinical practice. This research suggests that efforts by clinicians to explain the choices available might help improve understanding, uptake or adherence. This will aid patients in making more informed decisions, potentially lessening the side effects experienced by some men.
Abstract
CONTEXT: Despite support for active surveillance (AS) as a first treatment choice for men with low-risk prostate cancer (PC), this strategy is largely underutilised.
OBJECTIVE: To systematically review barriers and facilitators to selecting and adhering to AS for low-risk PC.
EVIDENCE ACQUISITION: We searched PsychINFO, PubMed, Medline 2000-now, Embase, CINAHL, and Cochrane Central databases between 2002 and 2017 using the Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) statement. The Purpose, Respondents, Explanation, Findings and Significance (PREFS) and Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) quality criteria were applied. Forty-seven studies were identified.
EVIDENCE SYNTHESIS: Key themes emerged as factors influencing both choice and adherence to AS: (1) patient and tumour factors (age, comorbidities, knowledge, education, socioeconomic status, family history, grade, tumour volume, and fear of progression/side effects); (2) family and social support; (3) provider (speciality, communication, and attitudes); (4) healthcare organisation (geography and type of practice); and (5) health policy (guidelines, year, and awareness).
CONCLUSIONS: Many factors influence men's choice and adherence to AS on multiple levels. It is important to learn from the experience of other chronic health conditions as well as from institutions/countries that are making significant headway in appropriately recruiting men to AS protocols, through standardised patient information, clinician education, and nationally agreed guidelines, to ultimately decrease heterogeneity in AS practice.
