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A Single Educational Seminar Increases Confidence and Decreases Dropout from Active Surveillance by 5 Years After Diagnosis of Prostate Cancer

Research output: Contribution to journalArticlepeer-review

Original languageEnglish
JournalEuropean Urology Oncology
Early online date11 Oct 2018
DOIs
Accepted/In press16 Sep 2018
E-pub ahead of print11 Oct 2018

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King's Authors

Abstract

Background
Researchers remain divided on the major causes of dropout from active surveillance (AS), with rates of up to 38% among men with no evidence of prostate cancer (PC) progression.

Objective
To develop and evaluate an educational intervention in terms of adherence to AS among men with low- to intermediate-risk PC.

Design, setting, and participants
We first carried out focus group discussions with men who had remained on and dropped out of AS to inform an intervention to increase adherence to AS. A total of 255 consecutive men who had selected AS were then recruited to either standard care (written information and access to a nurse specialist) or standard care and the intervention.

Intervention
An educational seminar was designed by patients and clinicians including information on imaging, biopsy techniques, understanding pathology, large AS cohorts - mortality and morbidity risk and diet and lifestyle advice.

Outcome measurements and statistical analysis
The proportion of men dropping out of AS for reasons other than disease progression was assessed at 1 and 5 yr after AS selection using multivariate logistic regression.

Results and limitations
Common themes influencing decision-making by men on AS were identified: (1) clinical consistency; (2) information; and (3) lifestyle advice. Addition of an educational seminar led to significantly fewer men dropping out of AS: at 1 and 5 yr the dropout rate was 25% and 42%, respectively, in the standard care group, compared to 11% and 22% (p = 0.001) in the intervention group. In the intervention group, 18 men failed to attend the seminar.

Conclusions
The AS dropout rate was halved following a single educational seminar delivered to groups of men with intermediate- or low-risk PC, even at 5 yr.

Patient summary
Men on active surveillance (AS) for prostate cancer feel more supported when provided with an educational seminar within 3 mo of their treatment choice. The seminar halved the number of men dropping-out of AS, even at 5 yr.

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