An Exploration of Wellbeing in Men diagnosed with Prostate Cancer undergoing Active Surveillance: a Qualitative Study

Omar Eymech; Oliver Brunckhorst; Louis Fox; Anam Jawaid; Mieke Van Hemelrijck; Robert Stewart; Prokar Dasgupta; Kamran Ahmed

doi:10.1007/s00520-022-06976-w

An Exploration of Wellbeing in Men diagnosed with Prostate Cancer undergoing Active Surveillance: a Qualitative Study

Omar Eymech, Oliver Brunckhorst^*, Louis Fox, Anam Jawaid, Mieke Van Hemelrijck, Robert Stewart, Prokar Dasgupta, Kamran Ahmed

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

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Abstract

Purpose: There is a growing emphasis on improving quality of life of people with prostate cancer. However, those undergoing active surveillance remain underrepresented in the literature with less known about their unique challenges. Therefore, we aimed to explore their lived experiences post diagnosis and its effect on their mental, social, and physical wellbeing. Methods: Qualitative semi-structured interviews were conducted with 13 men undergoing active surveillance for low-risk disease. Thematic analysis was used to inductively co-construct themes through the lens of the biopsychosocial model. Results: Mental wellbeing was strongly affected in our participants due to the overwhelming emotional impact of their diagnosis resulting in an ‘Emotional Diagnostic Disequilibrium’. Informational awareness and education about prostate cancer helped patients with ‘Recognition of the Impact’. Patients experienced an ‘Unsettling Monitoring Cycle’ due to the increased fear and anxiety around PSA monitoring appointments, with some men ignoring their mental wellbeing needs as their disease is ‘A Future Problem’. ‘Concealment of Diagnosis’ left many feeling isolated and highlighted an important coping mechanisms in the ‘Importance of a Social Support Network’ theme. Finally, physical health mostly changed through alterations in health behaviour, leading to ‘A Healthier Lifestyle’ with increasing attribution of physical symptoms to age through ‘Symptomatic Overshadowing’. Conclusion: The greatest disease impact on men’s wellbeing was at the time of diagnosis, with a subsequent cyclical anxiety and fear of disease progression prominent around monitoring appointments. Future research should explore ways to better support patients with these issues and at these times, improving their quality of life.

Original language	English
Pages (from-to)	5459-5468
Number of pages	10
Journal	Supportive Care in Cancer
Volume	30
Issue number	6
Early online date	19 Mar 2022
DOIs	https://doi.org/10.1007/s00520-022-06976-w
Publication status	Published - 27 Apr 2022

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@article{2d67b69ed3d7437caa982133667be62a,

title = "An Exploration of Wellbeing in Men diagnosed with Prostate Cancer undergoing Active Surveillance: a Qualitative Study",

abstract = "Purpose: There is a growing emphasis on improving quality of life of people with prostate cancer. However, those undergoing active surveillance remain underrepresented in the literature with less known about their unique challenges. Therefore, we aimed to explore their lived experiences post diagnosis and its effect on their mental, social, and physical wellbeing. Methods: Qualitative semi-structured interviews were conducted with 13 men undergoing active surveillance for low-risk disease. Thematic analysis was used to inductively co-construct themes through the lens of the biopsychosocial model. Results: Mental wellbeing was strongly affected in our participants due to the overwhelming emotional impact of their diagnosis resulting in an {\textquoteleft}Emotional Diagnostic Disequilibrium{\textquoteright}. Informational awareness and education about prostate cancer helped patients with {\textquoteleft}Recognition of the Impact{\textquoteright}. Patients experienced an {\textquoteleft}Unsettling Monitoring Cycle{\textquoteright} due to the increased fear and anxiety around PSA monitoring appointments, with some men ignoring their mental wellbeing needs as their disease is {\textquoteleft}A Future Problem{\textquoteright}. {\textquoteleft}Concealment of Diagnosis{\textquoteright} left many feeling isolated and highlighted an important coping mechanisms in the {\textquoteleft}Importance of a Social Support Network{\textquoteright} theme. Finally, physical health mostly changed through alterations in health behaviour, leading to {\textquoteleft}A Healthier Lifestyle{\textquoteright} with increasing attribution of physical symptoms to age through {\textquoteleft}Symptomatic Overshadowing{\textquoteright}. Conclusion: The greatest disease impact on men{\textquoteright}s wellbeing was at the time of diagnosis, with a subsequent cyclical anxiety and fear of disease progression prominent around monitoring appointments. Future research should explore ways to better support patients with these issues and at these times, improving their quality of life.",

author = "Omar Eymech and Oliver Brunckhorst and Louis Fox and Anam Jawaid and {Van Hemelrijck}, Mieke and Robert Stewart and Prokar Dasgupta and Kamran Ahmed",

note = "Funding Information: OB, PD and KA acknowledge research support from the MRC Centre for Transplantation. PD also acknowledges support from the KCL-Vattikuti Institute of Robotic Surgery and the GSTT Charity. KA acknowledges support from The Urology Foundation and the Pelican Foundation. RS is part-funded by: (i) the National Institute for Health Research (NIHR) Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust and King{\textquoteright}s College London; (ii) the Medical Research Council (MRC) DATAMIND HDR-UK mental health data hub; (iii) an NIHR Senior Investigator Award; (iv) the National Institute for Health Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) at King{\textquoteright}s College Hospital NHS Foundation Trust. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. Funding Information: This study was funded by the King{\textquoteright}s Medical Research Trust (KMRT), the Malcolm Coptcoat Trust and the Royal College of Surgeons of England. Funding Information: OB, PD and KA acknowledge research support from the MRC Centre for Transplantation. PD also acknowledges support from the KCL-Vattikuti Institute of Robotic Surgery and the GSTT Charity. KA acknowledges support from The Urology Foundation and the Pelican Foundation. RS is part-funded by: (i) the National Institute for Health Research (NIHR) Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust and King?s College London; (ii) the Medical Research Council (MRC) DATAMIND HDR-UK mental health data hub; (iii) an NIHR Senior Investigator Award; (iv) the National Institute for Health Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) at King?s College Hospital NHS Foundation Trust. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. Publisher Copyright: {\textcopyright} 2022, The Author(s).",

year = "2022",

month = apr,

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doi = "10.1007/s00520-022-06976-w",

language = "English",

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T1 - An Exploration of Wellbeing in Men diagnosed with Prostate Cancer undergoing Active Surveillance: a Qualitative Study

AU - Eymech, Omar

AU - Brunckhorst, Oliver

AU - Fox, Louis

AU - Jawaid, Anam

AU - Van Hemelrijck, Mieke

AU - Stewart, Robert

AU - Dasgupta, Prokar

AU - Ahmed, Kamran

N1 - Funding Information: OB, PD and KA acknowledge research support from the MRC Centre for Transplantation. PD also acknowledges support from the KCL-Vattikuti Institute of Robotic Surgery and the GSTT Charity. KA acknowledges support from The Urology Foundation and the Pelican Foundation. RS is part-funded by: (i) the National Institute for Health Research (NIHR) Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust and King’s College London; (ii) the Medical Research Council (MRC) DATAMIND HDR-UK mental health data hub; (iii) an NIHR Senior Investigator Award; (iv) the National Institute for Health Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) at King’s College Hospital NHS Foundation Trust. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. Funding Information: This study was funded by the King’s Medical Research Trust (KMRT), the Malcolm Coptcoat Trust and the Royal College of Surgeons of England. Funding Information: OB, PD and KA acknowledge research support from the MRC Centre for Transplantation. PD also acknowledges support from the KCL-Vattikuti Institute of Robotic Surgery and the GSTT Charity. KA acknowledges support from The Urology Foundation and the Pelican Foundation. RS is part-funded by: (i) the National Institute for Health Research (NIHR) Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust and King?s College London; (ii) the Medical Research Council (MRC) DATAMIND HDR-UK mental health data hub; (iii) an NIHR Senior Investigator Award; (iv) the National Institute for Health Research (NIHR) Applied Research Collaboration South London (NIHR ARC South London) at King?s College Hospital NHS Foundation Trust. The views expressed are those of the authors and not necessarily those of the NIHR or the Department of Health and Social Care. Publisher Copyright: © 2022, The Author(s).

PY - 2022/4/27

Y1 - 2022/4/27

N2 - Purpose: There is a growing emphasis on improving quality of life of people with prostate cancer. However, those undergoing active surveillance remain underrepresented in the literature with less known about their unique challenges. Therefore, we aimed to explore their lived experiences post diagnosis and its effect on their mental, social, and physical wellbeing. Methods: Qualitative semi-structured interviews were conducted with 13 men undergoing active surveillance for low-risk disease. Thematic analysis was used to inductively co-construct themes through the lens of the biopsychosocial model. Results: Mental wellbeing was strongly affected in our participants due to the overwhelming emotional impact of their diagnosis resulting in an ‘Emotional Diagnostic Disequilibrium’. Informational awareness and education about prostate cancer helped patients with ‘Recognition of the Impact’. Patients experienced an ‘Unsettling Monitoring Cycle’ due to the increased fear and anxiety around PSA monitoring appointments, with some men ignoring their mental wellbeing needs as their disease is ‘A Future Problem’. ‘Concealment of Diagnosis’ left many feeling isolated and highlighted an important coping mechanisms in the ‘Importance of a Social Support Network’ theme. Finally, physical health mostly changed through alterations in health behaviour, leading to ‘A Healthier Lifestyle’ with increasing attribution of physical symptoms to age through ‘Symptomatic Overshadowing’. Conclusion: The greatest disease impact on men’s wellbeing was at the time of diagnosis, with a subsequent cyclical anxiety and fear of disease progression prominent around monitoring appointments. Future research should explore ways to better support patients with these issues and at these times, improving their quality of life.

AB - Purpose: There is a growing emphasis on improving quality of life of people with prostate cancer. However, those undergoing active surveillance remain underrepresented in the literature with less known about their unique challenges. Therefore, we aimed to explore their lived experiences post diagnosis and its effect on their mental, social, and physical wellbeing. Methods: Qualitative semi-structured interviews were conducted with 13 men undergoing active surveillance for low-risk disease. Thematic analysis was used to inductively co-construct themes through the lens of the biopsychosocial model. Results: Mental wellbeing was strongly affected in our participants due to the overwhelming emotional impact of their diagnosis resulting in an ‘Emotional Diagnostic Disequilibrium’. Informational awareness and education about prostate cancer helped patients with ‘Recognition of the Impact’. Patients experienced an ‘Unsettling Monitoring Cycle’ due to the increased fear and anxiety around PSA monitoring appointments, with some men ignoring their mental wellbeing needs as their disease is ‘A Future Problem’. ‘Concealment of Diagnosis’ left many feeling isolated and highlighted an important coping mechanisms in the ‘Importance of a Social Support Network’ theme. Finally, physical health mostly changed through alterations in health behaviour, leading to ‘A Healthier Lifestyle’ with increasing attribution of physical symptoms to age through ‘Symptomatic Overshadowing’. Conclusion: The greatest disease impact on men’s wellbeing was at the time of diagnosis, with a subsequent cyclical anxiety and fear of disease progression prominent around monitoring appointments. Future research should explore ways to better support patients with these issues and at these times, improving their quality of life.

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JO - Supportive Care in Cancer

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ER -

An Exploration of Wellbeing in Men diagnosed with Prostate Cancer undergoing Active Surveillance: a Qualitative Study

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