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How do doctors really feel about active surveillance?

September 10, 2018

Doctors


Over the past decade, active surveillance (AS) has emerged as a safe, primary management strategy that reduces the risk of overtreatment for men with low-risk prostate cancer. But despite significant evidence proving the benefits of AS, many men still opt against it, choosing instead to undergo invasive therapies that can lead to damaging side-effects.

So, what are some of the barriers that prevent more men from embracing AS, and how can health care professionals encourage them to accept this evidence-based approach to prostate cancer management?

These are just two of the questions tackled by members of the TFRI-funded Canadian Prostate Cancer Biomarker Network in Describing perspectives of health care professionals on active surveillance for the management of prostate cancer, a new study that looks at AS from the perspective of health care professionals.

“It is critically important to understand the perspectives of the professionals who treat patients with prostate cancer with regards to active surveillance to better understand why some physicians and patients are reluctant or open to the concept of active surveillance,” said the paper’s lead author Dr. Fred Saad (Centre de recherche du Centre hospitalier de l'Université de Montréal (CRCHUM)).

To gain these insights, researchers met with 48 health care professionals (HCPs), including general practitioners, urologists and radiation oncologists from six Canadian academic institutions in four different provinces. During these discussions it became apparent that several factors converged to make it harder for physicians to “sell” the idea of AS to their patients.

“The AS approach conflicts with the usual message promoted to the public of undergoing curative treatment promptly following a cancer diagnosis and is often perceived as “doing nothing” during a time of heightened emotional distress for men and their families, which can make new learning and decision-making difficult,” reads the study.

Because AS is initially perceived as counterintuitive, things like age, mood and personality play an important role in a patient’s decision to embrace it, according to the health care professionals interviewed in the study, who also highlighted that anxiety and depression made men more likely to select radical treatment over AS.

The study also reveals that HCPs often struggle to “sell” AS to their patients because some of them are still reticent about the approach themselves. This occurs partly because of a lack of clear biomarkers that indicate exactly when it is the best option for patients, placing a large responsibility on physicians to help their patient’s make the right choice.

“Most participants agreed that the development of a standardized approach for AS would be beneficial, given the current variations in terms of protocol, level of patient education materials, methods, and medical community philosophy on AS,” wrote the study authors.

Given this information, Dr. Saad believes that the insights derived from this study will fuel the team’s pursuit to develop biomarkers that can clearly show when AS is most appropriate, helping to make it easier for both HCPs and patients to embrace this effective approach to prostate cancer.

“These findings will allow us to attempt to create tools that more accurately address the issues faced by clinicians,” he said. “Physicians that are better equipped to predict outcomes of AS will feel more confident in helping patients make decisions regarding therapeutic choices in dealing with a diagnosis of prostate cancer.”

Study

Describing perspectives of health care professionals on active surveillance for the management of prostate cancer

Authors

Kittie Pang, Margaret Fitch, Veronique Ouellet, Simone Chevalier, Darrel E. Drachenberg, Antonio Finelli, Jean-Baptiste Lattouf, Alan So, Simon Sutcliffe, Simon Tanguay, Fred Saad and Anne-Marie Mes-Masson

Funding

This research was funded by the Terry Fox Research Institute as part of a pan-Canadian initiative named the Canadian Prostate Cancer Biomarker Network.

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