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

Netty Kinsella; Kerri Beckmann; Declan Cahill; Oussama Elhage; Rick Popert; Paul Cathcart; Ben Challacombe; Christian Brown; Mieke Van Hemelrijck

doi:10.1016/j.euo.2018.09.007

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

Eur Urol Oncol. 2019 Jul;2(4):464-470. doi: 10.1016/j.euo.2018.09.007. Epub 2018 Oct 11.

Authors

Netty Kinsella¹, Kerri Beckmann², Declan Cahill³, Oussama Elhage⁴, Rick Popert⁵, Paul Cathcart⁵, Ben Challacombe⁵, Christian Brown⁶, Mieke Van Hemelrijck⁷

Affiliations

¹ Department of Uro-Oncology, The Royal Marsden Hospital, London, UK; Translational Oncology and Urology Research, King's College London, London, UK; Centre for Population Health Research, University of South Australia, Adelaide, Australia. Electronic address: netty.kinsella@rmh.nhs.uk.
² Translational Oncology and Urology Research, King's College London, London, UK; Centre for Population Health Research, University of South Australia, Adelaide, Australia; Department of Urology, Guys and St. Thomas NHS Foundation Trust, London, UK.
³ Department of Uro-Oncology, The Royal Marsden Hospital, London, UK.
⁴ Department of Urology, Guys and St. Thomas NHS Foundation Trust, London, UK; MRC Transplantation, King's College London, London, UK.
⁵ Department of Urology, Guys and St. Thomas NHS Foundation Trust, London, UK.
⁶ Department of Urology, Guys and St. Thomas NHS Foundation Trust, London, UK; Department of Urology, Kings Hospital, London, UK.
⁷ Translational Oncology and Urology Research, King's College London, London, UK; Centre for Population Health Research, University of South Australia, Adelaide, Australia.

PMID: 31277784
DOI: 10.1016/j.euo.2018.09.007

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 5yr 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 5yr 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 5yr.

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 5yr.

Keywords: Active surveillance; Adherence; Intervention; Prostate cancer.

Publication types

Controlled Clinical Trial

MeSH terms

Aged
Focus Groups
Humans
Male
Middle Aged
Motivation
Patient Compliance*
Patient Education as Topic*
Pilot Projects
Prostatic Neoplasms*
Watchful Waiting*