TY - JOUR
T1 - Psychological distress associated with active surveillance in patients younger than 70 with a small renal mass
AU - Goldberg, Hanan
AU - Ajaj, Rami
AU - Cáceres, Jaime Omar Herrera
AU - Berlin, Alejandro
AU - Chandrasekar, Thenappan
AU - Klaassen, Zachary
AU - Wallis, Christopher J.D.
AU - Ahmad, Ardalan E.
AU - Leao, Ricardo
AU - Petrella, Anika R.
AU - Kachura, John R.
AU - Fleshner, Neil
AU - Matthew, Andrew
AU - Finelli, Antonio
AU - Jewett, Michael A.S.
AU - Hamilton, Robert J.
N1 - Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/6
Y1 - 2020/6
N2 - Purpose: To compare the psychological distress throughout several predefined disease time points in patients younger than 70 with small renal masses (SRMs) treated with either active surveillance (AS) or ablative/surgical therapy. Methods: Using the Edmonton Symptom Assessment System - revised (ESAS-r) questionnaire, we focused on psychological distress symptoms in all consecutive patients with an SRM between 2014 and 2017. We further evaluated the psychological distress sub-score (PDSS) of ESAS-r, consisting of the sum scores of anxiety, depression, and well-being. PDSS of patients treated with AS or ablation/surgery were compared at 4 distinct time points (before and after diagnosis, after a biopsy is performed, and at last follow-up). Multivariable linear regression models were performed to assess factors associated with worse PDSS (1-point score increase). Results: We examined 477 patients, of whom 217 and 260 were treated with AS and surgery/ablation, respectively. Similar ESAS-r and PDSS scores were shown at all predefined disease time points except following an SRM biopsy and at last, follow-up, where AS-treated patients with a biopsy-proven malignancy had significantly worse PDSS (11.4 vs. 6.1, P = 0.035), and (13.2 vs. 5.4, P = 0.004), respectively. At last follow-up, multivariable linear models demonstrated that a biopsy-proven malignancy (B = 2.630, 95% CI 0.024–5.236, P = 0.048) and AS strategy (B = 6.499, 95% CI 2.340–10.658, P = 0.002) were associated with worse PDSS in all patients, and in those who underwent a biopsy, respectively. Conclusions: Offering standardized psychological supportive care may be required for patients younger than 70 years on AS for SRM, especially for those with a biopsy-proven tumor.
AB - Purpose: To compare the psychological distress throughout several predefined disease time points in patients younger than 70 with small renal masses (SRMs) treated with either active surveillance (AS) or ablative/surgical therapy. Methods: Using the Edmonton Symptom Assessment System - revised (ESAS-r) questionnaire, we focused on psychological distress symptoms in all consecutive patients with an SRM between 2014 and 2017. We further evaluated the psychological distress sub-score (PDSS) of ESAS-r, consisting of the sum scores of anxiety, depression, and well-being. PDSS of patients treated with AS or ablation/surgery were compared at 4 distinct time points (before and after diagnosis, after a biopsy is performed, and at last follow-up). Multivariable linear regression models were performed to assess factors associated with worse PDSS (1-point score increase). Results: We examined 477 patients, of whom 217 and 260 were treated with AS and surgery/ablation, respectively. Similar ESAS-r and PDSS scores were shown at all predefined disease time points except following an SRM biopsy and at last, follow-up, where AS-treated patients with a biopsy-proven malignancy had significantly worse PDSS (11.4 vs. 6.1, P = 0.035), and (13.2 vs. 5.4, P = 0.004), respectively. At last follow-up, multivariable linear models demonstrated that a biopsy-proven malignancy (B = 2.630, 95% CI 0.024–5.236, P = 0.048) and AS strategy (B = 6.499, 95% CI 2.340–10.658, P = 0.002) were associated with worse PDSS in all patients, and in those who underwent a biopsy, respectively. Conclusions: Offering standardized psychological supportive care may be required for patients younger than 70 years on AS for SRM, especially for those with a biopsy-proven tumor.
KW - Active surveillance
KW - Edmonton Symptom Assessment System
KW - Psychological distress
KW - Small renal mass
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U2 - 10.1016/j.urolonc.2020.02.015
DO - 10.1016/j.urolonc.2020.02.015
M3 - Article
C2 - 32253117
AN - SCOPUS:85082875020
SN - 1078-1439
VL - 38
SP - 603.e17-603.e25
JO - Urologic Oncology: Seminars and Original Investigations
JF - Urologic Oncology: Seminars and Original Investigations
IS - 6
ER -