The Relationship between Intolerance of Uncertainty and Anxiety in Men on Active Surveillance for Prostate Cancer.
The Relationship between Intolerance of Uncertainty and Anxiety in Men on Active Surveillance for Prostate Cancer.
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DOI：
10.1016/j.juro.2016.01.108
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发表时间：
2016-06
期刊：
影响因子：
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通讯作者：
Stanton AL
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文献类型：
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作者：
Tan HJ;Marks LS;Hoyt MA;Kwan L;Filson CP;Macairan M;Lieu P;Litwin MS;Stanton AL
焦虑可能是参与AS的主要障碍。对不确定性的不容忍倾向于将负面事件的潜在可能性视为不确定性与癌症相关的担忧有关。因此，我们前瞻性地探讨了前列腺癌患者对不确定性的不耐受与焦虑沿着及其他临床因素的关系。从2011年到2014年，119名参与主动监测的D 'Amico低风险前列腺癌男性完成了HADS，MAX-PC，IUS和IPSS调查。在调整患者特征、癌症信息和IPSS评分后，我们使用双变量和多变量分析评估了焦虑与IUS评分之间的关系。一些男性在广义（n=18，15.1%）和前列腺癌特异性（n=17，14.3%）量表上报告了具有临床意义的焦虑。在双变量分析中，患有中度/重度泌尿系统症状和较高IUS评分的男性比患有轻度泌尿系统症状和较低IUS评分的男性报告的广泛性焦虑和前列腺癌特异性焦虑更多（p≤0.008）。有抑郁症状（p=0.024）或前列腺癌家族史（p=0.006）的男性经历了更大的广泛性焦虑。在多因素分析中，IUS评分与广泛性焦虑（OR 1.22，95%CI 1.09-1.38）和前列腺癌特异性焦虑（OR 1.29，95%CI 1.13-1.49）显著相关，而中/重度泌尿系统症状与前列腺癌特异性焦虑（OR 6.89，95%CI 1.33-35.68）显著相关。对不确定性的不耐受和泌尿系统症状可能会增加前列腺癌患者的焦虑。患者教育，下尿路症状的管理和行为干预可以减轻与不确定性不耐受相关的焦虑，并有助于维持患者参与AS。
Anxiety may serve as a major barrier to participation in AS. Intolerance of uncertainty—the tendency to perceive the potential for negative events as threatening—has been linked to cancer-related worry. Accordingly, we explored prospectively the relationship of intolerance of uncertainty with anxiety along with other clinical factors among men managed with AS for prostate cancer. From 2011–2014, 119 men with D’Amico low-risk prostate cancer participating in active surveillance completed the HADS, MAX-PC, IUS, and IPSS surveys. We evaluated the relationship between anxiety and IUS score after adjusting for patient characteristics, cancer information, and IPSS score using bivariable and multivariable analyses. A number of men reported clinically significant anxiety on the generalized (n=18, 15.1%) and prostate-cancer-specific (n=17, 14.3%) scales. In bivariable analyses, men with moderate/severe urinary symptoms and higher IUS scores reported more generalized and prostate-cancer-specific anxiety than men with mild urinary symptoms and lower IUS scores, respectively (p≤0.008). Men with depressive symptoms (p=0.024) or family history of prostate cancer (p=0.006) experienced greater generalized anxiety. In multivariable analysis, IUS score was significantly associated with generalized (OR 1.22, 95% CI 1.09–1.38) and prostate-cancerspecific anxiety (OR 1.29, 95% CI 1.13–1.49) while moderate/severe urinary symptoms were associated with prostate-cancer-specific anxiety (OR 6.89, 95% CI 1.33–35.68). Intolerance of uncertainty and urinary symptoms may promote anxiety among men on AS for prostate cancer. Patient education, management of lower urinary tract symptoms, and behavioral interventions may lessen anxiety related to uncertainty intolerance and help maintain patient engagement in AS.