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Study: Emotional distress can influence cancer treatment choice

The anxiety that comes with a diagnosis of prostate cancer can lead men to choose more aggressive – and potentially unnecessary – treatments than they may need.

That’s the conclusion of a University at Buffalo study that calls for informed decision-making between physicians and patients about prostate cancer treatment, as well as better support to help men deal with the emotional distress of the diagnosis.

“Emotional distress may motivate men with low-risk prostate cancer to choose more aggressive treatment, such as choosing surgery over active surveillance,” said Heather Orom, lead author on the study published in the Journal of Urology.

The study looked at 1,531 men with newly diagnosed localized prostate cancer, meaning the disease hadn’t spread to other parts of the body. Researchers measured their emotional distress with a survey after diagnosis and soon after they made a treatment decision. The majority of study participants had low- or intermediate-risk disease. The most common treatment chosen was surgery – 48.4 percent – followed by radiation – 27.4 percent – and active surveillance – 27.4 percent.

Emotional distress after diagnosis predicted greater likelihood of patients choosing surgery and its potential side effects over active surveillance, which involves periodic tests to see if the cancer grows, the study found.

“Distress has a small effect, but it is important because it is happening in low-risk men for whom active surveillance is a viable option, and we can take steps to address that distress,” said Orom, associate professor of community health and health behavior in UB’s School of Public Health and Health Professions.

Prostate cancer is the most common cancer in American men after skin cancer. The American Cancer Society estimates there will be 161,360 new cases and 26,730 deaths in 2017. Prostate cancer can be a serious disease, but is often slow growing and many men don’t die from it.

As such, there is debate in the medical community about overtreatment with radiation and surgery, which may cause such side effects as erectile dysfunction and incontinence. Treatment decisions for prostate and other cancers can be complicated because of differences in effectiveness and side effects, as well as age and personal preferences, requiring patients to carefully consider the pros and cons for each choice.

Orom said medical care should strive for a decision-making experience that ensures men have full information and support to reduce the influence of distress on treatment choice.

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