Cancer causes uncertainty and anxiety – even in patients who don’t have the disease but who may have an increased risk through inheritance or other forms of predisposition.
I was interested to read about a recent study that measured the psychological impact of screening for prostate cancer in men who had a close relative with the disease.
Prostate cancer, the most common cancer in men, has a strong heritable component to risk. A man who has a first-degree relative (father, brother or son) with prostate cancer has twice the risk of the general population of getting the disease – about a one-in-four chance.
Around 100 common genetic variants – along with a few rare mutations, such as those in the BRCA1 and BRCA2 genes – have been linked with an increased risk of prostate cancer. This offers the tantalising prospect of profiling a man’s genes in order to determine his risk of developing prostate cancer. Those at a greater risk than the general population can then be put on a programme of regular check-ups to try to catch the disease when it first develops.
But waiting for test results is particularly unpleasant for many cancer patients. The paper I read focused on this type of anxiety and other types of cancer worry, in an attempt to find out the psychological impact of prostate cancer screening on men without the disease but at an increased risk of getting it.
Waiting for results from a blood test or scan can be particularly unpleasant for many cancer patients. The men were assessed for general and prostate cancer-specific worry as they underwent both a genetic profiling test – which assessed their lifetime risk of prostate cancer – and a prostate specific antigen (PSA) screen – which can spot early signs of the disease.
Perhaps unsurprisingly, men who had seen a family member suffer with the disease overestimated their risk of getting the disease themselves – even when the results of the genetic profiling test indicated that they had a lower risk than the general population. Although the study authors did not observe any psychological distress in the group as a whole, they did spot acute anxiety in men waiting for their blood test results.
Dr Elizabeth Bancroft, who is a researcher in the Oncogenetics Team here at The Institute of Cancer Research and is also a registered nurse at The Royal Marsden NHS Foundation Trust, provided a suggestion based on this observation: “Particularly for high-risk groups, timeframes for receiving results should be kept to a minimum.”
The study identified men with different attitudes towards their real or perceived risk of prostate cancer. One such group was termed the ‘information seekers’. These men used the internet and newspapers to learn more about the disease and its risks, and used this to follow what they perceived to be good advice.
What interested me about this group was that by seeking information about risk (or about prostate cancer in general), the men were taking control of the situation. The authors state that this behaviour made these men feel less anxious about their condition. Dr Bancroft explained: “Men described feeling less worried about their risk of prostate cancer at the end of the study, which could be explained by an increase in knowledge, making them feel more in control. This behaviour shows how important education and information provision are for supporting patients’ understanding of disease risk and the role of genetics.”
Many of the men talked about how prostate cancer risk was communicated – often this was done through family members. “There was often one key person,” explained Dr Bancroft. “Either a close male with prostate cancer or a female, such as a wife or sister concerned about their risk. Gender roles featured as a key component of the discussions and there was a belief among the men that they were ‘burying their heads in the sand’, while the women in their families were proactive about health.”
This observation could be used, suggested Dr Bancroft, to develop new pathways to communicate prostate cancer risk to men at risk of the disease – using the assistance of female family members to make sure men who are at risk get screened.
Screening programmes can play an important role in spotting patients at higher cancer risk who have early-stage – and thus easier to treat – cancer, but they may cause otherwise healthy people to worry unnecessarily. By understanding what causes stress during a screening programme, clinicians will be able to successfully screen for cancer risk while keeping patients informed and their anxiety in check.
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