The reality of cancer treatment consequences

Chair: Diana Greenfield, Sheffield Teaching Hospitals NHS Foundation Trust, UK
Chair: Elspeth Banks, NCRI Consumer Forum, UK
Presenter: Eila Watson, Oxford Brookes University, UK
Presenter: Hashim Ahmed, Imperial College London, UK
Speaker: Adrian Edwards, University of Cardiff, UK
Speaker: Navneet Majhail, Cleveland Clinic, USA
Speaker: Nick Robinson, BBC, Patient representative

2:00 pm-4:00 pm

Room: Lomond Auditorium

This session will cover: a multi-system overview of late effects risks of established treatment modalities using a well understood paradigm (haematopoietic stem cell transplantation) to illustrate lessons learnt and how to avoid future problems; how to determine and explain treatment risks to the patient using Decision Aids; The lived experience of the trade-off between survival and treatment complications; The lived experience of having treatable but not curable cancer and the patient perspective on the big issues that need to be addressed to improve experience and outcomes.

Session speakers:
•Dr Navneet Majhail, Director of Blood and Marrow Transplant Program, Cleveland Clinic, Ohio, USA
•Professor Adrian Edwards, University of Cardiff
•Mr Nick Robinson, BBC

Proffered paper presentations:
– The psychological impact of being on a monitoring pathway for early stage prostate cancer: a UK-wide mixed methods study. – Eila Watson

– Evaluating the trade-offs men with localised prostate cancer make between the risks and benefits of treatments: the COMPARE study – Hashim Ahmed

Surviving the Cure: Blood and Marrow Transplantation as Model For Cancer Survivorship
Speaker: Navneet Majhail
Affiliation: Cleveland Clinic


Blood and marrow transplant survivors are at risk for unique treatment related late complications and quality of life impairments. They also face challenges that limits their ability to receive appropriate patient-centric and coordinated survivorship care. Extensive research has been conducted in the field of transplant survivorship, which can serve as a model for addressing issues that cancer survivors face in general.

The psychological impact of being on a monitoring pathway for early stage prostate cancer: a UK-wide mixed methods study.
Speaker: Eila Watson
Affiliation: Oxford Brookes University


As increasing numbers of men diagnosed with prostate cancer (PCa) go on an Active Surveillance (AS) or Watchful Waiting (WW) pathway, it is important to understand the psychological impact of not receiving active treatment.  As part of the UK-wide Life After Prostate Cancer Diagnosis study, the psychological status of men with PCa on AS/WW was explored, and compared with that of men who underwent active treatment.


Cross-sectional postal survey of UK men diagnosed with PCa 18-42 months previously (n=16,726 with localised disease at diagnosis).  Twenty-five survey respondents on AS/WW were interviewed to explore their experiences in depth.   Psychological status was measured using two validated scales (SWEMWEBS, well-being; K6, distress). Univariable and multi-variable analyses compared outcomes between men on AS/WW and those who received active treatment.  Interviews were analysed using Framework analysis.


3,986 (23.8%) respondents were on AS/WW.  Overall, psychological scores were positive.  Men on AS/WW had similar or better scores than those who received active treatment (SWEMWBS:  Poor well-being; 6.9% AS/WW vs 8.1% active treatment, p=0.02; K6: severe psychological distress; 4.4% vs 5.1%, p=0.05). Multivariable analysis indicated no difference in outcomes between men on AS/WW and active treatment.  Interviews indicated most participants on AS/WW had adjusted well.  Men with poorer well-being were less able to accept and normalise the diagnosis, and described receiving insufficient information and support, and a lack of confidence in their health-care team. 


Most men on a monitoring pathway cope well psychologically, and this information should be helpful to men making treatment decisions.  Factors associated with how men adjust indicate ways in which health professionals can improve the support they provide.

The Life After Prosate Cancer Diagnosis study was funded by the Movember Foundation, in partnership with Prostate Cancer UK.