Factors associated with emotional distress in newly diagnosed prostate cancer patients

Abstract

Objective-Early identification and intervention have been recommended for newly diagnosed prostate cancer patients who experience significant emotional distress; however, there is little empirical basis for designing or selecting interventions for these men. We sought to identify factors that are associated with distress in these men as a basis for identifying suitable intervention strategies.Methods-Using cross-sectional data and validated scales, we investigated the extent to which clinical, demographic, belief, and personality characteristics are associated with emotional distress assessed with the Distress Thermometer in 1425 men newly diagnosed with clinically localized prostate cancer (pre-treatment).Results-Beliefs potentially amenable to psycho-educational interventions [low self-efficacy for decision-making (B=−0.11, p=.02), low confidence in cancer control (B=−0.03, p<.001), and masculine identity threat (B=−0.26, p=.001)] were associated with higher emotional distress, as were personality factors [low optimism (B=−0.04, p=.052) and low resilience (B=−0.83, p<.001)].Conclusions-Findings provide a framework for the development of interventions for prostate cancer patients with elevated emotional distress. These may include improving provider communication about prostate cancer prognosis for those with low confidence in cancer control; providing decision-making support to increase decision-making self-efficacy; or referral to brief cognitive behavioral interventions to help patients reframe masculine identity threat or those with low optimism or resilience reframe and adjust to the health threat. *Corresponding author: Heather Orom, 304 Kimball Tower, 3435 Main St., Buffalo, NY 14214; Phone: 716-829-6682; Fax: 716-829-6040; horom@buffalo.edu. Cancer patients often experience elevated levels of emotional distress, not only at diagnosis and during treatment, but also long past initial treatment [1,2]. There is growing consensus that identifying and intervening to reduce emotional distress is an essential component of cancer care [3,4]. One strategy for preventing distress in later stages of survivorship is identifying those who experience significant distress soon after diagnosis and providing appropriate early intervention [5]. However, even though effective screening tools for emotional distress, anxiety or depression are available to identify those who could benefit from additional support [6,7], less is known about the kinds of intervention components that are needed [8]. To match intervention and patient, we need a better understanding of factors underlying distress. The present work advances our understanding of the factors associated with emotional distress in newly diagnosed prostate cancer (PCa) patients, the second largest group of survivors in the U.S., numbering 2.8 million [9], so as to inform the design of suitable early interventions for these patients. HHS Public AccessStudies investigating psychological wellbeing in men diagnosed with PCa have demonstrated two patterns. First, emo...

Racial Disparities in Emotional Distress Among Cancer Survivors: Insights from the Health Information National Trends Survey (HINTS)

“…After adjusting for several previously identified confounding variables, the findings show a moderating effect of race on the relationship between cancer history and emotional distress, with African American cancer long-term survivors experiencing significantly higher levels of emotional distress compared to the general cancer and non-cancer populations. Consistent with previous studies, the study also found associations between socio-demographic factors [7], physical health [20], self-efficacy [11,21], optimal lifestyle behaviors [22][23][24], and emotional distress.…”

“…However, compared to the matched Caucasian control group, a lower proportion of African American patients in this study reported depressive symptoms. In contrast, Orom et al [11] observed a marginally significant (p = 0.05) positive association between African American race and emotional distress among newly diagnosed prostate cancer patients.…”

“…In addition to clinical factors, non-clinical factors reported to be associated with emotional distress among cancer survivors include socio-demographic factors, such as age [7,8] and educational level [7]; limited functional status [9]; low self-efficacy [10,11]; suboptimal social support [10]; poor coping mechanisms, including emotional suppression [10,12]; and financial stress resulting from costly cancer care [13].…”

Emotional Distress Increases the Likelihood of Undergoing Surgery among Men with Localized Prostate Cancer

“…Distress was slightly lower after men had made their treatment decision, but it remained a predictor of having chosen surgery over active surveillance and surgery over radiation in the sample as a whole and in men with low risk disease. A number of studies have shown that emotional distress is relatively high among newly diagnosed men, 12,16,24 but our study is novel as it demonstrates both prospectively and cross-sectionally that emotional distress motivates PCa patients to choose more aggressive treatment.…”

“…study of PCa treatment decision making and survivorship. 16 Participants with newly diagnosed clinically localized PCa were approached at two comprehensive cancer centers and three community facilities between July 2010 and August 2014. Of the 3337 patients approached to participate, 2,476 were consented; 2,008 completed the first survey.…”