Effect of Depression on Diagnosis, Treatment, and Mortality of Men With Clinically Localized Prostate Cancer

Abstract

Purpose Although demographic, clinicopathologic, and socioeconomic differences may affect treatment and outcomes of prostate cancer, the effect of mental health disorders remains unclear. We assessed the effect of previously diagnosed depression on outcomes of men with newly diagnosed prostate cancer. Patients and Methods We performed a population-based observational cohort study using Surveillance, Epidemiology, and End Results-Medicare linked data of 41,275 men diagnosed with clinically localized prostate cancer from 2004 to 2007. We identified 1,894 men with a depressive disorder in the 2 years before the prostate cancer diagnosis and determined its effect on treatment and survival. Results Men with depressive disorder were older, white or Hispanic, unmarried, resided in nonmetropolitan areas and areas of lower median income, and had more comorbidities (P < .05 for all), but there was no variation in clinicopathologic characteristics. In adjusted analyses, men with depressive disorder were more likely to undergo expectant management for low-, intermediate-, and high-risk disease (P ≤ .05, respectively). Conversely, depressed men were less likely to undergo definitive therapy (surgery or radiation) across all risk strata (P < .01, respectively). Depressed men experienced worse overall mortality across risk strata (low: relative risk [RR], 1.86; 95% CI, 1.48 to 2.33; P < .001; intermediate: RR, 1.25; 95% CI, 1.06 to 1.49; P = .01; high: RR, 1.16; 95% CI, 1.03 to 1.32; P = .02). Conclusion Men with intermediate- or high-risk prostate cancer and a recent diagnosis of depression are less likely to undergo definitive treatment and experience worse overall survival. The effect of depression disorders on prostate cancer treatment and survivorship warrants further study, because both conditions are relatively common in men in the United States.

Suicide and accidental deaths among patients with non‐metastatic prostate cancer

“…These findings suggest that the psychological factors underlying the refusal of definitive primary treatment in men who are appropriate candidates for it may translate into an increased risk of suicide, an association that has previously been reported in lung cancer [34]. Within the SEER-Medicare dataset, men with pre-existing depression and diagnosed with prostate cancer were significantly less likely to undergo definitive therapy (surgery or radiation) and had worse overall mortality [35]. Physicians, therefore, need to: (i) be mindful of the fact that men with loco-regional prostate cancer who refuse or otherwise do not undergo definitive treatment represent an at-risk, 'rescuable' population for suicidal death and may need close monitoring [36,37], (ii) work with mental health professionals, social workers and trained oncology nurses to identify the unique predisposing factors that may drive this risk, and (iii) encourage active participation of the patient's family and self-help groups in developing support mechanisms, as the perception of social support by a patient with cancer is an important risk modifier [38,39].…”

Socioeconomic inequalities in prostate cancer survival: A review of the evidence and explanatory factors

“…33 studies indicate a significant association between SES and survival among prostate cancer patients (fully adjusted model if multivariate analyses were conducted) (Aarts et al, 2013a(Aarts et al, , 2013b; Australian Institute of Health and Walfare (2013); Berglund et al, 2012;Bravo et al, 2014;Burns et al, 2014;Byers et al, 2008;Chang et al, 2012;Du et al, 2006;Freeman et al, 2011;Hall et al, 2005a;Hellenthal et al, 2010;Hussain et al, 2008;Jansen et al, 2014;Jeffreys et al, 2009;Li et al, 2012;Louwman et al, 2010;Luo et al, 2013;Marsa et al, 2008;Niu et al, 2010;Prasad et al, 2014;Rachet et al, 2010;Robbins et al, 2007aRobbins et al, , 2007b; Rowan et al, 2008;Schwartz et al, 2009;Shack et al, 2007;Tewari et al, 2005Tewari et al, , 2006 one study also reports this trend without presenting data about significance (Pokhrel et al, 2010), and another study does not indicate significant results regarding the most current calendar period but former periods (Dutta Roy et al, 2005). 11 studies did not verify a significant association in the fully adjusted model (Haynes et al, 2008;McPhail et al, 2013;Miki et al, 2014;Movsas et al, 2014;Papa et al, 2014;Rapiti et al, 2009;Shafique et al, , 2012b…”

The Impact of Preexisting Mental Health Disorders on the Diagnosis, Treatment, and Survival among Lung Cancer Patients in the U.S. Military Health System

“…Socioeconomically, people with mental health disorders may be more likely to be unemployed, have lower education level, and live at or below the poverty level; these factors are associated with less access to healthcare, screening services, in-patient care and out-patient clinical visits, thereby resulting in delayed diagnosis (15–17), inadequate or less-aggressive treatments (16, 18, 19) and poorer survival (14–18, 20–25). Behaviorally, mental health disorders are commonly linked to unhealthy lifestyles such as smoking, alcohol and substance abuse, physical inactivity, poor nutrition and poor physical health, which contribute to cancer progression and mortality (10, 11, 14, 26, 27).…”