Psychological morbidity associated with prostate cancer: Rates and predictors of depression in the RADICAL PC study

Abstract

Introduction: Across all cancer sites and stages, prostate cancer has one of the greatest median five-year survival rates, highlighting the important focus on survivorship issues following diagnosis and treatment. In the current study, we sought to evaluate the prevalence and predictors of depression in a large, multicenter, contemporary, prospectively collected sample of men with prostate cancer.
 Methods: Data from the current study were drawn from the baseline visit of men enrolled in the RADICAL PC study. Men with a new diagnosis of prostate cancer or patients initiating androgen deprivation therapy for prostate cancer for the first time were recruited. Depressive symptoms were evaluated using the nine-item version of the Patient Health Questionnaire (PHQ-9). To evaluate factors associated with depression, a multivariable logistic regression model was constructed, including biological, psychological, and social predictor variables.
 Results: Data from 2445 patients were analyzed. Of these, 201 (8.2%) endorsed clinically significant depression. Younger age (odds ratio [OR] 1.38; 95% confidence interval [CI] 1.16–1.60 per 10-year decrease), being a current smoker (OR 2.77; 95% CI 1.66–4.58), former alcohol use (OR 2.63; 95% CI 1.33–5.20), poorer performance status (OR 5.01; 95% CI 3.49–7.20), having a pre-existing clinical diagnosis of depression or anxiety (OR 3.64; 95% CI 2.42–5.48), and having high-risk prostate cancer (OR 1.49; 95% CI 1.05–2.12) all conferred independent risk for depression.
 Conclusions: Clinically significant depression is common in men with prostate cancer. Depression risk is associated with a host of biopsychosocial variables. Clinicians should be vigilant to screen for depression in those patients with poor social determinants of health, concomitant disability, and advanced disease.

Post-Treatment Adverse Health Correlates among Prostate Cancer Survivors in a Sample of Men Residing in Atlantic Canada

“…This study population is demographically consistent with other population studies that have investigated the relationship between the presence of a history of a cancer diagnosis and mental health [7][8][9][10][11][12]. It contributes to the body of literature in its findings that prostate cancer survivors cannot be broadly categorized with the mental health needs of other cancer survivors and, furthermore, there are differences among prostate cancer survivors themselves.…”

“…Taken together, when these biopsychosocial factors emerge, it is not surprising that clinical depression is noted among the prostate cancer survivors group. These findings combined with other emerging results in the literature point to the need for clinicians to be vigilant to screen for depression in prostate cancer patients who show poor social determinants of health, especially when surgery is chosen as the choice of treatment for their disease [8,17].…”

“…It is important that patients are fully informed about the potential side effects of treatment, including surgery, and that mental health support is provided in the short-and long-term. New studies have emerged in the past few years stressing the importance of providing multidisciplinary education and survivorship care to survivors of prostate cancer, given the higher rates of depression and anxiety compared to men with any other form of cancer in the short and long term [7][8][9][10][11][12].…”

“…With over 1.1 million men diagnosed annually, there is an ever growing population of patients living with a prostate cancer diagnosis [3][4][5][6]. As such, it is becoming increasingly important to understand what unmet survivorship needs may lead to poor quality of life and short-and long-term mental health issues in this population [7][8][9][10][11][12]. Prostate cancer treatments including surgery, radiation, hormone therapy, chemotherapy, or a combination are highly effective, but are also plagued by a host of life-altering side effects.…”

“…In recent years, mental health issues emerging from unmet survivorship needs among prostate cancer survivors revealed a silent epidemic of loneliness and disconnect [7,9,12]. A recent report presents evidence of an association between poor mental health and psychological morbidity and biopsychosocial variables, including poor oncological outcomes, particularly but not limited to advanced forms of the disease [8]. More than one in two men diagnosed with prostate cancer experience mental health distress [16], with 10-40% scoring positive for clinically significant depression at various points during their survivorship journey [9,12,17,18].…”