Trajectory of Depression among Prostate Cancer Patients: A Secondary Analysis of a Randomized Controlled Trial

Abstract

Background: While psychological difficulties, such as depression, among prostate cancer patients are known, their longitudinal burden remains understudied. We assessed the burden of depression across low-, intermediate- and high-risk prostate cancer groups, and the association between regret and long-term depression. Methods: Secondary analysis of data from a multi-centered randomized controlled study among localized prostate cancer patients was carried out. Assessments were performed at baseline, and at 3-, 6-, 12- and 24-month follow-up. Depression was assessed using the Center for Epidemiologic Studies Depression (CES-D) scale. A CES-D score ≥ 16 indicates high depression. Regret was measured using the regret scale of the Memorial Anxiety Scale for Prostate Cancer (MAX-PC). The proportion of patients with high depression was compared over time, for each risk category. Logistic regression was used to assess the association between regret, and long-term depression after adjusting for age, race, insurance, smoking status, marital status, income, education, employment, treatment, number of people in the household and study site. Results: The study had 743 localized prostate cancer patients. Median depression scores at 6, 12 and 24 months were significantly larger than the baseline median score, overall and for the three prostate cancer risk groups. The proportion of participants with high depression increased over time for all risk groups. Higher regret at 24-month follow-up was significantly associated with high depression at 24-month follow-up, after adjusting for covariates. Conclusions: A substantial proportion of localized prostate cancer patients continued to experience long-term depression. Patient-centered survivorship care strategies can help reduce depression and regret, and improve outcomes in prostate cancer care.

Assessing the Efficacy of a 28-Day Comprehensive Online Prostate Cancer Patient Empowerment Program (PC-PEP) in Facilitating Engagement of Prostate Cancer Patients in Their Survivorship Care: A Qualitative Study

“…Patients stated that the program filled a gap between the medical care they received in the hospital and their psychosocial survivorship needs that could be traced back to the time of diagnosis, which became more complex post-treatment due to treatment side effects. Indeed, research shows that prostate cancer patients report receiving inadequate information on strategies to address psychosocial needs cooccurring with oncological treatment, such as the need for social support, the adoption of healthier lifestyle habits related to sleep, physical fitness, eating, and stress around treatment and the possibility of cancer reoccurrence [ 32 , 36 , 41 , 42 ]. Patients reported feeling empowered, having greater agency and self-efficacy and confidence that they can better manage their treatment-related side-effects and improve their overall health.…”

“…The competency of the program’s lead was also perceived as high, 9.89/10. Together they may have contributed to the PC-PEP intervention’s success and the program’s high rates of compliance whether over the shorter duration of 28 days or the extended period of 6 months [ 32 , 33 ]. Indeed, health recommendations provided to patients by a clinician or health care professional can action positive changes in overcoming unhealthy behaviors especially when patients’ ownership over their own health is emphasized when a sense of partnership in care between clinician and patient is conveyed, when small steps toward the desired changes are identified, and a sense of genuine personal care for patients is communicated [ 73 ].…”

“…Nonetheless, future studies should attempt to replicate the qualitative assessments for the PC-PEP with independent interviewers. Two follow-up studies by our team are underway attempting to qualitatively evaluate the effectiveness of Phase 3 RCT and Phase 4 multisite implementation trials, testing the effectiveness of a 6-month PC-PEP program with interviews performed by independent interviewers [ 32 , 76 ].…”

“…Conversely, effectively addressing the support needs of cancer patients during their journey can lead to improved mental health, enhanced quality of life, better communication, and reduced healthcare utilization [ 29 , 30 , 31 ]. Therefore, identifying and managing psychological distress in prostate cancer patients is of paramount importance [ 19 , 20 , 23 , 24 , 29 , 31 , 32 ].…”

Changes in Stress Reduction Following a 28-Day Prostate Cancer Patient Empowerment Program (PC-PEP) among Prostate Cancer Survivors

“…Additionally, this population has been shown to have higher rates of depression, anxiety, and overall distress symptoms compared to those without a lifetime cancer diagnosis, which are common manifestations of stress [ 6 , 7 , 8 ]. For example, Chhatre and colleagues surveilled 743 patients with PCa over the course of 24 months and found that rates of depression increased significantly from baseline for all cancer-risk groups (14.9% to 43.5% for low-risk group, 24.9% to 43.2% for intermediate-risk, and 21.6% to 47.1% for high-risk) [ 9 ]. Similarly, in another study, 10.9% of PCa patients reported anxiety via the Memorial Anxiety Scale for Prostate Cancer, and 14.1% scored within the anxious range on the Hospital Anxiety and Depression Scale [ 10 ].…”