What are the levels of psycho-social distress in men with advanced prostate cancer, including that related to PSA anxiety?
Up to 35% of patients with cancer experience clinically significant distress, with this rate increasing even further when the person has poor prognosis and experiences more symptom burden. Research into anxiety and depression in men with prostate cancer lags behind comparable research in women with breast cancer, and there is limited evidence to guide specific recommendations in this population. An Australian cross-sectional study of 195 men diagnosed with prostate cancer between 7 and 71 months previously reported that 12% of the sample had clinically significant levels of anxiety, and 16% had similar levels of depression. None of the subjects in this study had advanced disease. A cross-sectional study of 716 men with prostate cancer aged 50-93 years evaluated depression using the Hospital Anxiety and Depression Scale. This study found that aging was related to less distress and less anxiety, but greater depressive symptoms.
Research in patients with advanced prostate cancer is similarly limited. A prospective study conducted in the US examined depression and fatigue in 53 men with recurrent or advanced prostate cancer who had been randomised to treatment with either parenteral leuprolide or oral bicalutamide. Over a 12 month period rates of at least mild depression ranged from 10.4% to 16.3%, with no significant differences between the groups, and no significant change in depression over time, despite the fact that fatigue increased during this period.
The following studies relate to mixed cancer populations with advanced disease. One study of 33 males and 35 females with advanced cancer reported prevalence of anxiety and depression as 25% and 22% respectively. Although structured measures of mood were used, the response rate was low, and only 13% of the subjects had prostate cancer. A cross-sectional study of 74 patients attending a palliative care day unit found that depression affected one in four patients. Pain and low mood were noted to be closely related, although the direction of causality is not clear. The proportion of patients with prostate cancer in the sample was not stated, although the male/female ratio was equal and all patients had advanced disease.
Detection and treatment of anxiety and depression is important for several reasons. Analysis of studies involving 16,922 patients with chronic medical illness demonstrated that patients with depression had significantly greater symptoms when severity of medical illness was controlled for. Furthermore, depression has been reported to be associated with reduced adherence to recommended treatments amongst patients with medical illness.The identification of depression is aided by attention to known risk factors for psychological morbidity. These include advanced stage of disease; presence of pain or functional disability; side-effects of treatment; fatigue and poor prognosis. Individual risk factors include a past history of depression, economic adversity, lack of social support and poor marital or family functioning. Treatment of anxiety and depression is generally effective and ideally incorporates psychotherapeutic interventions and often the use of medications. However, an Australian randomised controlled trial of antidepressant medication in patients with advanced cancer demonstrated no survival advantage and no benefit for mood for patients who did not meet criteria for major depressive disorder.
Evidence summary and recommendations
|There is little high-quality evidence describing the prevalence of anxiety and depression in patients with advanced prostate cancer.||III-3||, , |
Health professionals should be aware of risk factors for the development of anxiety and
depression and be prepared to treat appropriately.
Evidence from research in mixed cancer populations is that anxiety and depression are important comorbidities experienced by patients with advanced cancer, and that effective treatments are available.
Further information about practical approaches to the diagnosis of anxiety and depression, effective treatments and strategies for referral for specialist treatment is contained in the Clinical Practice guidelines for the psychosocial care of adults with cancer. These guidelines and the consumer resource: Cancer: How are you travelling? can be downloaded from the National Breast and Ovarian Cancer Centre website http://nbocc.org.au/health-professionals/clinical-best-practice/psychosocial-guidelines
The Prostate Cancer Foundation of Australia has produced a booklet: Maintaining your well-being: information on depression and anxiety for men with prostate cancer and their partners, in collaboration with Beyondblue, the national depression initiative:
- ↑ Zabora J, BrintzenhofeSzoc K, Curbow B, Hooker C, Piantadosi S. The prevalence of psychological distress by cancer site. Psychooncology 2001;10(1):19-28 Available from: http://www.ncbi.nlm.nih.gov/pubmed/11180574.
- ↑ Sharpley CF, Christie DR. An analysis of the psychometric profile and frequency of anxiety and depression in Australian men with prostate cancer. Psychooncology 2007 Jul;16(7):660-7 Available from: http://www.ncbi.nlm.nih.gov/pubmed/17086572.
- ↑ Nelson CJ, Weinberger MI, Balk E, Holland J, Breitbart W, Roth AJ. The chronology of distress, anxiety, and depression in older prostate cancer patients. Oncologist 2009 Sep;14(9):891-9 Available from: http://www.ncbi.nlm.nih.gov/pubmed/19738000.
- ↑ Pirl WF, Greer JA, Goode M, Smith MR. Prospective study of depression and fatigue in men with advanced prostate cancer receiving hormone therapy. Psychooncology 2008 Feb;17(2):148-53 Available from: http://www.ncbi.nlm.nih.gov/pubmed/17443645.
- ↑ 5.0 5.1 Smith EM, Gomm SA, Dickens CM. Assessing the independent contribution to quality of life from anxiety and depression in patients with advanced cancer. Palliat Med 2003 Sep;17(6):509-13 Available from: http://www.ncbi.nlm.nih.gov/pubmed/14526884.
- ↑ 6.0 6.1 Lloyd-Williams M, Dennis M, Taylor F. A prospective study to determine the association between physical symptoms and depression in patients with advanced cancer. Palliat Med 2004 Sep;18(6):558-63 Available from: http://www.ncbi.nlm.nih.gov/pubmed/15453627.
- ↑ Katon W, Lin EH, Kroenke K. The association of depression and anxiety with medical symptom burden in patients with chronic medical illness. Gen Hosp Psychiatry 2007;29(2):147-55 Available from: http://www.ncbi.nlm.nih.gov/pubmed/17336664.
- ↑ 8.0 8.1 DiMatteo MR, Lepper HS, Croghan TW. Depression is a risk factor for noncompliance with medical treatment: meta-analysis of the effects of anxiety and depression on patient adherence. Arch Intern Med 2000 Jul 24;160(14):2101-7 Available from: http://www.ncbi.nlm.nih.gov/pubmed/10904452.
- ↑ 9.0 9.1 National Breast Cancer Centre, National Cancer Control Initiative. Clinical practice guidelines for the psychosocial care of adults with cancer. Camperdown, NSW: National Breast Cancer Centre 2003 Jan 1 Available from: http://www.nhmrc.gov.au/_files_nhmrc/file/publications/synopses/cp90.pdf.
- ↑ National Breast Cancer Centre, National Cancer Control Initiative. Clinical practice guidelines for the psychosocial care of adults with cancer. Camperdown, NSW: National Breast Cancer Centre 2003 Jan 1 Available from: http://www.nhmrc.gov.au/_files_nhmrc/file/publications/synopses/cp90.pdf.