Psychosocial distress at diagnosis and 12 months later

Every prostate cancer patient (and many patients subsequently found not to have prostate cancer) have been through the psychological and social distress associated with the risk of a diagnosis of prostate cancer. It’s no fun. Prostate cancer — like its rarer cousin, testicular cancer — hits deeply at some of the most fundamental issues of “maleness.”

An Australian research team has recently made an attempt to assess levels of psychosocial distress in men with early (localized) and advanced (metastatic) forms of prostate cancer at the time of initial diagnosis (Time 1) and again 12 months later (Time 2). They also wanted to try and identify psychosocial factors that might be predictive of later distress.

The study conducted by Couper et al. was an observational, prospective study of > 350 consecutive attendees recruited at seven clinics in Melbourne between April 1, 2001 and December 30, 2005. All patients completed questionnaires at Time 1 and at Time 2. The research team used standard survey instruments to assess things like health-related quality of life; psychological distress, including depression and anxiety; and coping patterns.

The basic results of the study showed the following:

  • The total number of study participants was 367 men: 211 with early stage disease and 156 with advanced disease.
  • Between Time 1 and Time 2, both the early and advanced stage groups of patients showed reduced vitality and increased depression and anxiety; this effect was greater in the advanced PCA group
  • Mental health, social functioning, and role-emotional functioning also deteriorated in the advanced group.
  • For patients in the early stage group
    • Predictors of depression at Time 2 were depression, vitality, and a fatalistic coping pattern at Time 1.
    • Predictors of anxiety at Time 2 were anxiety and vitality at Time 1.
  • For patients in the advanced stage group
    • Predictors of depression at Time 2 were depression and mental health at Time 1.
    • Predictors of anxiety at Time 2 were anxiety, mental health, cognitive avoidance and lower anxious preoccupation at Time 1.

The conclusions drawn by the authors in their abstract are unsurprising:

  • That men with early stage prostate cancer experience decreasing vitality and increasing psychological distress over the 12 months following diagnosis.
  • That this trend is accelerated after a diagnosis of advanced prostate cancer.
  • That a “fatalistic” coping pattern at diagnosis of early stage disease predicts later depression
  • That cognitive avoidance and lower anxious preoccupation at diagnosis of advanced disease predict later anxiety.

The more interesting aspect of this study is its size and the fact that we are starting to see real interest in this issue as a research topic. This has future implications for a serious initiative to look at the long-term psychosocial consequences of a diagnosis of prostate cancer and the need to build suitable “coping” and post-treatment strategies into the management of this disease, along with the clinical treatment of the cancer itself.

6 Responses

  1. Is anyone surprised by these results? I would think that the outcome of this study would have been obvious from the start of it. How do people think an individual is going to react to a diagnosis of cancer? Throw a party? I can’t tell you how many people tried to trivialize my diagnosis by saying “none of us has a guarantee in life. I could get hit by a bus tomorrow. ”

    Guess what. None of them offered to trade places with me either. Just like anyone who is told they have a potentially fatal illness, it’s devastating. Like the lyrics in a country song I heard once, “Everyone wants to go to Heaven, just not right now. “

  2. As Homer Simpson might say, “Duuh!”, which is the sound he makes caused by the pain of expressing the self-evident like it’s a revelation.

    One clarification worth making: Based on everything I’ve read to date, early stage and/or indolent prostate cancers are essentially asymptomatic. They do not cause a loss in “vitality.” The treatments, and the treatments alone, cause the loss in “vitality.”

    As long as we keep intellectually and emotionally clouding these issues, the medical field is provided a rationalization to continue the status quo state of treatments (and act like they’re a miracle), which if performed in other contexts would be considered forms of torture outlawed by the Geneva Convention. It’s the treatment that causes the impact on “vitality” — time to quit lying about it and own it.

  3. According to the original abstract and your recap, “Over the 12 months, both the early and advanced PCA group showed reduced vitality and increased depression and anxiety.” Neither your summary or the original abstract mention if either earlier or more advanced prostate cancer subjects in this study had any treatment between the first survey or the one 12 months later? How are we to know if increased anxiety occurred because of the nature of the disease, versus the impact of whatever treatments these patients went through? That intervening variable (with prognoses after treatment) would make a big difference in affect during the year of study, no?

  4. Dear Rabbi Ed:

    Yes. Of course it would. If you have access to that particular issue of the Medical Journal of Australia, you will probably find the detail you are looking for in the full test of the article. Unfortunately I do not. If you get a copy of the article, please feel free to forward a copy to me too!

  5. Just to bring my favourite subject — active surveillance into the mix, one of the points AGAINST active surveillance is said to be the additional anxiety created — and, with anxiety, depression often comes along too. This extract from an Insight article puts that issue into some focus, I think:

    “The psychological effects of living for many years with untreated cancer are a potential concern. Does the cumulative effect, year after year, of knowing one is living with untreated cancer lead to depression or other adverse effects? The best data on this comes from a companion study to the Holmberg randomized trial of surgery vs. watchful waiting in Sweden. It found absolutely no significant psychological difference between the two groups after five years. Worry, anxiety, depression, all were equal between the two arms. While surveillance may be stressful for some men, the reality is that most patients with prostate cancer, whether treated or not, are concerned about the risk of progression. Anxiety about PSA recurrence is common among both treated and untreated patients. It is hoped that with education patients will begin to understand the very indolent natural history of most good-risk prostate cancers and, with the realization that the disease is not life-threatening, may avoid much of this anxiety.”

  6. The study Terry cites indicates that anxiety or depression occurs some time after diagnosis, whether or not a patient has a more active treatment or active surveillance, and both worry about not being cured. This is in contrast to those I profiled in my book (Conquer Prostate Cancer), who felt a sense of loss due to post-treatment diminished function. But many — especially those who had surgery with a post-surgical negative margins — felt “cured.” Feeling you’re cured and feeling anxious or depressed appear to be separate issues when it comes to prostate cancer treatment effects. I wonder if there is any scientific study of my admittedly anecdotal conclusion?

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