Psychiatric treatment among Swedish men with prostate cancer

A new paper in the European Journal of Cancer suggests that men with prostate cancer are at increased risk for depression, for post-traumatic stress disorder, and for use of antidepressant drugs compared to age-matched controls.

Bill-Axelson et al. used data from the PCBaSE Sweden database to explore whether self-reported psychological distress among men with prostate cancer required psychiatric treatment. Specifically they set out to calculate and compare the relative risks (RRs) of psychiatric treatment due to depression, anxiety, and post-traumatic stress disorder while controlling for patient age and socioeconomic factors.

Here is what they found:

  • The database included 72,613 men with prostate cancer and 217,839 men without prostate cancer who were suitable for analyses.
  • Risk for psychiatric hospitalization among patients with prostate cancer was significantly increased as a result of
    • Depression (RR = 1.29)
    • Anxiety (RR = 1.42)
    • Post-traumatic stress disorder (RR = 1.61)
  • Psychiatric hospitalization  due to anxiety was only increased in men with more advanced forms of prostate cancer (RR = 2.28).
  • The use of antidepressants was increased among all men with prostate cancer (RR = 1.65) and across all types of treatment (RR = 1.93).

The authors conclude that a diagnosis of prostate cancer (at least among Swedish patients) was associated with an increased risk of psychiatric treatment for depression and post-traumatic stress disorder, as well as the use of antidepressants (regardless of risk group and treatment strategy) compared to age-matched controls. In contrast, only  more advanced forms of prostate cancer were associated with severe anxiety disorders.

3 Responses

  1. Urological surgeons, radiologists and oncologists use increasingly sophisticated techniques. Unfortunately us prostate cancer patients are the same old fearful human beings. Even in the 21st century cancer still has a unique ability to terrify.

    Surgeons and other specialists take immense care to make sure that their treatments do not injure the prostate cancer patient — the punctured rectum, the hospital acquired infection, etc., are feared complications. Depression should be viewed as one of those complications. If the clinical specialists do not take this very seriously, those who are financing the lengthy treatment and rehabilitation of the patients affected — insurance companies or, as in the UK, the taxpayers — certainly should.

    I say this because the serious anxiety and depression of the prostate cancer patient can be caused and can be avoided by how the clinician talks to the patient — manages expectations, breaks bad news, and (very important this) is able to communicate the nuances and “grey areas” of doubtful outcomes such as positive margins without causing panic.

    It seems to me that, even today, much of medicine is about talking to people, but perhaps, in this era of the latest robot, radiation beam, and drug combination, it is a tool that is undervalued. The skill and sensitivity of the specialist and the nurse (or the lack thereof) when having having a two-way conversation with the old-fashioned, fearful human being that is their patient can cause or prevent that fear from turning into depression.

  2. Thanks for sharing your views about depression. I am a medical student and researching on depression. I think these words would really help me.

  3. Psychiatry is the medical specialty devoted to the study and treatment of mental disorders. These mental disorders include various affective, behavioral, cognitive and perceptual abnormalities. Men with prostate cancer are at increased risk for depression. I really love to read articles that have good information about depression and ideas to share to each reader.

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