Clinical depression among prostate cancer patients: a 10-year analysis

The association of depression with a diagnosis of and subsequent treatment for prostate cancer is well appreciated, but the prevalence of that depression and the burden it places on men with prostate cancer over time has been less well documented.

Jayadevappa et al. have used data from the linked Surveillance, Epidemiology and End Results-Medicare (SEER-Medicare) database to identify men diagnosed with prostate cancer between 1995 and 1998 and carry out a retrospective assessment of information about these patients for a maximum of 1 year pre-diagnosis and up to 8 years post-diagnosis. Clearly the vast majority of patients in this database would have been men of 65+ years of age who were eligible for Medicare, so this study is focused — de facto — on older prostate cancer patients and can not be used to provide accurate guidance about the incidence and prevalence of depression in younger prostate cancer patients.

Here are the key findings of this retrospective data analysis:

  • The study identified 50,147 men newly diagnosed with prostate cancer between 1995 and 1998.
  • 4,285/50,147 men (8.54 percent) also had a diagnosis of depression.
  • A diagnosis of depression during the treatment phase was associated with greater likelihood (higher odds ratio or OR) of
    • Visits to hospital emergency departments (OR = 4.45)
    • Hospitalizations (OR = 3.22)
    • Outpatient visits (OR = 1.71)
  • A diagnosis of depression during the treatment phase was also associated with excess risk of death over the course of the follow-up interval (hazard ratio [HR] = 2.82).

Inevitably, health care-related costs associated with depression were elevated among the prostate cancer patients with depression (compared with costs for the patients without depression) over the course of the follow-up.

The authors state that, “These findings emphasize the need to effectively identify and treat depression in the setting of prostate cancer.”

What this study also does not tell us about is the prevalence and the burden of undiagnosed depression among prostate cancer patients on Medicare. Men have a strong tendency to avoid admitting to depression, which means that they never get clinically diagnosed, and so it seems highly likely that the true prevalence of depression is significantly higher than the 8.5 percent documented in this study.

It is difficult to know whether the association with an increase in mortality reported in this study is a  chicken or an egg problem. In other words, does it mean that men at higher risk of prostate cancer mortality are more likely to be diagnosed with clinical depression, or does it imply that men with prostate cancer and diagnosed clinical depression are really at greater risk for prostate cancer-specific mortality? We have no insights into this from the available data.

5 Responses

  1. Mike,

    I have been seeing a counselor at MSKCC to discuss my mental side effects from ADT treatment issues and depression. A couple of times he has suggested possible medication for depression. I believe I am suffering from depression but have resisted treatment to date. I thought I could tough it out. I have recently had some issues and just called him today to ask about possibly starting some depression medication. My oncologist does not support any mental or cognitive issues related to the use of ADT and his acertians to my disability carrier (I had/have an approved claim) are likely to force me back into the workplace. There is no way I will be able to function in the workplace without some medication and even then I am going to have to take a position at a reduced capacity or stop IADT. Not a great choice … which adds to my issues!!

  2. Bill:

    Are you saying that your medical oncologist (a) denies the existence of mental/cognitive side effects associated with long-term ADT or that s/he thinks that (b) you are better off not getting treated for them because you are better off being out on disability than having to try to work while on the ADT? That doesn’t sound like much of a choice to me.

  3. Even though I explained in great detail (in writing and verbally) the effects ADT has on my cognition and how it impairs my work as a senior financial executive, my oncologist completely ignores this when completing the attending physician update to my LTD carrier and in fact wrote that I can return to work if I feel up to it.

    The carrier now states I have no medical reason for disability. Now I am 55 (6 years since diagnosis) so I have no choice but to try to go back to work. I know for sure the impact ADT has on my ability to work at a very senior level. It will be my decision to forgo future ADT if in fact I need to return to work.

    I am going for an cognitive evaluation from a new doctor to see if this will support my claim. It is a real rock and a hard place situation.

  4. I wonder how many of those diagnosed in the treatment stage actually had undiagnosed depression prior to treatment. A cancer diagnosis and treatment has a big and complex effect on the psyche, no doubt about that. There is nothing like prostate cancer and its often humiliating treatment side effects to make you feel not so tough anymore. One effect might be to cause a formerly tough guy to face up to his previously unadmitted depression and seek help. I know I did.

  5. Geez!

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