Now here’s a REALLY unsurprising piece of news!

A new report in the journal JAMA Oncology is said to have detailed “the psychological damage” that a cancer diagnosis “often leaves in its wake for patients.”

To be fair to the authors, this is a huge study, involving data from > 300,000 cancer patients and > 3 million people without cancer, all randomly selected from the entire Swedish population. However, one does have to wonder what the authors were either expecting or hoping to prove with this study.

Lu et al. carried out a nationwide, matched cohort study based on data in Swedish population and health registries from January 1, 2001, to December 31, 2010. Each patient with cancer was matched to roughly 10 people without cancer by sex and by year of birth. They then used these data to estimate risk from a variety of mental disorders over time — from as much as 2 years prior to a diagnosis of cancer to 10 years after such a diagnosis, while making adjustments for things like age, sex, calendar period, and educational level. They also looked at data on the use of psychiatric medications in the management of milder mental conditions and symptoms among patients diagnosed with cancer in 2008 and 2009.

Here is what they found:

  • Average (median) age at diagnosis for the patients with cancer was 69 years, and 46.9 percent of the patients were female.
  • Among the cancer patients (compared to the cancer-free individuals) the relative rate for all studied mental disorders
    • Began to increase at 10 months before cancer diagnosis (hazard ratio [HR] = 1.1)
    • Peaked during the first week after diagnosis (HR = 6.7)
    • Decreased rapidly thereafter, but …
    • Remained elevated at 10 years after diagnosis (HR = 1.1)
  • The increase in the rate of all mental disorders was
    • Evident for all major cancers
    • Not evident for non-melanomatous skin cancer
    • Stronger for cancers that have poorer prognoses
  • Among the cancer patients (compared to the cancer-free individuals), an increase in use of psychiatric medications
    • Became evident at 1 month before cancer diagnosis
    • Peaked at around 3 months after diagnosis

The authors conclude that:

Patients diagnosed as having cancer had increased risks of several common mental disorders from the year before diagnosis. These findings support the existing guidelines of integrating psychological management into cancer care and further call for extended vigilance for multiple mental disorders starting from the time of the cancer diagnostic workup.

Arguably, it may be surprising that these numbers are this low, and that the risk for mental disorders appears to “wear off” as fast as the authors seem to suggest. Although the available data from this study is relatively limited with respect to specific types of cancer, what you will see if you look at Figure 4 in the full text of the article is that men diagnosed with prostate cancer were significantly less likely to be given prescriptions to address mental disorders than patients being told they had some other forms of cancer. Of course this could just reflect the male tendency to believe that they should just be able to “tough things out” without the need for recourse to pharmaceutical assistance for stress, depression, and other types of reaction commonly associated with a diagnosis of cancer.

Of course what we know in the “real world” (as opposed to the world of registries and databases) is that — for a significant proportion of men who are diagnosed with and treated for prostate cancer — there can be really serious mental and social consequences to their treatment that affect their social relationships, their marriages, and their entire sense of “self”. We have very little idea just how prevalent such effects really are. Many men simply will not talk about this at all. Their wives and partners know. Their children know. Many of their co-workers may have some clue. But the patients do not speak about any of this to their doctors and are unwilling to seek any type of professional help because they see any expression of their very real distress as a “weakness” that they can’t afford to admit to.

5 Responses

  1. This is a very important issue, and one where support groups and proper advocacy are so important. I have read uncountable tales of men treating with low-grade, low-volume prostate cancer because of the psychological pressure of having “cancer” and needing to “do something” about it.

    Proper education and counseling could save so many … :-(

  2. “Began to increase at 10 months before cancer diagnosis (hazard ratio [HR] = 1.1)
    Peaked during the first week after diagnosis (HR = 6.7)
    Decreased rapidly thereafter,”

    Yes, most people know before diagnosis.

    The first week is not when you want to start planning treatment.

    Curious what kind of a hazard split would occur between treated and active surveillance in prostate cancer, had that been tracked.

  3. Mike,

    This still seems strange: do most people really know a full 10 months before their diagnosis? I didn’t …

  4. Steve:

    This paper deals with patients with all types of cancers, not just prostate cancer. Many people with cancers of different types will know there is something “not quite right” months before they get a diagnosis. This would still be true today for men who get diagnosed when they have metastatic prostate cancer — but is unlikely for most men getting diagnosed with localized prostate cancer.

  5. Your last paragraph … no truer words were ever spoken.

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