THE "NEW" PROSTATE CANCER INFOLINK

Your sitemaster is going to write this commentary with as much tact as he can muster but he is aware that this is going to be a very sensitive subject for some readers to deal with.

Some of us are invariably brave; some of us not. Some of us are worriers; some of us are not. Some of us are control freaks; some of us are not. But how most of us respond to a diagnosis of prostate cancer, the subsequent needs for treatment, and the consequences of that treatment is profoundly affected by the varied aspects of our personalities.

A new report by Perry et al. in the journal in Psycho-oncology set out to explore the nature of the relationship between personality and emotional distress in men who had been diagnosed with prostate cancer. They did this by asking > 200 men with a history of prostate cancer to participate in a study that measured a whole spectrum of information that ranged from concrete data (like the patients’ ages, their educational history, the time since their diagnosis, and whether they did or didn’t have metastatic prostate cancer ) to psycho-social issues (like personality, anxiety, depression, and whether they had ever considered suicide). They used a series of well-validated measures to assess the psycho-social profiles of the study participants.

Here is what Perry et al. report:

• 212 men with a history of prostate cancer participated fully in the study.
• About 78/212 men (37 percent) reported emotional distress associated with their prostate cancer, including
  • Depression (37 percent)
  • Anxiety (15 percent)
  • Suicidal ideation (10 percent)

Note that this means that roughly three-quarters of the patients did not exhibit emotional distress.

And let’s be very clear here: thinking about suicide can be a very long way from actually be willing to do it. “Suicidal ideation” is not a measure of the risk that someone will actually commit suicide. It is “only” a measure of whether it has actually crossed one’s mind to a lesser or a greater degree. Your sitemaster, for example, has quite commonly considered the idea on bad days over the past 60-odd years. He has never actually considered it seriously as a way to deal with a specific problem or issue.

So before we move to the next set of results, it is important to appreciate that the authors started this study with an hypothesis. Their hypothesis was this: that “neuroticism” and “introversion” would be shown to be associated with clinically significant symptoms of emotional distress.

Now “neuroticism” and “introversion” are scientifically defined terms as opposed to judgements about people’s personalities. We’re all “neurotic” some of the time and many of us can alternate between “introversion and “extraversion” depending on circumstances. Their definitions need to be seen in the context of what are known as the “big five” traits commonly used by psychologists in classification and  categorization of personality types.

• Neuroticism is the tendency to experience unpleasant emotions (anger, anxiety, depression, and vulnerability) easily; it can also be used to refer to the degree of emotional stability and impulse control expressed by an individual person.
• Introversion is the opposite of extraversion, and extraversion is a measure of energy, positive emotions, surgency, assertiveness, sociability, the tendency to seek stimulation in the company of others, and talkativeness; low extraversion (“introversion”) is associated with a reserved, reflective personality (sometimes perceived as aloof or self-absorbed).

With those definitions out of the way, let’s look at the second set of findings from this study, which are the following:

• Compared to the average, men who were categorized as “neurotic” by the study findings were more likely to report
  • Emotional distress (44.5 vs. 26.9 percent; odds ratio [OR] = 2.78, p = 0.004)
  • Depression (31.9 vs. 11.8 percent; OR = 4.23, p =0.001)
  • Suicidal ideation (29.4 vs. 9.7 percent; OR = 4.15, p = 0.001)
• Compared to the average, men who were categorized as “introverts” by the study findings were more likely to report
  • Emotional distress (45.2 vs. 28.7 percent; OR = 2.32, p = 0.012)
  • Depression (30.8 vs. 15.7 percent; OR = 2.57, p = 0.014).
• Compared to men with no sign of metastatic prostate cancer, men with metastases were more likely to report
  • Emotional distress (51.7 vs. 31.2 percent; OR = 4.56, p < 0.001)

Arguably, these findings are not exactly a surprise. What it tells us is that,

 … in the context of treatment for prostate cancer, patient distress reflects disease characteristics (e.g., metastases presence) as well as stable personality traits.

What is probably more important is that understanding each patient’s personality profile is an important factor in the overall management of that patient and in understanding how one needs to  be able to talk with him about treatment needs and opportunities in an appropriate manner.

Your sitemaster would also point out that (to whatever extent we are willing to accept what we know about ourselves) most of us have a reasonably clear understanding where we fall on the “neuroticism” scale as well as on the “extravert/introvert” scale. Knowing this about ourselves is something that should be made clear in conversations with our doctors so that they don’t “sugar-coat the truth” when it is the truth we want to hear and that they know how to  package information for us in ways that we can cope with given our individual personalities.

Filed under: Diagnosis, Living with Prostate Cancer, Management, Risk, Treatment | Tagged: Diagnosis, distress, introversion, neuroticism, personality, Treatment |