Anxiety and Depression in Patients with Prostate Cancer, at Cancer Diagnosis and after a One-Year Follow-Up

Abstract

Prostate cancer (PCa) is the most prevalent among men, and psychological symptoms may affect many patients. This study aims to describe the prevalence of probable anxiety and depression before PCa treatments and after one year and to identify sociodemographic and clinical factors associated with these outcomes. Between February 2018 and March 2020, 292 patients recently diagnosed with PCa were recruited at the Instituto Português de Oncologia—Porto. The Hospital Anxiety and Depression Scale (HADS) was used to define probable anxiety and depression (cutoff = 11). The prevalence of probable anxiety remained stable from baseline to one year (7.8% vs. 8.5%, p = 0.866) while there was an increase in probable depression (3.1% vs. 6.8%, p = 0.012). After one year, probable depression persisted in 55.6% of patients with probable depression at baseline and 47.8% of those with probable anxiety at the first assessment had normal anxiety scores. At baseline, anxiety was more frequent among dwellers in rural areas (adjusted odds ratio—aOR, 95%CI: 2.80, 0.91–8.58) and less frequent in patients with body mass index 25–29.9 kg/m2 (aOR, 95%CI: 0.33, 0.12–0.91) compared to 18.5–24.9 Kg/m2, while those living alone had higher odds of depression (aOR, 95%CI: 6.35, 1.43–28.30). The frequency of anxiety and depression fluctuated during the course of treatment. Monitoring these symptoms would identify the most affected patients, contributing for a better use of mental health services.

Demographic and Clinical Factors Associated With Health-Related Quality-of-Life Profiles Among Prostate Cancer Survivors

“…37,38 One previous study of PCa survivors found that poorer overall physical health was associated with older age and more comorbidities, whereas poorer mental health was associated with younger age, more comorbidity, and higher stage at diagnosis. 39 Our study identifies subgroups of PCa survivors who may be at risk for poor overall health during their survivorship.…”

“…We also observed a strong association of having comorbidities with being in the low HRQOL profile, consistent with previous studies of PCa showing that greater comorbidity burden is associated with worse HRQOL. 39,51,52 Men who received systemic therapy (mostly hormonal therapy) were more likely to be in the low HRQOL profile than men who did not receive therapy, adjusting for stage and all other variables, which may relate to hormonal therapy increasing fatigue and affecting general physical function. 53…”

“…50 We also observed a strong association of having comorbidities with being in the low HRQOL profile, consistent with previous studies of PCa showing that greater comorbidity burden is associated with worse HRQOL. 39,51,52 Men who received systemic therapy (mostly hormonal therapy) were more likely to be in the low HRQOL profile than men who did not receive therapy, adjusting for stage and all other variables, which may relate to hormonal therapy increasing fatigue and affecting general physical function. 53 While most associations were similar in the baseline and follow-up survey, one notable exception was for educational attainment, which was not associated with HRQOL on the baseline survey, but was very strongly associated with HRQOL profiles on the follow-up survey.…”

Determining the optimal cut-off scores for the Chinese version of the Memorial Anxiety Scale for Prostate Cancer (MAX-PC)

“…Diagnosis and treatment of PCa cause not only physical complications, such as urinary incontinence, urinary tract irritation, and erectile dysfunction [ 2 ], but also mental health issues. Anxiety is the most frequently reported negative emotion among patients with PCa, with incidence rates ranging from 15.09 to 32.6%, as revealed by various studies employing different anxiety assessment tools [ 3 , 4 ]. In patients with PCa, regular testing of the prostate-specific antigen (PSA) index is essential to monitor treatment outcomes and disease progression [ 5 ].…”