Abstract
BackgroundThere are uncertainties about prostate cancer‐related anxiety's (PCRA) associations with health‐related quality of life (HRQOL) and major depression, and these could affect the quality of mental healthcare provided to prostate cancer patients. Addressing these uncertainties will provide more insight into PCRA and inform further research on the value of PCRA prevention. The goals of this study were to measure associations between PCRA and HRQOL at domain and subdomain levels, and to evaluate the association between PCRA and probable (ie, predicted major) depression.MethodWe analyzed secondary cross‐sectional data from the North Carolina Prostate Cancer Comparative Effectiveness & Survivorship Study (NC ProCESS—a population‐based cohort of prostate cancer patients enrolled shortly after diagnosis [between January 2011 and June 2013] and followed prospectively). Patient‐reported measures of PCRA and HRQOL from 1,016 enrollees who participated in NC ProCESS’s 1‐year follow‐up survey were assessed. Outcomes of interests were a) linear correlations between contemporaneous memorial anxiety scale for prostate cancer (MAX‐PC) and Short Form 12 (SF‐12) scores, and b) measures of association between indicators of clinically significant PCRA (ie, MAX‐PC > 27) and probable depression during survey contact (ie, SF‐12 mental component score ≤43).ResultsPCRA measures had notable associations with SF‐12’s mental health subscale (assesses low mood/nervousness [rho = −0.42]) and emotional role functioning subscale (assesses subjective productivity loss [rho = −0.46]). Additionally, the risk of probable depression was significantly higher in participants with clinically significant PCRA compared with those without it (weighed risk ratio = 5.3, 95% confidence interval 3.6‐7.8; P < .001).ConclusionProstate cancer patients with clinically significant PCRA should be assessed for major depression and productivity loss.
Highlights
Prostate cancer patients stand to benefit from widespread adoption of these recommendations because (a) men are less likely than women to report mental health symptoms or seek mental healthcare,[7,8] and (b) their unmet mental healthcare needs increase over time.[9]
Not much is known about Prostate Cancer Related Anxiety (PCRA) and it may be mistaken for other anxiety disorders. 7,8 This is important as limitations in current knowledge of PCRA may adversely affect patients’ safety
Survivorship guidelines state that “Survivors with significant or persistent prostate-specific antigen (PSA) anxiety may be at heightened risk of depressive symptoms....”14,15—published evidence supporting this statement is mixed and this could introduce uncertainty into clinical decision-making on whether prostate cancer patients with clinically significant PCRA should be assessed for major depression and vice versa.[10,16,17,18,19,20]
Summary
This research was funded by the Agency for Healthcare Research and Quality (AHRQ), US Department of Health and Human Services (DHHS) as part of the DEcIDE program, contract HHSA29020050040I, and the Patient-Centered Outcomes Research Institute® (PCORI) Award (CER 1310-06543).
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