Abstract
PurposeThere are known associations between treatment of prostate cancer (PCa) involving Androgen Deprivation Therapy (ADT) and psychological and physical side effects. We investigate the associations between cancer-related symptoms, health-related quality of life (HRQL), and poor psychological outcomes in men whose treatment for PCa involved ADT.MethodsA cross-sectional postal questionnaire was administered to UK men 18–42 months post diagnosis of PCa. Men completed items on functional outcomes using the Expanded Prostate Cancer Index Composite (EPIC-26), EuroQol-5D (EQ-5D), and the European Organisation for Research and Treatment of Cancer (EORTC) Fatigue subscale. Psychological outcomes (mental well-being and psychological distress) were assessed using the Short Warwick–Edinburgh Mental Well-being Scale (SWEMWBS) and the Kessler 6-item scale (K6), respectively. Associations between explanatory variables and psychological outcomes were assessed using stepped logistic regression.Results13,097 men treated with ADT completed a questionnaire. A minority of men reported poor mental well-being (15.5%) or severe psychological distress (6.6%). After controlling for sociodemographic and clinical variables, reporting clinically significant fatigue was strongly associated with severe psychological distress (OR 9.92; 95% CI 7.63 to 12.89) and poor well-being (OR 3.86; 95% CI 3.38 to 4.42). All cancer-related symptoms and HRQL variables were associated with both psychological outcomes.ConclusionsWhile the majority of men treated with ADT did not report poor psychological outcomes, a small proportion reported severe problems. Clinically significant fatigue was demonstrated as a possible indicator of poor outcomes. Healthcare systems need to have clear protocols in place which specifically and routinely target psychological distress and fatigue.
Highlights
Prostate cancer (PCa) is the most common cancer in men in the UK [1]
Aim: As part of the Life After Prostate Cancer Diagnosis (LAPCD) study, we aim to investigate which cancer-related symptoms and health-related quality of life (HRQL) variables are associated with mental well-being and psychological distress in men 18-42 months post diagnosis of PCa who reported receiving Androgen Deprivation Therapy (ADT)
In the overall LAPCD sample, 35,823 men responded to the questionnaire (60.8% response rate) of whom 30,114 men reported receiving one of the most common treatment types (Online Resource 2). 13,097 (43.5%) men reported receiving ADT
Summary
Prostate cancer (PCa) is the most common cancer in men in the UK [1]. Over the last 40 years, the number of men living with a diagnosis of PCa survival has tripled [2]. With increasing numbers living for long periods with and beyond their diagnosis, understanding and improving the experience of patients post diagnosis and treatment are growing priorities [3]. Quality of Life Research (2019) 28:2741–2751 the negative psychological impact of PCa is the increasingly prevalent group of men, with earlier stage of disease, treated with Androgen Deprivation Therapy (ADT) [6, 7]. A recent meta-analysis of 18 studies found that risk of depression increased by 41% in men on ADT [12]. Further studies have shown that 19.6% of men on ADT report clinically significant anxiety and that increasing ADT length is associated with poorer quality of life [13], and increased risk of anxiety [14]
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