Abstract
PurposeThe constructs evaluated in investigating association between psychosocial factors and cancer survival has varied between studies, and factors related to quality of life (QOL) have shown contradictory results. We investigated the effect of socioeconomic and early QOL and psychological factors on disease-free time and survival in localized prostate cancer.MethodsA consecutive sample of patients with localized prostate cancer (T1–3, N0, M0) treated with external beam radiotherapy completed validated questionnaires on coping with cancer (the Ways of Coping Questionnaire WOC-CA), anger expression (the Anger Expression Scale), life events (the Life Experience Survey), and various aspects of QOL (the Rotterdam Symptom Checklist, the Depression Scale DEPS, the EORTC QLQ-C30, the LENT-SOMA outcome measure) approximately 4.5 months after diagnosis. Cox regression analyses were used to determine the predictors of the disease-free and overall survival times measured from the date of diagnosis to the date of a PSA-relapse and date of death.ResultsAfter controlling for biological prognostic factors, age, and adjuvant hormonal therapies, moderate and high socioeconomic status and an increased level of pain predicted longer survival, whereas an increased level of prostate-area symptoms and fatigue and, especially, reports of no/few physical symptoms were predictors of a shorter survival time. A longer PSA-relapse-free time was predicted by Cognitive Avoidance/Denial coping, whereas problems in social functioning, hopelessness, and an excellent self-reported QOL predicted a shorter PSA-relapse-free time.ConclusionsHigher socioeconomic status was prognostic for longer survival, as previously reported. Patients with a seemingly good QOL (few physical complaints, excellent self-reported QOL) had poorer prognoses. This association may due to the survival decreasing effect of emotional non-expression; patients with high emotional non-expression may over-report their wellbeing in simple measures, and thus actually be in need of extra attention and care.
Highlights
The association between psychosocial factors and cancer survival has been convincingly demonstrated only during recent decades [1,2,3,4,5,6,7,8,9,10,11,12]
Information on progression of the prostate cancer, i.e., prostate-specific antigen (PSA) follow-up was available for 77 patients, and 18 (23%) of them had been diagnosed with PSA verification of prostate cancer relapse
Overall survival and disease-free time in patients with localized prostate cancer were predicted by socioeconomic status, psychological factors, and patient-reported quality of life (QOL)
Summary
The association between psychosocial factors and cancer survival has been convincingly demonstrated only during recent decades [1,2,3,4,5,6,7,8,9,10,11,12]. Emotional non-expression (“repression”) [6, 17,18,19], hopelessness [7, 20, 21], depression [1, 10, 11, 20], and stress-related psychological factors [8, 12, 20] have been suggested to predict a shorter survival, whereas social support [22] and denial or minimizing coping response to the cancer to predict a more favorable prognosis [2, 5,6,7,8, 12, 21]. A good reported QOL has shown an association with a poorer prognosis [6, 7, 9]
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