Abstract
BackgroundSudden, unwelcome and repetitive thoughts about a traumatic event – intrusive thoughts – could relate to how men assess their quality of life after prostate-cancer diagnosis. We aimed to study the prevalence of intrusive thoughts about prostate cancer and their association with quality-of-life outcomes before and after radical prostatectomy.MethodsDuring the first year of the LAPPRO-trial, 971 men scheduled for radical prostatectomy were prospectively included from 14 urological centers in Sweden. Of those, 833 men responded to two consecutive study-specific questionnaires before and three months after surgery (participation rate 86%). The association of intrusive thoughts with three quality-of-life outcomes, i.e. self-assessed quality of life, depressive mood and waking up with anxiety was estimated by prevalence ratios that were calculated, together with a 95% confidence interval, at the same time-point as well as over time. Fisher’s exact-test was used to analyze differences between respondents and non-respondents. Wilcoxon signed-ranks and Cochran-Armitage trend tests were used for analysis of change over time. To validate new questions on intrusive thoughts, written answers to open-ended questions were read and analyzed by qualitative content analysis.ResultsBefore surgery, 603 men (73%) reported negative intrusive thoughts about their cancer at some time in the past month and 593 men (59%) reported such thoughts three months after surgery. Comparing those reporting intrusive thoughts at least weekly or once a week before surgery with those who did not, the prevalence ratio (95% confidence interval), three months after surgery, for waking up in the middle of the night with anxiety was 3.9 (2.7 to 5.5), for depressed mood 1.8 (1.6 to 2.1) and for impaired self-assessed quality of life 1.3 (1.2 to 1.5).ConclusionThe prevalence of negative intrusive thoughts about prostate cancer at the time of surgery associates with studied quality-of-life outcomes three months later.Trial registrationCurrent Controlled Trials, ISRCTN06393679
Highlights
When facing a diagnosis of a life-threatening disease such as prostate cancer, disease-related thoughts could relate to men’s assessment of quality of life
Studies performed at one time-point in the disease process or among patients receiving various treatments, suggest that there could be an association between intrusive thoughts and impaired quality of life among men with prostate cancer [4,6,7,8,9], but quality-of-life measurement scales rarely include questions on thoughts [10]
Prospective large-scale studies in welldefined study-groups could reveal if the association between intrusive thoughts and quality-of-life outcomes is sufficiently well based for further utilization in studies or clinical interventions
Summary
When facing a diagnosis of a life-threatening disease such as prostate cancer, disease-related thoughts could relate to men’s assessment of quality of life. In direct relation to a traumatizing event, possibly the frequency and intensity of intrusive thoughts can serve as a measure of the quality of life. Studies performed at one time-point in the disease process or among patients receiving various treatments, suggest that there could be an association between intrusive thoughts and impaired quality of life among men with prostate cancer [4,6,7,8,9], but quality-of-life measurement scales rarely include questions on thoughts [10]. Unwelcome and repetitive thoughts about a traumatic event – intrusive thoughts – could relate to how men assess their quality of life after prostate-cancer diagnosis. We aimed to study the prevalence of intrusive thoughts about prostate cancer and their association with quality-of-life outcomes before and after radical prostatectomy
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