Abstract
Background: Recent large population-based studies have shed light on an association between prostate cancer (PCa) survivorship and mental health, which emerged when the comparison group was either men without a history of cancer or those with any other type of cancer except prostate. Here we examine the role of surgery alone, compared to other types of treatment modalities in this association in a population-based sample of men with prostate or other types of cancer. Methods: A cross-sectional analysis was conducted on a subsample of 632 male participants aged 36–69 from the 2009–2015 survey cycle of the Atlantic PATH cohort study. The primary outcomes were the presence of mild, moderate or severe depression or anxiety indicators and were assessed using the seven-item generalized anxiety disorder (GAD-7) scale and the nine-item Patient Health Questionnaire (PHQ-9), respectively. The presence of a lifetime history of PCa or other form of cancer (except PCa) was the main predictor variable and was assessed in cancer treatment modality (surgery or other types of treatment modalities) stratified analyses. Covariates included age, marital status, household income, comorbidity, and survivorship time. Results: The presence of depression in this sample was prevalent among 17.7% of men, and of anxiety among 9.3% of men. Survivors who were treated with surgery for their PCa diagnosis had 7.55 statistically significantly higher odds of screening positive for current depression symptoms compared with those of other forms of cancer in controlled analyses. These differences were not observed for anxiety. Conclusions: These findings emphasize the need for multidisciplinary survivorship care plans among PCa patients, especially those who undergo surgery. Targeted programming aimed at prioritizing and delivering comprehensive mental health support to PCa survivors early in the survivorship journey is justified.
Highlights
Prostate cancer is the second most common cancer in men worldwide and the fifth leading cause of men’s cancer death [1]
Results were pooled in a summary measure following multiple imputation (MI) analyses with analytic sample of 268 for each of our two outcomes and were compared with the listwise exclusion original dataset which had analytic samples of 299 and 291 responses for each of our two outcomes, respectively. In this population-based sample, 22.1% of men reported having a history of prostate cancer (PCa) diagnosis and 77.9% reported having a history of other forms of cancer
The fitted model for surgery was statistically significant (X2 (8) = 32.91, p < 0.001) and stable (Hosmer and Lameshow X2 (8) = 4.24, p > 0.05), predicting 41% of depression (Nagelkerke R2 = 0.41). Results of this analysis revealed that men with a history of prostate cancer who were treated with surgery for their cancer diagnosis had 7.55 (ORMI = 5.09) statistically significant higher odds for screening positive for current depression status, compared to those with other types of cancer who were treated with surgery for their cancer diagnosis
Summary
Prostate cancer is the second most common cancer in men worldwide and the fifth leading cause of men’s cancer death [1]. Mental health issues emerging from unmet survivorship needs among prostate cancer survivors revealed a silent epidemic of loneliness and disconnect [7,9,12]. Caucasian ethnicity, urinary problems and erectile dysfunction, dissatisfaction in relationships with current partner, substance abuse, and multimorbidity have been identified as factors predicting depression and/or anxiety in prostate cancer survivors [9,10,11,12]. The most salient risk factors for suicide attempts among prostate cancer survivors include Caucasian ethnicity, older age, male gender, living alone, and distant disease as men are most at risk for suicide >15 years after diagnosis [4]
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