Abstract
Objectives To estimate the prevalence of unsuspected anxiety or depression in prostate cancer patients and their spouses, as well as factors involved in its onset. Materials and Methods. A prospective study of 184 patients and 137 spouses evaluated in our hospital during 2019 using the Memorial Anxiety Scale for Prostate Cancer (MAX-PC), Hospital Anxiety and Depression Scale (HADS) and Patient Health Questionnaire depression module (PHQ-9). This study provides an internal validity assessment of the scales and their correlation (alpha and rho coefficients; index r). The contributions of age, education level, months after diagnosis, pain, prostate-specific antigen (PSA) level, stage of the disease and treatment performed to the positivity of the questionnaires were studied using the Wilcoxon–Mann–Whitney and chi-square tests. Results The prevalence of anxiety was 10.9% (MAX-PC) and 28.3% (MAX-PC-PSA). The HADS-A questionnaire indicated pathology in 14.1% of the patients and 16.05% of the spouses. Depression was detected in 7% (HADS-D) and 9.2% (PHQ-9) of patients as well as in 8.8% (HADS-D) and 16.05% (PHQ-9) of their spouses. The greatest concordance between men and women was with the PHQ-9 (Spearman's rho: 0.78; p = 0.01). Education level is significantly related to the presence of anxiety and depression, regardless of the questionnaire applied. The probability of detecting pathology in the MAX-PC varied from 6% in patients with elementary education to 23.5% in university students (p = 0.04). The greatest differences were detected when applying the PHQ-9 to patients (4% pathological, elementary education vs. 35.3% pathological, university education). Our study confirms the lack of a relationship between rates of anxiety and depression and factors such as PSA level, age of the patient and number of comorbidities. Conclusion There is a high prevalence of unsuspected anxiety and depression in patients with prostate cancer and their wives. Education level correlates with such prevalence.
Highlights
A total of 22.3% had undergone multimodal treatment. e median time from diagnosis to our evaluation disease was 18 months for patients who underwent RP, 12 months for those treated with RT, 23 months for patients who underwent HT and 48 months for those who opted for AS as the first treatment modality
Education level (Table 5) was clearly and consistently related among all the questionnaires. is association is independent of the questionnaire used and was demonstrated in spouses. e probability of detecting pathology in the Memorial Anxiety Scale for Prostate Cancer (MAX-prostate cancer (PC)) varied from 6% in patients with elementary education to 23.5% in university students (푝 = 0.04). e greatest differences were detected when applying the PHQ-9 to patients (4% pathological, elementary education vs. 35.3% pathological, university education)
E high statistical concordance between the results obtained from the questionnaires used in our patients indicates the possibility of using any of the instruments, the MAX-PC (PSA) is possibly the most robust when determining the anxiety produced by the periodic determination of this marker
Summary
Due to advances in the early diagnosis of prostate cancer (PC) and improvements in treatment in the different phases of the disease, we are witnessing a significant increase in the number of patients who “coexist” with their PC [1]. is increase in survival is not exempt from morbidity, and the functional sequelae of the treatments used have been widely described, including urinary incontinence, erectile dysfunction, intestinal disorders, hot flashes, weakness and fatigue.Despite the high prevalence of patients and the potential symptomatology of adverse effects, there is a striking lack of research on the nature and prevalence of psychological disorders and psychiatric illness in this population [2,3,4]. is lack of research is multifactorial, but it may be due in large part to the prioritization of survival outcomes over the quality of life by health professionals involved in the follow-up of these patients. Due to advances in the early diagnosis of prostate cancer (PC) and improvements in treatment in the different phases of the disease, we are witnessing a significant increase in the number of patients who “coexist” with their PC [1]. Is lack of research is multifactorial, but it may be due in large part to the prioritization of survival outcomes over the quality of life by health professionals involved in the follow-up of these patients. Our objectives are to estimate the prevalence of clinically relevant, not previously diagnosed or treated, depressive symptoms in PC patients with good control of their disease and in their spouses, how it is interrelated, and the possible clinical and oncological factors involved in the onset itself.
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