Prostate Cancer Anxiety in Survivors, Results from a Population-Based Cohort

Abstract

Anxiety in cancer survivors can be harmful because it is associated with depression, poorer adherence to medical treatment, poorer treatment outcomes, and higher rates of mortality. However, anxiety in prostate cancer survivors has not been well-studied and is not well understood. In the only modern, fully-prospective, population-based cohort, 951 men diagnosed from 2011-13 with localized prostate cancer were enrolled throughout the state in collaboration with the North Carolina state cancer registry. All patients were prospectively followed, and anxiety assessed using the validated Memorial Anxiety Scale for Prostate Cancer (MAX-PC); 11 items assess prostate cancer anxiety with total score range from 0 (none) to 33 (most anxiety). Multivariable analysis using generalized estimating equations assessed patient and diagnostic factors associated with anxiety. Diversity of the cohort reflects population-based recruitment: 26% non-white, 30% high school education or less, 23% rural. Median age 65. Mean anxiety score for the entire cohort was 6.1 (out of maximum 33) at 12 months, 5.1 at 24 months, 4.8 at 36 months, and 5.0 at 48 months. Mean score at 48 months by subgroup is summarized in Table. Multivariable analysis showed that longer follow-up (48 vs 12 months, estimate -1.1, p<.01), lower risk cancer (low vs high, estimate -1.5, p<.05; intermediate vs high, estimate -1.5, p=.04), and older age (estimate -0.1 per year, p<.01) were associated with less anxiety. Conversely, non-white men (vs white, estimate 2.4, p<.01) and lower education (vs college, estimate 2.1, p<.01) were associated with higher anxiety. Active surveillance patients had borderline higher anxiety compared to RT (estimate 1.0, p=.068). Anxiety in prostate cancer survivors decreases over time, but certain subgroups—especially minority patients and those with lower educational attainment—experience higher anxiety than other subgroups at 48 months follow-up. While disparities in prostate cancer treatment and survival are well-described, to our knowledge this is the first study demonstrating disparity by race and education in mental well-being in prostate cancer survivors.Abstract 198; Table 1Mean Prostate Cancer Anxiety score at 48 months by subgroup (range 0–33)Treatment ModalityActive surveillance5.6Radical prostatectomy4.9RT4.6RaceWhite4.2Non-white7.4NCCN Risk CategoryLow5.1Intermediate4.6High5.3EducationHigh school or less6.4College or higher4.3 Open table in a new tab