ASCO 2022: Longitudinal Screening for Depression and Anxiety in Prostate Cancer and Association With Disease and Treatment Factors

(UroToday.com) At the 2022 American Society of Clinical Oncology Annual Meeting held in Chicago and virtually, the poster session focused on Prostate, Testicular, and Penile cancers on Monday afternoon included a presentation from Dr. Risa L. Wong discussing mental health outcomes and screening in men with prostate cancer.

In patients with cancer, untreated depression and anxiety are associated with worse oncologic outcomes. As a result, there are recommendations for longitudinal screening; however, many patients are only assessed at the start of care and not longitudinally through their cancer journey. Prostate cancer is, typically, a disease with a prolonged natural history through which men traverse many phases of disease or treatment over a span of years. Further, prostate cancer treated with androgen deprivation therapy (ADT) has been associated with mood changes and depression. However, the longitudinal trends in depressive or anxiety symptoms in men with prostate cancer, and how they are influenced by disease and treatment factors, is not well-described.

Thus, the authors emailed men with at least one 1 Urology or Medical Oncology clinic visit for prostate cancer in the prior 6 months the PHQ-9 and GAD-7 depression and anxiety screening tools every 60 days. Using these screening tools, a score of ≥10 (moderate to severe symptoms) on either was considered a positive screen.

The authors then collected further data on baseline characteristics and disease/treatment changes (PSA, radiographic, or biopsy progression, treatment change or start, or discontinuation of treatment due to lack of efficacy or toxicity) by survey and chart review. In this analysis, they are focused on examining those factors associated with a positive screen or change in screening status. They used a forward stepwise binary logistic regression model to identify significantly associated factors using the following model inputs: receipt of ADT or disease/treatment change during study, and variables previously associated with depression or anxiety: age, race, marital status, education, income, history of psychiatric disorder, use of psychoactive medication, time since diagnosis, and localized, biochemically recurrent, or metastatic disease.

Between June 2021 and December 2021, 201 men were identified and enrolled. At baseline, 50.7% had localized, 18.9% biochemically recurrent, and 30.3% metastatic disease. Reflecting this distribution, 40.8% were on ADT.

Interestingly baseline mental health conditions were prevalent: 30.8% had a history of psychiatric disorder (22.9% depression, 19.9% anxiety, 9.0% other) and 24.9% were on psychoactive medication (19.9% antidepressant, 8.5% anxiolytic, 2.0% antipsychotic).

Among the 201 men enrolled, 184 men completed at least 2 screens allowing for longitudinal assessment, with a mean follow-up of 6.5 months (SD 1.3) between screens. 32 men (15.9%) screened positive at least once (15.4% PHQ-9, 4.5% GAD-7), of which half (N = 16) initially screened negative and later positive. Changing from a negative to positive screen was more likely when a disease/treatment change occurred during the study (18.3% vs 4.5%, p = 0.003). A higher proportion of men on ADT screened positive, especially if newly started during the study or in the 60 days preceding (35.7% new ADT vs 24.7% continuing ADT vs 8.0% no ADT, p = 0.002). In fully adjusted multivariable analyses, factors associated with a positive screen were a history of psychiatric disorder (OR 6.3, 95% CI 2.6-15.4, p < 0.001), receipt of ADT (OR 3.8, 95% CI 1.5-9.5, p = 0.005), and lower income bracket (OR 1.7, 95% CI 1.3-2.5, p = 0.002).

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Thus, the authors concluded that longitudinal screening for depression and anxiety in men with prostate cancer not infrequently identifies men who initially screen negative and subsequently develop significant mental health concerns. Symptoms are associated with ADT and disease or treatment changes, which may inform optimal screening practices.



Presented by: Risa L. Wong, MD, Department of Medicine, Division of Hematology/Oncology, University of Pittsburgh, Pittsburgh, PA