CUA 2018: Mental Health Outcomes in Adult Men with a History of Prostate Cancer Diagnosis

Halifax, Nova Scotia ( Cancer diagnoses have been established to have a significant impact on patient mental health, including in GU malignancies. Prostate cancer (PCa), especially localized prostate cancer, is unique in its relatively long survival outcomes; a longer time period for potential impact on mental health. In this study, the authors from Nova Scotia, Newfoundland and PEI, examined the mental health burden of men with localized and specifically assessed its impact/association with urinary, sleep problems, and relationship difficulties. 

Over a 1 year period (2017-2018), they included 151 men 50 years of age or older (mean age 68.39, range 50-86) with a history of clinically localized PCa. All men completed an online 15-minute survey between May 2017 and March 2018 assessing patient reported quality of life outcomes – not just mental health related! Included were Kessler Psychological Distress Scale (K10), International Prostate Symptom Score (IPSS), and Screening for Distress questionnaire (for sleep and relationship difficulties). The primary outcome of interest were the results of the K10. 

Unfortunately, as this is an ongoing study, attrition rate was not able to calculated or reported. Therefore, unclear what proportion of men actually completed the survey.

Of the 151 men, 17% men scored positive for mental health issues at the time the survey was completed – 4% for moderate and 3% for severe mental disorders. 9.4% men were on medication for anxiety, depression, or both. Of these patients, 12.6% of participants were on active surveillance (AS) and 87.4% reported having already been treated with active treatment modalities (e.g., surgery, radiation, hormonal manipulation). Post-treatment status was uncertain and not reported.

There were no documentation in the slides regarding the statistical analysis (univariate, multivariable model). 

Of these patients, 50% reported mild, 45% moderate, and 5% severe urinary problems. Relative risk was 1.70 (95% confidence interval [CI] 1.21-2.38) for screening positive for mental health problems among survivors with moderate to severe urinary problems compared with those with mild urinary problems. 

The relative risk for screening positive for mental health problems among survivors with sleep problems and current worries about relationship difficulties was 3.24 (95% CI 1.53-6.86) and 2.99 (95% CI 1.43-6.26), respectively, compared with those with no sleep problems and worries about relationship difficulties. 

Importantly, approximately 20% of the men had felt that they do not have sufficient resources to make an informed decision – and 9% regretted their decision!

Based on these simple associations, all we safely can conclude is those older men with urinary, sleep, and relationship difficulties problems are associated with having mental health problems after diagnosis and treatment of prostate cancer – though causation is far from established! 

This is an ongoing study and is continuing to accrue. At this time there are 450 patients in the sample, and the results remain the same.

Presented by: Gabriela Ilie, Soillse Scientist in Prostate Cancer Quality of Life Research, Dalhousie University, Halifax, Canada

Co-Authors: David Bell1,4, Tetteh Ago2,5, Gavin Langille1,6, David Bowes2,5, Padraic O'Malley1,4, Derek Wilke2,5, Ricardo Rendon1,4, Patil Nikhilesh2,5, Gregory Bailly1,4, Amanda Caissie2,7, Robert Thompson2,7, Larry Pan2,8, Dilip Panjwani8, Matthew Acker1,6, Thomas Whelan1,6, Joseph Lawen1,4, John Grantmyre1,4, Holly Campbell2,7, P. Scott Bagnell1,6, Manpreet Tiwana8, James E. Ashfield1,6, Robert D.H. Rutledge2,5.
Author Information:
1. Urology, Dalhousie University, Halifax, NS, Canada
2. Radiation Oncology, Dalhousie University, Halifax, NS, Canada
3. Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
4. Urology, Halifax Infirmary - QEII - Nova Scotia Health Authority, Halifax, NS, Canada
5. Nova Scotia Cancer Centre, Queen Elizabeth II Health Sciences Centre, Halifax, NS, Canada
6. Urology, Saint John Regional Hospital - Horizon Health Network, St. John's, NB, Canada;
7. Radiation Oncology, Saint John Regional Hospital - Horizon Health Network, St. John's, NB, Canada 
8. PEI Cancer Treatment Centre, Queen Elizabeth Hospital, Charlottetown, PE, Canada

Written By: Thenappan Chandrasekar, MD, Clinical Fellow, University of Toronto   Twitter: @tchandra_uromd at the 73rd Canadian Urological Association Annual Meeting - June 23 - 26, 2018 - Halifax, Nova Scotia