Cancer-related symptoms, mental well-being, and psychological distress in men diagnosed with prostate cancer treated with androgen deprivation therapy.

There are known associations between treatment of prostate cancer (PCa) involving Androgen Deprivation Therapy (ADT) and psychological and physical side effects. We investigate the associations between cancer-related symptoms, health-related quality of life (HRQL), and poor psychological outcomes in men whose treatment for PCa involved ADT.

A cross-sectional postal questionnaire was administered to UK men 18-42 months post diagnosis of PCa. Men completed items on functional outcomes using the Expanded Prostate Cancer Index Composite (EPIC-26), EuroQol-5D (EQ-5D), and the European Organisation for Research and Treatment of Cancer (EORTC) Fatigue subscale. Psychological outcomes (mental well-being and psychological distress) were assessed using the Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS) and the Kessler 6-item scale (K6), respectively. Associations between explanatory variables and psychological outcomes were assessed using stepped logistic regression.

13,097 men treated with ADT completed a questionnaire. A minority of men reported poor mental well-being (15.5%) or severe psychological distress (6.6%). After controlling for sociodemographic and clinical variables, reporting clinically significant fatigue was strongly associated with severe psychological distress (OR 9.92; 95% CI 7.63 to 12.89) and poor well-being (OR 3.86; 95% CI 3.38 to 4.42). All cancer-related symptoms and HRQL variables were associated with both psychological outcomes.

While the majority of men treated with ADT did not report poor psychological outcomes, a small proportion reported severe problems. Clinically significant fatigue was demonstrated as a possible indicator of poor outcomes. Healthcare systems need to have clear protocols in place which specifically and routinely target psychological distress and fatigue.

Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation. 2019 May 21 [Epub ahead of print]

Sarah Wilding, Amy Downing, Penny Wright, Peter Selby, Eila Watson, Richard Wagland, David W Donnelly, Luke Hounsome, Hugh Butcher, Malcolm Mason, Ann Henry, Anna Gavin, Adam W Glaser

Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK. ., Leeds Institute of Medical Research at St James's, University of Leeds, Leeds, UK., Department of Midwifery, Community and Public Health, School of Nursing and Midwifery, Oxford Brookes University, Oxford, UK., Faculty of Health Sciences, University of Southampton, Southampton, UK., Northern Ireland Cancer Registry, Queen's University Belfast, Belfast, UK., National Cancer Registration and Analysis Service, Public Health England, Bristol, UK., Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK.