Psychosocial problems that adversely affect quality of life are common among men after receiving treatment for prostate cancer (PCa), and they need help managing depression, coping with fear of cancer recurrence, and dealing with other issues, according to investigators.
Using data from a web-based support system that was part of a National Cancer Institute-funded 5-year study of 431 men with PCa, Erin K. Tagai, PhD, MPH, a postdoctoral fellow at Fox Chase Cancer Center/Temple University Health System in Philadelphia, and colleagues examined psychosocial concerns of men within 1 year of PCa treatment. They examined how confident men felt about maintaining their health and relationships with others and their satisfaction with how they communicate with their physicians. They also investigated practical concerns related to managing family, job, and financial responsibilities.
Dr Tagai’s team labeled the first year post-treatment as the re-entry phase because patients are leaving the identity of patient and entering survivorship. “We know from previous research that prostate cancer patients often do not feel prepared for managing this transition into post-treatment care,” Dr Tagai told Renal & Urology News. “Moreover, research has not yet investigated prostate cancer patients’ psychosocial concerns when re-entering their pre-diagnostic roles with their family, friends, and other responsibilities.”
Treatment, racial differences
The study showed that men with higher incomes and health literacy levels have more confidence re-entering post-treatment life, whereas patients with clinically significant depression reported lower self-efficacy for re-entry, negative interactions with medical providers, and greater overall concerns. In addition, the study revealed racial differences, with non-Hispanic black patients reporting less self-efficacy for re-entry compared with non-Hispanic white patients.
“One finding was particularly surprising and of relevance to urologists,” Dr Tagai said. “Patients who had undergone surgery had more practical concerns with managing their daily activities than those who had undergone radiation. While both treatments often lead to side effects, it appears that surgical patients have more perceived concerns about how their diagnosis and treatment will impact their lives in survivorship.”
Dr Tagai presented the findings at the American Public Health Association’s 2019 Annual Meeting and Expo in Philadelphia.
Co-investigator Suzanne M. Miller, PhD, Professor of Cancer Prevention and Control at Fox Chase, said urologists should pay attention to the different concerns men may have after completing treatment. “Urologists can tailor their patient-provider communication by talking directly to patients about managing their side effects and post-treatment care, as well as addressing any concerns they may have such as maintaining relationships with family or managing their job, finances, or stress,” Dr Miller said. “While urologists may not be able to directly resolve these concerns, such as financial issues, urologists should be prepared to refer their patients to other resources that may be of help.”
Justin R. Gregg, MD, Assistant Professor of Urology at The University of Texas MD Anderson Cancer Center in Houston, said the prevalence of depression following PCa treatment is estimated to be around 20%. “Given the rates of, and potential racial disparities in, depression and self-efficacy following treatment, I think that this is certainly a relevant issue for prostate cancer survivors,” Dr Gregg said. “While awareness of risk factors for depression and poor-function will help providers in their daily interactions with prostate cancer survivors, further investigations into interventions that may help ameliorate these risks, including subspecialty referrals to mental health professionals and transition to survivorship clinics with expertise in common post-treatment patient concerns, would likely help the broad population of men who have been treated with prostate cancer.”
High-quality survivorship care needed
Nynikka R. A. Palmer, DrPH, MPH, of the University of California in San Francisco (UCSF), said it is critical to provide high-quality survivorship care that meets the needs of patients with PCa, especially vulnerable and underserved patients who often report poorer QoL.
“African-American men in particularly bear a disproportionate burden of prostate cancer and report poorer quality of life,” said Dr Palmer, who is the Helen Diller Family Chair in Community Education and Outreach for Urologic Cancer at UCSF. “And, there are substantial racial/ethnic and socioeconomic disparities in quality of care and health outcomes. All options for prostate cancer management and treatment have quality of life side effects. Approximately third of men diagnosed with prostate cancer will receive hormone therapy in their lifetime, and unfortunately this treatment has significant side effects that increase risk of morbidity and mortality, including depression.”
Even patients with low-risk PCa opting for active surveillance (AS) face side effects that impact QoL, such as illness uncertainty, anxiety, and fear of disease progression. Some men discontinue AS because of anxiety and distress, she said. “Future interventions to address these issues should take type of treatment into consideration, as well as quality of care received across the cancer care continuum from screening through survivorship,” Dr Palmer said.
Tagai EK, Miller S, Kutikov A, et al. Psychosocial concerns of prostate cancer patients in the first year post-treatment. Presented at the American Public Health Association’s 2019 annual meeting held November 3 to 6 in Philadelphia.