Treatment Type a Non-Factor in Prostate Cancer Patients' Anxiety

Incidence of anxiety among prostate cancer patients was similar, no matter what type of primary treatment they chose, a researcher said.

No matter if prostate cancer patients underwent risk-based active surveillance/watchful waiting (AS/WW) or active treatment (AT) with radical prostatectomy or radiation therapy, median incidence of anxiety was comparable (16% in both groups), reported Rhea Mundle, BS, of the University of Illinois at Urbana-Champaign.

However, median incidence of depression was slightly lower (9.9%) in the active surveillance group versus the active treatment group (15%), she said at the Oncology Nursing Society virtual annual meeting.

In prostate cancer, patients face decisions at several points along the trajectory of their illness that can be particularly stressful -- specifically the point at which they make their primary treatment decision.

In general, she said, patients with low- or intermediate-risk prostate cancer (based on the D'Amico risk-stratification method) tend to choose active surveillance/watchful waiting, while high-risk patients are more likely to opt for active treatment.

"With the diagnosis, symptom burden, and treatment side effects, anxiety and depression are common in these patients" -- which can lead to "decisional regret" over time, Mundle added.

For the analysis, she and her co-authors conducted a literature search, ultimately selecting 13 studies, with eligibility based on validated assessment tools and available data for anxiety and depression after diagnosis or at later follow-up.

The researchers used mean scores for anxiety and depression at baseline and at a median 12 months of follow-up to calculate a percentage change to determine how depression and anxiety improved or worsened between these two points in time.

In the period between baseline and the median 12-month follow-up, both sets of patients were more likely to show improvements in anxiety than depression, Mundle said. For anxiety there were 12.5% and 16% improvements in AS/WW and AT, respectively, while the improvement in depression was only 1.9% in AS/WW and 4.1% in AT.

"Within the active treatment group, relative improvement in anxiety was significantly higher than in depression," she said.

Study limitations, the team noted, included that only a limited number of studies were included, with varying types of tools used to measure anxiety and depression as well as in the data-reporting methodologies.

"Anxiety and depression may be present following diagnosis and the 12-month follow-up time regardless of active surveillance or active treatment choice," Mundle said, adding that without psychological intervention limited improvement is seen in anxiety, and even less in depression. "If there are timely psychological interventions there may be less decisional regret over treatment choice," she said.

Given their close involvement with patients, nurses can play a key role in helping patients deal with the emotional and psychological issues associated with treatment choice, Mundle noted. "A nurse-led psychological intervention is highly desirable."

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