The effectiveness of psychological intervention for depression, anxiety, and distress in prostate cancer: A systematic review of literature

Journal article extract: Prostate Cancer and Prostatic Diseases, March 2021

Rhea Mundle, Evans Afenya, Neeraj Agarwal

DOI 10.1038/s41391-021-00342-3

“The increasing incidence and declining mortality rates seen in prostate cancer will result in a growing survivorship with a burden of health conditions, warranting attention to psychological health. Depression, anxiety, and distress have prognostic significance; attempts have been made to reduce them with psychological interventions using cognitive- and/or education-based approaches. The review of literature attempted to measure a clinically meaningful difference between pre- and post-intervention scores that were previously reported in randomized clinical trials.

The frequency of anxiety and depression may increase after biochemical recurrence while on androgen deprivation therapy (ADT) and/or after metastasis especially in relation to repeated PSA testing. PSA- related anxiety may be temporally limited to the time of PSA testing only and specifically may coincide with disease progression when a rise in PSA is seen. On the other hand, cancer-related anxiety and general anxiety may be more directly relevant to prostate cancer survivorship regardless of PSA levels and may manifest even past 10 years after the initial diagnosis. Overall, prostate cancer patients are likely to have 2.5- fold higher odds of experiencing anxiety and 2-fold higher odds of experiencing depression as compared to population without a lifetime history of cancer.

Using the PRISMA-checklist, we identified 22 studies that assessed psychological interventions by randomizing against care as usual (CAU). We calculated a percent change between pre- and post-trial mean scores for depression, anxiety, and distress in each study and analyzed effectiveness of intervention versus CAU.

Our analysis of randomized psychological intervention studies in prostate cancer demonstrates encouraging success in improving anxiety, depression, and distress. The untreated psychological issues have serious consequences. Therefore, even 20–40% lowering of anxiety, depression, and/or distress seen in our analysis is significant and may warrant attention in regular clinical practice at all stages of their long prostate cancer survivorship. Most prostate cancer patients tend to be older with a considerable medication burden and recurring psychological issues during survivorship. Treating them with cognitive-behavioral solutions and/or appropriate education may thus be a highly prefer- able alternative, as opposed to immediately prescribing antidepressant or anti-anxiety medications.

Our study sheds light on the urgent need for urologists and oncologists to routinely monitor prostate cancer patients for early signs of anxiety, depression, or distress. As shown by our findings, psychological intervention with cognitive and educational components may provide an easy, non-invasive, and effective solution if used in a timely manner while the symptoms are mild to moderate. With the majority of prostate cancer patients being elderly, already having a significant burden of other medications, such non-pharmaceutical interventions may be of special value.

Our analytical study underscores the need for periodic psychological screening and the benefit of a timely psychological intervention for anxiety, depression, and distress. In the long survivorship of prostate cancer, this may particularly contribute to better long-term health outcomes in patients and also may provide savings of medical resources. In addition, the study highlights the importance of using interventions that comprise both cognitive and educational components in a standardized protocol easy to adopt into clinical guidelines and routine practice.”

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