Recent research on psychological care for men with prostate cancer

Depression, anxiety, and suicidality in patients with prostate cancer: A systematic review and meta-analysis of observational studies

Prostate Cancer and Prostatic Diseases Volume 24 2021

DOI 10.1038/s41391-020-00286-0

“Psychiatric implications of prostate cancer are increasingly recognised, having important effects on oncological and functional outcomes. However, findings for co-occurring depression, anxiety, and suicidality remain variable. Therefore, this review of observational studies aimed to establish best estimates of the prevalence and rates of these outcomes in prostate cancer patients.

A systematic literature search was conducted using MEDLINE, Scopus, PsycInfo, and Cochrane Library databases from inception up to 26 May 2020. The review sought to provide best estimates for depression, anxiety, and suicidality after a diagnosis of prostate cancer. Our identified prevalence of clinical diagnoses of depressive disorders were consistent with global estimates in the general population of 4.4%, particularly when considering estimates of 5.5% for males aged between 55 and 74. These results are also in keeping with estimates in a cancer specific population of between 4 and 11%. Significant depressive and anxiety symptoms were common in our analysis, with these figures also largely consistent with the high prevalences of these symptoms in cancer populations as a whole. Similarly, recent suicidal ideation was common; present in 9.85%, and considerably higher than 2% 1-year general population estimates. Subsequently, the suicide mortality rate seen was high, with our identified rate considerably higher than quoted rates in the United States of 16.7 and 31.4 per 100,000 person years for both general and cancer specific populations respectively. This remains the case even when considering the higher risk groups of elderly and male patients. These results therefore demonstrate the high psychiatric morbidity and mortality experienced by men post prostate cancer diagnosis.

The findings in this meta-analysis have important clinical implications. Increased awareness of the psychiatric impact of prostate cancer and is needed. We demonstrate this to be frequent, thereby requiring a central role during follow-up. Integration of psychosocial services into current pathways is vital for improving current care Psychiatric complications of prostate cancer are common. A high prevalence of depressive and anxiety symptoms is seen in this cohort. Additionally, recent suicidal ideation and suicide mortality are high when compared to general population estimates. This highlights the importance of integrating mental health care within urological and oncological follow-up. Regular screening of patients and at-risk groups is vital for early identification and treatment and should be evaluated for improving overall quality of life and functional outcomes in prostate cancer patients.”

An exploration of the Role of the Prostate Cancer Specialist Nurse from Two International Perspectives
Seminars in Oncology Nursing Volume 36, Issue 4, August 2020

DOI 10.1016/j.soncn.2020.151043

“Specialist nursing roles have developed within different frameworks and in response to very different political drivers in the UK and in Australia. An evidence base has developed demonstrating that prostate cancer specialist nurses offer positive outcomes for men and their families. Despite some differences in the scope of international roles, there are common aspects. Both health care settings have challenges in terms of education, role definition, and capacity. Yet both prostate cancer specialist nurses roles have delivered innovative models of specialist care in terms of service delivery and patient support and education. Prostate cancer specialist nurses have the potential to significantly decrease the burden on the public health system and influence change. For men with prostate cancer and their families, prostate cancer specialist nurses can improve care through holistic nursing models focussing on what is important to individuals: support, education, management of side effects, rehabilitation, and by delivering and improving access to high-quality care.”

Prostate cancer survivorship priorities for men and their partners: Delphi consensus from a nurse specialist cohort
Journal of Clinical Nursing, Volume 29, Issue 1-2, 2020

DOI 10.1111/jocn.15096

“Specialist nurses are providing long-term survivorship care to men and their partners, however, few prostate cancer survivorship interventions are effective and priorities for nurse-led survivorship care are poorly understood. The results from this study showed that prostate cancer specialist nurses characterised the prostate cancer survivorship experience of men as under-resourced, disjointed and distressing. In all, 11 survivorship priorities for men and three for partners were identified within five broad areas: capacity building; care coordination; physical and psychosocial care; community awareness and early detection; and palliative care. Internationally, prostate cancer survivorship care for men and their partners requires urgent action to meet future need and address gaps in capacity and care coordination. Low feasibility of survivorship priorities may reflect translational challenges related to capacity. Prostate cancer survivorship care guidelines connected to practice priorities are urgently needed.”

Assessment of Current Mental Health Status in a Population-Based Sample of Canadian Men With and Without a History of Prostate Cancer Diagnosis: An Analysis of the Canadian Longitudinal Study on Aging (CLSA)
Frontiers in Psychiatry, 16 December 2020

DOI 10.3389/fpsyt.2020.586260

“Taken together with other recent reports in the literature, the results of this study point to a need that is currently unacknowledged and unaddressed in prostate cancer survivorship care plans throughout Canada. Leaving mental health needs unattended leads to poor quality of life among prostate cancer survivors, poor oncological outcomes, and could potentially burden health care systems. In light of the current and recent studies, the necessity of assessing patients’ needs as they emerge after the diagnosis and treatment, understanding the role treatment modalities play in their development, and creating survivorship care plans that address these needs including earlier interventions in the form of pre-habilitation as well as survivorship programs is evident. Results observed here, point to the need to develop multidisciplinary survivorship care teams that include mental health care experts who can diagnose and treat patients and survivors in need of mental health support. They also point to the need to develop patient education and empowerment interventions for programs and survivors that address directly their psychosocial oncological needs, including, but not limited to, unmet emotional needs (e.g., loss of sexual function and unmet intimacy needs), social isolation, and lack of social support. Results here indicate that preventative efforts to reduce the mental health burden during prostate cancer survivorship are warranted.”

Androgen Deprivation Therapy and Mental Health: Impact on Depression and Cognition
European Urology Focus Volume 6 Issue 6 2020

DOI: 10.1016/j.euf.2019.11.010

“Androgen deprivation therapy (ADT) is a common treatment for many men with prostate cancer. Use of ADT can have significant impacts on the mental health of patients with both localized and advanced disease. Prostate cancer patients receiving ADT have a 41% higher risk of depression and a 47% higher risk of dementia. Risk factors for the development of depression in this group of men include older age, marital status, greater comorbidity, and a previous history of depression, while being retired may offer a protective effect. Optimal treatment strategies for depression for these men are not well established in the literature.

Depression, anxiety, and patterns of mental health care among men with prostate cancer on androgen deprivation therapy (ADT)
Journal of Clinical Oncology Volume 38 Supplement 2020

DOI: 10.1200/JCO.2020.38.15_suppl.12100

Androgen deprivation therapy (ADT) is associated with an increased risk of depression and anxiety, raising the concern that a substantial portion of men with prostate cancer need mental health care. We sought to investigate the development of depression or anxiety and subsequent patterns of mental health care in men with prostate cancer on ADT. Results showed that among 37,388 men in the final analytic cohort, 11.3% received new diagnoses of depression or anxiety. Those who received a diagnosis of depression or anxiety were more likely to be white; no differences were noted in age, education, or household income. Among those with a new diagnosis of depression or anxiety, 34.9% a selective serotonin reuptake inhibitor, 11.6% a serotonin norepinephrine reuptake inhibitor, and 19.9% a benzodiazepine, a drug class with risks of dependence, cognitive impairment, falls, and fractures. Receipt of psychotherapy was rare (0.07%). Further investigation into how to improve the mental health care of men on ADT is needed.

Anxiety and depression symptoms in adult males in Atlantic Canada with or without a lifetime history of prostate cancer
Psycho-oncology Volume 29 2019

DOI 10.1002/pon.5244

“The findings of the current study add significantly to the understanding of the relationship between prostate cancer and mental health. Unlike other segments of the population, survivors of prostate cancer are faced with several possible side effects of treatment that go to the heart of their identity as men, including erectile dysfunction, urinary incontinence, bowel issues, or feeling disconnected in their relationship due to lack of sexual function. Therefore, for mental health interventions to be successful, future interventions may need to focus on identifying those survivorship needs that lead to mental health issues and address them through patient education and/or empowerment programs offered early in the survivorship journey in order to successfully control and prevent the development of mental health issues. Clinicians know assessing survivors’ direct oncological outcomes (e.g., urinary, bowel and sexual function) is critical to addressing physical health, but may not be aware that mental health issues and survivorship needs are also critical for identifying men at risk of poor oncological and quality of life outcomes. We consider that screening and treating anxiety and depression during prostate cancer survivorship is a key priority for prostate cancer clinical oncology teams in order to insure oncological outcomes are not negatively affected by the onset of mental health issues among survivors and their persistence during the cancer journey. This research points out the vulnerability of prostate cancer survivors compared with that of survivors of other forms of cancer. The findings of this research, coupled with a growing emphasis on cancer survivorship, highlight the importance of a multidisciplinary effort to prioritize and deliver comprehensive mental health support to both patients and survivors of prostate cancer.”

New Challenges in Psycho‐Oncology Research III: A systematic review of psychological interventions for prostate cancer survivors and their partners: clinical and research implications
Psycho‐Oncology Volume 26 2017

DOI 10.1002/pon.4431

“Psychosocial concerns are prevalent with 30%‐50% of prostate cancer survivors reporting unmet sexuality, psychological, and health system and information needs and 10%‐23% of men clinically distressed. Risk of suicide is increased after prostate cancer diagnosis and can persist for a decade or more. Psychosocial and psychosexual intervention can improve decision‐related distress, mental health, domain‐specific, and health‐related quality of life in men with prostate cancer. Combinations of educational, cognitive behavioural, communication, and peer support have been most commonly applied and found effective; followed by decision support and relaxation; and to a much lesser extent supportive counselling.

In this review, approximately one‐quarter of interventions reported effects moderated by sociodemographic or psychosocial variables; with age, educational level, domain‐specific quality of life, baseline mental health, and social support important considerations in designing care. Hence, as well as taking into account levels of distress, it is also important to consider factors that both moderate intervention effectiveness and place men at risk of greater psychosocial distress and poorer quality of life (such as age, domain‐specific quality of life, socioeconomic deprivation) over the longer term.

Survivorship care plans for prostate cancer patients will need to be stepped according to the type and depth of need. In conclusion, there is sufficient evidence to recommend multi‐modal psychosocial and psychosexual interventions for men with prostate cancer; with distress screening and risk and need assessment built in to tailor support to the individual.”

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