Androgen Deprivation Therapy and Mental Health: Impact on Depression and Cognition

Journal article Abstract: 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.”

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)

Journal article extract: Frontiers in Psychiatry, 16 December 2020

Louise Moodie, Gabriela Ilie, Robert Rutledge, Pantelis Andreou and Susan Kirkland

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.”

Prostate cancer survivorship priorities for men and their partners: Delphi consensus from a nurse specialist cohort

Journal article extract: Journal of Clinical Nursing, Volume 29, Issue 1-2, 2020

Nicholas Ralph, Anna Green, Sally Sara, Suzanne McDonald, Philip Norris, Victoria Terry, Jeffrey C. Dunn, Suzanne K. Chambers

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.”

An exploration of the Role of the Prostate Cancer Specialist Nurse from Two International Perspectives

Journal article extract: Seminars in Oncology Nursing Volume 36, Issue 4, August 2020

Louisa Fleure & Sally Sara

DOI 10.1016/j.soncn.2020.151043

“A diagnosis of prostate cancer is a major life-changing event that brings social, psychological, physical, financial, and spiritual challenges. In both the United Kingdom (UK) and Australia, prostate cancer specialist nurses have a unique role in the care of men and their families.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 focusing on what is important to individuals: support, education, management of side effects, rehabilitation, and by delivering and improving access to high-quality care.”

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.”

Development and Initial Evaluation of a Multifaceted Intervention to Improve Mental Health and Quality of Life Among Prostate Cancer Survivors

Journal article Abstract: International Journal of Mental Health and Addiction, 18, 2020

Gabriela Ilie, Ross Mason, David Bell, Greg Bailly, Ricardo A. Rendon, Robert Mann, Joseph G. Lawen, David Bowes, Derek Wilke, Nikhilesh Patil, and Robert D. H.

DOI 10.1007/s11469-019-00108-y

Mental health issues affect a third of prostate cancer survivors. Here, we describe the development and preliminary evaluation of a unique multifaceted intervention, the Prostate Cancer–Patient Empowerment Program (PC-PEP), designed to improve mental health and quality of life among survivors. The 28-day pilot PC-PEP Intervention was developed following the engagement of patients, survivors, caregivers and health care professionals in identifying survivorship needs and well-being resources for improved mental health. The pilot intervention was implemented with a group of 30 prostate cancer survivors in Halifax, Canada. Measures collected over the 28-day program included psychological distress and physical health indicators, as well as program compliance. Participation in PC-PEP resulted in significant improvement in measures of mental and physical health over the 28-day program. Very good to excellent compliance with all five components of PC-PEP was observed. This evaluation provides strong initial support for a multifaceted program to improve mental health outcomes in prostate cancer survivors.

Anxiety and depression symptoms in adult males in Atlantic Canada with or without a lifetime history of prostate cancer

Journal article extract: Psycho-Oncology October 2019

Gabriela Ilie, Robert Rutledge, Ellen Sweeney

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.”