Authors Couper JW, Love AW, Duchesne GM, et al
Review Date Sep 2010
Citation Med J Aust 2010;193(5):S58-S61
There is still much to learn about the psychosocial impact of a prostate cancer diagnosis and how to support men after a prostate cancer diagnosis. Many previous studies have been cross-sectional in design thereby not able to assess psychosocial impacts over time.
To assess psychosocial distress in patients with early (localised) and advanced (metastatic) prostate cancer (PCA) at diagnosis (Time 1) and 12 months later (Time 2), and identify psychosocial factors predictive of later distress.
Design, participants and setting: Observational, prospective study of men newly diagnosed with early (n=211) or advanced (n=156) PCA recruited as consecutive attendees at clinics at seven public hospitals and practices in metropolitan Melbourne between 1 April 2001 and 30 December 2005. Recruitment of men with early PCA took place at the beginning of definitive treatment and those with advanced PCA were recruited after they had been told they had metastatic disease. All men recruited completed a questionnaire at Time 1; 178 of the early PCA group (84%) and 87 (56%) of the advanced PCA groups completed a questionnaire at Time 2.
Main outcome measures: Health-related quality of life as assessed by the Short Form 36-item Health Survey; psychological distress, including depression and anxiety as assessed by the Brief Symptom Inventory; and coping patterns as assessed by the Mini-Mental Adjustment to Cancer scale.
Men who completed only Time 1 questionnaires showed greater psychosocial dysfunction at baseline than those who completed both Time 1 and 2 questionnaires. Over the 12 months, both the early and advanced PCA group showed reduced vitality and increased depression and anxiety; this effect was greater in the advanced PCA group.
Mental health, social functioning and role-emotional functioning also deteriorated in the advanced group. Predictors of depression at Time 2 for the early PCA group were depression, vitality and a fatalistic coping pattern at Time 1; anxiety at Time 2 was predicted by anxiety and vitality at Time 1. In the advanced PCA group, depression at Time 2 was predicted by depression and mental health at Time 1; anxiety at Time 2 was predicted by anxiety, mental health, cognitive avoidance and lower anxious preoccupation at Time 1.
Men with advanced PCA experienced worse psychosocial adjustment over the 12 months following diagnosis than those with early PCA. A fatalistic coping pattern at diagnosis of early PCA predicts later depression while cognitive avoidance and lower anxious preoccupation at diagnosis of advanced PCA predict later anxiety.
These findings support a 2005 review concluding that problem-focused and emotion-focused coping styles were associated with better adjustment and avoidance-style coping with poorer adjustment in men with PCA.
Points to Note
- Men living with PCA experience decreased vitality and increased psychological distress over 12 months following diagnosis with early PCA.
- Men with advanced PCA have higher levels of distress than those with early PCA after diagnosis and experience greater declines in psychosocial functioning over 12 months
- The predictors of distress at 12 months following diagnosis suggest that psychological interventions that encourage problem-focused and emotion-focused coping and challenge avoidant tendencies, while instilling hope and a sense of control might be beneficial mental health strategies for men diagnosed with PCA.
- A limitation of the study was the high non-response at Time 2 in the advanced PCA group. Given the higher distress levels of the non-responders, these findings might under-estimate the extent of psychological distress.