Men receiving androgen deprivation therapy (ADT) for prostate cancer (PC) had higher rates of anxiety or depression, but few received mental health care, according to results of a study published in The Oncologist.
One-fifth of men aged 65 years and older with localized prostate develop anxiety or depression within 10 years of their diagnosis. This study sourced data from Optum’s deidentified Clinformatics Data Mart Database to evaluate the role of ADT in mental health status. A cohort of 37,388 men with PC treated with ADT between 2001 and 2015 was evaluated for the 10-year incidence of anxiety or depression and use of psychotropic medication. Outcomes were compared with a control cohort of men with PC not receiving ADT and a cohort of healthy men.
At a median of 9.3 months after initiating ADT, 2028 (5.4%) had incident depression, 1250 (3.3%) incident anxiety, and 686 (1.8%) both depression and anxiety. The patients who developed anxiety and/or depression were more likely to be White, have comorbidities, and have metastatic disease (all P <.01).
Among those participants with a new diagnosis of anxiety or depression, 1892 (47.7%) received no treatment, 1321 (33.3%) received a selective serotonin reuptake inhibitor, 282 (7.1%) received a serotonin-norepinephrine reuptake inhibitor, 744 (18.8%) received a benzodiazepine, and 10 (0.3%) received psychotherapy.
Of the patients who received psychotropic medications, 72.2% received the prescription from their primary care provider (P <.001), 17.7% through a psychiatrist, 0.7% through symptom management, and 4.8% from a cancer specialist.
The overall incidence of anxiety and depression in the experimental cohort (10.6%) was higher than in the non-ADT cohort with PC (7.7%; P <.01) or the healthy cohort (7.3%; P <.01). The non-ADT controls were associated with lower uptake of psychotropic medication uptake.
These findings only included data from men with commercial insurance or Medicare Advantage and may not be generalizable for other populations.
This study suggests that many men with PC who receive ADT could have an unmet psychiatric care need.
Reference Tsao PA, Ross RD, Bohnert ASB, Mukherjee B, Caram MEV. Depression, anxiety, and patterns of mental health care among men with prostate cancer receiving androgen deprivation therapy. Oncologist. Published online March 17, 2022. doi:10.1093/oncolo/oyab033