Prior diagnosis of depression worsens outcomes in prostate cancer

Depression, even in a physically healthy patient, can be debilitating. Add to that a cancer that can affect a man’s ability to have a normal social life or to perform sexually, and the outcomes can be dire. Although studies have shown a clear impact of a cancer diagnosis on a patient’s mental health, little is known about patients who already experience symptoms of depression prior to a cancer diagnosis. A recent study sought to help improve understanding about how pre-existing depression may affect a cancer patient’s decisions about treatment.¹

Sandip M. Prasad, MD, MP, and colleagues looked at Surveillance, Epidemiology, and End Results (SEER) Medicare linked data of patients with prostate cancer and a depression diagnosis approximately 2 years prior to the cancer diagnosis to see how their mental status influenced their decisions about treatment options, and ultimately, their outcomes. The population-based observational cohort study included data from 41,275 cases of men with clinically localized prostate cancer from 2004 to 2007. Of those, the researchers identified 1,894 men, 67 years and older, with a depressive disorder.¹

The data show that men with depression were less likely to follow through with treatment and experience worse outcomes than men without depression. In adjusted analyses, men with depressive disorder were more likely to pursue a watchful waiting philosophy for low-, intermediate-, and high-risk disease. Conversely, depressed men were less likely to undergo definitive therapy (surgery or radiation).

The researchers believe that this study is the first to demonstrate that a pre-existing diagnosis of depressive disorder is independently associated with treatment choice and outcomes of localized prostate cancer. Men with depression and a diagnosis of intermediate- and high-risk prostate cancer were less likely to choose to undergo a definitive therapy such as radical prostatectomy (RP) or radiotherapy (RT). The difference in overall survival (OS) between men with and without a depression diagnosis was independent of prostate cancer treatment type. The bottom line: depressed men experienced worse overall mortality.

Nurses should be mindful of unintended biases that could lead to disparities in patient care, although there is no consensus on what constitutes disparities or how they are measured.² The 2002 Institute of Medicine (IOM) report, “Unequal Treatment: Confronting Racial and Ethnic Disparities in Healthcare,” stated “[al]though myriad sources contribute to these disparities, some evidence suggests that bias, prejudice, and stereotyping on the part of healthcare providers may contribute to differences in care.”³

Although there were no differences in clinicopathologic characteristics, the men with depression varied in ethnicity, race, income, and comorbidities. Men with diagnoses of depressive disorder were, on average, older, more likely to be non-Hispanic white, less likely to be black or Asian, less likely to be married, more likely to have a lower median household income, more likely to have more comorbid illnesses, and more likely to reside in nonmetropolitan areas.¹ An earlier study about marriage and cancer outcomes, suggested that married people or those with a supportive social circle experience better outcomes than single, widowed, or those without a social support.⁴