IMPORTANCE OF SCREENING
Screening for depression is just as important as screening for physical conditions, as the whole patient is treated, not only the area surrounding cancerous cells. The study showed increased rates of anxiety, depression, cardiovascular issues, and suicide may be the result of uncertainties regarding treatment, cancer control (prostate-specific antigen [PSA] anxiety), as well as the possibility of erectile dysfunction or urinary incontinence following treatment.
The researchers on Prasad’s team concluded that, “the effect of depression disorders on prostate cancer treatment and survivorship warrants further study, because both conditions are relatively common in men in the United States.”1
Frank dela Rama, RN, MS, AOCNS, an oncology clinical nurse specialist who works with prostate cancer patients at Palo Alto Medical Foundation, in California, suggests that early and continued assessment is critical. “Assess for depression early, but also let men know expectations and share other similar patient experiences, to give them perspective,” advises dela Rama. “Mild to moderate depression is expected early on, but nurses should refer to the appropriate providers (eg, social workers, psychological professionals, support groups) when any concern arises,” he adds.
As dela Rama knows first-hand, some men may be resistant to the idea of PSA screening and all that it may entail. His blog on the topic suggested that the more childhood idols, such as professional sports players, raise awareness about surveillance and treatment, the more it normalizes the idea of screening and also prostate cancer treatment. “In cancer, I’d much rather play defense (screening) vs. offense (treatment)!” he wrote.5
A prostate cancer diagnosis is associated with greater psychological distress and a 2.5-fold increased risk of suicide within 1 year of the diagnosis compared with men in the general population, and an increased risk after that time.6 Epidemiologic studies have shown that risk for suicide is higher among prostate cancer survivors than in the general population due to disease-related physical and physiologic dysfunction.7
But there is good news. In his experience, dela Rama found that when men choose active surveillance mainly to avoid sexual dysfunction, it is because they are somewhat fearful until they learn the scope of their disease. “Even if we find a rising PSA or slightly higher grade cancer, the success of treatment outcomes are still very good with low-risk cancers,” he said.
Lauren Davis is a medical writer based in Chesapeake Beach, Maryland.
1. Prasad SM, Eggener SE, Lipsitz SR, et al. Effect of depression on diagnosis, treatment, and mortality of men with clinically localized prostate cancer [published online ahead of print July 7, 2014]. J Clin Oncol. pii: 2013.51.1048.
2. Miranda J, McGuire TG, Williams DR, Wang P. Mental health in the context of health disparities. Am J Psychiatry. 2008;165:1102-1108. http://ajp.psychiatryonline.org/article.aspx?articleID=100114. Accessed August 6, 2014.
3. Institute of Medicine. Unequal treatment: What healthcare providers need to know about racial and ethnic disparities in healthcare [Report brief]. http://www.iom.edu/~/media/Files/Report%20Files/2003/Unequal-Treatment-Confronting-Racial-and-Ethnic-Disparities-in-Health-Care/Disparitieshcproviders8pgFINAL.pdf. Accessed August 6, 2014.
4. Fang F, Fall K, Mittleman MA, et al. Suicide and cardiovascular death after a cancer diagnosis. N Engl J Med. 2012;366(14):1310-1318. http://www.nejm.org/doi/full/10.1056/NEJMoa1110307. Accessed August 6, 2014.
5. dela Rama, F. Prostate cancer: A family affair. MyLifeStages: Health and wellness Web site from Sutter Health. https://www.mylifestages.org/blog/prostate-cancer-a-family-affair/childhood-idols-and-cancer-screening. Accessed August 6, 2014
6. Recklitis CJ, Zhou ES, Zwemer EK, et al. Suicidal ideation in prostate cancer survivors: Understanding the role of physical and psychological health outcomes [published online ahead of print June 24, 2014]. Cancer. doi:10.1002/cncr.28880.
7. Aizer AA, Chen MH, McCarthy EP, et al. Marital status and survival in patients with cancer. J Clin Oncol. 2013;31(31):3869-3876.