PROSTATE CANCER: DEPRESSION AFFECTS PROGNOSIS
Depressed men with localized prostate cancer were more likely to be diagnosed with more aggressive prostate cancer, received less effective treatments and survived for shorter times than prostate cancer patients who were not depressed, a UCLA study has found.
The negative
outcomes may be the result of several factors such as bias against the mentally
ill, depression's impact on biological cancer processes, the depressed man's
lack of investment in his general health and disinterest in receiving more
effective care, and missed opportunities by physicians to educate patients
about prostate cancer screening and treatment, said study lead author Dr. Jim
Hu, UCLA's Henry E. Singleton Professor of Urology and director of robotic and
minimally invasive surgery at the David Geffen School of Medicine at UCLA.
The population-based
observational study using patients from the Surveillance, Epidemiology and End
Results (SEER) Medicare database focused on 41,275 men diagnosed with localized
prostate cancer between 2004 and 2007 and observed through 2009. Of those,
researchers identified 1,894 men with a depressive disorder discovered in the
two years before the cancer was diagnosed.
"Men with
intermediate- or high-risk prostate cancer and a recent diagnosis of depression
are less likely to undergo definitive treatment and experience worse overall
survival," Hu said. "The effect of depressive disorders on prostate
cancer treatment and survivorship warrants further study, because both
conditions are relatively common in men in the United States."
The study appears
this week in the early online edition of the Journal of Clinical Oncology,
a peer-reviewed journal of the American Society of Clinical Oncology.
Hu said that
although demographic and socioeconomic differences can affect treatment and
outcomes in prostate cancer, the effect of mental health disorders has remained
unclear. Depression has been associated with increased likelihood of not
getting the best treatment, as well as lower overall survival in other cancers,
including breast and liver cancers. However, little is known about the
relationship between depression and diagnosis, treatment and outcomes in
prostate cancer. This study helps shed some light on the issue, but further
examination is warranted, Hu said.
The study also found
that men with prostate cancer who were older, lower income, who had other
medical problems, were white or Hispanic, who were unmarried and those residing
in non-metropolitan areas were more likely to be depressed.
In addition,
depressed men were less likely to seek out definitive therapy such as surgery
or radiation in contrast to prostate cancers who were not depressed.
"This was
surprising, because depressed men were more likely to see physicians in the two
years prior to prostate cancer diagnosis compared to non-depressed men,"
Hu said.
Prostate cancer is
the most frequently diagnosed cancer in men aside from skin cancer. An
estimated 233,000 new cases of prostate cancer will occur in the United States
in 2014. Of those, nearly 30,000 men will die.
"These results
point toward a newly identified disparity in the management of men with
incident prostate cancer," the study states. "Considering the marked
prevalence of both prostate cancer and depression, additional efforts are
needed to better understand and ameliorate the decreased survival following
prostate cancer diagnosis in the depressed male patient.
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