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Emotional distress may lead to unnecessary treatment for prostate cancer
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Men with emotional distress after a prostate cancer diagnosis may be more likely to choose aggressive treatment, such as surgery rather than active surveillance, according to published findings.
“The good news is that there’s already a shift in the field toward being more concerned about cancer patients’ emotional well-being,” Heather Orom, PhD, assistant dean for equity, diversity and inclusion at the School of Public Health and Health Professions of University at Buffalo, told HemOnc Today. “What this study tells us is that we should be concerned about prostate cancer patients’ well-being from the point of diagnosis, not just after treatment.”
Prostate cancer overtreatment often occurs among men with low-risk disease. For these men, active surveillance or monitoring for cancer progression — with the option to undergo some sort of therapy or surgery later if necessary — can be a viable course of treatment.
This research showed that most low-risk or intermediate-risk men were good candidates for active surveillance instead of surgery, but the patients’ emotions played a role in alternate treatment decision-making, Orom said.
“Although men with both low- and intermediate-risk prostate cancer were more likely to choose surgery over active surveillance if they were more emotionally distressed, I think our most important clinical implication is for men with low-risk disease,” she said. “Many of these men might be good candidates for active surveillance, and emotional distress may be pushing them toward a more aggressive treatment option.”
In the study, Orom and colleagues measured emotional distress among 1,531 men (83% non-Hispanic white; 11% non-Hispanic black; and 6% Hispanic) with newly diagnosed, localized prostate cancer from two academic and three community facilities.
Of these men, 36% had low-risk cancer, 49% had intermediate-risk cancer and 15% had high-risk cancer. Twenty-four percent chose active surveillance, 27% chose radiation and 48% chose surgery.
Researchers used the Distress Thermometer — an 11-point scale ranging from 0 (no distress) to 10 (extreme distress) — to measure patients’’ distress after diagnosis and again after treatment decision-making.
The mean emotional distress was 4.37 (standard deviation [SD], 2.56) at baseline, and reduced to 4.1 (SD, 2.58; P < .001) after a patient made their treatment decision.
Multivariate logistic regression analysis showed men who experienced distress shortly after diagnosis were more likely to choose surgery over active surveillance (relative risk ratio [RRR] = 1.07; 95% CI, 1.01-1.14). Men who experienced distress around the time of treatment decision were more likely to choose surgery over active surveillance (RRR = 1.16; 95% CI, 1.09-1.24) and over radiation therapy (RRR = 1.12; 95% CI, 1.05-1.19).
Among men with low-risk disease, distress shortly after diagnosis was associated with choosing surgery over active surveillance (RRR = 1.11; 95% CI, 1.02-1.22). Distress around the time of treatment decision also increased the likelihood of choosing surgery over active surveillance (RRR = 1.21; 95% CI, 1.1-1.34) and over radiation therapy (RRR = 1.25; 95% CI, 1.09-1.45).
Among men with intermediate-risk disease, distress at decision-making was associated with a greater likelihood of choosing surgery over active surveillance (RRR = 1.15; 95% CI, 1.03-1.28) and over radiation therapy (RRR = 1.09; 95% CI, 1-1.19). However, distress shortly after diagnosis was not linked to treatment choices.
Among men with high-risk disease, no association between distress and treatment choice was observed.
There is interest among physicians to assist patients in their decision-making experience to help prevent any overtreatment, and that they don’t want men making decisions they may regret later, Orom said in a press release.
“Supporting men’s emotional well-being could help them make treatment decisions they are happy with for the rest of their lives,” she said. – by Melinda Stevens
For more information:
Heather Orom, PhD, can be reached at University at Buffalo, 304 Kimball Tower, 3435 Main St., Buffalo, NY 14214; email: horom@buffalo.edu.
Disclosures: Orom reports no relevant financial disclosures.
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