Psychological Effects From ADT a Growing Challenge in Prostate Cancer


“Androgen-deprivation therapy (ADT) can be associated with significant psychological effects in patients with prostate cancer.

“Additionally, these side effects—which include depression, Alzheimer disease, and coronary disease—are often underreported by patients, according to Heather Jim, MD.

“ ‘It is really important for the clinician to let [patients] know that a lot of men experience this. Let’s get them help and try to help them feel better,’ said Jim, who discussed these significant events in her lecture at the 2016 OncLive State of the Science Summit on Genitourinary Cancers.”

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Study Supports Early Intervention for Prostate Cancer Patients Who Experience Significant Emotional Distress

“A study led by the University at Buffalo and Roswell Park Cancer Institute has identified beliefs and personality traits that are associated with higher levels of distress in newly diagnosed prostate cancer patients.

“The findings support the value of emotional and informational support for patients and perhaps early counseling for some who are the most distressed.

“Factors that were associated with greater distress included a lack of confidence in deciding how to treat the cancer, being concerned that the cancer will progress, feeling that one’s masculinity was under threat and tendencies to be less optimistic and resilient.

“The study, ‘Factors Associated with Emotional Distress in Newly Diagnosed Prostate Cancer Patients,’ was first published online in Psycho-Oncology in January 2015. The results are from a larger longitudinal study of prostate cancer patients, ‘Live Well Live Long!’ The research was based on assessments of 1,425 men newly diagnosed with prostate cancer at five different centers.”

Melanoma Surgery Delays Are Common for Medicare Patients

“One in five Medicare patients with melanoma experience delays in getting surgery, a Yale study found. The research was published April 8 in JAMA Dermatology.

“Melanoma, a type of skin cancer, is a leading cause of new cancer diagnoses in the United States. A delay between diagnosis and surgery to remove melanomas may cause patients psychological harm and affect health-care quality. Using the national Surveillance, Epidemiology, and End Result-Medicare database, the Yale team conducted the first population-based analysis of delay of surgery among Medicare patients with melanoma.

“The researchers reviewed data on more than 32,000 Medicare patients diagnosed with melanoma. They found that 22% of patients waited longer than 1.5 months for melanoma surgery, and 8% were delayed more than 3 months. Although no gold standard exists, a timeframe of less than six weeks between diagnosis and surgery has been recommended.

” ‘Delay for melanoma surgery in this population is more common than we expected,’ said Jason Lott, M.D., who was first author of the study as postdoctoral fellow in the Robert Wood Johnson Foundation Clinical Scholars Program at Yale School of Medicine.”

HR-Positive Breast Cancer Patients May Have More Anxiety

“Women with hormone receptor (HR)-positive breast cancer may be more scared, anxious, or concerned about treatment-related adverse events and cancer symptoms compared with their counterparts with HR-negative disease, according to the results of a survey conducted by Marc Citron, MD, of ProHEALTH Care Associates, Lake Success, New York, and colleagues.

“According to Citron, this increased anxiety may ‘stem from differences in disease characteristics between HR-positive and HR-negative/unknown patients.’

“Citron presented the results of the survey at the poster session at the 32nd Annual Miami Breast Cancer Conference, held February 26-28.

“According to the poster, the 2013 Global Count Us, Know Us, Join Us, survey found that more than half of US women with metastatic breast cancer would like to have more time to discuss their needs during clinic visits, and 60% believe their cancer treatment options are limited. Therefore, Citron and colleagues wanted to examine what, if any, unmet emotional, communication, and care needs women with metastatic breast cancer had, and compare results among women with HR-positive and HR-negative disease.”

Delayed Breast Reconstruction after Mastectomy May Be More Stressful than Mastectomy Alone

The gist: Women who do not have breast reconstruction after mastectomy may have less cancer-related distress than women who start breast reconstruction more than one year after mastectomy. Women who have mastectomies have three choices: no reconstruction, immediate reconstruction started during the mastectomy surgery, or delayed breast reconstruction. Researchers recently compared women who had no breast reconstruction with women who started reconstruction more than one year after mastectomy. The women who had delayed breast reconstruction had higher levels of distress and obsessiveness than women who did not have reconstruction. 

“In women who have undergone mastectomy, those who underwent delayed breast reconstruction experienced greater cancer-related distress over the long term compared with women who underwent mastectomy alone, according to a prospective study by Metcalfe et al in the Journal of Surgical Oncology

“Metcalfe and colleagues conducted a prospective study to examine the psychosocial outcomes in women who had mastectomy alone compared to those who underwent breast reconstruction more than 1 year postmastectomy. Psychosocial functioning was assessed according to levels of total distress, obsessiveness, and cancer-related distress…

“According to the investigators, psychosocial functioning improved over time in patients treated with mastectomy in the long-term breast cancer survivorship period, which may be related to the effect of time posttreatment and not whether or not these women chose to undergo delayed breast reconstruction. Over the course of the study, the investigators did not observe any statistically significant differences in changes in quality of life over time as a result of having mastectomy alone or delayed breast reconstruction.

“ ‘It is critical for health-care providers to recognize that women who seek out delayed breast reconstruction may have higher baseline levels of distress and body image issues postmastectomy, which may persist after delayed breast reconstruction,’ the authors said.”

End of Life Planning Does Not Make Cancer Patients Hopeless or Anxious

“For a small group of advanced cancer patients, using an online tool for learning about end-of-life medical decisions and developing an advance directive document did not lead to psychological distress, according to a new study.

“ ‘One thing we noticed is that many patients with advanced cancer had not had these conversations,’ said lead author Dr. Michael J. Green of the humanities and medicine departments at Penn State College of Medicine in Hershey, Pennsylvania.

“ ‘When we talked to the oncologists about it, a response we heard again and again is, “it’s not appropriate at this time, it’s going to make them anxious, take away their hope”,’ Green told Reuters Health.

“He and his team set out to see if it was true that working through end of life planning took away cancer patients’ hope or raised their anxiety levels.

“They used an interactive decision aid with audio and video elements called ‘Making Your Wishes Known: Planning Your Medical Future, (MYWK) which is available online.”