‘Why I feel bad’: refinement of the Effects of Prostate Cancer Upon Lifestyle Questionnaire and an initial exploration of its links with anxiety and depression among prostate cancer patients

Translation and validation of a lifestyle questionnaire related to prostate cancer

BACKGROUND

Valid and reliable instruments are needed to measure prostate cancer-related lifestyle changes, plan evidence-based interventions to modify lifestyle, and improve treatment outcomes. Due to the lack of appropriate instruments, this study was conducted to translate the Effects of Prostate Cancer upon Lifestyle Questionnaire (EPCLQ) into Persian and examine its psychometric properties in a sample of Iranian older adults with prostate cancer.

METHODS

This methodological study was carried out between 2021 and 2022. Initially, the EPCLQ, comprising 36 items, was translated into Persian through a meticulous translation and back-translation procedure. Subsequent steps involved the assessment of face validity, qualitative content validity, content validity index, content validity ratio, construct validity via confirmatory factor analysis, and reliability testing of the Persian version of the EPCLQ.

RESULTS

The psychometric evaluation led to the exclusion of 4 items from the EPCLQ. The refined model demonstrated satisfactory fit indices (PCFI = 0.732, PNFI = 0.696, CMIN/DF = 2.29, RMSEA = 0.072, IFI = 0.920, CFI = 0.919, and GFI = 0.971), indicating an appropriate fit of the final model. The internal consistency, as measured by Cronbach's alpha, was 0.67, and the intraclass correlation coefficient for the questionnaire was 0.938, reflecting high reliability.

CONCLUSIONS

The Persian version of the EPCLQ, now consisting of 32 items, has been validated and is reliable for assessing the impact of prostate cancer on lifestyle among older adults. Its simplicity and the clarity of the items make it suitable for use in clinical settings or during home visits for follow-up assessments.

Deterioration in Sleep Quality Affects Cognitive Depression in Prostate Cancer Patients

Men who suffer from prostate cancer (PCa) need to make important decisions regarding their treatment options. There is some evidence that these men may suffer from sleep difficulties due to their cancer or its diagnosis and treatment. Although sleep difficulties have been associated with cognitive depression in other samples of men, they have not been examined in PCa patients, despite the importance of decision-making for these men. This study was designed to investigate the association between sleep difficulties and cognitive depression in PCa patients. A sample of 96 PCa patients completed a background questionnaire, the Zung Self-Rating Depression Scale, and the Insomnia Severity Index. Comparison was made between sleep difficulty scores from before the patients received their diagnosis of PCa to the time of survey, allowing use of a “retrospective pretest” methodology. Just over 61% of the sample reported a deterioration in sleep quality, and this was significantly associated with cognitive depression (r = .346, p = .007). At the specific symptom level, having a clear mind significantly contributed to the variance in difficulty falling asleep (R² change = .140, F for change = 9.298, p = .003). Sleeping difficulties, particularly falling asleep, are common and associated with depression-related to ability to think clearly in PCa patients. This has potentially adverse effects upon the ability of men with PCa to understand their treatment options and make decisions about them.

Depression and Prostate Cancer: Examining Comorbidity and Male-Specific Symptoms

Depression in men with prostate cancer is a significant and complex issue that can challenge clinicians’ diagnostic efforts. The objective of the current study was to evaluate prototypic and male-specific depression symptoms and suicidal ideation in men with a diagnosis of prostate cancer relative to those with and without comorbidity. The Patient Health Questionnaire-9 (PHQ-9) and Male Depression Risk Scale-22 (MDRS-22) were completed online along with demographic and background variables by 100 men with a diagnosis of prostate cancer (n = 54 prostatectomy, n = 33 receiving active treatment). Hierarchical logistic regression was used to examine recent (past 2 weeks) suicide ideation. Over one-third of the sample (38%) reported a comorbidity, and this group had significantly higher total depression scores on the PHQ-9 (Cohen’s d = 0.65), MDRS-22 emotion suppression (d = 0.35), and drug use subscales (d = 0.38) compared to respondents without comorbidity. A total of 14% reported recent suicidal ideation, of which 71.4% of cases were identified by the PHQ-9 “moderate” cut-off, and 85.7% of cases were identified by the MDRS-22 “elevated” cut-off. After control variables, MDRS-22 subscales accounted for 45.1% of variance in recent suicidal ideation. While limited by the exclusive use of self-report data, findings point to the potential benefits of evaluating male-specific symptoms as part of depression and suicide risk screening in men with prostate cancer and the need to be mindful of the heightened risk for depression among men with prostate cancer who have comorbidity.

African American prostate cancer survivorship: Exploring the role of social support in quality of life after radical prostatectomy

Purpose: The aim of this study was to explore the African American prostate cancer survivorship experience following radical prostatectomy and factors contributing to quality of life during survival. Design: African American men who were part of a larger prostate cancer cohort were invited to participate in a focus group. Eighteen open-ended questions were designed by the study team and an experienced moderator to elicit participants' survivorship experiences. Results: Twelve men consented to participate in the study. Emergent themes included views of prostate cancer in the African American community, perceptions of normalcy, emotional side effects following radical prostatectomy, and social support involvement and impact during recovery. Conclusions: Previous findings suggest that African American men may experience more distress than Caucasian men when facing typical prostate cancer side effects. Traditional masculine role norms and negative perceptions of “disease disclosure” in the African American community could be contributing to the distress reported by some in this study. Strengthening social support systems by promoting more prosocial coping and help-seeking behaviors early in the survivorship journey may help bypass the detrimental health effects associated with masculine role identification, resulting in improved quality of life throughout the lengthy survival period anticipated for these men.

Using cluster analysis of anxiety-depression to identify subgroups of prostate cancer patients for targeted treatment planning

BACKGROUND

To explore any possible subgroupings of prostate cancer (PCa) patients based upon their combined anxiety-depression symptoms for the purposes of informing targeted treatments.

METHODS

A sample of 119 PCa patients completed the GAD7 (anxiety) and PHQ9 (depression), plus a background questionnaire, by mail survey. Data on the GAD7 and PHQ9 were used in a cluster analysis procedure to identify and define any cohesive subgroupings of patients within the sample.

RESULTS

Three distinct clusters of patients were identified and were found to be significantly different in the severity of their GAD7 and PHQ9 responses, and also by the profile of symptoms that they exhibited.

CONCLUSIONS

The presence of these 3 clusters of PCa patients indicates that there is a need to extend assessment of anxiety and depression in these men beyond simple total score results. By applying the clustering profiles to samples of PCa patients, more focussed treatment might be provided to them, hopefully improving outcome efficacy.

The incidence and causes of different subtypes of depression in prostate cancer patients: implications for cancer care

Although depression occurs in prostate cancer patients at a higher incidence than in age-matched non-cancer peers, little is known about the relative incidence of subtypes of depression among these patients. To examine this issue, 507 prostate cancer patients completed a survey questionnaire of background factors, depression symptoms, and common prostate cancer-related stressors. Five common subtypes of depression were defined from the wider literature, and patients' depressive symptomatology was used to determine their scores on each of the five depression subtypes. Nearly half of the patients had scores which could be classified as clinically significant for at least one of the five depression subtypes, with some patients showing clinically significant scores for multiple depression subtypes. Different depression subtypes were predicted by different prostate-cancer-related stressors. Because each of the five depressive subtypes examined here has different symptomatologies and treatment recommendations, these data suggest that treatment goals for prostate cancer patients might vary according to the type of depression a patient presents.

Variability Over Time-Since- Diagnosis in the Protective Effect of Psychological Resilience Against Depression in Australian Prostate Cancer Patients

Although there is some evidence that psychological resilience may “buffer” against depression following major stressors, no data have been reported on the nature and variability of this buffering effect among prostate cancer patients during the 5 years following their initial diagnosis. Patients from two sites in Australia and who had received their initial diagnosis within 5 years ( n = 255) were surveyed, and the results indicated that there was a significant inverse relationship between resilience and depression in the overall data, but that was mostly accounted for by a single factor of the resilience scale (“Confidence to cope with change”). Variability in that buffering effect was noted over time since diagnosis, with peaks during the first 6 months, at 24 and 60 months. These findings support the argument to develop focused psychiatric interventions at various periods following a diagnosis of prostate cancer.

Do patient-reported androgen-deprivation therapy side effects predict anxiety and depression among prostate cancer patients undergoing radiotherapy? Implications for psychosocial therapy interventions

Antiandrogen therapy (AAT) is a common adjunct treatment for prostate cancer (PCa) patients and has shown significant benefits to long-term outcomes from radiation or surgery. Although AAT has some adverse side effects and data from breast cancer patients indicate that such side effects from hormonal therapies may contribute to anxiety and depression and may also hinder AAT treatment compliance, this issue has not been investigated within a sample of PCa patients. This study explores the incidence of AAT side effects in a sample of PCa patients, the links between those side effects and anxiety and depression, the possible ways in which these factors may contribute to AAT treatment noncompliance in PCa patients, and how psychosocial treatments might be developed to attend to this issue. 147 PCa patients completed questionnaires on demographic factors, treatment compliance, AAT side effects, anxiety and depression. About 18% of the sample reported AAT side effects, and there was a significant association between the presence of side effects and elevated anxiety and depression scores. Increased frequency of side effects was significantly associated with elevated anxiety, but not depression. The most powerful relationship between AAT side effects and anxiety-depression was for the subfactors of (1) Fatigue, Pain and Discomfort, and (2) Psychological Agitation and Pessimism. Although fatigue, pain, and discomfort may be outcomes of the hormonal treatment itself, psychological agitation and pessimism represent a discrete psychological pathway between AAT side effects and anxiety and depression and (potentially) treatment noncompliance. Methods of addressing patients' loss of optimism in their treatment outcomes are discussed.