Depression often occurs with serious health conditions such as cancer, heart disease and diabetes, and can exacerbate symptoms and play a role in decision-making about treatment. Last year, Science Life spoke to William Dale and Ashwin Kotwal about their research showing that men who are depressed are less likely to get screened for prostate cancer. Other studies have shown increased rates of anxiety, depression, cardiovascular problems and even suicide that stem from uncertainty over prostate cancer treatment. But less is known about how depression affects overall outcomes and treatment decisions made by men once they have been diagnosed with prostate cancer.
In a study published in July in the Journal of Clinical Oncology, urologist Scott Eggener, MD, and his colleagues explored this relationship, and found that men with intermediate- or high-risk prostate cancer and depression had worse survival rates, and were less likely to undergo definitive treatment like surgery or radiation therapy.
“I think it’s something that as urologists we don’t focus enough attention on,” Eggener said. “We focus just on the specifics of the cancer, and probably underappreciate the role many medical conditions like depression play in decision-making and outcomes.”
Eggener, who is Co-Director of the Prostate Cancer Program at the University of Chicago Medicine, and researchers from the University of South Carolina, Brigham and Women’s Hospital, and the University of California Los Angeles, looked at Medicare data of men who were diagnosed with prostate cancer from 2004 to 2007. Out of those more than 41,000 patients, nearly 1,900 had been diagnosed with a depressive disorder in the two years prior to their prostate cancer diagnosis.
These men were more likely to choose “expectant therapy,” or monitoring the disease progression, than more proactive treatment like radiation or surgery. They also had worse overall mortality than men who were not depressed.
Eggener said it’s not clear why men with depression make different decisions about their course of treatment, or whether doctors change their recommendations for men with depression. But, he said the clear differences in outcomes seen in this study point to the need for greater awareness of the effects of depression in these patients.
“We certainly see plenty of patients that have both depression and prostate cancer, and it’s important to learn how they might be the same or different than the general population,” he said. “We need to build public awareness among physicians who take care of these men. They’re more complex cases, their decision-making is different, and perhaps we need to be more attuned to provide high quality care.”
Prasad S.M., S. R. Lipsitz, M. R. Irwin, P. A. Ganz & J. C. Hu (2014). Effect of Depression on Diagnosis, Treatment, and Mortality of Men With Clinically Localized Prostate Cancer, Journal of Clinical Oncology, DOI: http://dx.doi.org/10.1200/jco.2013.51.1048