Maintaining quality of life after prostate cancer diagnosis

Abstract: Knowledge of real-life factors that are associated with men’s self-assessed quality of life after prostate-cancer diagnosis could improve the support from health-care professionals in maintaining the men’s quality of life. Sudden, unwelcome and repetitive thoughts about a traumatic event – intrusive thoughts – constitute one factor of post-traumatic stress disorder. Recurrent thoughts of death, not just fear of dying, are one indicator for depressive disorder. Prior research suggests that psychological interventions targeting intrusive thoughts could facilitate coping with a traumatic event such as the diagnosis of prostate cancer. In this thesis the focus was on exploring and describing men’s thoughts after prostate cancer diagnosis. The aim was to find suitable targets for interventions that can help men in maintaining their quality of life after radical prostatectomy as well as to identify those individuals who might need them most. Methods Following a one-year preparatory-phase including in-depth interviews, observations, questionnaire development, face-to-face validation and a pilot-study, the LAPPRO trial started inclusion on September 1 2008. Men planned for open or robot-assisted laparoscopic radical prostatectomy at 13 urological centers in Sweden were prospectively registered. During the first inclusion year, 971 men were enrolled, of which 833 (86%) answered two questionnaires, before and three months after surgery. These included questions on quality of life, intrusive thoughts, thoughts about death and care-related factors, among others. Results Before surgery, 603 men (73%) reported having negative intrusive thoughts about their prostate cancer at some time, as did 493 (59%) three months after surgery. Comparing those reporting negative intrusive thoughts at least weekly before surgery with those not reporting this, the prevalence ratio (PR) for waking up with anxiety after surgery was 3.9, for depressed mood 1.8 and for impaired self-assessed quality of life 1.3. Men uncertain of cure by the planned surgery (PR 1.9), not prepared for urinary (PR 1.3) or sexual bother (PR 1.3) had more occurrence of negative intrusive thoughts before surgery. Reporting negative intrusive thoughts before surgery predicted reporting such thoughts three months after surgery (Adjusted Odds Ratio (OR) 3.6). Multivariate analysis revealed that younger age (OR 1.8), living alone (OR 1.7), and non-active health-care seeking (OR 0.5) predicted the occurrence of negative intrusive thoughts three months after surgery. Twenty-five percent of the participants reported thoughts about their own death at least once a week during the previous month, before surgery and 18 percent three months after surgery. Men living in urban environment (OR 2.3) and those reporting having low control in their lives (OR 2.2), being uncertain of the future (OR 3.3) or crying (OR 2.0) before surgery, more often had thoughts about their own death three months after surgery. Findings A number of men diagnosed with clinically localized prostate cancer planned for surgery experienced intrusive thoughts with negative content as well as thoughts about their own death both before and three months after surgery. These thoughts were associated with various symptoms of psychological distress such as crying, feeling lack of control, uncertainty and not being prepared. Certain individuals seemed to be more vulnerable than others. Conclusion Despite the availability of treatments that can cure, the diagnosis of cancer is still frightening. The upcoming surgery for prostate cancer seems to lead to the accumulation of psychological reactions among men. Screening for and recognizing distressing thoughts could be valuable in supporting men shortly after prostate cancer diagnosis to maintain their quality of life. Intervention studies aiming at neutralizing negative intrusive thoughts, such as by expressive writing, could be designed based on our findings.