Assessment and interventions on mental health of survivors are crucial to prevent depression

Prostate cancer is the most prevalent diagnosed cancer in men (American Cancer Society, 2015). About one in seven men will be diagnosed with prostate cancer during his life.

Fortunately, the average life expectancy of patients newly diagnosed with prostate cancer is a decade or longer (Ferlay et al., 2010). According to the American Cancer Society a ‘long-term cancer survivor’ is a person who is alive five years after being diagnosed with cancer. Therefore, the majority of patients with prostate cancer will become long-term survivors.

Men diagnosed with prostate cancer have higher levels of anxiety, depression and suicide compared to an age- and gender comparable cohort from the general population (Bennett & Badger, 2005; Mehnert, Lehmann, Graefen, Huland, & Koch, 2010). Ongoing assessment, identification, and psychological interventions have been found successful in relieving distress for prostate cancer patients and survivors (Skolarus et al., 2014). Unfortunately, they are inconsistently available in prostate cancer survivorshipcare. These interventions are especially important for prostate cancer patients and survivors who are at high risk for mental health problems (the target population).

Therefore, in our study (collaboration between UMC Utrecht Cancer Center and The Netherlands Cancer Institute), we aimed to describe this target population and we further unraveled the long-term relation between prostate cancer and mental health. These general aims were divided in three research questions: 1. Are prostate cancer survivors more at risk for mental health problems than an age and sex matched reference group without prostate cancer?; 2. What are risk factors for mental health problems in prostate cancer survivors?; and 3. Do these risk factors differ from risk factors in the reference group? To answer these three questions we composed two groups. The first group, ‘The prostate cancer survivors’, consisted of 644 prostate cancer survivors. The second group, ‘Reference group’, consisted of 644 men from the general population with a comparable age but without a history of prostate cancer (Figure 1).

‘Mental health’ is not something you can easily see. We used a standardized questionnaire, the Short Form (36) Health Survey to measure the quality of life of the men in the study. This respondent-reported survey contains a mental health scale (MHI-5). One can score between 0 and 100. A score of 52 points or less suggests severe depressive symptomatology (Ware, Snow, Kosinski, & Gandek, 1993).


The next step was to perform analyses to answer the three research questions. First, we compared the mental health scores of ‘Prostate cancer survivors’ with the ‘Reference group’ (Question 1, Figure 1). We observed that our ‘Reference group’ had significantly better mental health scores compared to the ‘Prostate Cancer survivors’ (difference of -6.52, p < 0.01). This means that in the ‘Prostate cancer survivors group’ 14% of the men were suspected of having depressive symptomatology. This was only 6% in the ‘Reference group’ (OR 0.41, 95% confidence interval 0.28-0.60).

Secondly, we identified prostate cancer survivors who were particularly at risk for mental health problems (Question 2, Figure 2). We observed six important risk factors: 1. Being a widower; 2. A low socioeconomic status; 3. Poor general health; 4. Bodily pain; 5. Urinary bother; and 6. Less sexual satisfaction. Health professionals should pay extra attention to survivors with these characteristics or health problems. These men are at risk for developing mental health problems.

Lastly, we analyzed whether these risk factors in the ‘Prostate Cancer Survivors’ group differed from the risk factors in the ‘Reference group’ (Question 3). Two differences between the groups were observed. 1. In the ‘Reference group’ a higher age was a risk factor for mental health problems. No association between mental health and age was found in the prostate cancer group. 2. A poor general health was a stronger risk factor in the prostate cancer group.

In summary, prostate cancer survivors are more at risk for mental health problems. Therefore, this study stresses the importance of ongoing assessment and interventions focusing on the mental health of prostate cancer survivors especially for men who have to cope with additional physical, economic and emotional disturbances.

Mental health problems are not only a problem for prostate cancer patients. Many other patients experience depressive symptoms possibly associated with the effects of a disease. However, possibilities to help these patients (e.g. by referring to a mental health professional) are often not well known by health professionals. Thinking about the answer to the following question might be the first step: What can you do in your professional setting when you suspect a patient of having mental health problems?

Author: Marie-Anne van Stam, Dept. of Urology UMC Utrecht Cancer Center, The Netherlands Cancer Institute Utrecht (NL)
Co-Authors: J.L.H.R. Bosch, H.G. van der Poel, S. Horenblas, N.K. Aaronson