Hormonal Therapy Associated with Anxiety in Men with Localized Prostate Cancer

TON - May 2017, Vol 10, No 3

Orlando, FL—Androgen deprivation therapy (ADT) for the treatment of prostate cancer has adverse effects that may be difficult for men to tolerate. Well-documented adverse events include weight gain, fatigue, cardiovascular effects, hot flashes, and cognitive effects. According to results of a new study presented at the 2017 Genitourinary Cancers Symposium, anxiety should be added to the list of side effects related to ADT.

In a large study of >78,000 patients with localized prostate cancer, the cumulative incidence of anxiety at 3 years was significantly higher among men treated with ADT versus those who did not receive ADT (4.1% vs 3.5%, respectively [P <.001]). Whereas the absolute difference is .6%, numerically this translates to 3198 men with anxiety related to ADT and 2730 with anxiety unrelated to ADT.

Using propensity score matching, any ADT use was associated with a 17% increased risk of an anxiety diagnosis (P <.001).

“These results suggest that anxiety should be considered among the possible psychiatric effects of ADT
and discussed prior to initiating ADT, particularly if a long course of treatment is anticipated,” the investigators reported.

The study was designed to assess whether ADT and longer treatment with ADT were associated with anxiety. The study cohort included 78,552 men aged ≥66 years with stage I to III prostate cancer included in the SEER- Medicare Linked Database from 1992 to 2006. Patients were excluded from the study if they died within 6 months of diagnosis, had orchiectomy, had stage IV or unknown stage of disease, or had received psychiatric treatment in the 12 months before and 6 months after prostate cancer diagnosis.

Comorbidity status was calculated using the Charlson Comorbidity Index. Patients could have received radiation, surgery, or no local therapy, with or without ADT, within 6 months of prostate cancer diagnosis.

An International Classification of Diseases, Ninth Edition diagnosis of anxiety was the primary end point. Baseline factors significantly associated with receipt of ADT included older age, intermediate risk (stage I-II and Gleason score 7-10, poorly differentiated), higher Charlson Comorbidity Index, and 1 to 6 months of ADT (all factors, P <.001).

In a multivariate analysis adjusted for demographic, clinical, and treatment factors, the following were significant factors associated with anxiety: ≥12 months of ADT (P = .010), unmarried status (P <.001), and higher Charlson Comorbidity Index ≥2 (P <.001).

These results may represent the tip of the iceberg, because patients were required to have an International Classification of Diseases, Ninth Edition, diagnosis of anxiety, and many patients may be anxious but not fulfill diagnostic criteria.

The take-home message is that clinicians who see patients with prostate cancer treated with ADT should be aware that their patients may be anxious, and they should ask them about it.

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