ABSTRACT
Background: Small-scale studies indicate an increase in mental health disorders among prostate cancer survivors compared to the general population, but large population-based data assessing this relationship are scarce. The present study examined the prevalence of lifetime history of prostate cancer in a cross-sectional sample of Canadian men and assessed the contribution of lifetime history of a prostate cancer diagnosis, multimorbidity, and current alcohol and smoking status to the association with current mental health outcomes in this population. Methods: The analytical sample included 25,183 men (aged 45 to 85 years old), who completed a survey as part of the Canadian Longitudinal Study on Aging (CLSA). The Center for Epidemiological Studies Depression Scale (CES-D10), Kessler's Psychological Distress Scale (K10), and self-reported mental health were mental health outcomes. Multiple logistic regression analyses, and controlling for the complexity of the design and covariates, evaluated the association between prostate cancer survivorship, multimorbidity, alcohol and smoking status, and current mental health outcomes. Results: The prevalence of lifetime history of prostate cancer diagnosis in this population-based sample of men was 4% (95% CI: 3.7, 4.4). Our results indicate statistically significantly higher odds of current psychological distress (aOR = 1.52, 95% CI: 1.09, 2.11) and screening positive for depression (aOR = 1.24; 95% CI: 1.02, 1.51) among survivors of prostate cancer, compared to men without a history of prostate cancer diagnosis in demographics controlled analyses. After addition of multimorbidity and substance use, the odds of screening positive for depression among survivors of prostate cancer are 1.32 (95% CI: 1.06, 1.64) higher compared to men who never had a history of prostate cancer diagnosis. Interpretation: Patient education and empowerment programs aimed at addressing concerns during the diagnosis and treatment and enhancing survivorship care plans by adding routine screening for mental distress to help survivors overcome poor mental health during the cancer survivorship journey, are warranted.
ABSTRACT
Objective: Response-shift has been cited as an important measurement consideration when assessing patient reported quality of life (QoL) outcomes over time among patients with severe chronic conditions. Here we report the results of a systematic review of response shift in studies assessing QoL among cancer patients. Methods: A systematic review using MEDLINE, EMBASE, and PsychINFO along with a manual search of the cited references of the articles selected, was conducted. A quality review was performed using STROBE criteria and reported according to PRISMA guidelines. Results: A systematic review of 1,487 records published between 1,887 and December 2018 revealed 104 potentially eligible studies, and 35 studies met inclusion criteria for content and quality. The most common cancer patient populations investigated in these studies were breast (18 studies), lung (14 studies), prostate (eight studies), and colorectal (eight studies). Response shift was identified among 34 of the 35 studies reviewed. Effect sizes were reported in 17 studies assessing QoL outcomes among cancer patients; 12 of which had negligible to small effect sizes, four reported medium effect sizes which were related to physical, global QoL, pain, and social (role) functioning and one reported a large effect size (fatigue). The most prevalent method for assessing response shift was the then-test, which is prone to recall bias, followed by the pre-test and post-test method. Given the heterogeneity among the characteristics of the samples and designs reviewed, as well as the overall small to negligible effect sizes for the effects reported, conclusions stating that changes due to internal cognitive shifts in perceived QoL should account for changes observed in cancer patients' QoL outcomes should be interpreted with caution. Conclusion: Further work is needed in this area of research. Future studies should control for patient characteristics, time elapsed between diagnosis and baseline assessment and evaluate their contribution to the presence of response shift. Time between assessments should include short and longer periods between assessments and evaluate whether the presence of response shift holds over time. Possible avenues for inquiry for future investigation are discussed.
