局部前列腺癌治疗与心理健康结局的关联。
Association between Treatment for Localized Prostate Cancer and Mental Health Outcomes.
机构信息
Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee.
Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.
出版信息
J Urol. 2022 May;207(5):1029-1037. doi: 10.1097/JU.0000000000002370. Epub 2022 Mar 3.
PURPOSE
We aimed to compare patient-reported mental health outcomes for men undergoing treatment for localized prostate cancer longitudinally over 5 years.
MATERIALS AND METHODS
We conducted a prospective population-based analysis using the Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study. Patient-reported depressive symptoms (Centers for Epidemiologic Studies Depression [CES-D]) and domains of the Medical Outcomes Study 36-item Short Form survey evaluating emotional well-being and energy/fatigue were assessed through 5 years after treatment with surgery, radiotherapy (with or without androgen deprivation therapy) and active surveillance. Regression models were adjusted for outcome-specific baseline function, demographic and clinicopathological characteristics, and treatment approach.
RESULTS
A total of 2,742 men (median [quartiles] age 64 [59-70]) met inclusion criteria. Baseline depressive symptoms, as measured by the CES-D, were low (median 4, quartiles 1-8) without differences between groups. We found no effect of treatment modality on depressive symptoms (p=0.78), though older age, poorer health, being unmarried and baseline CES-D score were associated with declines in mental health. There was no clinically meaningful association between treatment modality and scores for either emotional well-being (p=0.81) or energy/fatigue (p=0.054).
CONCLUSIONS
This prospective, population-based cohort study of men with localized prostate cancer showed no clinically important differences in mental health outcomes including depressive symptoms, emotional well-being, and energy/fatigue according to the treatment received (surgery, radiotherapy, or surveillance). However, we identified a number of characteristics associated with worse mental health outcomes including: older age, poorer health, being unmarried, and baseline CES-D score which may allow for early identification of patients most at risk of these outcomes following treatment.
目的
我们旨在比较 5 年内接受局部前列腺癌治疗的男性患者的心理健康报告结果。
材料与方法
我们使用比较手术和放疗效果分析（CEASAR）研究进行了一项前瞻性基于人群的分析。通过手术、放疗（联合或不联合雄激素剥夺治疗）和主动监测治疗后 5 年内，采用中心流行病学研究抑郁量表（CES-D）和医疗结局研究 36 项简明健康调查评估情绪健康和精力/疲劳的各领域来评估患者报告的抑郁症状。回归模型根据特定结局的基线功能、人口统计学和临床病理特征以及治疗方法进行了调整。
结果
共有 2742 名男性（中位[四分位数]年龄 64 [59-70]）符合纳入标准。CES-D 测量的基线抑郁症状较低（中位数 4，四分位数 1-8），各组之间无差异。我们发现治疗方式对抑郁症状没有影响（p=0.78），但年龄较大、健康状况较差、未婚和基线 CES-D 评分与心理健康下降有关。治疗方式与情绪健康（p=0.81）或精力/疲劳（p=0.054）评分之间没有明显的临床相关关系。
结论
这项针对局部前列腺癌男性的前瞻性、基于人群的队列研究表明，根据所接受的治疗（手术、放疗或监测），心理健康结局（包括抑郁症状、情绪健康和精力/疲劳）没有明显的临床差异。然而，我们确定了一些与更差的心理健康结局相关的特征，包括：年龄较大、健康状况较差、未婚和基线 CES-D 评分，这可能有助于在治疗后早期识别最有可能出现这些结局的患者。
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