UroToday.com – Dr. William Dale and associates reported on the influence of anxiety when a patient with prostate cancer (CaP) and biochemical recurrence (BCR) initiates androgen deprivation therapy (ADT).
A total of 67 patients with a mean age of 68 years participated and 70% of these rated their own health as very good or excellent. Data was collected from surveys and medical records. Participants completed an initial baseline survey and a follow-up at each subsequent visit until they started ADT. Metrics assessed through numerous validated instruments included demographics, psychological state and physical functioning. The patient’s perception of his and the physician’s relative contributions to the decision to initiate ADT were asked. The relative importance of 16 factors related to the initiation of ADT were ranked from 1 (not important) to 5 (very important).
The anxiety evaluation demonstrated excellent internal consistency reliability. Elevated CaP-specific anxiety was present in 22% at presentation. Both attending oncologists and oncology fellows rated PSA doubling time as the most important factor in deciding when to start a patient with BCR on ADT. They rated patient anxiety as the third least important factor, but patient preference as the second most important factor. Several multivariable models were assessed. Elevated anxiety was the strongest predictor of early ADT and correctly classified 74% of the cases. PSA also independently correlated with early initiation of ADT, but PSA did not correlate with anxiety scores. However, in 2 of the multivariable models, PSA doubling time was not even significant. In participants with elevated anxiety scores, the average time to initiation of ADT was 11 months after presentation. In men with lower anxiety it was 24.9 months.
The study is remarkable in documenting that patient anxiety is more important than clinical parameters in determining the time to initiation of ADT in men with a BCR of CaP.
Dale W, Hemmerich J, Bylow K, Mohile S, Mullaney M, Stadler WM
J Clin Oncol. 2009 Mar 2. (Epub ahead of print)
Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS
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