Thinking about one’s own death after prostate-cancer diagnosis

Abstract

Background

Prostate-cancer diagnosis increases the risk for psychiatric morbidity and suicide. Thoughts about one’s own death could indicate need for psychiatric care among men with localized prostate cancer. We studied the prevalence and predictors of thoughts about own death among men with prostate cancer.

Methods

Of the 3930 men in the prospective, multi-centre LAPPRO-trial, having radical prostatectomy, 3154 (80%) answered two study-specific questionnaires, before and three months after surgery. Multivariable prognostic models were built with stepwise regression and Bayesian Model Averaging.

Results

After surgery 46% had thoughts about their own death. Extra-prostatic tumor-growth [Adjusted Odds-Ratio 2.06, 95% Confidence Interval 1.66–2.56], university education [OR 1.66, CI 1.35–2.05], uncertainty [OR 2.20, CI 1.73–2.82], low control [OR 2.21, CI 1.68–2.91], loneliness [OR 1.75, CI 1.30–2.35], being a burden [OR 1.59, CI 1.23–2.07], and crying [OR 1.55, CI 1.23–1.96] before surgery predicted thoughts about one’s own death after surgery.

Conclusions

We identified predictors for thoughts about one’s own death after prostate cancer diagnosis and surgery. These factors may facilitate the identification of psychiatric morbidity and those who might benefit from psychosocial support already during primary treatment.

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References

  1. 1.

    Bill-Axelson A, Garmo H, Lambe M, Bratt O, Adolfsson J, Nyberg U, Steineck G, Stattin P (2010) Suicide risk in men with prostate-specific antigen-detected early prostate cancer: a nationwide population-based cohort study from PCBaSe. Sweden European Urology 57(3):390–395. https://doi.org/10.1016/j.eururo.2009.10.035

    Article  PubMed  Google Scholar 

  2. 2.

    Fall K, Fang F, Mucci LA, Ye W, Andrén O, Johansson J-E, Andersson S-O, Sparén P, Klein G, Stampfer M, Adami H-O, Valdimarsdottir U (2009) Immediate risk for cardiovascular events and suicide following a prostate cancer diagnosis: prospective cohort study. PLoS Med 6(12):e1000197. https://doi.org/10.1371/journal.pmed.1000197

    Article  PubMed  PubMed Central  Google Scholar 

  3. 3.

    Fang F, Fall K, Mittleman MA, Sparen P, Ye W, Adami H-O, Valdimarsdottir U (2012) Suicide and cardiovascular death after a cancer diagnosis. N Engl J Med 366(14):1310–1318. https://doi.org/10.1056/NEJMoa1110307

    Article  PubMed  Google Scholar 

  4. 4.

    Fang F, Keating NL, Mucci LA, Adami H-O, Stampfer MJ, Valdimarsdottir U, Fall K (2010) Immediate risk of suicide and cardiovascular death after a prostate cancer diagnosis: cohort study in the United States. J Natl Cancer Inst 102(5):307–314. https://doi.org/10.1093/jnci/djp537

    Article  PubMed  Google Scholar 

  5. 5.

    Llorente MD, Burke M, Gregory GR, Bosworth HB, Grambow SC, Horner RD, Golden A, Olsen EJ (2005) Prostate cancer: a significant risk factor for late-life suicide American. Journal of Geriatric Psychiatry 13(3):195–201. https://doi.org/10.1097/00019442-200503000-00004

    Article  Google Scholar 

  6. 6.

    Jonsson A, Aus G, Bertero C (2010) Living with a prostate cancer diagnosis: a qualitative 2-year follow-up. The Aging Male 13(1):25–31. https://doi.org/10.3109/13685530903424170

    Article  PubMed  Google Scholar 

  7. 7.

    Kelly D (2009) Changed men: the embodied impact of prostate cancer qualitative. Health research 19:151–163

    Google Scholar 

  8. 8.

    Westman B, Bergenmar M, Andersson L (2006) Life, illness and death - existential reflections of a Swedish sample of patients who have undergone curative treatment for breast or prostatic cancer. Eur J Oncol Nurs 10(3):169–176. https://doi.org/10.1016/j.ejon.2005.06.002

    CAS  Article  PubMed  Google Scholar 

  9. 9.

    Bisson JI, Chubb HL, Bennett S, Mason M, Jones D, Kynaston H (2002) The prevalence and predictors of psychological distress in patients with early localized prostate cancer. BJU Int 90(1):56–61. https://doi.org/10.1046/j.1464-410X.2002.02806.x

    CAS  Article  PubMed  Google Scholar 

  10. 10.

    Thorsteinsdottir T, Hedelin M, Stranne J, Valdimarsdottir H, Wilderang U, Haglind E, Steineck G (2013) Intrusive thoughts and quality of life among men with prostate cancer before and three months after surgery. Health Qual Life Outcomes 11(1):154. https://doi.org/10.1186/1477-7525-11-154

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    Thorsteinsdottir T, Valdimarsdottir H, Hauksdottir A, Stranne J, Wilderäng U, Haglind E, Steineck G (2017) Care-related predictors for negative intrusive thoughts after prostate cancer diagnosis—data from the prospective LAPPRO trial. Psycho-Oncology 26(11):1749–1757. https://doi.org/10.1002/pon.4359

  12. 12.

    Thorsteinsdottir T, Stranne J, Carlsson S, Anderberg B, Bjorholt I, Damber J-E, Hugosson J, Wilderang U, Wiklund P, Steineck G, Haglind E (2011) LAPPRO: a prospective multicentre comparative study of robot-assisted laparoscopic and retropubic radical prostatectomy for prostate cancer Scandinavian. Journal of Urology and Nephrology 45:102–112

    Google Scholar 

  13. 13.

    Bill-Axelson A, Holmberg L, Garmo H, Rider JR, Taari K, Busch C, Nordling S, Haggman M, Andersson SO, Spangberg A, Andren O, Palmgren J, Steineck G, Adami HO, Johansson JE (2014) Radical prostatectomy or watchful waiting in early prostate cancer. N Engl J Med 370(10):932–942. https://doi.org/10.1056/NEJMoa1311593

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  14. 14.

    Enblom A, Johnsson A, Hammar M, Onelov E, Steineck G, Borjeson S (2012) Acupuncture compared with placebo acupuncture in radiotherapy-induced nausea--a randomized controlled study. Ann Oncol 23(5):1353–1361. https://doi.org/10.1093/annonc/mdr402

    CAS  Article  PubMed  Google Scholar 

  15. 15.

    Kreicbergs U, Valdimarsdottir U, Onelov E, Henter JI, Steineck G (2004) Talking about death with children who have severe malignant disease. N Engl J Med 351(12):1175–1186. https://doi.org/10.1056/NEJMoa040366

    CAS  Article  PubMed  Google Scholar 

  16. 16.

    Steineck G, Helgesen F, Adolfsson J, Dickman PW, Johansson JE, Norlen BJ, Holmberg L (2002) Quality of life after radical prostatectomy or watchful waiting. N Engl J Med 347(11):790–796. https://doi.org/10.1056/NEJMoa021483

    Article  PubMed  Google Scholar 

  17. 17.

    Steineck G, Bergmark K, Henningsohn L, Al-Abany M, Dickman PW, Helgason A (2002) Symptom documentation in cancer survivors as a basis for therapy modifications. Acta Oncol 41(3):244–252. https://doi.org/10.1080/02841860260088782

    Article  PubMed  Google Scholar 

  18. 18.

    Lind H, Waldenstrom AC, Dunberger G, Al-Abany M, Alevronta E, Johansson KA, Olsson C, Nyberg T, Wilderang U, Steineck G, Avall-Lundqvist E (2011) Late symptoms in long-term gynaecological cancer survivors after radiation therapy: a population-based cohort study. Brit J Cancer 105(6):737–745. https://doi.org/10.1038/bjc.2011.315

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  19. 19.

    Bursac Z, Gauss CH, Williams DK, Hosmer DW (2008) Purposeful selection of variables in logistic regression. Source Code Biol Med 3(1):17. https://doi.org/10.1186/1751-0473-3-17

    Article  PubMed  PubMed Central  Google Scholar 

  20. 20.

    Genell A, Nemes S, Steineck G, Dickman PW (2010) Model selection in medical research: a simulation study comparing Bayesian model averaging and stepwise regression. BMC Med Res Methodol 10(1):108. https://doi.org/10.1186/1471-2288-10-108

    Article  PubMed  PubMed Central  Google Scholar 

  21. 21.

    Kass RE, Raftery AE (1995) Bayes factors. J Am Stat Assoc 90(430):773–795. https://doi.org/10.1080/01621459.1995.10476572

    Article  Google Scholar 

  22. 22.

    Development Core Team R (2005) R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna

    Google Scholar 

  23. 23.

    Sobin L, Gospodarowicz MK, Wittekind C (2010) TNM classification of malignant Tumours. In: Editor (ed) Book TNM classification of malignant Tumours. Wiley, Blackwell City, p 256

    Google Scholar 

  24. 24.

    Lepore SJ, Helgeson VS (1998) Social constraints, intrusive thoughts, and mental health after prostate cancer. J Soc Clin Psychol 17(1):89–106. https://doi.org/10.1521/jscp.1998.17.1.89

    Article  Google Scholar 

  25. 25.

    Walker J, Waters RA, Murray G, Swanson H, Hibberd CJ, Rush RW, Storey DJ, Strong VA, Fallon MT, Wall LR, Sharpe M (2008) Better off dead: suicidal thoughts in cancer patients. J Clin Oncol 26(29):4725–4730. https://doi.org/10.1200/JCO.2007.11.8844

    Article  PubMed  Google Scholar 

  26. 26.

    Walker J, Hansen CH, Butcher I, Sharma N, Wall L, Murray G, Sharpe M (2011) Thoughts of death and suicide reported by cancer patients who endorsed the “suicidal thoughts” item of the PHQ-9 during routine screening for depression. Psychosomatics 52(5):424–427. https://doi.org/10.1016/j.psym.2011.02.003

    Article  PubMed  Google Scholar 

  27. 27.

    Walker J, Hansen CH, Hodges L, Thekkumpurath P, O'Connor M, Sharma N, Kleiboer A, Murray G, Kroenke K, Sharpe M (2010) Screening for suicidality in cancer patients using item 9 of the nine-item patient health questionnaire; does the item score predict who requires further assessment? Gen Hosp Psychiatry 32(2):218–220. https://doi.org/10.1016/j.genhosppsych.2009.11.011

    Article  PubMed  Google Scholar 

  28. 28.

    Sunny L, Hopfgarten T, Adolfsson J, Steineck G (2007) Economic conditions and marriage quality of men with prostate cancer. British Journal of Urology International 99(6):1391–1397. https://doi.org/10.1111/j.1464-410X.2007.06807.x

    Article  Google Scholar 

  29. 29.

    Sharpley CF, Christie DH, Bitsika V, Oar AJ (2013) The effects of low- and high-dose-rate brachytherapy on depressive symptoms in prostate cancer patients. Int J Clin Oncol 19(6):1080–1084. https://doi.org/10.1007/s10147-013-0647-1

  30. 30.

    Cacioppo JT, Hawkley LC, Thisted RA (2010) Perceived social isolation makes me sad: 5-year cross-lagged analyses of loneliness and depressive symptomatology in the Chicago health, aging, and social relations. Study Psychol Aging 25(2):453–463. https://doi.org/10.1037/a0017216

    Article  PubMed  Google Scholar 

  31. 31.

    Helgason AR, Dickman PW, Adolfsson J, Steineck G (2001) Emotional isolation: prevalence and the effect on well-being among 50-80-year-old prostate cancer patients. Scand J Urol Nephrol 35(2):97–101

    CAS  Article  PubMed  Google Scholar 

  32. 32.

    Steineck G, Hunt H, Adolfsson J (2006) A hierarchical step-model for causation of bias-evaluating cancer treatment with epidemiological methods. Acta oncologica (Stockholm, Sweden) 45(4):421–429. https://doi.org/10.1080/02841860600649293

    Article  Google Scholar 

  33. 33.

    Litwin MS, Lubeck DP, Henning JM, Carroll PR (1998) Differences in urologist and patient assessments of health related quality of life in men with prostate cancer: results of the CaPSURE database. J Urol 159(6):1988–1992. https://doi.org/10.1016/S0022-5347(01)63222-1

    CAS  Article  PubMed  Google Scholar 

  34. 34.

    Månsson A, Henningsohn L, Steineck G, Månsson W (2004) Neutral third party versus treating institution for evaluating quality of life after radical cystectomy. Eurpean Urology 46(2):195–199. https://doi.org/10.1016/j.eururo.2004.04.010

    Article  Google Scholar 

  35. 35.

    Skoogh J, Steineck G, Johansson B, Wilderang U, Stierner U (2013) Psychological needs when diagnosed with testicular cancer: findings from a population-based study with long-term follow-up. BJU Int 111(8):1287–1293. https://doi.org/10.1111/j.1464-410X.2012.11696.x

    Article  PubMed  Google Scholar 

  36. 36.

    Stinesen-Kollberg K, Thorsteinsdottir T, Wilderang U, Steineck G (2013) Worry about one's own children, psychological well-being, and interest in psychosocial intervention. Psycho-Oncology 22(9):2117–2123. https://doi.org/10.1002/pon.3266

    Article  PubMed  Google Scholar 

  37. 37.

    Skoogh J, Ylitalo N, Larsson Omerov P, Hauksdottir A, Nyberg U, Wilderang U, Johansson B, Gatz M, Steineck G (2010) ‘A no means no’--measuring depression using a single-item question versus hospital anxiety and depression scale (HADS-D). Ann Oncol 21(9):1905–1909. https://doi.org/10.1093/annonc/mdq058

    CAS  Article  PubMed  Google Scholar 

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Acknowledgements

The authors gratefully acknowledge the participants in the LAPPRO trial, the members of the steering committee, the investigators at the participating hospitals, and the personnel at the trial secretariat for their provision of study material and administrative support.

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Correspondence to Thordis K. Thorsteinsdottir.

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No conflicts of interest declared. The authors alone are responsible for the content and writing of the manuscript.

Additional information

Eva Haglind Principal investigator of the LAPPRO trial; Gunnar Steineck Deputy principal investigator

This work was supported by: The LAPPRO trial was supported by the Swedish Cancer Society (CAN2008/922, CAN2009/1099, CAN2010/593), Västra Götaland Region (ALFGBG-11573) and the Sahlgrenska University Hospital (HTAVGR-6011).

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Thorsteinsdottir, T.K., Valdimarsdottir, H., Stranne, J. et al. Thinking about one’s own death after prostate-cancer diagnosis. Support Care Cancer 26, 1665–1673 (2018). https://doi.org/10.1007/s00520-017-3986-z

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Keywords

  • Prostate cancer
  • Psychological adaptation
  • Clinical trial
  • Thoughts about death