Prostate Cancer’s ‘Elephant in the Room’

November 2, 2022 Mark Lichty, 73, said it took him a decade to overcome anxiety, fear of death and uncertainty about the future after being diagnosed with low-grade prostate cancer in 2005.

Lichty, of East Stroudsburg, PA, channeled some of that anxious energy into the launch. Active Surveillance Patients International (ASPI), which he co-founded in 2017 to help men with low-risk prostate tumors cope with the anxiety that their condition can turn from benign to life-threatening.

Many men call this condition “anxious monitoring” — an underlying level of anxiety that worsens as they wait for the results of intermittent blood tests, depending on the results. , may indicate the need for surgery or radiation therapy to remove it. A tumor that has become more aggressive.

Ironically, Lichty says, those same tests – which look at levels of a protein called prostate-specific antigen, or PSA – led to the “epidemic of overdiagnosis” of prostate cancer in the 1990s. This led to overtreatment that led to erectile dysfunction, incontinence and other problems for many patients — and now, he says, “an epidemic of anxiety monitoring that has resulted in these patients It can lead to unnecessary pain and even overtreatment.”

For prostate cancer patients, mental distress is often referred to as the “elephant in the room” that does not require immediate treatment. For years, these concerns were largely ignored, according to advocates and health professionals.

But recently, the prostate cancer community has begun to focus on mental health for this group. One factor is the stress caused by COVID-19.

“The mental health crisis from the COVID-19 pandemic has brought this issue into focus in prostate cancer,” says Rick Davis of Tucson, AZ, who was diagnosed with the disease in 2007.

Davis is the founder. Ann Cain Foundationwhich runs a support group for people with prostate cancer – the most commonly diagnosed cancer in men. According to American Cancer Society268,000 men in the United States will learn they have prostate cancer this year, about 10,000 more than in 2021. The group says an estimated 1 in 8 men will be diagnosed with the disease in their lifetime.

For Davis, these statistics point to a need for more services like those her foundation provides.

“We’ve tried to do some programming, but we haven’t taken the bull by the horns,” he says. “We really saw that this was the elephant in the room, and we needed to identify it and do something about it.”

AnCan and ASPI launched one of the first virtual support groups for patients with low- and favorable-intermediate-risk prostate cancer in 2019. A 2021 survey of 168 people in a support group found that 30% reported anxiety symptoms.

That’s according to a 2014 study by UK researchers who found that of nearly 4,500 prostate cancer patients across the treatment spectrum, 17% of men reported depression, and 27% reported anxiety, before treatment. They should be treated.

John Olaf, founder and lead investigator at the University of British Columbia, says the rate of anxiety is about twice that of the general population of men in the United States. Men’s Health Research The program says that untreated anxiety can lead to other mental health problems, including depression and suicidal thoughts and behaviors.

“Anxiety is often overlooked. The true extent and gravity of men’s anxiety is unknown, particularly concerning, with undiagnosed and untreated anxiety affecting the future,” Oliff says. predicts adverse mental health outcomes.

In September, the Prostate Cancer Foundation, the largest private funder of prostate cancer research, launched a patient-based Program. On November 17, Prostate Cancer Impact Alliance Conducting a webinar on emotional well-being.

“The world is recognizing the mental health issues in cancer much more than it should,” says Scott Tagawa, MD, medical director of the Genitourinary Oncology Research Program at Weill Cornell Health in New York City, and spokesperson for the American Society of Clinical Oncology. The COVID-19 pandemic started to happen before, but it was caused by some problems with the pandemic.

Tagawa says the total number of men with mental distress may be underestimated. “Men are less communicative and verbal,” he says. “They hide things.”

Jim C. Howe, MD, professor of urology at Weill Cornell, said mental health issues are now emerging because of “more emphasis on the whole patient.” It goes with patient-centered care. There is a focus on mental health issues in terms of patient care, especially when it comes to cancer patients.

Primary care physicians play a major role in providing psychiatric care and can provide emotional support for these patients, says Corey Levin, MD, vice chair of clinical affairs in the department of family medicine at the University of Colorado School of Medicine. Emphasis on “whole person care”.

“But many clinics aren’t necessarily screening because they don’t know what to do with the results,” says Levin, chair of the American Academy of Family Physicians’ guidelines committee. “They don’t have the tools or the resources if a patient has high anxiety levels or high symptoms of anxiety or depression. If they don’t know what to do with the results, they don’t screen.

Successful approaches

A few reputable clinics, such as Memorial Sloan Kettering Cancer Center in New York City, routinely screen prostate cancer patients for mental health problems.

Andrew J. Roth, MD, a psychologist who has devoted his career at the Center for Mental Health Issues and Prostate Cancer Patients and Their Families, developed scales to measure distress in prostate cancer patients. helped create, such as the Distress Thermometer in 1998. Roth also helped develop the Memorial Anxiety Scale for prostate cancer and is working on a scale to identify depression in older cancer patients.

“Distress screening tries to identify signs that someone is having trouble coping with cancer that can interfere with making treatment decisions, managing treatment, improving quality of life,” Roth says. , or that a particular patient doesn’t have enough social support,” says Roth. “Then they have the opportunity to get the help they need. If we don’t ask, we might not find out, and we can’t help these men deal with their prostate cancer and their lives in time.” I won’t be able to help.”

But not everyone agrees on the value of such devices. Darrell Mitteldorf, a licensed clinical social worker and founder based in New York City Melchior Support groups for prostate cancer are among the skeptics.

“Give [anxiety] The scale that Roth came up with and many others use very well for clinical trials. “But in a practical day-to-day sense, helping people with prostate cancer get on with their lives and be as happy and hopeful as possible is irrelevant.”

Through the Prostate Cancer Impact Alliance, an advocacy group within the American Urological Association, Davis began promoting a screening effort for mental distress in September. He says the approach is for clinical specialties involved in the care of prostate cancer patients. Urologists, radiation oncologists, genitourinary oncologists, primary care doctors, and even psychiatrists. Develop guidelines as a group.

“They all need to come together, and the idea is to monitor, identify and navigate people to treatment to deal with these mental health issues and perhaps crises,” Davis says. ” “Right now, we are not even identifying these people.

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