Definitive therapy for prostate cancer (e.g., surgery, radiotherapy) often has side effects, including urinary, sexual, and bowel dysfunction. The purpose of this study was to test whether urinary, sexual, and bowel function contribute to emotional distress during the first two years post treatment, and whether distress may, in turn, decrease function.
Participants were 1,148 men diagnosed with clinically localized disease who were treated with either surgery (63%) or radiotherapy (37%). Men's urinary, sexual, and bowel function were assessed with the Expanded Prostate Cancer Index Composite (EPIC) Emotional distress was assessed with the Distress Thermometer. Assessment time points were pre-treatment, 6 weeks, and 6, 12, 18, and 24 months post-treatment. We used time-lagged multilevel models to test whether physical function predicted emotional distress and vice versa.
Men with worse urinary, bowel, and sexual functioning reported more emotional distress than others at subsequent time points. The relationships were bidirectional; those who reported worse distress also reported worse urinary, bowel, and sexual functioning at subsequent time points.
To improve wellbeing in prostate cancer survivorship, clinicians, supported by practice and payer policies, should screen for, and facilitate treatment of side-effects and heightened emotional distress. These interventions may be cost-effective given that emotional distress can negatively impact functioning across life domains.
The Journal of urology. 2017 Dec 26 [Epub ahead of print]
Heather Orom, Caitlin Biddle, Willie Underwood, Christian J Nelson
University at Buffalo. Electronic address: ., University at Buffalo., Roswell Park Cancer Institute., Memorial Sloan Kettering Cancer Center.