Long-term prospective data on correlation between overall mortality and HADS (Hospital Anxiety and Depression Scale) assessed psychological distress in prostate cancer patients (11 year follow-up data).

person Santhanam Sundar Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom info_outline Santhanam Sundar, Ewan Shawcroft, Lauren Jones, Micheal O'Cathail, Shaymaa Usama Hosni, Jessica Little, Georgina Walker, Ashley Cox, Eamonn Fergusson

Authors person Santhanam Sundar Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom info_outline Santhanam Sundar, Ewan Shawcroft, Lauren Jones, Micheal O'Cathail, Shaymaa Usama Hosni, Jessica Little, Georgina Walker, Ashley Cox, Eamonn Fergusson Organizations Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom, Nottingham University Hospitals NHS trust, Nottingham, United Kingdom, St Bartholomew's Hospital, London, United Kingdom, Nottingham University Hospital NHS Trust, Nottingham, United Kingdom, Royal United Hospitals Bath NHS Foundation Trust, Bath, United Kingdom, University of Nottingham, Nottingham, United Kingdom Abstract Disclosures Research Funding No funding received None. Background: We prospectively assessed whether Psychological factors such as anxiety and depression can have a detrimental effect on long term overall survival of prostate cancer patients (pts). Methods: Prostate cancer pts participating in an ethics Committee approved, Prospective study evaluating an Andropause rating scale. All pts had radical radiotherapy with androgen deprivation therapy. Pts completed a baseline HADS questionnaire before any treatment was initiated & at 3mths & after completion of hormone therapy. Patient characteristics: Median age: 69 yrs (50 to 78 yrs). Charlson Comorbidity Index (CCI) prevalence at baseline as follows CCI-I 6.1%; CCI-II: 33.8%; CCI-III: 37.2%; CCI-IV: 14.2%; CCI-V: 6.1% and CCI-VI: 2.7%.; At the survival update in Feb 2023, 49.3% of patients have died [n = 148]; Gleeson grade was Low risk in 7.2%; Intermediate in 53.4% and high risk in 39.2%; Baseline PSA was < 10 ug/L in 45.3%; 10-20 ug/L in 33.1% and > 20 ug/L in 21.6% ; Tumour stage was T1 in 8.1% ; T2 in 63.5% and T3 in 28.4%. Baseline Median serum testosterone was 11.9 nmol/l (min 2.6 and max 26.7). Hormone duration was < 3 mths in 22.3%; 3-6mths in 35.8% ; 6 to < 36mths in 19.6% and > 36mths in 22.3%. Cox regression models estimated hazard ratios (HR) and 95% confidence intervals (CI) of overall mortality, while controlling for the following covariates (Age, T stage, Gleeson risk category, PSA Category, Baseline Serum Testosterone, ADT duration category and Charlson Comorbidity index). Results: Higher anxiety at time of diagnosis had a statistically significant adverse effect on overall survival (table); Higher depression symptoms at baseline did not affect survival but depressive symptoms after completing cancer treatment did affect all-cause mortality in this mature dataset with a median follow up of more than 11 years. Conclusions: Higher anxiety and depression symptoms in prostate cancer patients are associated with significantly higher long-term all-cause mortality. Normal HADS SCORE (1-7) Median survival Abnormal HADS SCORE ( > / = 8) Median survival Cox Regression Exp(B) with 95.0% CI for Exp(B) Anxiety subscale (HADS-A): Baseline 15.32 yrs 12.29 yrs P = 0.006 Exp(B) 2.38; (1.28 - 4.44 ) HADS-A : At 3 months 15.32 yrs 13.11 yrs P = 0.013 Exp(B) 2.10 (1.17, 3.78) HADS-A : Post therapy 14.81 yrs 13.05 yrs P = 0.043 Exp(B) 2.25 (1.02, 4.94 ) Depression subscale (HADS-D):Baseline 14.81 yrs 12.29 yrs P = 0.067 Exp(B) 2.41 (0.94 - 6.16) HADS-D : At 3 months 15.32 yrs 13.20 yrs P = 0.20 Exp(B) 1.59 (0.77 - 3.26) HADS-D : Post therapy 15.02 yrs 11.79 yrs P = 0.007 Exp(B) 3.18 (1.37 - 7.35)