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The effectiveness of psychological intervention for depression, anxiety, and distress in prostate cancer: a systematic review of literature

Prostate Cancer and Prostatic Diseases volume 24, pages 674–687 (2021)Cite this article

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Abstract

Background

The increasing incidence and declining mortality rates seen in prostate cancer will result in a growing survivorship with a burden of health conditions, warranting attention to psychological health. Depression, anxiety, and distress have prognostic significance; attempts have been made to reduce them with psychological interventions using cognitive- and/or education-based approaches. The review of literature attempted to measure a clinically meaningful difference between pre- and post-intervention scores that were previously reported in randomized clinical trials.

Methods

Using the PRISMA-checklist, we identified 22 studies that assessed psychological interventions by randomizing against care as usual (CAU). We calculated a percent change between pre- and post-trial mean scores for depression, anxiety, and distress in each study and analyzed effectiveness of intervention versus CAU.

Results

The patient group receiving intervention showed significantly greater improvement in depression, anxiety, as well as general and cancer-specific distress as compared to CAU. The effectiveness of intervention was retained even in subgroups upon limiting analysis to seven studies that used one single assessment tool, the Hospital Anxiety and Depression Scale (HADS), or to 14 studies with localized prostate cancer (LPC). Improvement in depression did not correlate with anxiety but correlated significantly with a reduction in distress. Lastly, improvement in all three parameters was numerically greater in three studies that combined cognitive- and education-based approaches versus studies using either approach alone.

Conclusions

The present analysis underscores the utility of psychological intervention for depression, anxiety, and distress related to prostate cancer. Future research should ascertain their impact on long-term clinical outcomes, like disease progression and survival.

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Fig. 1: A CONSORT diagram (PRISMA flow diagram) describing the literature search strategy.
Fig. 2: Percent change in the mean scores with intervention versus control arm as reported in individual studies in the overall study group.
Fig. 3: Measurement of anxiety, depression, and distress by single assessment tool, viz. Hospital Anxiety and Depression Scale (HADS), in different studies.

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Authors and Affiliations

  1. College of Liberal Arts and Sciences, University of Illinois at Urbana Champaign, Urbana, IL, USA

    Rhea Mundle

  2. Department of Mathematics, Elmhurst University, Elmhurst, IL, USA

    Evans Afenya

  3. Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA

    Neeraj Agarwal

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Contributions

All authors designed the study and contributed to the interpretation of the results. Also, NA provided an oversight of the overall study and EA provided an oversight of the data analysis. RM and NA drafted the manuscript and all authors reviewed/revised the manuscript.

Corresponding author

Correspondence to Neeraj Agarwal.

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Conflict of interest

This review study was an independent collaboration and did not receive any funding. Author disclosures: Neeraj Agarwal: disclosure as follows, Consultancy to: Astellas, Astra Zeneca, Bayer, Bristol Myers Squibb, Clovis, Eisai, Eli Lilly, EMD Serono, Exelixis, Foundation Medicine, Genentech, Janssen, Merck, Nektar, Novartis, Pfizer, Pharmacyclics, and Seattle Genetics. Research funding to Dr. Agarwal’s institution: Astra Zeneca, Bavarian Nordic, Bayer, Bristol Myers Squibb, Calithera, Celldex, Clovis, Eisai, Eli Lilly, EMD Serono, Exelixis, Genentech, Glaxo Smith Kline, Immunomedics, Janssen, Medivation, Merck, Nektar, New Link Genetics, Novartis, Pfizer, Prometheus, Rexahn, Roche, Sanofi, Seattle Genetics, Takeda, and Tracon. RM and EA declare no competing interests.

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Mundle, R., Afenya, E. & Agarwal, N. The effectiveness of psychological intervention for depression, anxiety, and distress in prostate cancer: a systematic review of literature. Prostate Cancer Prostatic Dis 24, 674–687 (2021). https://doi.org/10.1038/s41391-021-00342-3

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