DEPRESSIVE SYMPTOMS INFLUENCE TREATMENT DECISION PROCESSES AMONG NEWLY DIAGNOSED PROSTATE CANCER PATIENTS

Purpose.  Making a treatment decisions for a localized prostate cancer is a complex process.  The present study uses a prospective design to examine the influence of depressive symptoms on treatment decision making after diagnosis of prostate cancer and the impact of the decision on regret 6 months later. Methods. Of the 1370 newly diagnosed (T1-2N0M0) referred patients, 923 patients completed questionnaires at baseline (after diagnosis) and six months later (after treatment). Patients were on average 65.83 years old (SD = 8.10, range 39- 95 years), Caucasians (89.1 %), married (80.5%), had college education or post-graduate education (48.9 %), or were retired at the time of baseline assessment (57.6%).  Baseline measures included the Center for Epidemiologic Studies Depression scale (CES-D;  Radloff, 1971) as well as scales designed to assess treatment related cognitive and affective factors (i.e., beliefs about treatment efficacy, seriousness of disease, perceived vulnerability, treatment values and attributes, reasons for choosing treatment, and worries about treatment side effects (Diefenbach & Uzzo, 2002).  Items from the decisional regret scale (Brehaut et al., 2003) were used at six months.
Results.  At baseline, patients with higher levels of depressive symptoms were significantly less informed about their prostate cancer treatment options, more worried about surgery and radiation therapy, and their side effects, more worried about cancer spread, and had less strong beliefs about treatment efficacy than patients with lower levels of depressive symptoms. The degree of the importance of avoiding incontinence, erectile dysfunction, painful urination, general pain, and fatigue was significantly higher among patients with higher levels of depressive symptoms than patients with lower levels of depressive symptoms.  At six months the influence of depressive symptoms continued.  Patients with higher levels of depressive symptoms reported that they had more difficulty making a treatment decision and were more distressed about it, were more worried about whether they made the right decision, and indicated less satisfaction with their decision. They were also less certain and more regretful about the decision than patients with lower levels of depressive symptoms.

Conclusions.  Depression and emotional distress can influence decision making processes and reduce decision satisfaction among prostate cancer patients even below clinical levels. Heath care providers should probe for and address depressive symptoms among prostate cancer patients to ensure optimal decision making.