1. PHQ2 Screening Negative PHQ2 Screening Positive
Quality of Life among Self-Reported Prostate Cancer Individuals with Depression
Gressler LE, Payakachat N
College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
INTRODUCTION
RESULTS
Prostate cancer is the most common malignancy in men, affecting one in every three men.1 This generates about 200,000 new cases of prostate cancer each year.2
Even though the life expectancy for patients with prostate cancer has increased significantly, many patients still experience a decline in general health, a risk of low testosterone, lifelong erectile dysfunction, urinary incontinence, and other long-lasting treatment effects. These physical symptoms may greatly affect the mental health of these patients.
The morbidity of depression is under recognized and, therefore, is also more likely to be inadequately treated. This can lead to indirect healthcare costs, such as decreased medical adherence, increased hospital stays, and possible suicides.
OBJECTIVE
Compared their Quality of Life (QoL) to the US norms
Determined factors associated with the QoL
Explored impact of depression on QoL
The average PCS12 and MCS12 scores were 52.4 and 43.3, respectively.
Participants reported prostate cancer aged had significantly lower PCS12 and MCS12 scores than the US norm.
Regression analysis indicated that a higher degree of education (p<0.001), and employment status (p<0.001) were factors associated with higher mental health component scores.
Age (p<0.001) and unemployment (p<0.001) were associated with lower physical health scores.
A higher degree of education (p<0.001) and increased income (p=0.037) were contributed to increased physical health scores.
19.8% had a PHQ2 score of 2 or higher and therefore screened positive for depression.
Factors associated with increased PHQ2 scores and positive screening included PCS12 score (p<.0001).
Reliability estimates were .862 and .889 for the physical and mental health components of the SF-12 respectively.
10.67%
Table 1: Comparison of Mean PCS12 Scores of patients with prostate cancer and the U.S. norms
Mean
Standard
Error
U.S. Norm Mean
Difference
SF-12 Physical Health Component
Between 18 and 44 years old
53.7
1.69
52.45
1.25
Between 45 and 54 years old
46.1
1.71
51.01
-4.91
Between 55 and 64 years old
47.6
0.79
49.36
-1.76
Older than 65 years old
41.9
0.39
45.53
-3.63
All
43.3
0.35
SF-12 Mental Health Component
51.5
3.98
48.42
3.08
50.5
1.59
50.08
0.42
51.2
0.68
52.94
-1.74
52.8
0.31
53.67
-0.87
52.4
0.28
METHODS
Study Design:
A cross-sectional, retrospective database study
Database:
We extracted data from the Medical Expenditure Panel Survey (MEPS).
MEPS is a national health survey of healthcare costs, health states, and service utilization within the U.S. ambulatory population.
Study Population:
Men with self-reported prostate cancer above the age of 18 during the five year range from 2009 to 2013.
Outcome Measures:
QoL was that primary outcome variable and was measured using the SF-12 Health Survey (version 2.0).
Physical Component Score (PCS12)
Mental Component Score (MCS12)
Depression measured by PHQ2
Statistical Analysis:
The average PCS12 and MCS12 were calculated for specific age groups and compared to published U.S. norms scores within the respective age groups. A difference of 5 points or greater was considered clinically significant difference.
Linear regression was used to explore factors associated with PCS12 and MCS12 scores.
Logistic regression was conducted to determine factors associated with positive screening for depression among the prostate cancer population..
All analyses were performed in SAS version 9.3 (Cary, NC) using PROC SURVEY, incorporating the individual person weight, strata, and cluster variables provided by MEPS.
Table 2: Comparison of Physical and Mental SF-12 Scores in Positive and Negative Screening of Depression
Mean
Standard Error
95% Confidence Interval
SF-12 Physical Health Component
PHQ2 Screening Negative
44.96
0.3763
PHQ2 Screening Positive
36.7
0.7786
SF-12 Mental Health Component
55.31
0.2227
40.98
0.6232
LIMITATIONS
This study was a cross-sectional study and, therefore, no causal inferences should be made from the data.
The findings did not account for severity of the disease, stage, and type of tumor, nor treatment received due to the limitation of the data.
The data were self-reported, therefore, their validity was subject to recall bias.
CONCLUSION
The findings of the study demonstrated that men diagnosed with prostate cancer have higher mental and physical health scores than the U.S. norms. The results of this study may give clinical insight to physicians treating these patients, especially those with lower education, reduced income, increased age, and decreased physical health scores.
RESULTS
A total of 1,242 individuals with self-reported prostate cancer were identified in the 5-year time period.
A majority of the participants were white (85.97%), 75 or older (76.14%), unemployed (70.05%), married (67.82%), and high school graduates (56.1%). The majority of the population also had high income (48.47%).
REFERENCES
1. Landis, S. H., Murray, T., Bolden, S. & Wingo, P. a. Cancer statistics, CA. Cancer J. Clin. 48, 6–29 (1998).
2. Kassabian, V. & Graham, S. Urologic and Male Genital Cancers. Am. Cancer Soc. Textb. Clin. Oncol. 315 (1995).