Pain 1 of 3 in a Cluster of Symptoms Affecting Men After Prostate Cancer

One in 13 survivors of prostate cancer are afflicted with pain, fatigue, and depression as one cluster of symptoms, according to a recent analysis.

This cluster of these 3 specific symptoms is not unknown in cancer, and taken individually, they are also known in prostate cancer. The authors noted that up to 75% of prostate cancer survivors may experience cancer-related fatigue. Urethral pain is reported by 16% following radiation therapy. And on average, 18% of survivors have depression after treatment.

However, the authors sought to explore the specific association of this cluster with prostate cancer. Besides wanting to know the prevalence of this sequelae in prostate cancer, the researchers also aimed to understand more about the factors shared by these survivors.

While the incidence of prostate cancer is rising, so is survival, and so there are more men living with this cancer than any other malignancy, the authors noted.

The study took place in Ireland, where population-based cancer registries exist in both Northern Ireland and the Republic of Ireland. Participants came from both areas. A total of 6559 survivors were sent questionnaires; 3348 men participated (response rate = 54%; 297 men had died). They had been diagnosed with prostate cancer 2-18 years previously.

Cancer-related pain and fatigue were assessed using the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire Version 3.0 (EORTC QLQ-C30). For depression, the men answered the the 21-question version of the Depression, Anxiety and Stress Scale (DASS-21).

After initially summarizing the 3 variables for the cluster and computing Pearson coefficients, the researchers created 3 binary variables in order to classify the men according to whether they scored in the range for clinically significant cancer-related pain, clinically significant cancer-related fatigue and depression. These cut-offs were pain ≥ 25, fatigue ≥ 39, and depression ≥ 10. Multivariate logistic regression was used to assess links between survivor-related factors, clinical variables, and specific prostate cancer physical symptoms and the symptom cluster.

Slightly more than 25% of respondents were aged 70 year or older at diagnosis; 35% had completed only primary level education; and almost a quarter had a first-degree family history of prostate cancer. Before diagnosis, the men had symptoms ranging from 7% for blood in urine to 51% for frequent urination.

Nearly half of participants were 2–5 years since diagnosis. Almost one quarter had advanced stage (stage 3/4) disease at diagnosis.

The most common treatments received were external beam radiation therapy (51%) and radical prostatectomy (28%); the most common impact after treatments were loss of sexual desire (47%) and impotence (59%). The median health-related quality of life (HRQoL) score was 75.0 out of a possible 100.

Twenty-four percent had clinically significant pain, 19.7% had clinically significant fatigue, and 14.4% had depression; 7.3% had all three symptoms.

In multivariate analysis, men living in Northern Ireland were more than 3 times as likely to have the symptom cluster than those in the Republic of Ireland. Other factors significantly associated with the symptom cluster were experiencing back pain at diagnosis as well as being affected by incontinence, loss of sexual desire, bowel problems, gynecomastia, and hot flashes post-treatment.

In addition, there was a strong association between the cluster and HRQoL (OR = 44.09; 95% CI 17.88–108.73).

The findings suggest that there is an opportunity to intervene in this population using techniques that are already known to help symptoms individually, such as antidepressant medication, psychotherapy, and exercise; the authors also noted that some therapies, such as physical exercise, may benefit more that 1 area, as well as HRQoL.

“More attention should be paid to identifying and supporting survivors who experience multiple symptoms; this may help health-related quality of life improve among the growing population of prostate cancer survivors,” the authors said.

Reference

Baden M, Lu L, Drummond FJ, Gavin A, Sharp L. Pain, fatigue and depression symptom cluster in survivors of prostate cancer. Support Care Cancer. 2020.28(10):4813-4824. doi: 10.1007/s00520-019-05268-0.