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Geriatric Oncology

The Chronology of Distress, Anxiety, and Depression in Older Prostate Cancer Patients

^aDepartment of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York, USA; ^bDepartment of Psychiatry, Weill Cornell Medical College, White Plains, New York, USA

Key Words. Psychological distress • Depression • Anxiety • Prostate cancer • Aging

Correspondence: Christian J. Nelson, Ph.D., Memorial Sloan-Kettering Cancer Center, Department of Psychiatry and Behavioral Sciences, 641 Lexington Avenue, Seventh Floor, New York, New York 10022, USA. Telephone: 646-888-0030; Fax: 212-888-2356; e-mail: nelsonc{at}mskcc.org

Received March 24, 2009; accepted for publication August 7, 2009; first published online in THE ONCOLOGIST Express on September 8, 2009.

Disclosures

Christian J. Nelson: None; Mark I. Weinberger: None; Eliana Balk: None; Jimmie Holland: None; William Breitbart: None; Andrew J. Roth: None.

Section editors Matti S. Aapro and Arti Hurria have disclosed no financial relationships relevant to the content of this article.

The content of this article has been reviewed by independent peer reviewers to ensure that it is balanced, objective, and free from commercial bias.

Objective. Current research suggests that older cancer patients report less distress than younger cancer patients. However, this research has generally not teased apart the differences among general distress, anxiety, and depression.

Methods. We conducted a secondary analysis of merged datasets using cross-sectional data on 716 men with prostate cancer (mean age, 68 ± 10 years; range, 50–93 years). Approximately half the participants were recruited from doctors' offices throughout the U.S. and the other half were from Memorial Sloan-Kettering Cancer Center (New York). Participants were asked to complete the Distress Thermometer, the Hospital Anxiety and Depression Scale, the Functional Assessment of Cancer Therapy–Prostate Quality of Life questionnaire, and a demographic questionnaire.

Results. Aging was related to less distress (r = –0.14), less anxiety (r = –0.22), and greater emotional quality of life (r = 0.16). In contrast, aging was associated with greater depressive symptoms in these cancer patients (r = 0.18). The mean depression scores of 5-year cohorts consistently trended upward. The significant association between age and depression remained after controlling for stage of disease, hormone therapy use, time since diagnosis, and social, physical, and functional well-being.

Conclusions. Despite theoretical and empirical evidence that older cancer patients may cope more effectively than younger cancer patients, depressive symptoms remain an important concern for aging cancer patients, and greater attention to this area is warranted. The increase in depression is in contrast to some findings in the general aging literature, raising the possibility that this trend is unique to older cancer patients.