Key result
Reporting negative intrusive thoughts about prostate cancer at least once a week before surgery was associated with a 3.9-fold higher prevalence of waking up with anxiety three months after surgery.
Why the study?
Do intrusive thoughts about prostate cancer before surgery associate with impaired quality-of-life outcomes three months after radical prostatectomy?
Cohort (n=833)
Yes
Do intrusive thoughts about prostate cancer before surgery associate with impaired quality-of-life outcomes three months after radical prostatectomy?
Relative Risk: 3.9 (95% CI 2.7–5.5)
Absolute Event Rate: 29% vs 7%
Negative intrusive thoughts about prostate cancer before surgery are strongly associated with impaired quality of life, depressed mood, and anxiety three months post-surgery.
Supports preoperative intrusive-thought assessment to flag post-prostatectomy anxiety risk; leaves open whether interventions alter this observational association.
BACKGROUND: Sudden, unwelcome and repetitive thoughts about a traumatic event--intrusive thoughts--could relate to how men assess their quality of life after prostate-cancer diagnosis. We aimed to study the prevalence of intrusive thoughts about prostate cancer and their association with quality-of-life outcomes before and after radical prostatectomy. METHODS: During the first year of the LAPPRO-trial, 971 men scheduled for radical prostatectomy were prospectively included from 14 urological centers in Sweden. Of those, 833 men responded to two consecutive study-specific questionnaires before and three months after surgery (participation rate 86%). The association of intrusive thoughts with three quality-of-life outcomes, i.e. self-assessed quality of life, depressive mood and waking up with anxiety was estimated by prevalence ratios that were calculated, together with a 95% confidence interval, at the same time-point as well as over time. Fisher's exact-test was used to analyze differences between respondents and non-respondents. Wilcoxon signed-ranks and Cochran-Armitage trend tests were used for analysis of change over time. To validate new questions on intrusive thoughts, written answers to open-ended questions were read and analyzed by qualitative content analysis. RESULTS: Before surgery, 603 men (73%) reported negative intrusive thoughts about their cancer at some time in the past month and 593 men (59%) reported such thoughts three months after surgery. Comparing those reporting intrusive thoughts at least weekly or once a week before surgery with those who did not, the prevalence ratio (95% confidence interval), three months after surgery, for waking up in the middle of the night with anxiety was 3.9 (2.7 to 5.5), for depressed mood 1.8 (1.6 to 2.1) and for impaired self-assessed quality of life 1.3 (1.2 to 1.5). CONCLUSION: The prevalence of negative intrusive thoughts about prostate cancer at the time of surgery associates with studied quality-of-life outcomes three months later. TRIAL REGISTRATION: Current Controlled Trials, ISRCTN06393679.
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Thorsteinsdóttir et al. (2013) conducted a cohort in Prostate cancer (n=833). Negative intrusive thoughts about prostate cancer (≥1 per week) vs. Negative intrusive thoughts <1 per week was evaluated on Waking up with worry or anxiety at least once a week, 3 months after surgery (PR 3.9, 95% CI 2.7-5.5). Reporting negative intrusive thoughts about prostate cancer at least once a week before surgery was associated with a 3.9-fold higher prevalence of waking up with anxiety three months after surgery.
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