Key factors associated with social distress after prostate cancer: results from the United Kingdom Life After Prostate Cancer Diagnosis study

Background: more men are living following a prostate cancer (PCa) diagnosis. They may need support to maximize the quality of their survival. Physical and psychological impacts of PCa are widely documented. Less is known about social impacts. We aimed to identify key factors associated with social distress following PCa. Methods : The Life After Prostate Cancer Diagnosis study is a UK national cross-sectional survey of men 18-42 months post diagnosis of PCa.. Men (n= 58 930) were invited to participate by their diagnosing cancer centre including 82% of English NHS Trusts (n=111) and 100% of all Health Boards in Northern Ireland (n=5), Scotland (n=14) and Wales (n=6). Social distress was measured using the Social Difficulties Inventory (SDI-21), 16 item Social Distress scale with men assigned to ‘socially distressed’/‘not socially distressed’ groups, according to published guidelines. Clinical and sociodemographic variables were collected from self-report and cancer registries. Results: response rate 60.8% (n= 35 823) of whom 97% (n=29 351) completed the Social Distress scale (mean age = 71.2; SD = 7.88). The proportion of ‘socially distressed’ men was 9.4%. Multivariable logistic regression analysis revealed unemployment versus employment (odds ratio (OR):11.58 [95% CI 9.16-14.63]) and ≥3 co-morbidities versus none (OR: 5.37 [95% CI 4.61-6.27]) as key associations. Others were Androgen Deprivation Therapy, External Beam Radiotherapy in combination with another treatment, age, prior mental health problems and living in a socio-economically deprived area.Conclusion: most men following PCa are socially resilient. A simple checklist could help clinicians identify men at risk of social distress.