What are the long-term psychological needs of men with prostate cancer?

Background: Prostate cancer is the most common cancer affecting UK men. Prostate cancer survivors may experience functional and psychological effects of the disease and its treatment for many years, which can significantly impact upon their quality of life (QoL). The National Cancer Research Institute (NCRI) has highlighted the importance of understanding the short and long-term psychological impacts of cancer and its treatment. Research has explored depression, anxiety, suicidality, illness representations, body image and masculinity in prostate cancer survivors. However, there is currently a lack of research relating to strategies for improving and supporting their long-term psychological wellbeing, and factors associated with variation in this. Understanding factors which contribute to the long-term psychological wellbeing of people with prostate cancer could aid the development and efficacy of person-centred interventions, improving outcomes of survivorship and QoL. This study aims to describe the long-term psychological needs, and explore the relationship between these and QoL, in people with prostate cancer. Method: A cross-sectional online survey design was used to conduct this observational, exploratory study. Participants were recruited through contacting third sector cancer charities and organisations and via online platforms. Data from 156 prostate cancer survivors were analysed. Participants provided demographic information, and then a set of validated questionnaires were used to gather information related to psychological needs (QoL, depression, anxiety, illness representation, body image, masculinity, and masculine self-esteem). Results: The median global QoL score for the participant group was 75 (interquartile range (IQR) = 58.33-83.33). For analysis, the QoL variable was transformed into two categories: low-moderate QoL, containing 58 (37.18%) participants, and high QoL, containing 98 (62.82%) participants. The median QoL score for the low-moderate QoL group was 50 (IQR = 41.67-66.67) compared with 83.33 (IQR = 75-91.67) in the high QoL group. Fully adjusted logistic regression models indicated three significant independent factors associated with poorer QoL. These were higher levels of depression (odds ratio (OR) 1.62, confidence intervals (CI) 1.14-2.31, p = 0.007), lower perceptions of personal control (OR 0.82, CI 0.68-0.99, p = 0.04) and prominence and importance of strength/fitness as a component of masculinity (OR 0.27, CI 0.08-0.89, p = 0.03). Discussion: This study found that, consistent with previous research, as a group prostate cancer survivors report good group median QoL and psychological wellbeing. Depression and anxiety scores for the overall group were comparable to that of the general population. However, this study explored factors which may be associated with poorer QoL in this group. Higher levels of depression, lower perceptions of personal control, and prominence and importance of strength and fitness (as a component of masculinity) were found to be significant independent factors associated with lower QoL in this population. The findings of this study contribute to existing research on the psychological needs of people with prostate cancer. It is hoped it will inform future research and clinical practice, which could explore how these findings could be integrated into assessments and interventions for prostate cancer survivors