November 2, 2022 – Mark Leste, 73, said it took him a decade before he overcame anxiety, fear of death and uncertainty about the future after being diagnosed with low-grade prostate cancer in 2005.
Lichty, of East Stroudsburg, PA, channeled some of that troubling energy to take off International Active Surveillance Patients (ASPI), which he co-founded in 2017 to help men with low-risk prostate tumors deal with the concern that their condition may progress from benign to life-threatening.
Many men used to call this state of forgetfulness ‘watching anxiety’ – a baseline level of anxiety that gets worse while they wait for the results of periodic blood tests which, depending on the results, could indicate the need for surgery or radiotherapy to remove a tumor that is becoming more aggressive. .
Ironically, Leste says, those same tests — which look at levels of a protein called prostate-specific antigen, or PSA — led to the “overdiagnosis epidemic” of prostate cancer in the 1990s. This, in turn, has led to over-treatment that has led to erectile dysfunction, incontinence, and other problems for many patients—and now, he says, “an epidemic of anxious surveillance that can lead to unnecessary distress for these patients and even to further over-treatment.”
Mental distress is called the “elephant in the room” for patients with prostate cancer that does not need treatment right away. For years, these concerns have been largely ignored, according to advocates and health professionals.
But recently, the prostate cancer community has begun to focus on the mental health of this group. One factor was the stress caused by COVID-19.
“The mental health crisis caused by the COVID-19 pandemic has led to a focus on this problem in prostate cancer,” says Rick Davis, of Tucson, Arizona, who was diagnosed with the disease in 2007.
Davis is the founder of the AnCan Foundation, which runs support groups for people with prostate cancer – the cancer most diagnosed in men. according to American Cancer Society268,000 men in the United States will know they have prostate cancer this year, an increase of about 10,000 from 2021. The group says 1 in 8 men will be diagnosed with the disease in their lifetime.
For Davis, these numbers indicate a dire need for more services like those provided by his organization.
“We tried to do some programming, but we didn’t take the bull by the horns,” he says. “We really saw that it was the elephant in the room, and we needed to identify it and do something about it.”
AnCan and the ASPI started one of the first virtual support groups for patients with low-risk and intermediate-risk prostate cancer in 2019. A 2021 survey of 168 people in the support group found that 30% reported symptoms of anxiety.
This is in line with a 2014 study by UK researchers that found that of nearly 4,500 prostate cancer patients across the treatment spectrum, 17% of men reported depression, and 27% reported anxiety, before they were treated for the disease.
John Olive, Ph.D., founder and principal investigator at the University of British Columbia, says the worry figure is twice as high as in the general population in the United States. Men’s Health Research a program. He says that untreated anxiety can lead to other mental health problems, including depression and suicidal thoughts and behavior.
Concern has often been overlooked. The true scope and severity of men’s anxiety is unknown, which is particularly concerning, given that undetected and untreated anxiety predicts adverse mental health outcomes in the future,” Olive says.
In September, the Prostate Cancer Foundation, the largest private funder of prostate cancer research, held a patient-oriented meeting a program. On November 17, a Prostate Cancer Impact Alliance Conducts a webinar on emotional wellness.
“The world is aware of the mental health issues in cancer more than it did,” says Scott Tagawa, MD, medical director of the Genitourinary Oncology Research Program at Weill Cornell Health in New York City, and a spokesperson for the American Society of Clinical Oncology. “It started happening before the COVID-19 pandemic. , but it was brought up by some epidemic-related issues.”
Tagawa says the total number of men experiencing mental distress may be an understatement. “Men tend to be less communicative and verbal,” he says. “They hide things.”
Jim C.Hu, professor of urology at Weill Cornell, said mental health issues are now coming into play because of “a greater focus on the patient as a whole. This is in line with patient-centered care. There is a focus on mental health issues in relation to patient care, Especially with regard to cancer patients.”
Corey Lyons, MD, vice president for clinical affairs in the Department of Family Medicine at the University of Colorado School of Medicine, says primary care physicians play a greater role in providing psychiatric care and can provide emotional support to these patients as part of a focus on “whole person care.”
“But a lot of clinics may not necessarily do this screening because they don’t know what to do with the results,” says Lyon, chair of the American Academy of Family Physicians’ Guidelines Committee. “They don’t have the tools or resources if a patient has a high level of distress or higher symptoms of anxiety or depression. If they don’t know what to do with the results, they tend not to check.”
successful approaches
A few leading clinics, such as Memorial Sloan Kettering Cancer Center in New York City, routinely screen prostate cancer patients for mental health problems.
Andrew J. Roth, a psychiatrist who has dedicated his career at the center to mental health issues and patients with prostate cancer and their families, helped develop scales to measure distress in prostate cancer patients, such as the distress thermometer in 1998. Roth also helped develop the Prostate Cancer Memorial Anxiety Scale and works On a scale for identifying depression in older cancer patients.
“Examination of distress attempts to identify signs that someone is having difficulty coping with cancer that may interfere with making treatment decisions, managing treatment, improving quality of life, or that a particular patient does not have adequate social support,” Roth says. Then there is a chance to get the help they need. If we don’t ask, we may not find out, and we won’t be able to help these men better deal with prostate cancer and their lives in time.”
But not everyone agrees with the value of these tools. Daryl Mitteldorf, Licensed Clinical Social Worker and Founder of New York City Malecare Prostate cancer support group, among the skeptics.
“The [anxiety] The scope that Roth created that many people use is great for clinical trials. “But in everyday practice, it has more or less nothing to do with helping people with prostate cancer move on with their lives and be as happy and optimistic as possible.”
Through the Prostate Cancer Impact Coalition, an advocacy group within the American Urological Association, Davis in September began promoting efforts to screen for mental disorders. He says the vision is for the medical specialties involved in the care of prostate cancer patients – Urologists, radiation oncologists, genitourinary oncologists, primary care physicians and even psychiatrists – To develop guidelines as a group.
“They all need to work together, and the idea is to monitor, identify and guide people to get treatment to deal with these mental health issues and maybe even crises,” Davis says. “Currently, we are not identifying these people.
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