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      Cancer-related symptoms, mental well-being, and psychological distress in men diagnosed with prostate cancer treated with androgen deprivation therapy

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          Abstract

          Purpose

          There are known associations between treatment of prostate cancer (PCa) involving Androgen Deprivation Therapy (ADT) and psychological and physical side effects. We investigate the associations between cancer-related symptoms, health-related quality of life (HRQL), and poor psychological outcomes in men whose treatment for PCa involved ADT.

          Methods

          A cross-sectional postal questionnaire was administered to UK men 18–42 months post diagnosis of PCa. Men completed items on functional outcomes using the Expanded Prostate Cancer Index Composite (EPIC-26), EuroQol-5D (EQ-5D), and the European Organisation for Research and Treatment of Cancer (EORTC) Fatigue subscale. Psychological outcomes (mental well-being and psychological distress) were assessed using the Short Warwick–Edinburgh Mental Well-being Scale (SWEMWBS) and the Kessler 6-item scale (K6), respectively. Associations between explanatory variables and psychological outcomes were assessed using stepped logistic regression.

          Results

          13,097 men treated with ADT completed a questionnaire. A minority of men reported poor mental well-being (15.5%) or severe psychological distress (6.6%). After controlling for sociodemographic and clinical variables, reporting clinically significant fatigue was strongly associated with severe psychological distress (OR 9.92; 95% CI 7.63 to 12.89) and poor well-being (OR 3.86; 95% CI 3.38 to 4.42). All cancer-related symptoms and HRQL variables were associated with both psychological outcomes.

          Conclusions

          While the majority of men treated with ADT did not report poor psychological outcomes, a small proportion reported severe problems. Clinically significant fatigue was demonstrated as a possible indicator of poor outcomes. Healthcare systems need to have clear protocols in place which specifically and routinely target psychological distress and fatigue.

          Electronic supplementary material

          The online version of this article (10.1007/s11136-019-02212-x) contains supplementary material, which is available to authorized users.

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          Most cited references21

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          Imputation of missing values is superior to complete case analysis and the missing-indicator method in multivariable diagnostic research: a clinical example.

          To illustrate the effects of different methods for handling missing data--complete case analysis, missing-indicator method, single imputation of unconditional and conditional mean, and multiple imputation (MI)--in the context of multivariable diagnostic research aiming to identify potential predictors (test results) that independently contribute to the prediction of disease presence or absence. We used data from 398 subjects from a prospective study on the diagnosis of pulmonary embolism. Various diagnostic predictors or tests had (varying percentages of) missing values. Per method of handling these missing values, we fitted a diagnostic prediction model using multivariable logistic regression analysis. The receiver operating characteristic curve area for all diagnostic models was above 0.75. The predictors in the final models based on the complete case analysis, and after using the missing-indicator method, were very different compared to the other models. The models based on MI did not differ much from the models derived after using single conditional and unconditional mean imputation. In multivariable diagnostic research complete case analysis and the use of the missing-indicator method should be avoided, even when data are missing completely at random. MI methods are known to be superior to single imputation methods. For our example study, the single imputation methods performed equally well, but this was most likely because of the low overall number of missing values.
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            Efficacy of exercise interventions in modulating cancer-related fatigue among adult cancer survivors: a meta-analysis.

            The purpose of this meta-analysis was to explore the efficacy of exercise as a nonpharmacologic intervention to reduce cancer-related fatigue (CRF) among adult cancer survivors. We also investigated how different components of the exercise prescription (Ex R(x)), methodologic considerations, and subject characteristics modulate CRF. A systematic search for randomized controlled trials was conducted using words related to cancer, exercise, and fatigue. In total, 44 studies with 48 interventions qualified, including 3,254 participants of varying cancer types, stages of diagnosis, treatments, and exercise interventions. Cancer survivors in exercise interventions reduced their CRF levels to a greater extent than usual care controls, d(+) = 0.31 (95% CI = 0.22-0.40), an effect that appeared to generalize across several types of cancer. CRF levels improved in direct proportion to the intensity of resistance exercise (β = 0.60, P = 0.01), a pattern that was stronger in higher quality studies (β = 0.23, P < 0.05). CRF levels also reduced to a greater extent when interventions were theoretically driven (β = 0.48, P < 0.001) or cancer survivors were older (β = 0.24, P = 0.04). Exercise reduced CRF especially in programs that involved moderate-intensity, resistance exercise among older cancer survivors and that were guided by theory. Our results indicate exercise interventions for adult cancer survivors should be multi-dimensional and individualized according to health outcome and cancer type. ©2011 AACR.
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              Cognitive effects of hormone therapy in men with prostate cancer: a review.

              Men who receive androgen-deprivation therapy (ADT) for prostate cancer experience several side effects from this treatment. A few recent studies have examined the cognitive implications of ADT and how they impact a patient's treatment decision-making, occupational pursuits, and quality of life. For this report, the authors explored possible mechanisms for this association, reviewed research in animal studies and aging men, and examined the growing literature focused on the relation between ADT and cognitive functioning in patients with prostate cancer. A systematic literature search was conducted using the PubMed and Information Sciences Institute Web of Knowledge-Web of Science databases to identify relevant studies that investigated the relation between ADT in men with prostate cancer and its cognitive effects. Testosterone and its derivatives may have an impact on cognition through several mechanisms in the brain, as supported by studies of animals and in aging men. Studies that researched the impact of ADT on cognition in patients with prostate cancer patients were designed relatively well but suffered from small sample sizes. Between 47% and 69% of men on ADT declined in at least 1 cognitive area, most commonly in visuospatial abilities and executive functioning. Some studies reported contradictory results with increased functioning in verbal memory. There is a strong argument that androgen-ablation therapy is linked to subtle but significant cognitive declines in men with prostate cancer. The authors believe that clinicians should become aware of this correlation as the use of ADT increases and should inform and monitor patients for this possible side effect of treatment. (c)2008 American Cancer Society.
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                Author and article information

                Contributors
                S.E.Wilding@leeds.ac.uk
                Journal
                Qual Life Res
                Qual Life Res
                Quality of Life Research
                Springer International Publishing (Cham )
                0962-9343
                1573-2649
                21 May 2019
                21 May 2019
                2019
                : 28
                : 10
                : 2741-2751
                Affiliations
                [1 ]GRID grid.9909.9, ISNI 0000 0004 1936 8403, Leeds Institute of Medical Research at St James’s, , University of Leeds, ; Leeds, UK
                [2 ]GRID grid.9909.9, ISNI 0000 0004 1936 8403, Leeds Institute for Data Analytics, , University of Leeds, ; Leeds, UK
                [3 ]GRID grid.7628.b, ISNI 0000 0001 0726 8331, Department of Midwifery, Community and Public Health, School of Nursing and Midwifery, , Oxford Brookes University, ; Oxford, UK
                [4 ]GRID grid.5491.9, ISNI 0000 0004 1936 9297, Faculty of Health Sciences, , University of Southampton, ; Southampton, UK
                [5 ]GRID grid.4777.3, ISNI 0000 0004 0374 7521, Northern Ireland Cancer Registry, , Queen’s University Belfast, ; Belfast, UK
                [6 ]GRID grid.271308.f, ISNI 0000 0004 5909 016X, National Cancer Registration and Analysis Service, , Public Health England, ; Bristol, UK
                [7 ]GRID grid.5600.3, ISNI 0000 0001 0807 5670, Division of Cancer and Genetics, School of Medicine, , Cardiff University, ; Cardiff, UK
                [8 ]GRID grid.9909.9, ISNI 0000 0004 1936 8403, Present Address: School of Psychology, , University of Leeds, ; Leeds, UK
                Author information
                http://orcid.org/0000-0002-7977-7132
                Article
                2212
                10.1007/s11136-019-02212-x
                6761086
                31115843
                d4a6ca98-134b-4c65-ad5f-8892f93e6b7a
                © The Author(s) 2019

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

                History
                : 11 May 2019
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000771, Prostate Cancer UK;
                Award ID: BO26/MO
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/100008719, Movember Foundation;
                Award ID: BO26/MO
                Award Recipient :
                Categories
                Article
                Custom metadata
                © Springer Nature Switzerland AG 2019

                Public health
                prostate cancer,psychological distress,mental well-being,androgen deprivation therapy,cancer-related symptoms,patient-reported outcome measures

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