More and more people have experienced periods of poor mental health during Covid, manifested as anxiety and depression arising from a continuing sense of uncertainty, fear and for many, an unbearable waiting for things to get better. This will sound very familiar to many men with prostate cancer, with uncertainty and fear all too common, and the unbearable waiting has only been exacerbated by Covid as appointments, tests and procedures are delayed and cancelled.
This, and the increase in both Active Surveillance and Hormone Therapy offered as treatments, has been a double whammy for the mental health of prostate cancer patients over the last year.
In A recent OnFocus discussion, TFTC Consultant Urologist Marc Laniado describes what he’s seen over the last year: “Being on active surveillance, a lot of people would get worried that they're going to miss the opportunity to have a successful treatment. And that's obviously not very nice.
Equally, some men have been put on hormonal therapy to tide them over during this time. And hormonal therapy causes issues itself - they get hot flushes. There can be mood swings. Men can feel tearful during this time. So hormonal therapy, although it will slow the cancer, it's not necessarily a fantastic treatment for prostate cancer because of those side effects”
A recent journal article at St George’s Hospital, London, highlighted the need for mental health services among prostate cancer patients and explored opportunities and approaches to address how mental health can be integrated into prostate cancer care. It points out that while surgical, radio-oncological, and medical anti-cancer therapies have developed at pace and scale in recent years, there remains a huge unmet need for mental health in cancer care.
Recent experience in the COVID-19 pandemic has added to recognition of this unmet need. It highlights an urgency more effective clinical integration of relevant services, which must be informed by patient choice and clinical need, and accessible throughout the patient’s whole cancer journey.
The author, Dr Asanga Fernando, points out that “as a clinical community we need to drive a shift in culture towards measurement of patient quality of life as a marker of treatment effectiveness. It appears that despite recent developments in cancer treatment, many of which have improved patient survival, the clinical community has been rather myopic in failing to adequately consider how investing in the mental health of cancer patients can improve patient experience, Quality of Life, functioning, and even engagement.
This involves doing things differently, namely thinking innovatively and more effectively integrating mental health and psychological wellbeing into routine cancer services” He cites two areas of opportunity for better integration of mental health into prostate cancer care. One is investment in clinicians’ mental health, which is often under continued strain and where direct experience of mental health support would inform good practice. Second is adoption of emerging digital technologies to support patients in their emotional journeys through prostate cancer treatment. Virtual reality technologies are suggested as a promising area in this regard.
Perhaps a silver lining to Covid19 is the emergence of a widespread, open and honest discussion about mental health. Now it’s time to recognise how this impacts men with prostate cancer and address it with all patients.
