Câncer de próstata e suicídio: qualidade de vida, ansiedade, depressão e o risco para o suicídio em um centro oncológico terciário / Prostate cancer and suicide: quality of life, anxiety, depression and the risk of suicide in an oncology center in the city of São Paulo

Nas últimas décadas, tem se verificado o aumento de diagnósticos de câncer. No Brasil, a estimativa é de 16.830 novos casos de câncer de próstata para este ano. São escassas as pesquisas sobre os riscos de suicídio após o diagnóstico de um câncer em nosso país. O objetivo deste estudo foi avaliar longitudinalmente o risco para suicídio, qualidade de vida, ansiedade e depressão em uma amostra de pacientes com câncer de próstata localizado. Trezentos e trinta e três pacientes foram entrevistados ao diagnóstico e novamente a partir do 18º mês após ter recebido o diagnóstico. Foram aplicados os questionários: a seção de risco de suicídio do questionário Mini International Neuropsychiatric Interview (MINI), a Escala Hospitalar de Ansiedade e Depressão (HADS), o questionário Cut down, Annoyed by criticism, Guilty and Eye opener (CAGE) sobre abuso ou dependência de álcool, o Teste de Fagerström para Dependência a Nicotina (FTND), o instrumento de qualidade de vida para pacientes com câncer de próstata UCLA Prostate Cancer Index (UCLA-PCI), três perguntas sobre a percepção da primeira fase da pesquisa, um questionário sociodemográfico e incluídas quatro perguntas sobre a pandemia da Covid-19. A prevalência de risco de suicídio entre os pacientes com câncer de próstata ao diagnóstico foi de 5,7% e de 3,7% no 18º mês após o diagnóstico. Ao diagnóstico, o risco de suicídio associou-se ao escore positivo de ansiedade (p<0,001) e não ter depressão (p<0,001), ao estado civil casado (p=0,031), não morar sozinho (p=0,025), risco intermediário pela classificação de recidiva D'Amico (p=0,009), indicação para cirurgia (p=0,03), não ter tratamento psiquiátrico prévio (p<0,001) e história familiar de comportamento suicida (p=0,025). Após o 18º mês do diagnóstico, apenas a HADs positiva para ansiedade foi associada ao risco de suicídio (p<0,001). Na análise comparativa para os pacientes que responderam ao UCLA-PCI, observou-se associação significativa da qualidade de vida com o risco de suicídio em relação às funções físicas (p=0,037), vitalidade (p=0,006), saúde mental (p=0,014), função social (p=0,011), saúde geral (p=0,019) e transição para a saúde (p=0,013) aos pacientes recém diagnosticados e em relação às funções físicas (p=0,003), limitações de função da saúde física (p<0,001) e de saúde emocional (p<0,001), vitalidade (p=0,008), saúde mental (p=0,007), função social (p<0,0001), dor corporal (p=0,033), saúde geral (p=0,014) e transição para a saúde (p=0,016) após o 18º mês do diagnóstico. Fatores como qualidade de vida, ansiedade e depressão devem ser monitorados ao diagnóstico e ao longo do tratamento e a oferta de orientação e assistência emocional ser oferecida aos pacientes.

In recent decades, there has been an increase in cancer diagnoses. In Brazil, the estimate is 16,830 new cases of prostate cancer for this year. There is little research on the risks of suicide after the diagnosis of cancer in our country. The aim of this study was to longitudinally evaluate the risk for suicide, quality of life, anxiety and depression in a sample of patients with localized prostate cancer. Three hundred and thirty-three patients were interviewed at diagnosis and again from the 18th month after diagnosis. The following questionnaires were applied: the suicide risk section of the Mini International Neuropsychiatric Interview (MINI) questionnaire, the Hospital Anxiety and Depression Scale (HADS), the Cut down, Annoyed by criticism, Guilty and eye opener questionnaire (CAGE) on alcohol abuse or dependence, the Fagerström Test for Nicotine Dependence (FTND), the UCLA Prostate Cancer Index (UCLA-PCI) quality of life instrument for prostate cancer patients, three questions about the perception of the first phase of the survey, a sociodemographic questionnaire and included four questions about the Covid-19 pandemic. The prevalence of suicide risk among prostate cancer patients at diagnosis was 5.7% and 3.7% at 18 months after diagnosis. At diagnosis, the risk of suicide was associated with positive scores of anxiety (p<0.001) and not having depression (p<0.001), married marital status (p=0.031), not living alone (p=0.025), intermediate risk according to the D'Amico recurrence classification (p=0.009), indication for surgery (p=0.03), not having previous psychiatric treatment (p<0.001) and family history of completed suicide (p=0.025). After the 18th month of diagnosis, only anxiety positive HADs questionnaire was associated with suicide risk (p<0.001). In the comparative analysis for patients who answered to UCLA-PCI, a significant association was observed between quality of life and suicide risk in relation to physical functions (p=0.037), vitality (p=0.006), mental health (p=0.014), social function (p=0.011), general health (p=0.019) and transition to health (p=0.013) in newly diagnosed patients and in relation to physical functions (p=0.003), limitations of physical health function (p<0.001) and emotional health (p<0.001), vitality (p=0.008) mental health (p=0.007), social function (p<0.0001), body pain (p=0.033), general health (p=0.014) and transition to health (p=0.016) after the 18th month of diagnosis. Factors such as quality of life, anxiety and depression should be monitored at diagnosis and throughout treatment and the provision of guidance and emotional assistance should be offered to patients

Assessment of suicidal behavior and factors associated with a diagnosis of prostate cancer

OBJECTIVES: To determine the incidence of suicide risk in a group of patients who have been diagnosed with localized prostate cancer (PC) and to identify the factors that affect suicidal behavior. METHODS: Patients from a tertiary care oncology center in São Paulo, Brazil participated in this study and were interviewed after being diagnosed with low-risk or intermediate-risk PC, per the D'Amico risk classification, between September 2015 and March 2016. Patients underwent suicide risk assessment sessions using the Mini International Neuropsychiatric Interview (MINI), the Hospital Anxiety and Depression Scale (HADS), and the CAGE substance abuse screening tool before they started treatment and surveillance. Psychiatric treatment history, family history of suicidal behavior, and the use of psychotropic drugs were also examined. RESULTS: The prevalence of suicide risk among 250 patients who were recently diagnosed with low-risk or intermediate-risk PC was 4.8%. According to the HADS, 10.8% and 6.8% of patients had a positive score anxiety and for depression, respectively. Alcoholism was suspected in 2.8% of the group. Suicide risk was associated with anxiety (p=0.001); depression (p=0.005); being divorced, separated, widowed, or single (p=0.045); living alone (p=0.028); and prior psychological treatment (p=0.003). CONCLUSIONS: After being diagnosed with PC, patients who display risk factors for suicide should be monitored by a mental health team.