The impact of health anxiety after curative treatment for prostate cancer: Quality of life, fear of cancer recurrence, cognitive maintenance processes and mental defeat.
You may remember a post back in January where Oxford University were looking for participants for a an online study related to the role of health anxiety in those living after treatment for prostate cancer. They have completed the study and wanted to provide some brief feedback to those who may have taken the time to take part. Below is some information on the study design and results.
What did we study and why?
- Prostate cancer is the most common form of cancer among males in the UK and with improvements in, and awareness of, the importance of testing, more people are being diagnosed with early stage prostate cancer and can undertake a form of curative treatment.
- Previous research into the psychological impacts of being diagnosed with and treated for prostate cancer show that it is a psychologically distressing experience that is linked with high rates of anxiety and depression. We think that this psychological distress might be more specific than these two broad categories through which it has typically been studied. We designed this study to find out whether health anxiety, a specific type of anxiety which is focused on perceived threats to one’s health, may be an important issue for those who undergo this experience.
- Based on the Cognitive Behavioural theoretical understanding of what maintains health anxiety, we think that some of those who have had treatment for prostate cancer may have elevated levels of perceived threat to their health and may interpret some of the physical side effects of their treatment as indicating an ongoing threat to their health.
- Previous studies of health anxiety have linked it to resulting in lower quality of life (QoL) for individuals who have elevated levels so, we predicted that this link would also exist within those living after prostate cancer with elevated health anxiety.
- The type of thinking bias associated with health anxiety is a specific form of catastrophising linked to health, and we therefore believed that those who had elevated forms of this may have similar forms of catastrophising in other psychological processes such as fear of cancer recurrence and mental defeat.
- In addition to this we also thought that health anxiety would be linked to some of the thinking styles which are theorised to contribute to it. These included having dysfunctional beliefs about health such as not being able to cope if you got a serious illness, or that the doctors around you would not be able to help you. Similarly, health anxiety has been linked to having beliefs about your responsibility to prevent harm, and we wanted to test this theory in this study.
- This is important because a type of psychological therapy known as Cognitive Behavioural Therapy (CBT) can target these types of thinking patterns.
What were our aims?
- We wanted to test whether health anxiety was linked to quality of life in those who were living after a successful treatment for prostate cancer. We also tested whether health anxiety was linked to higher levels of fear of cancer recurrence and mental defeat as we predicted it would be.
- We also wanted to test whether the thinking styles and beliefs about health and responsibility beliefs that were theorised to underpin health anxiety were linked to those people who had high levels of health anxiety.
What did we do?
- We first went and asked the advice of some people who had lived through this experience to see what they thought about our ideas and to get their advice on how to proceed.
- We then recruited a sample of people who had been diagnosed with prostate cancer and received a form of curative treatment for this. We asked these people to give their informed consent to undertake a series of questionnaires using an online survey platform. We calculated scores to these validated questionnaires and we looked at the relationships and associations in the data using certain types of statistical analysis that allowed us to be confident about when there was a significant finding.
- For some of our analysis, we divided this group of people who had treatment for prostate cancer into those who had low levels of health anxiety, and those who had high levels of health anxiety. This allowed us to compare the relative difference that health anxiety might play in shaping how people thought or behaved.
- In order to compare these groups to individuals who did not have cancer, we also recruited a healthy benchmark group of males who were of similar ages (50-85) but did not have cancer or treatment.
What did we find out?
- We found out that health anxiety was higher in those who reported worse physical side effects of treatment for prostate cancer, and in those who had higher levels of anxiety and depression.
- We found out health anxiety was linked with impairments in quality of life as the group of people who had higher levels of health anxiety also had lower levels of quality of life than those who had low levels of health anxiety or our healthy benchmark group across all quality of life domains.
- We also found out that health anxiety was also linked to having elevated levels of fear of cancer recurrence and mental defeat showing that other forms of catastrophising are linked.
- As we predicted, people with high levels of health anxiety also were more likely to have elevated dysfunctional beliefs about health and inflated beliefs about taking responsibility for preventing harm.
- We also found out that health anxiety and mental defeat were the only significant predictors of quality of life even when we considered age and the physical side effects of treatment.
How is this relevant?
- This is relevant to our understanding of the specific aspects of the psychological implications of being diagnosed with and treated for prostate cancer. This shows that health anxiety is a significant form of psychological distress for those who get successful treatment for prostate cancer. We also found out that high levels of health anxiety were associated with impaired quality of life, fear of cancer recurrence and mental defeat.
- We know that treatments for psychological distress such as health anxiety can be beneficial in helping with adjustment to life after cancer and improving quality of life. Such treatments, such as cognitive behavioural therapy, are underpinned by targeting changes in interpretations and beliefs associated with health anxiety such as the interpretation of physical pain, beliefs about health and responsibility. It may be that those who are living with elevated levels of health anxiety after treatment for prostate cancer might benefit from targeted psychological treatment for this and that this may improve their overall quality of life.
If you have any questions on this study or want to get in touch, please email gareth.mcateer@gtc.ox.ac.uk