Genitourinary Cancer

PV QA 1 - Poster Viewing Q&A 1

SU_25_2252 - ADT and Depression in Veterans with Prostate Cancer Treated With Definitive Radiation Therapy

Sunday, October 21
1:15 PM - 2:45 PM
Location: Innovation Hub, Exhibit Hall 3

ADT and Depression in Veterans with Prostate Cancer Treated With Definitive Radiation Therapy
R. Deka1, B. S. Rose2, A. K. Bryant2, R. R. Sarkar2, V. Nalawade2, R. Mckay3, J. D. Murphy2, and D. R. Simpson1; 1University of California, San Diego, La Jolla, CA, 2Department of Radiation Medicine, University of California, San Diego, La Jolla, CA, 3Department of Hematology-Oncology, University of California, San Diego, La Jolla, CA

Purpose/Objective(s): There is limited evidence on the association between the use of androgen deprivation therapy (ADT) and depression. Thus, the objective of this study is to determine whether ADT is associated with an increased risk in depression in prostate cancer (PC) patients treated with definitive radiation therapy (RT).

Materials/Methods: This is an observational cohort study of men diagnosed with non-metastatic PC at the United States Department of Veterans Affairs between January 1, 2001 and October 31, 2015 who received definitive RT with or without ADT. Patients with missing covariates, including prostate specific antigen (PSA), Gleason score, clinical T, M, and N stages, and income were excluded. We also excluded patients with a prior diagnosis of attention deficit hyperactive disorder, traumatic brain injury, posttraumatic stress disorder, schizophrenia, anxiety, bipolar disorder, depression or psychiatric use within one year prior to PC diagnosis. Finally, patients who initiated ADT more than one year after their PC diagnosis were excluded. Fine-Gray competing risks regression with inverse probability weighting of the propensity score was used to evaluate the association between ADT and depression. ADT was measured as a time-varying exposure. The primary outcome was new development of depression. Secondary outcomes included outpatient and inpatient psychiatry use. Exposure was ascertained from filled prescription records and outcomes from ICD-9 codes. Variables included in the propensity score and FG model were age, CCI score, statin use, antiplatelet use, antihypertensive use, antidepressant use, alcohol abuse, substance abuse, race, marital status, smoking status, region, Gleason score, income, education, clinical T stage, PSA, and year of diagnosis.

Results: The study cohort included 25,017 male veterans who were followed for a median time of 6.8 years. A total of 15,250 patients received RT alone while 9,767 received RT and ADT. During follow-up, 602 patients had a new diagnosis of depression, 243 had inpatient psychiatric use, and 5,056 had outpatient psychiatric use. In the multivariable competing risks regression model, there was an association between ADT and depression (SHR=1.51, 95% CI=1.33-1.73, p-value<0.0001), and a significant dose response effect at ADT length<1 year (SHR=1.33, 95% CI=1.16-1.54, p-value<0.0001) and length>1 year (SHR=1.94, 95% CI=1.66-2.27, p-value<0.0001). There was an association between ADT and outpatient psychiatric use (SHR=1.16. 95% CI=1.11-1.22, p-value<0.0001) but no association between ADT and inpatient psychiatric use (SHR=0.86, 95% CI=0.69-1.06, p-value=0.16).

Conclusion: We observed an increase in the risk of depression and outpatient psychiatric use among a large cohort of men with PC who received ADT with definitive RT. These results may highlight potential long-term risks of ADT on mental health in the treatment of PC.

Author Disclosure: R. Deka: None. B.S. Rose: None. A.K. Bryant: None. R. Mckay: None. D.R. Simpson: None.

Rishi Deka, PhD

Disclosure:
No relationships to disclose.

Presentation(s):

Send Email for Rishi Deka


Assets

SU_25_2252 - ADT and Depression in Veterans with Prostate Cancer Treated With Definitive Radiation Therapy



Attendees who have favorited this

Please enter your access key

The asset you are trying to access is locked. Please enter your access key to unlock.

Send Email for ADT and Depression in Veterans with Prostate Cancer Treated With Definitive Radiation Therapy