Long-Term Mental Health Outcomes in Prostate Cancer Survivors and Their Partners

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Prostate cancer (PC) is the most commonly diagnosed cancer among men in the US and in most countries worldwide. Over 3.6 million US men are currently living with PC, and this number is expected to increase to >5 million by 2030. Approximately 90% of PC cases are diagnosed at a local or regional stage, when the 5-year survival is >99%. Consequently, most men with PC survive >15-20 years after diagnosis. However, PC diagnosis and treatment can be devastating for men and their partners, and may increase risks of mental illness. Importantly, mental disorders are treatable, and early intervention could reduce suffering, improve quality of life, and prevent premature death. Despite the high public health burden of mental disorders, they are severely understudied compared with somatic outcomes of PC. A comprehensive understanding of long- term mental health sequelae is critically needed to improve care and outcomes for PC survivors and their partners. The few prior studies have had important limitations, including limited follow-up times and sample sizes, and ascertainment of mental disorders using only hospital data, which captures only the most severe cases. No large-scale studies have included partners. We will address these limitations by conducting the first comprehensive long-term study of mental health outcomes in PC survivors and partners in a national cohort (N >4 M) using highly complete data from primary care, specialty outpatient, and inpatient settings. We hypothesize that PC survivors and their partners have increased risks of major mental disorders and suicide. To test this hypothesis, we will examine these outcomes in 210,432 men diagnosed with PC in Sweden in 1987-2018 and their 163,085 partners, compared with 2.1 M men without PC and their 1.6 M partners, followed for up to 34 years through 2020. Sweden is an ideal setting because individual-level data an PC diagnoses, treatment, and mental health outcomes are available for the entire population with over 3 decades of follow-up, and the incidence and treatment of PC and common mental disorders are comparable to the US. This proposal addresses key priorities identified by the 2019 NCI workshop on "Evidence Gaps in Cancer Survivorship Care". Our specific aims are to identify: (1) long-term risks of 4 mental disorders (major depression, anxiety, alcohol and drug use disorders) and suicide in PC survivors; (2) high-risk subgroups who may benefit most from interventions; (3) whether mental disorders are associated with higher PC-specific mortality; and (4) long-term risks of mental disorders and suicide in partners of PC survivors. The proposed research is significant because millions of men are surviving with PC, and their mental health sequelae may have substantial impacts that are understudied and preventable. It is innovative because it will provide the first long-term assessment in a national cohort of PC survivors and partners by integrating unparalleled individual- level data for >4 M people. The results will identify the long-term mental health outcomes in PC survivors, their partners, and high-risk subgroups, and guide early interventions to improve their long-term health.