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

前列腺癌（PC）是美国和大多数国家男性中最常见的癌症 国际吧超过360万美国男性目前与PC生活在一起，预计这一数字将增加到5 到2030年，亿。大约90%的PC病例在局部或区域阶段被诊断出来，当5年 存活率> 99%。因此，大多数PC患者在诊断后存活>15-20年。然而，PC 诊断和治疗对男性及其伴侣来说可能是毁灭性的，并可能增加精神疾病的风险。 病重要的是，精神障碍是可以治疗的，早期干预可以减少痛苦，改善 提高生活质量，防止过早死亡。尽管精神障碍的公共卫生负担很高， 与PC的躯体结局相比，全面了解长期以来 长期心理健康后遗症是迫切需要改善护理和PC幸存者及其 伙伴少数先前的研究有重要的局限性，包括有限的随访时间和样本 规模，并确定精神障碍只使用医院的数据，其中只捕捉最严重的 例没有大规模的研究包括合作伙伴。我们将通过进行第一次 在一个国家队列中对PC幸存者及其伴侣的心理健康结果进行了一项全面的长期研究（N >4 M）使用来自初级保健、专科门诊和住院设置的高度完整的数据。我们 假设PC幸存者和他们的伴侣患主要精神障碍和自杀的风险增加。 为了验证这一假设，我们将在2009年对瑞典210,432名被诊断为PC的男性进行研究。 1987-2018年，他们的163，085名伴侣，相比之下，210万没有PC的男性和他们的160万伴侣， 到2020年，长达34年。瑞典是一个理想的环境，因为个人电脑诊断的个人数据， 治疗和心理健康结果可用于整个人群，随访时间超过30年， PC和常见精神障碍的发病率和治疗与美国相当。这 该提案解决了2019年NCI研讨会确定的关键优先事项“癌症的证据差距” 幸存者护理”。我们的具体目标是确定：（1）4种精神障碍的长期风险（主要 抑郁症，焦虑症，酒精和药物使用障碍）和自杀的PC幸存者;（2）高危亚组， 可能从干预中获益最多;（3）精神障碍是否与较高的PC特异性相关 死亡率;（4）PC幸存者伴侣的精神障碍和自杀的长期风险。拟议 这项研究意义重大，因为数百万男性在PC中生存，他们的心理健康后遗症可能 有着未被充分研究和可预防的重大影响。它是创新的，因为它将提供第一个 通过整合无与伦比的个人信息， >4 M人的水平数据。结果将确定PC幸存者的长期心理健康结果， 这一方案将为艾滋病毒/艾滋病感染者、艾滋病伙伴和高危亚组提供指导，并指导早期干预措施，以改善他们的长期健康。

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.