Anxiety Status and Its Relationship with General Health Related Quality of Life among Prostate Cancer Patients in Two University Hospitals in Kuala Lumpur, Malaysia

Article excerpt

Abstract

Background: This study aimed to determine the prevalence of anxiety among prostate cancer patients, and to ascer-tain the association between stress status, socio-demographic, medical and surgical illness, current urinary problem and cancer status with general health-related quality of life (HRQOL) among these patients.

Methods: A hospital based, cross sectional study was conducted at Surgical Clinic, University Malaya Medical Centre (UMMC) and Universiti Kebangsaan Malaysia Medical Centre (UKMMC) using universal sampling.

Result: A total of 193 patients were recruited. The prevalence of anxiety was 25.4% (95%CI: 19.2 - 31.6). The anxiety ratings were mild anxiety (10.4%), moderate anxiety (13.6%) and severe anxiety (1.6%). The total quality of life among stress group was 59.2 ± 14.7 and among non-stress group was 73.9 ± 12.7. There was a significant negative weak cor-relation between anxiety score and total quality of life (r^sub s^=-0.534, P<0.001). In multivariable analysis, there was a sig-nificant difference in the total quality of life (QOL) among anxiety status [adj. mean diff. = -9.1 (95%CI: -15.2, -4.7)]. The adjusted mean difference was associated by age category of the patients (P<0.001); living partner (P<0.001); in-termittency (P=0.035) and problem of hematuria during micturition (P=0.005).

Conclusion: The prevalence of anxiety among prostate cancer was moderately high. Treating the urination problem as well as encouraging living with spouse/family may improve the quality of life among anxiety condition of these pa-tients.

Keyword: Anxiety, Health, Quality of Life, Prostate cancer

Introduction

Anxiety is defined as a state of apprehension and fear arising from the anticipation of a threatening event and often impairing psychological and phys-ical functioning (1). According to the International Classification of Disorders (ICD-10) and other classification in psychiatry, a core anxiety symp-toms need to be present in order to diagnose anx-iety disorder (2) and that anxiety also be abnormal, causing disruption such as emotional distress or disruption of functioning, to fulfill an anxiety dis-order (3).

In response to danger, anxiety is normal when its severity is in the proportion, however it's become abnormal when the threat is outlasts (4). The pathological anxiety is identified by (3,5): (i) being out of proportion to the level of threat; (ii) persis-tence or deterioration without intervention; (iii) a level of symptoms which are unacceptable regard-less of the level of threat; and (iv) a disruption of usual or desirable functioning.

The physical symptoms of anxiety may include increased heart rate and breathing, tight muscles, restlessness, exercise perspiration, fatigue and headaches (6). Anxiety can be chronic (extended over time) or episodic (related to specific circums-tances) (7) and there are many types of anxiety disorder and each has a range of symptoms. Ma-huire et al., (8) has classified the feature of anxiety into apprehensive expectation, vigilance and scan-ning, motor tension and autonomic hyperactivity and Maynard et al., (9) classified anxiety into cog-nitive and somatic where cognitive anxiety is the mental aspect that involves negative thought pat-terns, while somatic anxiety is the psychological component of anxiety that involves autonomic arousal. Since anxiety is a frequent response to threat, it is found in all clinical populations.

Men diagnosed with prostate cancer were more likely to have anxiety disorder than men in the general community (10, 11). However, anxiety de-creased significantly with subsequent rounds of examination and with increasing age (12). The mean anxiety level clinically reduced from 20% to 12% from the time of diagnosis to the time of survey. It was associated with reductions in psy-chomotor, agitation, weakness, fatigue and pessi-mism (13). Low levels of anxiety among prostate cancer demonstrate the ability of patients to cope with the diagnosis and management of malignant disease (14). …

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