Human outcomes. Diseases and their treatment often have a significant effect on the emotions of patients, their families, and their friends. This is particularly true for men treated for prostate cancer, which can have such possible side effects as urinary, bowel, and sexual dysfunction -- all having the potential for an enormous impact on quality of life. While medical treatment outcomes usually are closely evaluated, careful examination of the behavioral, emotional, and interpersonal results of medical interventions are less common.

Jack Clark, an associate professor at the School of Public Health, recently completed a study on how prostate cancer patients felt about their diagnosis and treatments. The research team conducted a series of focus groups -- bringing together small groups of men to share their experiences about their diagnosis and treatment choices. These discussions were analyzed to pinpoint the topics and themes that were most important to the participants. The information was then used to develop a survey, which was sent to 540 men with prostate cancer and a control group of 658 men without prostate cancer.

The researchers identified 11 key quality-of-life factors, 7 of which are relevant to most older men: concerns about urinary control, sexual intimacy, sexual confidence, marital affection, masculine self-esteem, worry about health, and concern about PSA (a screening test for prostate cancer, and for those diagnosed with the disease, an indicator of cancer control). The other four are specific to treatment -- perceived cancer control, quality of decision-making, regret about choice of treatment, and cancer-related outlook.

The scales developed in this study, the researchers report, provide clearer definition and tools for further patient-centered research of the emotional concomitants of treatment. They believe that additional studies of newly diagnosed patients could shed light on how men adapt to diagnosis, the challenges they face in choosing a treatment, and how they deal with uncertain outcomes. According to Clark, “. . . we offer measures of how complications of treatment complicate men’s lives, and how realizing that one now lives with prostate cancer changes one’s sense of well-being.”

This research was reported in the August 2003 issue of the journal Medical Care. A related article appeared in the October 15 Journal of Clinical Oncology.

Statin status. Statins, a class of cholesterol-lowering drugs, are routinely taken by millions of people around the world. According to Forbes magazine, the drugs have earned .5 million for U.S. pharmaceutical companies in the past year alone. An enormous range of studies has been done on statins, revealing both benefits -- including possible beneficial effects for Alzheimer’s disease -- and safety concerns.

Among the concerns were studies indicating a possible link between lowered cholesterol levels and increased risk of depression and suicide. A recent study by MED Associate Professor Susan Jick of the Boston Collaborative Drug Surveillance Program and collaborators from the Harvard School of Public Health, National Yang-Ming University and Veterans General Hospital, both in Taipei, Taiwan, investigated these findings. The researchers analyzed records from the United Kingdom General Practice Research Database (GPRD), containing computerized medical records and demographic data for some three million UK residents. Their analysis of data from 94,441 adult medical records revealed that statins are not associated with an increased risk of depression or suicide, and in fact, might be associated with a reduced risk of depression.

The researchers identified three groups within the GPRD, patients taking statins, patients with high cholesterol who were not taking statins, and a random sample of patients who neither used statins nor had high levels of cholesterol. Within these groups they identified cases of newly treated depression and first-recorded diagnosis of suicidal behavior within a nine-year period from 1991 to 1999.

Jick’s team found that neither statin use nor untreated high cholesterol increased the risk of depression or suicide, but that current statin use seemed to substantially reduce the risk of depression. Since statins have no known pharmacological mechanism to account for this effect, the researchers hypothesize that lowered rates of depression may be the result of improved quality of life -- fewer cardiovascular events -- and increased health consciousness among people who are using statins to control their cholesterol levels.

This research was reported in the September 8 issue of the Archives of Internal Medicine.