Discussion
While elective surgeries have been postponed in most centers due to the
COVID-19 pandemic, emergency cases and oncological surgeries are
recommended to be performed with some precautions.8Therefore, we evaluated the anxiety and depression status of PCa
patients whose RALRP operations were postponed in our hospital, which is
one of the most important pandemic centers in Turkey. Through our study,
we obtained some important results. The patients’ state anxiety levels
are significantly higher than the trait anxiety level, and the state
anxiety level is more pronounced in young patients.
In the European Urology Guidelines, PCa is recommended to be divided
into risk groups according to the D’Amico classification system;
moreover, its treatment must be classified.9 According
to this classification system, radical prostatectomy (RP) remains the
most valid treatment method for low- and medium-risk PCa patients with a
10-year life expectancy; in addition, RP is recommended as part of
multimodal therapy in high-risk PCa.10,11 It has been
emphasized that during the COVID-19 pandemic period, RP treatment is
recommended to be postponed in patients with low- and medium-risk PCa to
the post-epidemic period; moreover, the surgery of selected high-risk
PCa patients may also be postponed as delaying surgical treatment for up
to 12 months does not affect operation results and cancer specific
survival even in high-risk patients.12 In the
literature, different results are highlighted in a limited number of
studies that have examined the anxiety and depression states in patients
whose operations were postponed. The study conducted by Frey et al.13, wherein the impact of the COVID-19 epidemic on
cancer treatments and quality of life of 555 patients diagnosed with
ovarian cancer was evaluated using the Hospital Anxiety and Depression
scale and the Cancer Anxiety Scale, reported the treatment of 28 (11%)
out of 225 patients who needed chemotherapy or surgical treatment and
whose operations were postponed. Therein, 23.4% of the participating
patients had anxiety and 7.6% of the patients had depression. In
addition, Frey et al. emphasized that the anxiety rate ranged between
13.9%–48.1% and the depression rate ranged between 5%–33.7% in the
non-epidemic period; furthermore, no difference was observed between the
two periods in terms of anxiety and depression rates. In another
study14 conducted before the pandemic, the depression
status of 390 patients on the waiting list for renal transplantation
were evaluated and the BDI was applied to the patients four times: at
the time when they entered the list, in the 12thwaiting month, in the 24th waiting month, and in the
3rd month after transplantation. According to the test
results, the mean BDI score was 5.5 ± 5.1 (mild depression) and the rate
of patients diagnosed with depression was 8.7% at the time they entered
the list, which increased to 12.4% in the 12thwaiting month, and on to 16.7% in the 24th waiting
month. After transplantation, this rate decreased to 2.3%. In a recent
study where Karahan et al.15 evaluated the effects of
postponing abdominal, endocrine, and orthopedic surgeries on patients’
anxiety levels for any reason regardless of the COVID-19 epidemic and
compared 50 patients with postponed surgery and 50 patients whose
surgeries were not postponed, it was reported that while there was no
significant difference between groups in terms of state anxiety levels,
the level of persistent trait anxiety in the group whose operation was
deferred was statistically significantly higher. This result was
interpreted by the authors in the sense that the high trait anxiety
scores of the patients whose surgical intervention was postponed might
be reflection of personal characteristics. In Rodler et al’s
study16, 92 patients with advanced genitourinary
cancers were surveyed about their perceptions of anxiety of COVID-19 and
cancer. 56.5 % of the patients were more anxious about cancer than
COVID-19, 26.1% of them were more anxious about COVID-19 than cancer.
They also declared that despite the pandemic, cancer remained the main
health issue for these patients and they were not willing to compromise
on their treatment.
To the best of our knowledge, no study has been conducted to investigate
the effects of this situation on anxiety and depression levels in
urooncology patients whose surgical treatment was postponed because of
the COVID-19 pandemic. While the strength of our study is that it is the
first study on this topic, its weakness is that the anxiety and
depression levels of the patients were not known before the pandemic
process. However, considering that this process is unpredictable, this
discrepancy seems to be acceptable. In a study that examined the factors
associated with the anxiety and depression status of patients with
prostate cancer, it was reported that PSA level, patient age, and number
of comorbidities are not related to anxiety and
depression17. In the present study, we did
not identify any relationship between PSA levels, history of smoking and
alcohol habitus, history of major surgery and comorbidity, and STAI-I,
STAI-II, and BDI scores. According to the results of our study, the
STAI-I levels of patients whose RALRP surgeries were postponed due to
the COVID-19 pandemic were significantly higher than those of STAI-II.
In addition, according to the BDI, the mean score of the patients was
4.3 (0–13), which signifies mild depression. This result can be
interpreted in the sense that the pandemic and/or the postponement of
the operation because of the pandemic caused additional anxiety in
patients. The STAI-I levels in younger patients were statistically
significantly higher than those in the elderly population. The higher
awareness level in young patients might explain why young patients have
higher anxiety levels in our study.
Because of the patient population in our study belongs to a narrow
cross-sectional timeframe, the number is small as expected. This low
number is a limitation of our study.