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.