title: Intrusive thoughts and quality of life among men with prostate cancer before and three months after surgery.
abstract: BACKGROUND
  Sudden, unwelcome and repetitive thoughts about a traumatic event--intrusive thoughts--could relate to how men assess their quality of life after prostate-cancer diagnosis. We aimed to study the prevalence of intrusive thoughts about prostate cancer and their association with quality-of-life outcomes before and after radical prostatectomy.
  
  
  METHODS
  During the first year of the LAPPRO-trial, 971 men scheduled for radical prostatectomy were prospectively included from 14 urological centers in Sweden. Of those, 833 men responded to two consecutive study-specific questionnaires before and three months after surgery (participation rate 86%). The association of intrusive thoughts with three quality-of-life outcomes, i.e. self-assessed quality of life, depressive mood and waking up with anxiety was estimated by prevalence ratios that were calculated, together with a 95% confidence interval, at the same time-point as well as over time. Fisher's exact-test was used to analyze differences between respondents and non-respondents. Wilcoxon signed-ranks and Cochran-Armitage trend tests were used for analysis of change over time. To validate new questions on intrusive thoughts, written answers to open-ended questions were read and analyzed by qualitative content analysis.
  
  
  RESULTS
  Before surgery, 603 men (73%) reported negative intrusive thoughts about their cancer at some time in the past month and 593 men (59%) reported such thoughts three months after surgery. Comparing those reporting intrusive thoughts at least weekly or once a week before surgery with those who did not, the prevalence ratio (95% confidence interval), three months after surgery, for waking up in the middle of the night with anxiety was 3.9 (2.7 to 5.5), for depressed mood 1.8 (1.6 to 2.1) and for impaired self-assessed quality of life 1.3 (1.2 to 1.5).
  
  
  CONCLUSIONS
  The prevalence of negative intrusive thoughts about prostate cancer at the time of surgery associates with studied quality-of-life outcomes three months later.
  
  
  BACKGROUND
  Current Controlled Trials, ISRCTN06393679.
authors.affiliation: Division of Clinical Cancer Epidemiology, Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg, 41345 Gothenburg, Sweden. thordis.thorsteinsdottir@gmail.com.
authors.forename: Thordis
authors.initials: T
authors.lastname: Thorsteinsdottir
authors.forename: Maria
authors.initials: M
authors.lastname: Hedelin
authors.forename: Johan
authors.initials: J
authors.lastname: Stranne
authors.forename: Heiddis
authors.initials: H
authors.lastname: Valdimarsdóttir
authors.forename: Ulrica
authors.initials: U
authors.lastname: Wilderäng
authors.forename: Eva
authors.initials: E
authors.lastname: Haglind
authors.forename: Gunnar
authors.initials: G
authors.lastname: Steineck
mesh_terms: D000328:Adult; D000368:Aged; D001007:Anxiety / Q000523:psychology*; D015331:Cohort Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011471:Prostatic Neoplasms / Q000523:psychology* / Q000601:surgery*; D011788:Quality of Life / Q000523:psychology*; D011795:Surveys and Questionnaires; D013548:Sweden
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