Maarten van der Doelen

Chapter 4

Supplementary table 5. Correlation of psychological distress and PSA response/progression. PSA progression was defined as a confirmed ≥25% increase in PSA blood levels (from baseline or nadir) during radium-223 therapy, according to Prostate Cancer Working Group 3 criteria (Scher et al, J Clin Oncol, 2016). A PSA response was defined as a 30% or greater reduction in PSA level during therapy, according to the ALSYMPCA trial definition. Based on the clinically relevant change of 3 points change for the total HADS score, changes in total HADS scores over time were classified as deteriorated, stable, improved and fluctuating. Eighty-nine patients had completed at least two HADS questionnaires and in these patients trajectory analysis of psychological distress was possible. Data on the PSA course during radium-223 were available in all of these 89 patients. In this subgroup, 14 of 89 patients (15.7%) had a PSA response and 80 of 89 patients (89.9%) experienced PSA progression during radium-223 therapy. We did not find a statistically significant correlation between psychological distress and PSA response/progression. However, these analyses may be underpowered due to the low number of subjects in each HADS subgroup. PSA response No PSA response Total Deteriorated HADS 3 (19%) 13 (81%) 16 (100%) Stable HADS 2 (8%) 24 (92%) 26 (100%) Improved HADS 6 (18%) 28 (82%) 34 (100%) Fluctuating HADS 3 (23%) 10 (77%) 13 (100%) Total 14 (16%) 75 (84%) 89 (100%) P = 0.572 (Pearson Chi Square test).

PSA progression No PSA progression

Total

Deteriorated HADS

14

(88%)

2

(13%)

16

(100%)

Stable HADS

25

(96%)

1

(4%)

26

(100%)

Improved HADS

29

(85%)

5

(15%)

34

(100%)

Fluctuating HADS

12

(92%)

1

(8%)

13

(100%)

Total

80

(90%)

9

(10%)

89

(100%)

P = 0.553 (Pearson Chi Square test).

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