Article Text

Download PDFPDF
Androgen deprivation therapy and radiation for prostate cancer—cognitive impairment, sleep, symptom burden: a prospective study
  1. Joshua Tulk1,
  2. Joshua A Rash1,
  3. John Thoms2,
  4. Richard Wassersug3,
  5. Brian Gonzalez4 and
  6. Sheila N Garland1,2
  1. 1 Department of Psychology, Memorial University, St. John's, Newfoundland and Labrador, Canada
  2. 2 Discipline of Oncology, Memorial University, St. John's, Newfoundland and Labrador, Canada
  3. 3 Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada
  4. 4 Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, Florida, USA
  1. Correspondence to Dr Sheila N Garland, Department of Psychology, Memorial University, St. John's, NL A1C 5S7, Canada; sheila.garland{at}


Objectives This paper (1) sought to compare sleep, mood and physical symptom profiles of men with prostate cancer (PCa) who experienced subjective and objective cancer-related cognitive impairment (CRCI) during the first year of treatment and (2) examine if fluctuations in mood and physical symptoms are associated with change in subjective or objective CRCI.

Methods This prospective observational cohort study examined 24 new patients with PCa receiving androgen deprivation therapy (ADT) and radiation therapy (RT) during the first 12 months of treatment. Participants completed subjective and objective assessments of cognition, sleep continuity and self-report measures of insomnia, fatigue, depression and anxiety. Independent sample t-tests, correlations and hierarchical regressions were used to compare groups, explore associations, and assess change over time. Effects are reported as corrected Cohen’s d (dc).

Results Men with objective CRCI reported worse subjective time asleep (dc=0.47) and more depression (dc=0.55). Men with subjective CRCI reported worse insomnia (dc=0.99), hot flashes (dc=0.76), sleep quality (dc=0.54), subjective total sleep time (dc=0.41), wake after sleep onset (dc=0.71), sleep efficiency (dc=0.49), fatigue (dc=0.67) and objectively estimated sleep latency (dc=0.72) than men without subjective CRCI. Declines in perceived cognition was associated with higher anxiety (p=0.05), fatigue (p≤0.01) and symptoms of insomnia (p=0.01). Finally, subjective time awake during the night (p=0.03) and fatigue (p=0.02) were associated with subjective cognitive decline, controlling for objective change.

Conclusions Subjective concerns of CRCI appear more critical to patient experience than objective measurements in men with PCa who have received RT and ADT. Interventions to improve sleep may result in an improved perception of cognition.

  • prostate
  • fatigue
  • quality of life
  • depression
  • psychological care

Data availability statement

Data are available upon reasonable request.

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Data availability statement

Data are available upon reasonable request.

View Full Text


  • Twitter @jgjtulk, @rjwassersug, @BrianDGonzalez, @SNGarlandPhD

  • Contributors The authors’ responsibilities were as follows: SNG and JThoms: designed the research and sought project funding; JT, SNG and JAR: cleaned, analysed data; JT and SNG: prepared the manuscript; JAR, JT, RW and BG: edited the manuscript; SNG: conducted the research and had the responsibility for the final content of the manuscript. All authors have read and approved the final manuscript.

  • Funding This work was supported by Memorial University of Newfoundland and the Beatrice Hunter Cancer Research Institute (BHCRI).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.