Effect of gender on psychological distress and fatigue over time in a prospective cohort of cancer survivors

Background: Studies indicate a higher level of distress in women than men with cancer, but whether this difference is retained during time is unknown. We studied the frequency and level of distress and fatigue during time according to gender in a cohort of cancer survivors. Patients and methods In this prospective study cancer survivors were invited to undergo a psychological session immediately before the medical visit. Distress was assessed by the Distress thermometer and fatigue by the ESAS-r scale. Patients underwent follow-up visits to assess changes over time. Results: A total of 305 patients and 568 visits were performed with a median follow up of 15.8 months. At baseline, female, young age and breast cancer had a significantly higher distress. However, there was an increase of distress of 0.29 points every 6 months in males (95% CI, 0.09-0.50) versus no change in females (0.03 points, 95% CI, -0.09-0.15; p-interaction=0.01). The different behavior of cancer distress during time according to gender was more evident in subjects aged 68 or older due to increasing physical problems in men (p-interaction=0.005). There was no change in fatigue with time according to gender. Conclusions: Women, younger age and breast cancer have increased cancer distress at initial visit. However, women tend to stabilize during follow-up whereas men tend to worsen their distress, especially because of physical and emotional problems, suggesting different coping capabilities. Implications for Cancer Survivors Interventions aimed at improving recognition of emotions related to disease experience in male cancer survivors appear necessary.