Cancer-related identity and advanced old age – analysis of prostate cancer survivors after radical prostatectomy over the age of 75

Abstract Background The struggle to incorporate the experience of suffering from PCa in their biography can be evident in men affected by PCa even years after the initial cancer diagnosis. Aim of this study was to assess the cancer-related identity and associated factors in men over 75 years affected by PCa and treated with radical prostatectomy to improve the understanding of cancer-related self-perception in older men. Methods 2,379 on average 82.2 ± 3.9 year-old prostate cancer survivors with a mean follow-up of 17.9 ± 3.7 after radical prostatectomy were asked to choose one of 5 cancer-related identities (“patient”, “victim”, “someone who has had cancer”, “cancer survivor,” and “cancer conqueror”). Associations with clinical data, aging-related factors (frailty, comorbidities, loneliness), and psychological factors were assessed. Results Most men identified with the neutral terms “someone who has had cancer” (45.7%) and patient (27.0%), which was associated with primarily clinical characteristics. Identification with negatively connoted cancer-related identities was less common (“cancer survivor” (15.7%), “victim” (2.1%)) and was associated with primarily aging-related and psychological factors. Identification as a “cancer survivor” was associated with more self-reported comorbidities (OR: 1.09 [1.01 – 1.17]) and symptoms of depression (OR: 1.71 [1.20 – 2.45]). Identification as a victim was associated with severe loneliness (OR: 5.09 [2.39 – 10.85]). The positively connoted cancer-related identity “cancer conqueror” (9.5%) was associated with a higher quality of life (OR: 1.41 [1.28 – 1.57]). Conclusions The cancer-related identity in long-term PCa survivors of advanced old age varies widely. Especially negatively connoted cancer-related identities reflect the subjective disease experience, the overall health status, and the lack of a social support system. Even years after the primary diagnosis and treatment, assessment of the cancer-related identity can identify men who are affected most by their cancer experience and might need further psycho-oncological assistance.