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Assessing Anxiety in Men With Prostate Cancer: Further Data on the Reliability and Validity of the Memorial Anxiety Scale for Prostate Cancer (MAX–PC)

Received February 2, 2005; revised September 2, 2005; accepted September 29, 2005. From the Dept. of Psychiatry and Behavioral Sciences, Dept. of Nursing, and Dept. of Medicine, Memorial Sloan-Kettering Cancer Center; and the Dept. of Psychology, Fordham University, Bronx, NY. Address correspondence and reprint requests to Dr. Nelson, Dept. of Psychiatry and Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, 1275 York Ave., New York, NY 10021. e-mail: nelsonc{at}mskcc.org

Identifying which men with prostate cancer might benefit from mental health treatment has proven to be a challenging task. The authors developed the Memorial Anxiety Scale for Prostate Cancer (MAX–PC) in order to facilitate the identification of prostate cancer-related anxiety. A revised version of this scale was tested in a more clinically varied population. Ambulatory men with prostate cancer (N=367) completed a baseline assessment packet that included the MAX–PC and other psychosocial questionnaires. The MAX–PC showed high internal consistency and concurrent and discriminant validity. Factor analysis identified three distinct factors for the MAX–PC that corresponded to the intended subscales (General Prostate Cancer Anxiety, PSA (prostate-specific antigen) Anxiety, and Fear of Recurrence). PSA levels were not correlated with anxiety overall; however, anxiety was significantly higher among patients whose PSA levels were changing (i.e., rising, falling, and unstable), versus those with stable PSA levels. Also, in a multivariate analysis, the change in PSA levels was a significant predictor of MAX–PC scores, but not Hospital Anxiety and Depression Scale (HADS) scores. These results indicate that the MAX–PC is a valid and reliable measure of anxiety that assesses aspects of anxiety unique to men with prostate cancer, and it may provide a more sensitive measure of anxiety than the HADS for this population.

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