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Low CE, Pillay RM, Teo FJJ, Loh CYL, Yau CE, Yan Bin Lee AR, Ho CSH, Chen MZ. Educational interventions to reduce depression and anxiety in older adults with cancer in the community: a systematic review, meta-analysis and meta-regression of randomised controlled trials. Age Ageing 2024; 53:afae111. [PMID: 38821857 DOI: 10.1093/ageing/afae111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Older adults make up half of those with cancer and are prone to mood disorders, such as depression and severe anxiety, resulting in negative repercussions on their health-related quality-of-life (HRQOL). Educational interventions have been shown to reduce adverse psychological outcomes. We examined the effect of educational interventions on the severity of psychological outcomes in older adults with cancer (OAC) in the community. METHOD This PRISMA-adherent systematic review involved a search of PubMed, MedLine, Embase and PsycINFO for randomised controlled trials (RCTs) that evaluated educational interventions impacting the severity of depression, anxiety and HRQOL in OAC. Random effects meta-analyses and meta-regressions were used for the primary analysis. RESULTS Fifteen RCTs were included. Meta-analyses showed a statistically insignificant decrease in the severity of depression (SMD = -0.30, 95%CI: -0.69; 0.09), anxiety (SMD = -0.30, 95%CI: -0.73; 0.13) and improvement in overall HRQOL scores (SMD = 0.44, 95%CI: -0.16; 1.04). However, subgroup analyses revealed that these interventions were particularly effective in reducing the severity of depression and anxiety in specific groups, such as OAC aged 60-65, those with early-stage cancer, those with lung cancer and those treated with chemotherapy. A systematic review found that having attained a higher education and income level increased the efficacy of interventions in decreasing the severity of adverse psychological outcomes. CONCLUSION Although overall meta-analyses were statistically insignificant, subgroup meta-analyses highlighted a few specific subgroups that the educational interventions were effective for. Future interventions can be implemented to target these vulnerable groups.
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Affiliation(s)
- Chen Ee Low
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Renish M Pillay
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Finn Jing Jie Teo
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Chun En Yau
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Cyrus Su Hui Ho
- Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Department of Psychological Medicine, National University Hospital, Singapore
| | - Matthew Zhixuan Chen
- Division of Geriatric Medicine, Department of Medicine, National University Hospital, Singapore
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Alberti A, Nicoletti R, Castellani D, Yuan Y, Maggi M, Dibilio E, Resta GR, Makrides P, Sessa F, Sebastianelli A, Serni S, Gacci M, De Nunzio C, Teoh JYC, Campi R. Patient-reported Outcome Measures and Experience Measures After Active Surveillance Versus Radiation Therapy Versus Radical Prostatectomy for Prostate Cancer: A Systematic Review of Prospective Comparative Studies. Eur Urol Oncol 2024:S2588-9311(24)00138-X. [PMID: 38816298 DOI: 10.1016/j.euo.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2024] [Revised: 05/02/2024] [Accepted: 05/14/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND AND OBJECTIVE Current management options for localized prostate cancer (PCa) include radical prostatectomy (RP), radiotherapy (RT), and active surveillance (AS). Despite comparable oncological outcomes, there is still lack of evidence on their comparative effectiveness in terms of patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs). We conducted a systematic review of studies comparing PROMs and PREMs after all recommended management options for localized PCa (RP, RT, AS). METHODS A literature search was performed in the MEDLINE, EMBASE, and Cochrane CENTRAL databases in accordance with recommendations from the European Association of Urology Guidelines Office and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. All prospective clinical trials reporting PROMs and/or PREMs for comparisons of RP versus RT versus AS were included. A narrative synthesis was used to summarize the review findings. No quantitative synthesis was performed because of the heterogeneity and limitations of the studies available. KEY FINDINGS AND LIMITATIONS Our findings reveal that RP mostly affects urinary continence and sexual function, with better results for voiding symptoms in comparison to other treatments. RT was associated with greater impairment of bowel function and voiding symptoms. None of the treatments had a significant impact on mental or physical quality of life. Only a few studies reported PREMs, with a high rate of decision regret for all modalities (up to 23%). CONCLUSIONS AND CLINICAL IMPLICATIONS All recommended treatments for localized PCa have an impact on PROMs and PREMs, but for different domains and with differing severity. We found significant heterogeneity in PROM collection, so standardization in real-world practice and clinical trials is warranted. Only a few studies have reported PREMs, highlighting an unmet need that should be explored in future studies. PATIENT SUMMARY We reviewed differences in patient reports of their outcomes and experiences after surgical prostate removal, radiotherapy, or active surveillance for prostate cancer. We found differences in the effects on urinary, bowel, and sexual functions among the treatments, but no difference for mental or physical quality of life. Our results can help doctors and prostate cancer patients in shared decision-making.
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Affiliation(s)
- Andrea Alberti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Rossella Nicoletti
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy; S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China
| | - Daniele Castellani
- Urology Unit, Azienda Ospedaliero-Universitaria delle Marche, Università Politecnica delle Marche, Ancona, Italy
| | - Yuhong Yuan
- Department of Medicine, McMaster University, Hamilton, Canada
| | - Martina Maggi
- Department of Urology, Sapienza Rome University, Rome, Italy
| | - Edoardo Dibilio
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Giulio Raffaele Resta
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Pantelis Makrides
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Francesco Sessa
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Arcangelo Sebastianelli
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Sergio Serni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Mauro Gacci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Cosimo De Nunzio
- Department of Urology, Sant'Andrea Hospital, La Sapienza University, Rome, Italy
| | - Jeremy Y C Teoh
- S.H. Ho Urology Centre, Department of Surgery, The Chinese University of Hong Kong, Hong Kong, China; Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Riccardo Campi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.
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3
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Ask S, Schildmeijer K, Kaldo V, Hellström A. The effect of psychosocial interventions for sexual health in patients with pelvic cancer: a systematic review and meta-analysis. Acta Oncol 2024; 63:230-239. [PMID: 38682457 PMCID: PMC11332557 DOI: 10.2340/1651-226x.2024.24204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 03/15/2024] [Indexed: 05/01/2024]
Abstract
AIM The aim of this systematic review and meta-analysis was to explore and evaluate the effect of psychosocial interventions in improving sexual health outcomes among post-treatment patients with pelvic cancer. METHODS Inclusion and exclusion criteria were pelvic cancer survivors; psychosocial interventions; studies with a control group and measures of sexual health. Five databases were searched for literature along with an inspection of the included studies' reference lists to extend the search. Risk of bias was assessed with the RoB2 tool. Standardised mean difference (SMD) with a random effects model was used to determine the effect size of psychosocial interventions for sexual health in patients with pelvic cancers. RESULTS Thirteen studies were included, with a total number of 1,541 participants. There was a large heterogeneity regarding the type of psychosocial intervention used with the source found in a leave one out analysis. Six studies showed statistically significant improvements in sexual health, while three showed positive but non-significant effects. The summary effect size estimate was small SMD = 0.24 (95% confidence interval [CI]: 0.05 to 0.42, p = 0.01). DISCUSSION There is limited research on psychosocial interventions for sexual health in pelvic cancer patients. There are also limitations in the different pelvic cancer diagnoses examined. Commonly, the included articles examined physical function rather than the whole sexual health spectrum. The small effect sizes may in part be due to evaluation of psychosocial interventions by measuring physical dysfunction. Future research should broaden sexual health assessment tools and expand investigations to more cancer types.
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Affiliation(s)
- Samuel Ask
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden.
| | - Kristina Schildmeijer
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
| | - Viktor Kaldo
- Department of Psychology, Faculty of Health and Life Sciences, Linnaeus University, Växjö, Sweden; Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet, & Stockholm Health Care Services, Region Stockholm, Sweden
| | - Amanda Hellström
- Department of Health and Caring Sciences, Faculty of Health and Life Sciences, Linnaeus University, Kalmar, Sweden
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Brick R, Padgett L, Jones J, Wood KC, Pergolotti M, Marshall TF, Campbell G, Eilers R, Keshavarzi S, Flores AM, Silver JK, Virani A, Livinski AA, Ahmed MF, Kendig T, Khalid B, Barnett J, Borhani A, Bernard G, Lyons KD. The influence of telehealth-based cancer rehabilitation interventions on disability: a systematic review. J Cancer Surviv 2023; 17:1725-1750. [PMID: 35218521 PMCID: PMC8881759 DOI: 10.1007/s11764-022-01181-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Accepted: 02/02/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To characterize delivery features and explore effectiveness of telehealth-based cancer rehabilitation interventions that address disability in adult cancer survivors. METHODS A systematic review of electronic databases (CINAHL Plus, Cochrane Library: Database of Systematic Reviews, Embase, National Health Service's Health Technology Assessment, PubMed, Scopus, Web of Science) was conducted in December 2019 and updated in April 2021. RESULTS Searches identified 3,499 unique studies. Sixty-eight studies met inclusion criteria. There were 81 unique interventions across included studies. Interventions were primarily delivered post-treatment and lasted an average of 16.5 weeks (SD = 13.1). They were most frequently delivered using telephone calls (59%), administered delivered by nursing professionals (35%), and delivered in a one-on-one format (88%). Risk of bias of included studies was primarily moderate to high. Included studies captured 55 measures of disability. Only 54% of reported outcomes had data that allowed calculation of effect sizes ranging -3.58 to 15.66. CONCLUSIONS The analyses suggest small effects of telehealth-based cancer interventions on disability, though the heterogeneity seen in the measurement of disability makes it hard to draw firm conclusions. Further research using more diverse samples, common measures of disability, and pragmatic study designs is needed to advance telehealth in cancer rehabilitation. IMPLICATIONS FOR CANCER SURVIVORS Telehealth-based cancer rehabilitation interventions have the potential to increase access to care designed to reduce disability across the cancer care continuum.
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Affiliation(s)
- Rachelle Brick
- Cancer Prevention Fellowship Program, Division of Cancer Prevention, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD, 20850, USA.
| | - Lynne Padgett
- VA Central Office, Health Services Research and Development, 1100 1st St NE, Suite 6, Washington, DC, 20002, USA
| | - Jennifer Jones
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, University Health Network, 200 Elizabeth Sr. PMB-B-045, Toronto, ON, M5G 2C4, Canada
| | - Kelley Covington Wood
- ReVital Cancer Rehabilitation, Select Medical, 4714 Gettysburg Road, Mechanicsburg, PA, 17055, USA
| | - Mackenzi Pergolotti
- ReVital Cancer Rehabilitation, Select Medical, 4714 Gettysburg Road, Mechanicsburg, PA, 17055, USA
| | - Timothy F Marshall
- Ivy Rehab Network, 1311 Mamaroneck Ave, Suite 140, White Plains, NY, 10605, USA
| | - Grace Campbell
- Duquesne University School of Nursing, 600 Forbes Avenue, Pittsburgh, PA, 15282, USA
- Department of Obstetrics, Gynecology, and Reproductive Sciences and UPMC Hillman Cancer Center at UPMC Magee, School of Medicine, University of Pittsburgh, 300 Halket Street, Pittsburgh, PA, 15213, USA
| | - Rachel Eilers
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Bridgeside Point I, 100 Technology Drive, Pittsburgh, PA, 15219, USA
| | - Sareh Keshavarzi
- Department of Biostatistics, Princess Margaret Cancer Center, 610 University Ave, Toronto, ON, Canada
- Biostatistics Division, Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON, Canada
| | - Ann Marie Flores
- Robert H. Lurie Comprehensive Cancer Center of Northwestern University, Chicago, IL, 60611, USA
- Department of Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, 645 North Michigan Avenue, 11th Floor, Chicago, IL, 60611, USA
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, 645 North Michigan Avenue, 11th Floor, Chicago, IL, 60611, USA
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA
- Massachusetts General Hospital, 55 Fruit Street, Boston, MA, USA
- Brigham and Women's Hospital, 55 Fruit Street, Boston, MA, USA
- Spaulding Rehabilitation Hospital, 55 Fruit Street, Boston, MA, USA
| | - Aneesha Virani
- Department of Rehabilitation Services, Northside Hospital, 1000 Johnson Ferry Road, Atlanta, GA, 30342, USA
| | - Alicia A Livinski
- National Institutes of Health Library, Office of Research Services, OD, NIH, MSC 1150, 10 Center Drive, Bethesda, MD, 20892, USA
| | - Mohammed Faizan Ahmed
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, University Health Network, 200 Elizabeth Sr. PMB-B-045, Toronto, ON, M5G 2C4, Canada
| | - Tiffany Kendig
- ReVital Cancer Rehabilitation, Select Medical, 4714 Gettysburg Road, Mechanicsburg, PA, 17055, USA
| | - Bismah Khalid
- Department of Occupational Science & Occupational Therapy, University of Toronto, 500 University Avenue, Toronto, ON, M5G 1VT, Canada
| | - Jeremy Barnett
- George Washington University School of Medicine and Health Sciences, 2300 I St. NW, Washington, DC, 20052, USA
| | - Anita Borhani
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, University Health Network, 200 Elizabeth Sr. PMB-B-045, Toronto, ON, M5G 2C4, Canada
| | - Graysen Bernard
- Cancer Rehabilitation and Survivorship Program, Princess Margaret Cancer Centre, University Health Network, 200 Elizabeth Sr. PMB-B-045, Toronto, ON, M5G 2C4, Canada
| | - Kathleen Doyle Lyons
- Department of Occupational Therapy, MGH Institute of Health Professions, Charlestown Navy Yard, Building 79/96, 79 13th Street, Boston, MA, 02129, USA
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Briggs LG, Sentana-Lledo D, Lage DE, Trinh QD, Morgans AK. Optimal assessment of quality of life for patients with prostate cancer. Ther Adv Med Oncol 2022; 14:17588359221141306. [PMID: 36531831 PMCID: PMC9747880 DOI: 10.1177/17588359221141306] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Accepted: 11/07/2022] [Indexed: 10/04/2023] Open
Abstract
The burden of cancer and oncologic treatment is reflected not only through morbidity and mortality, but also through impacts on patient quality of life (QoL). However, QoL has not been historically measured or addressed with the same rigorous methodology as traditional disease-related outcomes such as overall survival and progression, as these are driven by objective measurements and events. Prostate cancer (PCa) is one of the most prevalent non-cutaneous cancers in men around the world. Both the cancer and its treatment significantly impact patients' physical, emotional, sexual, social, and overall QoL. Ensuring assessment and integration of QoL in research and clinical care enables improvement in treatment outcomes that matter most to patients while also facilitating alignment of healthcare priorities with reimbursements. Great strides toward this end have been made over the last decade, but significant room for improvement remains. To ensure high quality, reliable data collection, QoL assessment tools must be psychometrically validated, standardized, widely implemented across trials, and regularly assessed to allow internal and external validity, longitudinal comparative effectiveness research, and quality control. Additional consideration should be taken for instruments used to measure the aspects of QoL specific to minority, caregiver, and elderly populations. Open clinical questions include how providers should weight changes in different QoL subscales and how clinically meaningful difference thresholds should be defined. Review of ongoing clinical trials encouragingly reveals an increased focus on measuring and improving QoL for men with PCa which will inform the way we utilize QoL assessments. However, additional efforts herein described are needed to fully optimize these processes. In summary, this review will explain the rationale for QoL assessments in PCa populations, discuss requirements for effective implementation, describe considerations for vulnerable and under-evaluated populations, and summarize ongoing clinical trials assessing patient QoL.
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Affiliation(s)
- Logan G Briggs
- Department of Urology, Mayo Clinic, Phoenix, AZ, USA
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Daniel Sentana-Lledo
- Department of Hematology-Oncology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Daniel E Lage
- Department of Hematology-Oncology, Massachusetts General Hospital, Boston, MA, USA
| | - Quoc-Dien Trinh
- Center for Surgery and Public Health, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Alicia K Morgans
- Faculty in Medicine, Department of Medical Oncology, Dana-Farber Cancer Institute, 450 Brookline Ave, Dana 09-930, Boston, MA 02215, USA
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Anderson D, Razzak AN, McDonald M, Cao D, Hasoon J, Viswanath O, Kaye AD, Urits I. Mental Health in Urologic Oncology. Health Psychol Res 2022; 10:37518. [DOI: 10.52965/001c.37518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
This article is a systematic review of mental health in urologic oncology patients with prostate cancer (PCa), bladder cancer (BC), renal cell carcinoma (RCC), testicular cancer (TC), or penile cancer (PeCa). For all pathologies, a focus on increasing quality of life post-treatment demonstrated a positive impact in reducing Mental Health Illness (MHI) prevalence. Cancer specific mental health care may be given to patients to reduce suicide risk in BC patients and sexual identify and masculinity counseling may improve mental health for TC or PeCa patients. In order to better accommodate patient’s mental health needs when undergoing GU cancer treatment, we recommend incorporation of mental health metrics such as questionnaires to assess early treatment of MHI, a greater emphasis on psychosocial support with the patient’s loved ones, peers, and healthcare team, alongside advising healthy habits such as exercise which has been shown to drastically reduce MHI incidence across all pathologies. We hope that these measures conducted by urologists and oncologists, alongside possible coordination with psychiatrists and psychologists for psychotherapy, psychopharmacology, and neuro-stimulation treatment modems may be helpful in the long term to reduce MHI incidence in urology oncology patients. Given the higher incidence of MHI in oncology patients and in the patient population after the Covid-19 pandemic, MHI awareness in the sphere of urologic oncologic treatment continues to be crucial when creating a collaborative treatment platform for patients.
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Affiliation(s)
| | | | | | | | | | - Omar Viswanath
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School; Valley Anesthesiology and Pain Consultants, Envision Physician Services; Department of Anesthesiology, University of Arizona College of Medicine Phoenix;Department of Anesthesiology, Creighton University School of Medicine
| | | | - Ivan Urits
- Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School; Department of Anesthesiology, Louisiana State University Health Shreveport
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Hughes S, Kassianos AP, Everitt HA, Stuart B, Band R. Planning and developing a web-based intervention for active surveillance in prostate cancer: an integrated self-care programme for managing psychological distress. Pilot Feasibility Stud 2022; 8:175. [PMID: 35945609 PMCID: PMC9361619 DOI: 10.1186/s40814-022-01124-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 07/15/2022] [Indexed: 12/24/2022] Open
Abstract
Objectives To outline the planning, development and optimisation of a psycho-educational behavioural intervention for patients on active surveillance for prostate cancer. The intervention aimed to support men manage active surveillance-related psychological distress. Methods The person-based approach (PBA) was used as the overarching guiding methodological framework for intervention development. Evidence-based methods were incorporated to improve robustness. The process commenced with data gathering activities comprising the following four components: • A systematic review and meta-analysis of depression and anxiety in prostate cancer • A cross-sectional survey on depression and anxiety in active surveillance • A review of existing interventions in the field • A qualitative study with the target audience The purpose of this paper is to bring these components together and describe how they facilitated the establishment of key guiding principles and a logic model, which underpinned the first draft of the intervention. Results The prototype intervention, named PROACTIVE, consists of six Internet-based sessions run concurrently with three group support sessions. The sessions cover the following topics: lifestyle (diet and exercise), relaxation and resilience techniques, talking to friends and family, thoughts and feelings, daily life (money and work) and information about prostate cancer and active surveillance. The resulting intervention has been trialled in a feasibility study, the results of which are published elsewhere. Conclusions The planning and development process is key to successful delivery of an appropriate, accessible and acceptable intervention. The PBA strengthened the intervention by drawing on target-user experiences to maximise acceptability and user engagement. This meticulous description in a clinical setting using this rigorous but flexible method is a useful demonstration for others developing similar interventions. Trial registration and Ethical Approval ISRCTN registered: ISRCTN38893965. NRES Committee South Central – Oxford A. REC reference: 11/SC/0355
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Affiliation(s)
- Stephanie Hughes
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, UK.
| | - Angelos P Kassianos
- Department of Nursing, Cyprus University of Technology, Limassol, Cyprus.,Department of Applied Health Research, University College London, London, UK
| | - Hazel A Everitt
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Beth Stuart
- Primary Care Population Sciences and Medical Education, University of Southampton, Southampton, UK
| | - Rebecca Band
- Health Sciences, University of Southampton, Southampton, UK
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8
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Park GR, Kim J. Gendered trajectories of depressive symptoms and social interactions among cancer patients. Eur J Oncol Nurs 2022; 56:102092. [PMID: 34999426 DOI: 10.1016/j.ejon.2021.102092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 10/08/2021] [Accepted: 12/29/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE This study examines whether and how depressive symptoms and social interactions change before and after cancer diagnosis, and whether this pattern varies by gender. METHODS This study used data about 722 middle- and older-aged adults from seven waves (3,963 person-observations) of the Korean Longitudinal Study of Ageing spanning 12 years between 2006 and 2018. Gender-stratified fixed effects regression models were used to investigate the effect of cancer diagnosis on changes in depressive symptoms and the frequency of social interactions (with friends, relatives, acquaintances, and neighbors) before and after cancer diagnosis. RESULTS For both men and women, an increase in depressive symptoms was found in the first and second year after cancer diagnosis, though the increase in the second year was significantly greater for men than women. Only men continued to suffer higher depressive symptoms after the third year and subsequent years. This study also found a decrease in the frequency of social interactions only among men in the second year and subsequent years after cancer diagnosis. CONCLUSION Trajectories of psychosocial adjustment to cancer are gendered. The psychosocial consequences of cancer are greater and last longer for men than women.
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Affiliation(s)
- Gum-Ryeong Park
- Department of Health, Aging & Society, McMaster University, Hamilton, Ontario, Canada; Korea Institute for Health and Social Affairs, Sejong, Republic of Korea
| | - Jinho Kim
- Department of Health Policy and Management, Korea University, Seoul, Republic of Korea; Interdisciplinary Program in Precision Public Health, Korea University, Seoul, Republic of Korea; Center for Demography of Health and Aging, University of Wisconsin-Madison, Madison, WI, USA.
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9
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Fagerlin A, Holmes-Rovner M, Hofer TP, Rovner D, Alexander SC, Knight SJ, Ling BS, A Tulsky J, Wei JT, Hafez K, Kahn VC, Connochie D, Gingrich J, Ubel PA. Head to head randomized trial of two decision aids for prostate cancer. BMC Med Inform Decis Mak 2021; 21:154. [PMID: 33980208 PMCID: PMC8117645 DOI: 10.1186/s12911-021-01505-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 04/26/2021] [Indexed: 11/20/2022] Open
Abstract
Background While many studies have tested the impact of a decision aid (DA) compared to not receiving any DA, far fewer have tested how different types of DAs affect key outcomes such as treatment choice, patient–provider communication, or decision process/satisfaction. This study tested the impact of a complex medical oriented DA compared to a more simplistic decision aid designed to encourage shared decision making in men with clinically localized prostate cancer.
Methods 1028 men at 4 VA hospitals were recruited after a scheduled prostate biopsy. Participants completed baseline measures and were randomized to receive either a simple or complex DA. Participants were men with clinically localized cancer (N = 285) by biopsy and who completed a baseline survey. Survey measures: baseline (biopsy); immediately prior to seeing the physician for biopsy results (pre- encounter); one week following the physician visit (post-encounter). Outcome measures included treatment preference and treatment received, knowledge, preference for shared decision making, decision making process, and patients’ use and satisfaction with the DA. Results Participants who received the simple DA had greater interest in shared decision making after reading the DA (p = 0.03), found the DA more helpful (p’s < 0.01) and were more likely to be considering watchful waiting (p = 0.03) compared to those receiving the complex DA at Time 2. While these differences were present before patients saw their urologists, there was no difference between groups in the treatment patients received.
Conclusions The simple DA led to increased desire for shared decision making and for less aggressive treatment. However, these differences disappeared following the physician visit, which appeared to change patients’ treatment preferences. Trial registration This trial was pre-registered prior to recruitment of participants. Supplementary Information The online version contains supplementary material available at 10.1186/s12911-021-01505-x.
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Affiliation(s)
- Angela Fagerlin
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, USA. .,Department of Population Health Sciences, University of Utah, 295 Chipeta Way Rm 1S105, Salt Lake City, UT, 84132, USA.
| | - Margaret Holmes-Rovner
- Center for Ethics and Department of Medicine, Michigan State University, East Lansing, MI, USA
| | - Timothy P Hofer
- Ann Arbor VA HSR&D Center for Practice Management and Outcomes Research, Ann Arbor, MI, USA.,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - David Rovner
- Center for Ethics and Department of Medicine, Michigan State University, East Lansing, MI, USA
| | | | - Sara J Knight
- Salt Lake City VA Informatics Decision-Enhancement and Analytic Sciences (IDEAS) Center for Innovation, Salt Lake City, UT, USA.,Department of Internal Medicine, University of Utah, Salt Lake City, UT, USA
| | - Bruce S Ling
- Department of Internal Medicine, University of Pittsburgh, Pittsburgh, PA, USA
| | - James A Tulsky
- Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, MA, USA.,Division of Palliative Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - John T Wei
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Khaled Hafez
- Department of Urology, University of Michigan, Ann Arbor, MI, USA
| | - Valerie C Kahn
- Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, USA
| | - Daniel Connochie
- Ann Arbor VA HSR&D Center for Practice Management and Outcomes Research, Ann Arbor, MI, USA
| | - Jeffery Gingrich
- Division of Urology, Department of Surgery, Duke University, Durham, NC, USA
| | - Peter A Ubel
- Sanford School of Public Policy, Duke University, Durham, NC, USA.,Fuqua School of Business, Duke University, Durham, USA
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10
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A systematic review and meta-analysis of psychological interventions to improve mental wellbeing. Nat Hum Behav 2021; 5:631-652. [PMID: 33875837 DOI: 10.1038/s41562-021-01093-w] [Citation(s) in RCA: 118] [Impact Index Per Article: 39.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Accepted: 03/05/2021] [Indexed: 12/20/2022]
Abstract
Our current understanding of the efficacy of psychological interventions in improving mental states of wellbeing is incomplete. This study aimed to overcome limitations of previous reviews by examining the efficacy of distinct types of psychological interventions, irrespective of their theoretical underpinning, and the impact of various moderators, in a unified systematic review and meta-analysis. Four-hundred-and-nineteen randomized controlled trials from clinical and non-clinical populations (n = 53,288) were identified for inclusion. Mindfulness-based and multi-component positive psychological interventions demonstrated the greatest efficacy in both clinical and non-clinical populations. Meta-analyses also found that singular positive psychological interventions, cognitive and behavioural therapy-based, acceptance and commitment therapy-based, and reminiscence interventions were impactful. Effect sizes were moderate at best, but differed according to target population and moderator, most notably intervention intensity. The evidence quality was generally low to moderate. While the evidence requires further advancement, the review provides insight into how psychological interventions can be designed to improve mental wellbeing.
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11
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The need for supportive mental wellbeing interventions in bladder cancer patients: A systematic review of the literature. PLoS One 2021; 16:e0243136. [PMID: 33507907 PMCID: PMC7842965 DOI: 10.1371/journal.pone.0243136] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Accepted: 11/16/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES There is an increased awareness of the effect of a bladder cancer diagnosis and its treatments on the mental wellbeing of patients. However, few studies have evaluated the efficacy, feasibility and acceptability of interventions to improve this mental wellbeing. This systematic review is the first phase of the Medical Research Council Framework for developing complex interventions and provides an overview of the published mental wellbeing interventions that could be used to design an intervention specific for BC patients. METHODS This review was conducted in accordance with the PRISMA guidelines in January 2019 and studies were identified by conducting searches for Medline, the Cochrane Central Register of Controlled Trials and Ovid Gateway. All included studies met the following criteria: mental wellbeing interventions of adults with medically confirmed diagnosis of any type of urological cancer, reported outcomes for specific HRQoL domains including psychological factors. The quality of evidence was assessed according to Down and Black 27-item checklist. RESULTS A total of 15,094 records were collected from the literature search and 10 studies matched the inclusion and exclusion criteria. Of these, nine interventions were for patients with prostate cancer and one for patients with kidney cancer. No studies were found for other urological cancers. Depression was the most commonly reported endpoint measured. Of the included studies with positive efficacy, three were group interventions and two were couple interventions. In the group interventions, all showed a reduction in depressive symptoms and in the couple interventions, there was a reduction in depressive symptoms and a favourable relationship cohesion. The couple interventions were the most feasible and acceptable, but further research was required for most of the studies. CONCLUSION While awareness of the importance of mental wellbeing in bladder cancer patients is growing, this systematic literature review highlights the gap of feasible and acceptable interventions for this patient population.
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12
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Abrahams HJG, Knoop H, Schreurs M, Aaronson NK, Jacobsen PB, Newton RU, Courneya KS, Aitken JF, Arving C, Brandberg Y, Chambers SK, Gielissen MFM, Glimelius B, Goedendorp MM, Graves KD, Heiney SP, Horne R, Hunter MS, Johansson B, Northouse LL, Oldenburg HSA, Prins JB, Savard J, van Beurden M, van den Berg SW, Verdonck-de Leeuw IM, Buffart LM. Moderators of the effect of psychosocial interventions on fatigue in women with breast cancer and men with prostate cancer: Individual patient data meta-analyses. Psychooncology 2020; 29:1772-1785. [PMID: 33448521 DOI: 10.1002/pon.5522] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Revised: 07/05/2020] [Accepted: 07/29/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Psychosocial interventions can reduce cancer-related fatigue effectively. However, it is still unclear if intervention effects differ across subgroups of patients. These meta-analyses aimed at evaluating moderator effects of (a) sociodemographic characteristics, (b) clinical characteristics, (c) baseline levels of fatigue and other symptoms, and (d) intervention-related characteristics on the effect of psychosocial interventions on cancer-related fatigue in patients with non-metastatic breast and prostate cancer. METHODS Data were retrieved from the Predicting OptimaL cAncer RehabIlitation and Supportive care (POLARIS) consortium. Potential moderators were studied with meta-analyses of pooled individual patient data from 14 randomized controlled trials through linear mixed-effects models with interaction tests. The analyses were conducted separately in patients with breast (n = 1091) and prostate cancer (n = 1008). RESULTS Statistically significant, small overall effects of psychosocial interventions on fatigue were found (breast cancer: β = -0.19 [95% confidence interval (95%CI) = -0.30; -0.08]; prostate cancer: β = -0.11 [95%CI = -0.21; -0.00]). In both patient groups, intervention effects did not differ significantly by sociodemographic or clinical characteristics, nor by baseline levels of fatigue or pain. For intervention-related moderators (only tested among women with breast cancer), statistically significant larger effects were found for cognitive behavioral therapy as intervention strategy (β = -0.27 [95%CI = -0.40; -0.15]), fatigue-specific interventions (β = -0.48 [95%CI = -0.79; -0.18]), and interventions that only targeted patients with clinically relevant fatigue (β = -0.85 [95%CI = -1.40; -0.30]). CONCLUSIONS Our findings did not provide evidence that any selected demographic or clinical characteristic, or baseline levels of fatigue or pain, moderated effects of psychosocial interventions on fatigue. A specific focus on decreasing fatigue seems beneficial for patients with breast cancer with clinically relevant fatigue.
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Affiliation(s)
- Harriët J G Abrahams
- Department of Medical Psychology, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Hans Knoop
- Department of Medical Psychology, Amsterdam Public Health research institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Maartje Schreurs
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Neil K Aaronson
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Paul B Jacobsen
- Division of Cancer Control and Population Science, National Cancer Institute, Bethesda, Maryland, USA
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Kerry S Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, Alberta, Canada
| | - Joanne F Aitken
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia.,Cancer Council Queensland, Brisbane, Queensland, Australia.,Institute for Resilient Regions, University of Southern Queensland, Brisbane, Queensland, Australia.,School of Public Health, University of Queensland, Brisbane, Queensland, Australia
| | - Cecilia Arving
- Department of Public Health and Caring Sciences, Uppsala University, Uppsala, Sweden
| | - Yvonne Brandberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Suzanne K Chambers
- Menzies Health Institute Queensland, Griffith University, Southport, Queensland, Australia.,Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia.,Institute for Resilient Regions, University of Southern Queensland, Springfield, Queensland, Australia.,Health and Wellness Institute, Edith Cowan University, Perth, Western Australia, Australia
| | | | - Bengt Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - Martine M Goedendorp
- Department of Health Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Kristi D Graves
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - Sue P Heiney
- College of Nursing, University of South Carolina, Columbia, South Carolina, USA
| | - Rob Horne
- UCL School of Pharmacy, University College London, London, UK
| | - Myra S Hunter
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Birgitta Johansson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | | | - Hester S A Oldenburg
- Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van, Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Judith B Prins
- Department of Medical Psychology, Radboud University Medical Center, Radboud, Institute for Health Sciences, Nijmegen, The Netherlands
| | - Josée Savard
- School of Psychology, Université Laval and Laval University Cancer Research Center, Quebec City, Québec, Canada
| | - Marc van Beurden
- Department of Gynecology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | | | - Irma M Verdonck-de Leeuw
- Department of Otolaryngology-Head and Neck Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Clinical, Neuro- and Developmental Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Laurien M Buffart
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Exercise Medicine Research Institute, Edith Cowan University, Joondalup, Western Australia, Australia.,Department of Medical Oncology, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands.,Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
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13
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Lee MK, Suh SR. Effects of Peer-Led Interventions for Patients With Cancer: A Meta-Analysis. Oncol Nurs Forum 2019; 45:217-236. [PMID: 29466347 DOI: 10.1188/18.onf.217-236] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PROBLEM IDENTIFICATION To evaluate the effects of peer-led supportive interventions for patients with cancer.
. LITERATURE SEARCH Six electronic databases (EMBASE, MEDLINE®, Google Scholar, Cochrane Library, ProQuest Medical Library, and CINAHL®) were searched for articles published from 1997 to May 2017.
. DATA EVALUATION A total of 159 studies were identified. Eighteen (16 randomized, controlled trials [RCTs] and 2 non-RCTs) were eligible for systematic review and 16 for meta-analysis. The Cochrane risk of bias tool and Comprehensive Meta-Analysis software were used for analysis.
. SYNTHESIS The authors synthesized the results of the effect size of each trial according to cancer symptoms, coping, emotional health, quality of life, self-efficacy, sexuality, social support, and health-related behaviors.
. IMPLICATIONS FOR RESEARCH The findings from this study suggest that an additional tiered evaluation that has a theoretical underpinning and high-quality methodology is required to confirm the efficacy of peer-led supportive interventions within cancer care models.
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14
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Romanzini AE, Pereira MDG, Guilherme C, Cologna AJ, de Carvalho EC. Predictors of well-being and quality of life in men who underwent radical prostatectomy: longitudinal study1. Rev Lat Am Enfermagem 2018; 26:e3031. [PMID: 30183870 PMCID: PMC6136529 DOI: 10.1590/1518-8345.2601.3031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/06/2018] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE to identify socio-demographic, clinical and psychological predictors of well-being and quality of life in men who underwent radical prostatectomy, in a 360-day follow-up. METHOD longitudinal study with 120 men who underwent radical prostatectomy. Questionnaires were used for characterization and clinical evaluation of the participant, as well as the instruments Visual Analog Scale for Pain, The Ways of Coping Questionnaire, Hospital Depression and Anxiety Scale, Satisfaction with Social Support Scale, Marital Satisfaction Scale, Subjective Well-Being Scale and Expanded Prostate Cancer Index. For data analysis, the linear mixed-effects model was used. RESULTS the socio-demographic factors age and race were not predictors of the dependent variables; time of surgery, problem-focused coping, and anxiety were predictors of subjective well-being; pain, anxiety and depression were negative predictors of quality of life; emotion-focused coping was a positive predictor. Marital dissatisfaction was a predictor of both variables. CONCLUSION predictor variables found were different from the literature: desire for changes in marital relationship presented a positive association with quality of life and well-being; emotion-focused coping was a predictor of quality of life; and anxiety was a predictor of subjective well-being.
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Affiliation(s)
| | | | - Caroline Guilherme
- PhD, Adjunct Professor, Curso de Enfermagem e Obstetrícia,
Universidade Federal do Rio de Janeiro, Macaé, RJ, Brazil
| | - Adauto José Cologna
- PhD, Senior Professor, Faculdade de Medicina de Ribeirão Preto,
Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Emilia Campos de Carvalho
- PhD, Senior Professor, Escola de Enfermagem de Ribeirão Preto,
Universidade de São Paulo, PAHO/WHO Collaborating Centre for Nursing Research
Development, Ribeirão Preto, SP, Brazil
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15
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Coughlin GD, Yaxley JW, Chambers SK, Occhipinti S, Samaratunga H, Zajdlewicz L, Teloken P, Dunglison N, Williams S, Lavin MF, Gardiner RA. Robot-assisted laparoscopic prostatectomy versus open radical retropubic prostatectomy: 24-month outcomes from a randomised controlled study. Lancet Oncol 2018; 19:1051-1060. [PMID: 30017351 DOI: 10.1016/s1470-2045(18)30357-7] [Citation(s) in RCA: 255] [Impact Index Per Article: 42.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 05/01/2018] [Accepted: 05/03/2018] [Indexed: 12/15/2022]
Abstract
BACKGROUND Previous trials have found similar early outcomes after robot-assisted laparoscopic prostatectomy and open radical retropubic prostatectomy. We report functional and oncological postoperative outcomes up to 24 months after surgery for these two surgical techniques. METHODS In this randomised controlled phase 3 study, men who had newly diagnosed clinically localised prostate cancer and who had chosen surgery as their treatment approach, and were aged between 35 years and 70 years were eligible and recruited from the Royal Brisbane and Women's Hospital (Brisbane, QLD, Australia). Participants were randomly assigned (1:1) to have either robot-assisted laparoscopic prostatectomy or open radical retropubic prostatectomy. Randomisation was computer generated and occurred in blocks of ten. This was an open trial; however, study investigators involved in data analysis were masked to each patient's surgical treatment. Primary outcomes were urinary function (urinary domain of Expanded Prostate Cancer Index Composite [EPIC]) and sexual function (sexual domain of EPIC and International Index of Erectile Function Questionnaire [IIEF]) at 6 months, 12 months, and 24 months and oncological outcome (biochemical recurrence and imaging evidence of progression). The trial was powered to assess health-related and domain-specific quality-of-life outcomes over 24 months. All analyses were done on a per-protocol basis. The trial was registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12611000661976. FINDINGS Between Aug 23, 2010, and Nov 25, 2014, 326 men were enrolled, of whom 163 were randomly assigned to robot-assisted laparoscopic prostatectomy and 163 to open radical retropubic prostatectomy. 18 withdrew (12 assigned to radical retropubic prostatectomy and six assigned to robot-assisted laparoscopic prostatectomy); thus, 151 in the radical retropubic prostatectomy group and 157 in the robot-assisted laparoscopic prostatectomy group proceeded to surgery. At the 24-month follow-up time point, 150 men remained in the robot-assisted laparoscopic prostatectomy group and 146 remained in the open radical retropubic prostatectomy group. Urinary function scores did not differ significantly between robot-assisted laparoscopic prostatectomy and open radical retropubic prostatectomy at 6 months post-surgery (88·68 [95% CI 86·79-90·58] vs 88·45 [86·54-90·36]; p1<0·0001, p2<0·0001), 12 months post-surgery (90·76 [88·89-92·62] vs 91·53 [90·07-92·98]; p1<0·0001, p2<0·0001), or 24 months post-surgery (91·33 [89·64-93·03] vs 90·86 [89·01-92·70]; p1<0·0001, p2<0·0001). Sexual function scores were not significantly different between robot-assisted laparoscopic prostatectomy and open radical retropubic prostatectomy at 6 months post-surgery (EPIC: 37·40 [33·60-41·19] vs 38·63 [34·76-42·49], p1=0·0001, p2<0·0001; IIEF: 29·75 [26·66-32·84] vs 29·78 [26·41-33·16], p1<0·0001, p2<0·0001), 12 months post-surgery (EPIC: 42·28 [38·05-46·51] vs 42·51 [38·29-46·72], p1<0·0001, p2<0·0001; IIEF: 33·10 [29·59-36·61] vs 33·50 [29·87-37·13], p1=0·0002, p2<0·0001), or 24 months post-surgery (EPIC: 45·70 [41·17-50·23] vs 46·90 [42·20-51·60], p1=0·0003, p2<0·0001; IIEF: 33·95 [30·11-37·78] vs 33·89 [29·82-37·96], p1=0·0003, p2=0·0004). Equivalence testing on the difference between the proportion of biochemical recurrences between the two groups (13 [9%] in the open radical retropubic prostatectomy group vs four [3%] in the robot-assisted laparoscopic prostatectomy group) showed that equality between the two techniques could not be established based on a 90% CI with a prespecified margin of 10%. However, a superiority test showed that the two proportions were significantly different (p=0·0199). Equivalence testing on the proportion of patients who had imaging evidence of progression revealed that the two groups were not significantly different (p=0·2956). INTERPRETATION Robot-assisted laparoscopic prostatectomy and open radical retropubic prostatectomy yielded similar functional outcomes at 24 months. We advise caution in interpreting the oncological outcomes of our study because of the absence of standardisation in postoperative management between the two trial groups and the use of additional cancer treatments. Clinicians and patients should view the benefits of a robotic approach as being largely related to its minimally invasive nature. FUNDING Cancer Council Queensland.
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Affiliation(s)
- Geoffrey D Coughlin
- Department of Urology, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
| | - John W Yaxley
- Department of Urology, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia; The University of Queensland Centre for Clinical Research, Brisbane, QLD, Australia
| | - Suzanne K Chambers
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia; The University of Queensland Centre for Clinical Research, Brisbane, QLD, Australia; Edith Cowan University, Perth, WA, Australia; Cancer Council Queensland, Brisbane, QLD, Australia; Prostate Cancer Foundation of Australia, Sydney, NSW, Australia; University of Technology Sydney, Sydney, NSW, Australia.
| | - Stefano Occhipinti
- Menzies Health Institute Queensland, Griffith University, Gold Coast, QLD, Australia
| | - Hema Samaratunga
- The University of Queensland Centre for Clinical Research, Brisbane, QLD, Australia; Aquesta Specialised Uropathology, Brisbane, QLD, Australia; Princess Alexandra Hospital, Brisbane, QLD, Australia
| | | | | | - Nigel Dunglison
- Department of Urology, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia
| | - Scott Williams
- Peter MacCallum Cancer Centre, Melbourne, VIC, Australia
| | - Martin F Lavin
- The University of Queensland Centre for Clinical Research, Brisbane, QLD, Australia
| | - Robert A Gardiner
- Department of Urology, Royal Brisbane & Women's Hospital, Brisbane, QLD, Australia; The University of Queensland Centre for Clinical Research, Brisbane, QLD, Australia; Edith Cowan University, Perth, WA, Australia
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Vartolomei L, Shariat SF, Vartolomei MD. Psychotherapeutic Interventions Targeting Prostate Cancer Patients: A Systematic Review of the Literature. Eur Urol Oncol 2018; 1:283-291. [PMID: 31100249 DOI: 10.1016/j.euo.2018.04.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 02/28/2018] [Accepted: 04/17/2018] [Indexed: 11/15/2022]
Abstract
CONTEXT Psychological counseling is a rarely discussed need for patients diagnosed with prostate cancer (PCa). OBJECTIVE To systematically review studies that investigated the effectiveness and feasibility of professional psychotherapeutic support for PCa patients. EVIDENCE ACQUISITION A systematic search was carried out using electronic databases, including PubMed, Web of Science, PsycInfo, and the Cochrane library. The search was performed up to September 1, 2017; only articles published in English were considered. The combination of the search words "prostate cancer" with "psychotherapy" was used. Inclusion criteria were: (1) studies with psychotherapy interventions that included PCa patients; (2) patients with localized or advance disease; and (3) professional psychotherapeutic support. EVIDENCE SYNTHESIS We identified a total of ten studies (1067 participants). Six studies investigated cognitive behavioral therapy (CBT; 713 participants). Two studies used supportive psychotherapy (88 participants) and two used cognitive essential couple therapy (133 couples). Most studies came from the USA (5 studies). CBT seemed to be beneficial in African Americans, Hispanics, men with higher interpersonal sensitivity, and those with relatively high levels of stress in single studies. Couples therapies seemed beneficial for patients and their partners. Supportive psychotherapy was usually integrated into multimodal supportive treatments. CONCLUSIONS Despite the limitations of the available studies, there is promising early evidence that specialized psychotherapeutic support for PCa patients is feasible and beneficial. Psychological intervention can significantly improve PCa patients' wellbeing after therapy. Further multicenter randomized controlled trials should focus on assessing which patients need psychotherapeutic help and which are most likely to benefit from such support, and which type of interventions are the most appropriate for each patient. PATIENT SUMMARY We report on studies comparing psychological outcomes in prostate cancer patients treated with psychotherapeutic interventions. Psychotherapeutic support is feasible and improves overall wellbeing and cancer-related distress in some prostate cancer patients.
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Affiliation(s)
- Liliana Vartolomei
- Department of Urology, Medical University of Vienna, Austria; Department of Clinical Psychology, University Dimitrie Cantemir, Tirgu Mures, Romania
| | - Shahrokh F Shariat
- Department of Urology, Medical University of Vienna, Austria; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA; Department of Urology, Weill Cornell Medical College, New York, NY, USA.
| | - Mihai Dorin Vartolomei
- Department of Urology, Medical University of Vienna, Austria; Department of Cell and Molecular Biology, University of Medicine and Pharmacy, Tirgu Mures, Romania
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17
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Suh SR, Lee MK. Effects of Nurse-Led Telephone-Based Supportive Interventions for Patients With Cancer: A Meta-Analysis. Oncol Nurs Forum 2018. [PMID: 28632251 DOI: 10.1188/17.onf.e168-e184] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PROBLEM IDENTIFICATION To evaluate the effects of nurse-led telephone-based supportive interventions (NTSIs) for patients with cancer.
. LITERATURE SEARCH Electronic databases, including EMBASE®, MEDLINE, Google Scholar,
Cochrane Library CENTRAL, ProQuest Medical Library, and CINAHL®, were searched through February 2016.
. DATA EVALUATION 239 studies were identified; 16 were suitable for meta-analysis. Cochrane's risk of bias tool and the Comprehensive Meta-Analysis software were used.
. SYNTHESIS The authors performed a meta-analysis of 16 trials that met eligibility criteria. Thirteen randomized, controlled trials (RCTs) and three non-RCTs examined a total of 2,912 patients with cancer. Patients who received NTSIs were compared with those who received attentional control or usual care (no intervention).
. CONCLUSIONS Telephone interventions delivered by a nurse in an oncology care setting reduced cancer symptoms with a moderate effect size (ES) (-0.33) and emotional distress with a small ES (-0.12), and improved self-care with a large ES (0.64) and health-related quality of life (HRQOL) with a small ES (0.3). Subgroup analyses indicated that the significant effects of NTSIs on cancer symptoms, emotional distress, and HRQOL were larger for studies that combined an application of a theoretical framework, had a control group given usual care, and used an RTC design.
. IMPLICATIONS FOR RESEARCH The findings suggest that an additional tiered evaluation that has a theoretical underpinning and high-quality methodology is required to confirm the efficacy of NTSI for adoption of specific care models.
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18
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Zhong W, Smith B, Haghighi K, Mancuso P. Systematic Review of Decision Aids for the Management of Men With Localized Prostate Cancer. Urology 2018; 114:1-7. [PMID: 29101005 DOI: 10.1016/j.urology.2017.10.022] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 10/03/2017] [Accepted: 10/10/2017] [Indexed: 11/24/2022]
Abstract
A broader range of decisional tools should be investigated. This paper will update the decisional outcome data and assess the features of decisional tool. Literature search strictly followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline. Articles that cited Lin et al and Violette et al were searched. Features of decisional tools were analyzed using the International Patient Decision Aid Standards Instrument criteria. The scores of the 31 decisional tools ranged from 6 to 15, which did not correlate proportionally with the positive decisional outcomes. Personal importance appeared to be a significant component. Multidisciplinary clinics are superior in improving decisional outcomes as they promote more at shared decision making.
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Affiliation(s)
| | - Ben Smith
- Centre for Oncology Education and Research Translation (CONCERT), Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, University of New South Wales, Sydney, Australia
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A standardized analysis of the current surgical and non-surgical treatment selection process for men with localized prostate cancer. J Robot Surg 2018; 12:215-221. [PMID: 29549504 DOI: 10.1007/s11701-018-0796-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2018] [Accepted: 03/08/2018] [Indexed: 10/17/2022]
Abstract
Robot-assisted radical prostatectomy to treat localized prostate cancer has increased in popularity, although other options exist, including radiotherapy and active surveillance. The decision about choosing the right treatment has become pertinent for many patients. This literature review aimed to assess the current state-of-the-art regarding decisional aids and the associated decisional outcomes for the purpose of designing a method for both patients and doctors to use to make the best treatment decision for the patient. A literature search was conducted via MEDLINE, Embase, and Web of Science databases using the keywords "prostate" and "cancer" and "impact" and "decisio*" and "treatment." Articles were included that focused on treatment outcomes, decision-making processes, and the use of decisional aids for localized prostate cancer. Articles that investigated prostate cancer in general or prostate cancer screening were excluded, as were articles that were not written in English. Altogether, 13 articles were finally critically reviewed for this study. Results were conflicting regarding the relations between patient factors, use of decisional aids, and decisional outcomes. There was a large gap in the literature regarding the optimal decision-making process for men with localized prostate cancer. The role of currently available decisional aids is limited to helping patients make the right decisions. There is a need to develop a novel decisional aid in which patient-physician discussion-involving evaluation of a spectrum of patient-, doctor-, and treatment-related factors-is included.
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20
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Kalter J, Verdonck-de Leeuw IM, Sweegers MG, Aaronson NK, Jacobsen PB, Newton RU, Courneya KS, Aitken JF, Armes J, Arving C, Boersma LJ, Braamse AMJ, Brandberg Y, Chambers SK, Dekker J, Ell K, Ferguson RJ, Gielissen MFM, Glimelius B, Goedendorp MM, Graves KD, Heiney SP, Horne R, Hunter MS, Johansson B, Kimman ML, Knoop H, Meneses K, Northouse LL, Oldenburg HS, Prins JB, Savard J, van Beurden M, van den Berg SW, Brug J, Buffart LM. Effects and moderators of psychosocial interventions on quality of life, and emotional and social function in patients with cancer: An individual patient data meta-analysis of 22 RCTs. Psychooncology 2018; 27:1150-1161. [PMID: 29361206 PMCID: PMC5947559 DOI: 10.1002/pon.4648] [Citation(s) in RCA: 64] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2017] [Revised: 01/02/2018] [Accepted: 01/10/2018] [Indexed: 01/25/2023]
Abstract
Objective This individual patient data (IPD) meta‐analysis aimed to evaluate the effects of psychosocial interventions (PSI) on quality of life (QoL), emotional function (EF), and social function (SF) in patients with cancer, and to study moderator effects of demographic, clinical, personal, and intervention‐related characteristics. Methods Relevant studies were identified via literature searches in 4 databases. We pooled IPD from 22 (n = 4217) of 61 eligible randomized controlled trials. Linear mixed‐effect model analyses were used to study intervention effects on the post‐intervention values of QoL, EF, and SF (z‐scores), adjusting for baseline values, age, and cancer type. We studied moderator effects by testing interactions with the intervention for demographic, clinical, personal, and intervention‐related characteristics, and conducted subsequent stratified analyses for significant moderator variables.Results: PSI significantly improved QoL (β = 0.14,95%CI = 0.06;0.21), EF (β = 0.13,95%CI = 0.05;0.20), and SF (β = 0.10,95%CI = 0.03;0.18). Significant differences in effects of different types of PSI were found, with largest effects of psychotherapy. The effects of coping skills training were moderated by age, treatment type, and targeted interventions. Effects of psychotherapy on EF may be moderated by cancer type, but these analyses were based on 2 randomized controlled trials with small sample sizes of some cancer types. Conclusions PSI significantly improved QoL, EF, and SF, with small overall effects. However, the effects differed by several demographic, clinical, personal, and intervention‐related characteristics. Our study highlights the beneficial effects of coping skills training in patients treated with chemotherapy, the importance of targeted interventions, and the need of developing interventions tailored to the specific needs of elderly patients.
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Affiliation(s)
- J Kalter
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - I M Verdonck-de Leeuw
- Department of Clinical Psychology, VU University Amsterdam, The Netherlands.,Department of Otolaryngology-Head and Neck Surgery, Amsterdam Public Health research institute and Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
| | - M G Sweegers
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands
| | - N K Aaronson
- Division of Psychosocial Research and Epidemiology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - P B Jacobsen
- Division of Cancer Control and Population Science, National Cancer Institute, Bethesda, Maryland, FL, USA
| | - R U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia
| | - K S Courneya
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, Edmonton, AB, Canada
| | - J F Aitken
- Menzies Health Institute Queensland, Griffith University, Southport, Australia.,Cancer Council Queensland, Brisbane, Australia.,Institute for Resilient Regions, University of Southern Queensland, Brisbane, Australia
| | - J Armes
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - C Arving
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - L J Boersma
- Department of Radiation Oncology, Maastricht University Medical Center (MAASTRO clinic), Maastricht, The Netherlands.,GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - A M J Braamse
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
| | - Y Brandberg
- Department of Oncology-Pathology, Karolinska Institute, Stockholm, Sweden
| | - S K Chambers
- Menzies Health Institute Queensland, Griffith University, Southport, Australia.,Cancer Council Queensland, Brisbane, Australia.,Prostate Cancer Foundation of Australia, Sydney, NSW, Australia
| | - J Dekker
- Department of Rehabilitation Medicine, VU University Medical Center, Amsterdam, The Netherlands.,Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands
| | - K Ell
- Department of Adults and Healthy Aging, University of Southern California, Los Angeles, CA, USA
| | - R J Ferguson
- Division of Hematology-Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, PA, USA
| | - M F M Gielissen
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
| | - B Glimelius
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - M M Goedendorp
- Department of Health Psychology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - K D Graves
- Lombardi Comprehensive Cancer Center, Georgetown University, Washington, DC, USA
| | - S P Heiney
- College of Nursing, University of South Carolina, Columbia, SC, USA
| | - R Horne
- UCL School of Pharmacy, University College London, London, UK
| | - M S Hunter
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - B Johansson
- Department of Immunology, Genetics and Pathology, Uppsala University, Uppsala, Sweden
| | - M L Kimman
- Department of Clinical Epidemiology and Medical Technology Assessment, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - H Knoop
- Department of Medical Psychology, Academic Medical Center, Amsterdam, The Netherlands
| | - K Meneses
- University of Alabama at Birmingham, School of Nursing, Birmingham, AL, USA
| | - L L Northouse
- University of Michigan School of Nursing, Ann Arbor, MI, USA
| | - H S Oldenburg
- Department of Surgical Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - J B Prins
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Savard
- School of Psychology, Université Laval and Laval University Cancer Research Center, Québec, QC, Canada
| | - M van Beurden
- Department of Gynecology, Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - S W van den Berg
- Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J Brug
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Amsterdam School of Communication Research (ASCoR), University of Amsterdam, Amsterdam, The Netherlands
| | - L M Buffart
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, VU University Medical Center, Amsterdam, The Netherlands.,Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.,Department of Medical Oncology, Cancer Center Amsterdam, VU University Medical Center, Amsterdam, The Netherlands
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21
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Gillessen S, Attard G, Beer TM, Beltran H, Bossi A, Bristow R, Carver B, Castellano D, Chung BH, Clarke N, Daugaard G, Davis ID, de Bono J, Borges Dos Reis R, Drake CG, Eeles R, Efstathiou E, Evans CP, Fanti S, Feng F, Fizazi K, Frydenberg M, Gleave M, Halabi S, Heidenreich A, Higano CS, James N, Kantoff P, Kellokumpu-Lehtinen PL, Khauli RB, Kramer G, Logothetis C, Maluf F, Morgans AK, Morris MJ, Mottet N, Murthy V, Oh W, Ost P, Padhani AR, Parker C, Pritchard CC, Roach M, Rubin MA, Ryan C, Saad F, Sartor O, Scher H, Sella A, Shore N, Smith M, Soule H, Sternberg CN, Suzuki H, Sweeney C, Sydes MR, Tannock I, Tombal B, Valdagni R, Wiegel T, Omlin A. Management of Patients with Advanced Prostate Cancer: The Report of the Advanced Prostate Cancer Consensus Conference APCCC 2017. Eur Urol 2018; 73:178-211. [PMID: 28655541 DOI: 10.1016/j.eururo.2017.06.002] [Citation(s) in RCA: 369] [Impact Index Per Article: 61.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Accepted: 06/01/2017] [Indexed: 12/22/2022]
Abstract
BACKGROUND In advanced prostate cancer (APC), successful drug development as well as advances in imaging and molecular characterisation have resulted in multiple areas where there is lack of evidence or low level of evidence. The Advanced Prostate Cancer Consensus Conference (APCCC) 2017 addressed some of these topics. OBJECTIVE To present the report of APCCC 2017. DESIGN, SETTING, AND PARTICIPANTS Ten important areas of controversy in APC management were identified: high-risk localised and locally advanced prostate cancer; "oligometastatic" prostate cancer; castration-naïve and castration-resistant prostate cancer; the role of imaging in APC; osteoclast-targeted therapy; molecular characterisation of blood and tissue; genetic counselling/testing; side effects of systemic treatment(s); global access to prostate cancer drugs. A panel of 60 international prostate cancer experts developed the program and the consensus questions. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS The panel voted publicly but anonymously on 150 predefined questions, which have been developed following a modified Delphi process. RESULTS AND LIMITATIONS Voting is based on panellist opinion, and thus is not based on a standard literature review or meta-analysis. The outcomes of the voting had varying degrees of support, as reflected in the wording of this article, as well as in the detailed voting results recorded in Supplementary data. CONCLUSIONS The presented expert voting results can be used for support in areas of management of men with APC where there is no high-level evidence, but individualised treatment decisions should as always be based on all of the data available, including disease extent and location, prior therapies regardless of type, host factors including comorbidities, as well as patient preferences, current and emerging evidence, and logistical and economic constraints. Inclusion of men with APC in clinical trials should be strongly encouraged. Importantly, APCCC 2017 again identified important areas in need of trials specifically designed to address them. PATIENT SUMMARY The second Advanced Prostate Cancer Consensus Conference APCCC 2017 did provide a forum for discussion and debates on current treatment options for men with advanced prostate cancer. The aim of the conference is to bring the expertise of world experts to care givers around the world who see less patients with prostate cancer. The conference concluded with a discussion and voting of the expert panel on predefined consensus questions, targeting areas of primary clinical relevance. The results of these expert opinion votes are embedded in the clinical context of current treatment of men with advanced prostate cancer and provide a practical guide to clinicians to assist in the discussions with men with prostate cancer as part of a shared and multidisciplinary decision-making process.
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Affiliation(s)
- Silke Gillessen
- Department of Medical Oncology, Cantonal Hospital St. Gallen and University of Berne, Switzerland.
| | - Gerhardt Attard
- Department of Medical Oncology, The Institute of Cancer Research/Royal Marsden, London, UK
| | - Tomasz M Beer
- Oregon Health & Science University Knight Cancer Institute, OR, USA
| | - Himisha Beltran
- Department of Medical Oncology, Weill Cornell Medicine, New York, NY, USA
| | - Alberto Bossi
- Department of Radiation Oncology, Genito Urinary Oncology, Prostate Brachytherapy Unit, Goustave Roussy, Paris, France
| | - Rob Bristow
- Department of Radiation Oncology, Princess Margaret Cancer Centre and University of Toronto, Toronto, ON, USA
| | - Brett Carver
- Department of Urology, Sidney Kimmel Center for Prostate and Urologic Cancers, New York, NY, USA
| | - Daniel Castellano
- Department of Medical Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Byung Ha Chung
- Department of Urology, Gangnam Severance Hospital, Yonsei University Health System, Seoul, Korea
| | - Noel Clarke
- Department of Urology, The Christie and Salford Royal Hospitals, Manchester, UK
| | - Gedske Daugaard
- Department of Medical Oncology, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Ian D Davis
- Monash University and Eastern Health, Eastern Health Clinical School, Box Hill, Australia
| | - Johann de Bono
- Department of Medical Oncology, The Institute of Cancer Research/Royal Marsden, London, UK
| | - Rodolfo Borges Dos Reis
- Department of Urology, Ribeirão Preto Medical School, University of São Paulo, São Paulo, Brazil
| | - Charles G Drake
- Department of Medical Oncology, Division of Haematology/Oncology, Columbia University Medical Center, New York, NY, USA
| | - Ros Eeles
- Department of Clinical Oncology and Genetics, The Institute of Cancer Research and Royal Marsden NHS Foundation Trust, London, UK
| | - Eleni Efstathiou
- Department of Medical Oncology, University of Texas MD Anderson Cancer Center, TX, USA
| | - Christopher P Evans
- Department of Urology, University of California, Davis School of Medicine, CA, USA
| | - Stefano Fanti
- Department of Nuclear Medicine, Policlinico S. Orsola, Università di Bologna, Italy
| | - Felix Feng
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - Karim Fizazi
- Department of Medical Oncology, Gustave Roussy, University of Paris Sud, Paris, France
| | - Mark Frydenberg
- Department of Surgery, Department of Anatomy and Developmental Biology, Faculty of Medicine, Nursing and Health Sciences, Monash University
| | - Martin Gleave
- Department of Urology, Vancouver Prostate Centre, University of British Columbia, Vancouver, BC, Canada
| | - Susan Halabi
- Department of Clinical trials and Statistics, Duke University, Durham, NC, USA
| | | | - Celestia S Higano
- Department of Medicine, Division of Medical Oncology, University of Washington and Fred Hutchinson Cancer Research Center, WA, USA
| | - Nicolas James
- Department of Clinical Oncology, Clinical Oncology Queen Elizabeth Hospital Birmingham and University of Birmingham, Birmingham, UK
| | - Philip Kantoff
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center and Weill Cornell Medical College, New York, NY, USA
| | - Pirkko-Liisa Kellokumpu-Lehtinen
- Department of Clinical Oncology, Tampere University Hospital, Faculty of Medicine and Life Sciences, University of Tampere, Finland
| | - Raja B Khauli
- Department of Urology, American University of Beirut Medical Center, Beirut, Lebanon
| | - Gero Kramer
- Department of Urology, Medical University of Vienna, Vienna, Austria
| | - Chris Logothetis
- Department of Genitourinary Medical Oncology, MD Anderson Cancer Centre, Houston, TX, USA
| | - Fernando Maluf
- Department of Medical Oncology Hospital Israelita Albert Einstein and Department of Medical Oncology Beneficência Portuguesa de São Paulo
| | - Alicia K Morgans
- Department of Medical Oncology and Epidemiology, Vanderbilt University Medical Center, Division of Hematology/Oncology, Nashville, TN, USA
| | - Michael J Morris
- Department of Medical Oncology, Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nicolas Mottet
- Department of Urology, University Hospital Nord St. Etienne, St. Etienne, France
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Mumbai, India
| | - William Oh
- Department of Medical Oncology, Division of Hematology and Medical Oncology, Icahn School of Medicine at Mount Sinai, The Tisch Cancer Institute, New York, NY, USA
| | - Piet Ost
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Anwar R Padhani
- Department of Radiology, Mount Vernon Cancer Centre and Institute of Cancer Research, London, UK
| | - Chris Parker
- Department of Clinical Oncology, Royal Marsden NHS Foundation Trust, Sutton, UK
| | | | - Mack Roach
- Department of Radiation Oncology, University of California, San Francisco, CA, USA
| | - Mark A Rubin
- Department of Pathology, University of Bern and the Inselspital, Bern (CH)
| | - Charles Ryan
- Department of Medical Oncology, Clinical Medicine and Urology at the Helen Diller Family Comprehensive Cancer Center at the University of, California, San Francisco, CA, USA
| | - Fred Saad
- Department of Urology, Centre Hospitalier de l'Université de Montréal, Montreal, QC, Canada
| | - Oliver Sartor
- Department of Medical Oncology, Tulane Cancer Center, New Orleans, LA, USA
| | - Howard Scher
- Department of Medical Oncology, Genitourinary Oncology Service, Memorial Sloan Kettering Cancer Centre, New York, NY, USA
| | - Avishay Sella
- Department of Medical Oncology, Department of Oncology, Assaf Harofeh Medical Centre, Tel-Aviv University, Sackler School of Medicine, Zerifin, Israel
| | - Neal Shore
- Department of Urology, Carolina Urologic Research Center, Myrtle Beach, SC, USA
| | - Matthew Smith
- Department of Medical Oncology, Massachusetts General Hospital Cancer Centre, Boston, MA, USA
| | - Howard Soule
- Prostate Cancer Foundation, Santa Monica, CA, USA
| | - Cora N Sternberg
- Department of Medical Oncology, San Camillo Forlanini Hospital, Rome, Italy
| | - Hiroyoshi Suzuki
- Department of Urology, Toho University Sakura Medical Center, Japan
| | - Christopher Sweeney
- Department of Medical Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Matthew R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, University College London, London, UK
| | - Ian Tannock
- Department of Medical Oncology, Princess Margaret Cancer Centre and University of Toronto, Toronto, ON, Canada
| | - Bertrand Tombal
- Department of Urology, Cliniques Universitaires Saint Luc, Brussels, Belgium
| | - Riccardo Valdagni
- Department of Oncology and Haemato-oncology, Università degli Studi di Milano. Radiation Oncology 1, Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | - Thomas Wiegel
- Department of Radiation Oncology, Klinik für Strahlentherapie und Radioonkologie des Universitätsklinikum Ulm, Albert-Einstein-Allee, Ulm, Germany
| | - Aurelius Omlin
- Department of Medical Oncology, Cantonal Hospital St. Gallen and University of Berne, Switzerland
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22
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Chambers SK, Ritterband LM, Thorndike F, Nielsen L, Aitken JF, Clutton S, Scuffham PA, Youl P, Morris B, Baade PD, Dunn J. Web-Delivered Cognitive Behavioral Therapy for Distressed Cancer Patients: Randomized Controlled Trial. J Med Internet Res 2018; 20:e42. [PMID: 29386173 PMCID: PMC5812983 DOI: 10.2196/jmir.8850] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 11/08/2017] [Accepted: 11/16/2017] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Web-based interventions present a potentially cost-effective approach to supporting self-management for cancer patients; however, further evidence for acceptability and effectiveness is needed. OBJECTIVE The goal of our research was to assess the effectiveness of an individualized Web-based cognitive behavioral therapy (CBT) intervention on improving psychological and quality of life outcomes in cancer patients with elevated psychological distress. METHODS A total of 163 distressed cancer patients (111 female, 68.1%) were recruited through the Queensland Cancer Registry and the Cancer Council Queensland Cancer Helpline and randomly assigned to either a Web-based tailored CBT intervention (CancerCope) (79/163) or a static patient education website (84/163). At baseline and 8-week follow-up we assessed primary outcomes of psychological and cancer-specific distress and unmet psychological supportive care needs and secondary outcomes of positive adjustment and quality of life. RESULTS Intention-to-treat analyses showed no evidence of a statistically significant intervention effect on primary or secondary outcomes. However, per-protocol analyses found a greater decrease for the CancerCope group in psychological distress (P=.04), cancer-specific distress (P=.02), and unmet psychological care needs (P=.03) from baseline to 8 weeks compared with the patient education group. Younger patients were more likely to complete the CancerCope intervention. CONCLUSIONS This online CBT intervention was associated with greater decreases in distress for those patients who more closely adhered to the program. Given the low costs and high accessibility of this intervention approach, even if only effective for subgroups of patients, the potential impact may be substantial. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12613001026718; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=364768&isReview=true (Archived by WebCite at http://www.webcitation.org/6uPvpcovl).
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Affiliation(s)
- Suzanne K Chambers
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- Cancer Council Queensland, Brisbane, Australia
- Prostate Cancer Foundation of Australia, Sydney, Australia
- Health and Wellness Institute, Edith Cowan University, Perth, Australia
- Centre for Clinical Research, The University of Queensland, Brisbane, Australia
| | - Lee M Ritterband
- University of Virginia, Charlottesville, VA, United States
- BeHealth Solutions, Charlottesville, VA, United States
| | | | | | - Joanne F Aitken
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- Cancer Council Queensland, Brisbane, Australia
- Institute for Resilient Regions, University of Southern Queensland, Springfield, Australia
| | | | - Paul A Scuffham
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
| | - Philippa Youl
- University of Sunshine Coast, Sippy Downs, Australia
- School of Public Health and Social Work, Queensland University of Technology, Brisbane, Australia
| | | | - Peter D Baade
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- Cancer Council Queensland, Brisbane, Australia
- School of Mathematical Sciences, Queensland University of Technology, Brisbane, Australia
| | - Jeff Dunn
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Australia
- Cancer Council Queensland, Brisbane, Australia
- Institute for Resilient Regions, University of Southern Queensland, Springfield, Australia
- School of Social Science, The University of Queensland, Brisbane, Australia
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23
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Abstract
OBJECTIVE To discuss lesbian, gay, bisexual, and transgender (LGBT)-specific survivorship issues including: integrating sexual and gender minority identities with cancer survivor identities; coordinating medical care and disclosing identities to health care providers; dealing with late effects of treatment; and addressing LGBT family and relationship issues. DATA SOURCES Published articles, quotes from an online survey of 311 LGBT survivors. CONCLUSION The transition from active cancer treatment to survivorship presents challenges, and LGBT cancer survivors may face additional challenges as they enter the survivorship phase. IMPLICATIONS FOR NURSING PRACTICE Oncology nurses can improve the quality of survivorship care delivered to LGBT survivors and their caregivers by addressing the disparities and gaps in health care.
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24
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Chambers SK, Hyde MK, Smith DP, Hughes S, Yuill S, Egger S, O'Connell DL, Stein K, Frydenberg M, Wittert G, Dunn J. New Challenges in Psycho-Oncology Research III: A systematic review of psychological interventions for prostate cancer survivors and their partners: clinical and research implications. Psychooncology 2017; 26:873-913. [PMID: 28691760 PMCID: PMC5535006 DOI: 10.1002/pon.4431] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2017] [Revised: 03/19/2017] [Accepted: 03/20/2017] [Indexed: 01/07/2023]
Affiliation(s)
- Suzanne K Chambers
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia.,Prostate Cancer Foundation of Australia, Sydney, New South Wales, Australia.,Health & Wellness Institute, Edith Cowan University, Perth, Australia.,Institute for Resilient Regions, University of Southern Queensland, Toowoomba, Queensland, Australia.,Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, New South Wales, Australia
| | - Melissa K Hyde
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
| | - David P Smith
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, New South Wales, Australia.,Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia.,Sydney Medical School-Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Suzanne Hughes
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
| | - Susan Yuill
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
| | - Sam Egger
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
| | - Dianne L O'Connell
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia.,Sydney Medical School-Public Health, University of Sydney, Sydney, New South Wales, Australia.,School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia
| | - Kevin Stein
- Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Mark Frydenberg
- Australian and New Zealand Urogenital and Prostate Cancer Trials Group, Sydney, New South Wales, Australia.,Department of Urology, Monash Health, Melbourne, Victoria, Australia.,Department of Surgery, Faculty of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Gary Wittert
- Freemasons Foundation Centre for Men's Health, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Jeff Dunn
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia.,Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia.,Institute for Resilient Regions, University of Southern Queensland, Toowoomba, Queensland, Australia
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25
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Matheson L, Watson EK, Nayoan J, Wagland R, Glaser A, Gavin A, Wright P, Rivas C. A qualitative metasynthesis exploring the impact of prostate cancer and its management on younger, unpartnered and gay men. Eur J Cancer Care (Engl) 2017; 26. [PMID: 28382745 DOI: 10.1111/ecc.12676] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2017] [Indexed: 11/29/2022]
Abstract
Prostate cancer (PCa) can negatively impact on men's sexual, urinary and emotional functioning, affecting quality of life. Most men with PCa are older (≥65 years), married and heterosexual and little is known about the impact on men who are younger, unpartnered or gay. We aimed to synthesise existing qualitative research on these three groups of men. A systematic metasynthesis was undertaken that included data on the unique impacts of PCa on younger (<65 years) (n = 7 papers), unpartnered (n = 17 papers) or gay or bisexual men (n = 11 papers) using a modified meta-ethnographic approach. The three overarching constructs illustrated the magnified disruption to men's biographies, that included: marginalisation, isolation and stigma-relating to men's sense of being "out of sync"; the burden of emotional and embodied vulnerabilities and the assault on identity-illustrating the multiple threats to men's work, sexual and social identities; shifting into different communities of practice-such as the shift from being part of a sexually active community to celibacy. These findings suggest that PCa can have a particular impact on the quality of life of younger, unpartnered and gay men. This has implications for the provision of tailored support and information to these potentially marginalised groups.
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Affiliation(s)
- L Matheson
- Department of Applied Health and Professional Development, Oxford Brookes University, Oxford, UK
| | - E K Watson
- Department of Applied Health and Professional Development, Oxford Brookes University, Oxford, UK
| | - J Nayoan
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - R Wagland
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - A Glaser
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - A Gavin
- School of Medicine, Dentistry and Biomedical Sciences, Centre for Public Health, Queen's University Belfast, Belfast, UK
| | - P Wright
- Leeds Institute of Cancer and Pathology, Faculty of Medicine and Health, University of Leeds, Leeds, UK
| | - C Rivas
- Faculty of Health Sciences, University of Southampton, Southampton, UK
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26
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Mervin MC, Lowe A, Gardiner RA, Smith DP, Aitken J, Chambers SK, Gordon LG. What does it cost Medicare to diagnose and treat men with localized prostate cancer in the first year? Asia Pac J Clin Oncol 2017; 13:152-159. [PMID: 28303657 DOI: 10.1111/ajco.12663] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Revised: 11/23/2016] [Accepted: 12/14/2016] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To estimate costs on the Medicare Benefits Schedule (MBS) and the Pharmaceutical Benefits Scheme (PBS) attributable to the diagnosis and treatment of prostate cancer. METHODS We used data from a cohort study of 1064 men with localized prostate cancer recruited between 2005 and 2007 by 24 urologists across 10 sites in Queensland, Australia (ProsCan). We estimated the MBS and PBS costs attributable to prostate cancer from the date of initial appointment to 12 months after diagnosis in 2013 Australian dollars using a comparison group without prostate cancer. We used generalized linear modeling to identify key determinants of higher treatment-related costs. RESULTS From the date of initial appointment to 12 months postdiagnosis, the average MBS costs attributable to prostate cancer were $9,357 (SD $191) per patient. These MBS costs were most sensitive to having private health insurance and the type of primary treatment received. The PBS costs were higher in the control group than in the ProsCan group ($5,641 vs $1,924). CONCLUSIONS The costs of treating and managing prostate cancer are high and these result in a substantial financial burden for the Australian MBS. Costs attributable to prostate cancer appear to vary widely based on initial treatment and these are likely to increase with the introduction of more expensive services and pharmaceuticals. There is a pressing need for better prognostic tools to distinguish between indolent and aggressive prostate tumors to reduce potential over treatment and help ease the burden of prostate cancer.
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Affiliation(s)
- Merehau C Mervin
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Nathan, Australia
| | - Anthony Lowe
- Griffith Health Institute, Griffith University, Gold Coast Campus, Queensland, Australia.,Prostate Cancer Foundation of Australia, St Leonards, NSW, Australia
| | - Robert A Gardiner
- School of Medicine, University of Queensland, Herston, Brisbane, Australia.,Centre for Clinical Research, University of Queensland, Herston, Brisbane, Australia.,Royal Brisbane and Women's Hospital, Herston, Brisbane, Australia
| | - David P Smith
- Griffith Health Institute, Griffith University, Gold Coast Campus, Queensland, Australia.,Cancer Council New South Wales, Woolloomooloo, NSW, Australia
| | - Joanne Aitken
- Cancer Council Queensland, Spring Hill, Brisbane, Australia
| | - Suzanne K Chambers
- Griffith Health Institute, Griffith University, Gold Coast Campus, Queensland, Australia.,Prostate Cancer Foundation of Australia, St Leonards, NSW, Australia.,School of Medicine, University of Queensland, Herston, Brisbane, Australia.,Cancer Council Queensland, Spring Hill, Brisbane, Australia
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27
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Johnson DC, Mueller DE, Deal AM, Dunn MW, Smith AB, Woods ME, Wallen EM, Pruthi RS, Nielsen ME. Integrating Patient Preference into Treatment Decisions for Men with Prostate Cancer at the Point of Care. J Urol 2016; 196:1640-1644. [PMID: 27346032 DOI: 10.1016/j.juro.2016.06.082] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/20/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE Men with clinically localized prostate cancer face an archetypal "preference sensitive" treatment decision. A shared decision making process incorporating patient values and preferences is paramount. We evaluated the benefit of a novel decision making application, and investigated associations between patient preferences and treatment choice. MATERIALS AND METHODS We used a novel, web based application that provides education, preference measurement and personalized decision analysis for patients with newly diagnosed prostate cancer. Preferences are measured using conjoint analysis. The application ranks treatment options according to their "fit" (expected value) based on clinical factors and personal preferences, and serves as the basis for shared decision making during the consultation. We administered the decisional conflict scale before and after completion of the application. Additionally, we compared post-visit perceptions of shared decision making between a baseline "usual care" cohort and a cohort seen after the application was integrated into clinical practice. RESULTS A total of 109 men completed the application before their consultation, and had decisional conflict measured before and after use. Overall decisional conflict decreased by 37% (p <0.0001). Analysis of the decisional conflict subscales revealed statistically significant improvements in all 5 domains. Patients completing the decision making application (33) felt more included in (88% vs 57%, p=0.01) and jointly responsible for (94% vs 52%, p <0.0001) the decision about further treatment compared to those receiving usual care (24). More patients who completed the application strongly agreed that different treatment options were discussed (94% vs 74%, p=0.02). CONCLUSIONS Implementation of this web based intervention was associated with decreased decisional conflict and enhanced elements of shared decision making.
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Affiliation(s)
- David C Johnson
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Dana E Mueller
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, Cancer Outcomes Research Group, Multidisciplinary Genitourinary Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Allison M Deal
- Lineberger Comprehensive Cancer Center Biostatistics Core Facility, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Mary W Dunn
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, Cancer Outcomes Research Group, Multidisciplinary Genitourinary Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Angela B Smith
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, Cancer Outcomes Research Group, Multidisciplinary Genitourinary Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michael E Woods
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, Cancer Outcomes Research Group, Multidisciplinary Genitourinary Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Eric M Wallen
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, Cancer Outcomes Research Group, Multidisciplinary Genitourinary Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Raj S Pruthi
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, Cancer Outcomes Research Group, Multidisciplinary Genitourinary Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Matthew E Nielsen
- Department of Urology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, Cancer Outcomes Research Group, Multidisciplinary Genitourinary Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Galvão DA, Taaffe DR, Spry N, Gardiner RA, Taylor R, Risbridger GP, Frydenberg M, Hill M, Chambers SK, Stricker P, Shannon T, Hayne D, Zopf E, Newton RU. Enhancing active surveillance of prostate cancer: the potential of exercise medicine. Nat Rev Urol 2016; 13:258-65. [PMID: 26954333 DOI: 10.1038/nrurol.2016.46] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Active surveillance (AS) is a strategy for the management of patients with low-risk, localized prostate cancer, in which men undergo regular monitoring of serum PSA levels and tumour characteristics, using multiparametric MRI and repeat biopsy sampling, to identify signs of disease progression. This strategy reduces overtreatment of clinically insignificant disease while also preserving opportunities for curative therapy in patients whose disease progresses. Preliminary studies of lifestyle interventions involving basic exercise advice have indicated that exercise reduces the numbers of patients undergoing active treatment, as well as modulating the biological processes involved in tumour progression. Therefore, preliminary evidence suggests that lifestyle and/or exercise interventions might have therapeutic potential in this growing population of men with prostate cancer. However, several important issues remain unclear: the exact value of different types of lifestyle and exercise medicine interventions during AS; the biological mechanisms of exercise in delaying disease progression; and the influence of the anxieties and distress created by having a diagnosis of cancer without then receiving active treatment. Future studies are required to confirm and expand these findings and determine the relative contributions of each lifestyle component to specific end points and patient outcomes during AS.
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Affiliation(s)
- Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia 6027, Australia
| | - Dennis R Taaffe
- Exercise Medicine Research Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia 6027, Australia.,School of Medicine, University of Wollongong, Wollongong, New South Wales 2522, Australia
| | - Nigel Spry
- Exercise Medicine Research Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia 6027, Australia.,Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia 6009, Australia
| | - Robert A Gardiner
- Exercise Medicine Research Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia 6027, Australia.,University of Queensland Medical School, 288 Herston Road, Herston, Brisbane, Queensland 4006, Australia.,Department of Urology, Royal Brisbane and Women's Hospital, Herston, Brisbane, Queensland 4029, Australia
| | - Renea Taylor
- Cancer Program, Monash Biomedicine Discovery Institute and Department of Physiology, Monash University, Melbourne, Victoria 3800, Australia
| | - Gail P Risbridger
- Cancer Program, Monash Biomedicine Discovery Institute and Department of Anatomy and Developmental Biology, Monash University, Melbourne, Victoria 3800, Australia
| | - Mark Frydenberg
- Department of Surgery, Monash University, Melbourne, Victoria 3800, Australia
| | - Michelle Hill
- The University of Queensland Diamantina Institute, The University of Queensland, Brisbane, Queensland 4072, Australia
| | - Suzanne K Chambers
- Exercise Medicine Research Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia 6027, Australia.,Menzies Health Institute of Queensland, Griffith University, Brisbane, Queensland 4222, Australia
| | - Phillip Stricker
- Suite 1001, St Vincent's Prostate Cancer Centre, 438 Victoria Street, Darlinghurst, Sydney, New South Wales 2010, Australia
| | - Tom Shannon
- Suite 32, Hollywood Specialist Centre, 95 Monash Avenue, Nedlands Western Australia 6009, Australia
| | - Dickon Hayne
- Department of Surgery, University of Western Australia (M704), 35 Stirling Highway, Crawley, Western Australia 6009, Australia
| | - Eva Zopf
- Exercise Medicine Research Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia 6027, Australia.,Institute of Cardiovascular Research and Sport Medicine, German Sport University, Graditzer Strasse 87D, Köln 50735, Germany
| | - Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, 270 Joondalup Drive, Joondalup, Western Australia 6027, Australia.,University of Queensland Medical School, 288 Herston Road, Herston, Brisbane, Queensland 4006, Australia
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Skinner TL, Peeters GG, Croci I, Bell KR, Burton NW, Chambers SK, Bolam KA. Impact of a brief exercise program on the physical and psychosocial health of prostate cancer survivors: A pilot study. Asia Pac J Clin Oncol 2016; 12:225-34. [PMID: 26923217 DOI: 10.1111/ajco.12474] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 11/11/2015] [Accepted: 01/13/2016] [Indexed: 12/31/2022]
Abstract
AIM It is well established that exercise is beneficial for prostate cancer survivors. The challenge for health professionals is to create effective strategies to encourage survivors to exercise in the community. Many community exercise programs are brief in duration (e.g. <5 exercise sessions); whilst evidence for the efficacy of exercise within the literature are derived from exercise programs ≥8 weeks in duration, it is unknown if health benefits can be obtained from a shorter program. This study examined the effect of a four-session individualized and supervised exercise program on the physical and psychosocial health of prostate cancer survivors. METHODS Fifty-one prostate cancer survivors (mean age 69±7 years) were prescribed 1 h, individualized, supervised exercise sessions once weekly for 4 weeks. Participants were encouraged to increase their physical activity levels outside of the exercise sessions. Objective measures of muscular strength, exercise capacity, physical function and flexibility; and self-reported general, disease-specific and psychosocial health were assessed at baseline and following the intervention. RESULTS Improvements were observed in muscle strength (leg press 17.6 percent; P < 0.001), exercise capacity (400-m walk 9.3 percent; P < 0.001), physical function (repeated chair stands 20.1 percent, usual gait speed 19.3 percent, timed up-and-go 15.0 percent; P < 0.001), flexibility (chair sit and reach +2.9 cm; P < 0.001) and positive well-being (P = 0.014) following the exercise program. CONCLUSION A four-session exercise program significantly improved the muscular strength, exercise capacity, physical function and positive well-being of prostate cancer survivors. This short-duration exercise program is safe and feasible for prostate cancer survivors and a randomized controlled trial is now required to determine whether a similar individualized exercise regimen improves physical health and mental well-being over the short, medium and long term.
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Affiliation(s)
- Tina L Skinner
- The University of Queensland, Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, Brisbane, Queensland, Australia
| | - Gmme Geeske Peeters
- The University of Queensland, Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, Brisbane, Queensland, Australia.,The University of Queensland, School of Public Health, Brisbane, Queensland, Australia
| | - Ilaria Croci
- The University of Queensland, Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, Brisbane, Queensland, Australia
| | - Katherine R Bell
- The University of Queensland, Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, Brisbane, Queensland, Australia
| | - Nicola W Burton
- The University of Queensland, Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, Brisbane, Queensland, Australia
| | - Suzanne K Chambers
- The University of Queensland, Centre for Clinical Research, Brisbane, Queensland, Australia.,Griffith University, Griffith Health Institute, Southport, Queensland, Australia.,Cancer Council Queensland, Brisbane, Queensland, Australia.,Prostate Cancer Foundation of Australia, Sydney, New South Wales, Australia.,Edith Cowan University, Edith Cowan University Health and Wellness Institute, Joondalup, Western Australia, Australia
| | - Kate A Bolam
- The University of Queensland, Centre for Research on Exercise, Physical Activity and Health, School of Human Movement and Nutrition Sciences, Brisbane, Queensland, Australia.,The Swedish School of Sport and Health Sciences, Åstrand Laboratory of Work Physiology, Stockholm, Sweden
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Flodgren G, Rachas A, Farmer AJ, Inzitari M, Shepperd S. Interactive telemedicine: effects on professional practice and health care outcomes. THE COCHRANE DATABASE OF SYSTEMATIC REVIEWS 2015. [PMID: 26343551 DOI: 10.1002/14651858.cd002098.pub2.] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Telemedicine (TM) is the use of telecommunication systems to deliver health care at a distance. It has the potential to improve patient health outcomes, access to health care and reduce healthcare costs. As TM applications continue to evolve it is important to understand the impact TM might have on patients, healthcare professionals and the organisation of care. OBJECTIVES To assess the effectiveness, acceptability and costs of interactive TM as an alternative to, or in addition to, usual care (i.e. face-to-face care, or telephone consultation). SEARCH METHODS We searched the Effective Practice and Organisation of Care (EPOC) Group's specialised register, CENTRAL, MEDLINE, EMBASE, five other databases and two trials registers to June 2013, together with reference checking, citation searching, handsearching and contact with study authors to identify additional studies. SELECTION CRITERIA We considered randomised controlled trials of interactive TM that involved direct patient-provider interaction and was delivered in addition to, or substituting for, usual care compared with usual care alone, to participants with any clinical condition. We excluded telephone only interventions and wholly automatic self-management TM interventions. DATA COLLECTION AND ANALYSIS For each condition, we pooled outcome data that were sufficiently homogenous using fixed effect meta-analysis. We reported risk ratios (RR) and 95% confidence intervals (CI) for dichotomous outcomes, and mean differences (MD) for continuous outcomes. MAIN RESULTS We included 93 eligible trials (N = 22,047 participants), which evaluated the effectiveness of interactive TM delivered in addition to (32% of studies), as an alternative to (57% of studies), or partly substituted for usual care (11%) as compared to usual care alone.The included studies recruited patients with the following clinical conditions: cardiovascular disease (36), diabetes (21), respiratory conditions (9), mental health or substance abuse conditions (7), conditions requiring a specialist consultation (6), co morbidities (3), urogenital conditions (3), neurological injuries and conditions (2), gastrointestinal conditions (2), neonatal conditions requiring specialist care (2), solid organ transplantation (1), and cancer (1).Telemedicine provided remote monitoring (55 studies), or real-time video-conferencing (38 studies), which was used either alone or in combination. The main TM function varied depending on clinical condition, but fell typically into one of the following six categories, with some overlap: i) monitoring of a chronic condition to detect early signs of deterioration and prompt treatment and advice, (41); ii) provision of treatment or rehabilitation (12), for example the delivery of cognitive behavioural therapy, or incontinence training; iii) education and advice for self-management (23), for example nurses delivering education to patients with diabetes or providing support to parents of very low birth weight infants or to patients with home parenteral nutrition; iv) specialist consultations for diagnosis and treatment decisions (8), v) real-time assessment of clinical status, for example post-operative assessment after minor operation or follow-up after solid organ transplantation (8) vi), screening, for angina (1).The type of data transmitted by the patient, the frequency of data transfer, (e.g. telephone, e-mail, SMS) and frequency of interactions between patient and healthcare provider varied across studies, as did the type of healthcare provider/s and healthcare system involved in delivering the intervention.We found no difference between groups for all-cause mortality for patients with heart failure (16 studies; N = 5239; RR:0.89, 95% CI 0.76 to 1.03, P = 0.12; I(2) = 44%) (moderate to high certainty of evidence) at a median of six months follow-up. Admissions to hospital (11 studies; N = 4529) ranged from a decrease of 64% to an increase of 60% at median eight months follow-up (moderate certainty of evidence). We found some evidence of improved quality of life (five studies; N = 482; MD:-4.39, 95% CI -7.94 to -0.83; P < 0.02; I(2) = 0%) (moderate certainty of evidence) for those allocated to TM as compared with usual care at a median three months follow-up. In studies recruiting participants with diabetes (16 studies; N = 2768) we found lower glycated haemoglobin (HbA1c %) levels in those allocated to TM than in controls (MD -0.31, 95% CI -0.37 to -0.24; P < 0.00001; I(2)= 42%, P = 0.04) (high certainty of evidence) at a median of nine months follow-up. We found some evidence for a decrease in LDL (four studies, N = 1692; MD -12.45, 95% CI -14.23 to -10.68; P < 0.00001; I(2 =) 0%) (moderate certainty of evidence), and blood pressure (four studies, N = 1770: MD: SBP:-4.33, 95% CI -5.30 to -3.35, P < 0.00001; I(2) = 17%; DBP: -2.75 95% CI -3.28 to -2.22, P < 0.00001; I(2) = 45% (moderate certainty evidence), in TM as compared with usual care.Seven studies that recruited participants with different mental health and substance abuse problems, reported no differences in the effect of therapy delivered over video-conferencing, as compared to face-to-face delivery. Findings from the other studies were inconsistent; there was some evidence that monitoring via TM improved blood pressure control in participants with hypertension, and a few studies reported improved symptom scores for those with a respiratory condition. Studies recruiting participants requiring mental health services and those requiring specialist consultation for a dermatological condition reported no differences between groups. AUTHORS' CONCLUSIONS The findings in our review indicate that the use of TM in the management of heart failure appears to lead to similar health outcomes as face-to-face or telephone delivery of care; there is evidence that TM can improve the control of blood glucose in those with diabetes. The cost to a health service, and acceptability by patients and healthcare professionals, is not clear due to limited data reported for these outcomes. The effectiveness of TM may depend on a number of different factors, including those related to the study population e.g. the severity of the condition and the disease trajectory of the participants, the function of the intervention e.g., if it is used for monitoring a chronic condition, or to provide access to diagnostic services, as well as the healthcare provider and healthcare system involved in delivering the intervention.
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Affiliation(s)
- Gerd Flodgren
- Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Roosevelt Drive, Headington, Oxford, Oxfordshire, UK, OX3 7LF
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Flodgren G, Rachas A, Farmer AJ, Inzitari M, Shepperd S. Interactive telemedicine: effects on professional practice and health care outcomes. Cochrane Database Syst Rev 2015; 2015:CD002098. [PMID: 26343551 PMCID: PMC6473731 DOI: 10.1002/14651858.cd002098.pub2] [Citation(s) in RCA: 343] [Impact Index Per Article: 38.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Telemedicine (TM) is the use of telecommunication systems to deliver health care at a distance. It has the potential to improve patient health outcomes, access to health care and reduce healthcare costs. As TM applications continue to evolve it is important to understand the impact TM might have on patients, healthcare professionals and the organisation of care. OBJECTIVES To assess the effectiveness, acceptability and costs of interactive TM as an alternative to, or in addition to, usual care (i.e. face-to-face care, or telephone consultation). SEARCH METHODS We searched the Effective Practice and Organisation of Care (EPOC) Group's specialised register, CENTRAL, MEDLINE, EMBASE, five other databases and two trials registers to June 2013, together with reference checking, citation searching, handsearching and contact with study authors to identify additional studies. SELECTION CRITERIA We considered randomised controlled trials of interactive TM that involved direct patient-provider interaction and was delivered in addition to, or substituting for, usual care compared with usual care alone, to participants with any clinical condition. We excluded telephone only interventions and wholly automatic self-management TM interventions. DATA COLLECTION AND ANALYSIS For each condition, we pooled outcome data that were sufficiently homogenous using fixed effect meta-analysis. We reported risk ratios (RR) and 95% confidence intervals (CI) for dichotomous outcomes, and mean differences (MD) for continuous outcomes. MAIN RESULTS We included 93 eligible trials (N = 22,047 participants), which evaluated the effectiveness of interactive TM delivered in addition to (32% of studies), as an alternative to (57% of studies), or partly substituted for usual care (11%) as compared to usual care alone.The included studies recruited patients with the following clinical conditions: cardiovascular disease (36), diabetes (21), respiratory conditions (9), mental health or substance abuse conditions (7), conditions requiring a specialist consultation (6), co morbidities (3), urogenital conditions (3), neurological injuries and conditions (2), gastrointestinal conditions (2), neonatal conditions requiring specialist care (2), solid organ transplantation (1), and cancer (1).Telemedicine provided remote monitoring (55 studies), or real-time video-conferencing (38 studies), which was used either alone or in combination. The main TM function varied depending on clinical condition, but fell typically into one of the following six categories, with some overlap: i) monitoring of a chronic condition to detect early signs of deterioration and prompt treatment and advice, (41); ii) provision of treatment or rehabilitation (12), for example the delivery of cognitive behavioural therapy, or incontinence training; iii) education and advice for self-management (23), for example nurses delivering education to patients with diabetes or providing support to parents of very low birth weight infants or to patients with home parenteral nutrition; iv) specialist consultations for diagnosis and treatment decisions (8), v) real-time assessment of clinical status, for example post-operative assessment after minor operation or follow-up after solid organ transplantation (8) vi), screening, for angina (1).The type of data transmitted by the patient, the frequency of data transfer, (e.g. telephone, e-mail, SMS) and frequency of interactions between patient and healthcare provider varied across studies, as did the type of healthcare provider/s and healthcare system involved in delivering the intervention.We found no difference between groups for all-cause mortality for patients with heart failure (16 studies; N = 5239; RR:0.89, 95% CI 0.76 to 1.03, P = 0.12; I(2) = 44%) (moderate to high certainty of evidence) at a median of six months follow-up. Admissions to hospital (11 studies; N = 4529) ranged from a decrease of 64% to an increase of 60% at median eight months follow-up (moderate certainty of evidence). We found some evidence of improved quality of life (five studies; N = 482; MD:-4.39, 95% CI -7.94 to -0.83; P < 0.02; I(2) = 0%) (moderate certainty of evidence) for those allocated to TM as compared with usual care at a median three months follow-up. In studies recruiting participants with diabetes (16 studies; N = 2768) we found lower glycated haemoglobin (HbA1c %) levels in those allocated to TM than in controls (MD -0.31, 95% CI -0.37 to -0.24; P < 0.00001; I(2)= 42%, P = 0.04) (high certainty of evidence) at a median of nine months follow-up. We found some evidence for a decrease in LDL (four studies, N = 1692; MD -12.45, 95% CI -14.23 to -10.68; P < 0.00001; I(2 =) 0%) (moderate certainty of evidence), and blood pressure (four studies, N = 1770: MD: SBP:-4.33, 95% CI -5.30 to -3.35, P < 0.00001; I(2) = 17%; DBP: -2.75 95% CI -3.28 to -2.22, P < 0.00001; I(2) = 45% (moderate certainty evidence), in TM as compared with usual care.Seven studies that recruited participants with different mental health and substance abuse problems, reported no differences in the effect of therapy delivered over video-conferencing, as compared to face-to-face delivery. Findings from the other studies were inconsistent; there was some evidence that monitoring via TM improved blood pressure control in participants with hypertension, and a few studies reported improved symptom scores for those with a respiratory condition. Studies recruiting participants requiring mental health services and those requiring specialist consultation for a dermatological condition reported no differences between groups. AUTHORS' CONCLUSIONS The findings in our review indicate that the use of TM in the management of heart failure appears to lead to similar health outcomes as face-to-face or telephone delivery of care; there is evidence that TM can improve the control of blood glucose in those with diabetes. The cost to a health service, and acceptability by patients and healthcare professionals, is not clear due to limited data reported for these outcomes. The effectiveness of TM may depend on a number of different factors, including those related to the study population e.g. the severity of the condition and the disease trajectory of the participants, the function of the intervention e.g., if it is used for monitoring a chronic condition, or to provide access to diagnostic services, as well as the healthcare provider and healthcare system involved in delivering the intervention.
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Affiliation(s)
- Gerd Flodgren
- Norwegian Institute of Public HealthThe Norwegian Knowledge Centre for the Health ServicesPilestredet Park 7OsloNorway0176
| | - Antoine Rachas
- European Hospital Georges Pompidou and Paris Descartes UniversityDepartment of IT and Public Health20‐40 Rue leBlancParisFrance75908
| | - Andrew J Farmer
- University of OxfordNuffield Department of Primary Care Health SciencesRadcliffe Observatory Quarter, Walton StreetOxfordUKOX2 6GG
| | - Marco Inzitari
- Parc Sanitari Pere Virgili and Universitat Autònoma de BarcelonaDepartment of Healthcare/Medicinec Esteve Terrades 30BarcelonaSpain08023
| | - Sasha Shepperd
- University of OxfordNuffield Department of Population HealthRosemary Rue Building, Old Road CampusHeadingtonOxfordOxfordshireUKOX3 7LF
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Matheson L, Boulton M, Lavender V, Protheroe A, Brand S, Wanat M, Watson E. Dismantling the present and future threats of testicular cancer: a grounded theory of positive and negative adjustment trajectories. J Cancer Surviv 2015; 10:194-205. [PMID: 26159160 DOI: 10.1007/s11764-015-0466-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Accepted: 06/15/2015] [Indexed: 11/29/2022]
Abstract
PURPOSE Testicular cancer commonly affects men in the prime of their lives. While survival rates are excellent, little previous research has examined men's experiences of adjustment to survivorship. We aimed to explore this issue in younger testicular cancer survivors. METHODS In-depth qualitative interviews were conducted with testicular cancer survivors over two time points approximately 6 months apart in the year following treatment completion. Interviews were analysed using a grounded theory approach. RESULTS The sample included 18 testicular cancer survivors between 22 and 44 years (mean age 34). A grounded theory was developed, which explained the process of positive adjustment over the first year following the treatment completion in terms of men's ability to dismantle the present and future threats of cancer, involving the key transitions of gaining a sense of perspective and striving to get on with life and restore normality. These were facilitated by six key processes. The processes that explained a negative adjustment trajectory are also presented. CONCLUSIONS These findings contribute to the understanding of the psychosocial impact of testicular cancer on younger men's lives and have implications for the provision of support to testicular cancer survivors. Further investigation into the feasibility of one-on-one peer support interventions is warranted, as well as informal support that respects men's desire for independence. IMPLICATIONS FOR CANCER SURVIVORS Understanding the processes involved in adjustment highlights ways in which health professionals can offer support to those struggling to adjust through challenging illness beliefs, encouraging emotional disclosure and facilitating peer mentoring.
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Affiliation(s)
- Lauren Matheson
- Cancer Care Research Group, Department of Applied Health and Professional Development, Faculty of Health and Life Sciences, Oxford Brookes University, Marston, Oxford, OX3 0FL, UK.
| | - Mary Boulton
- Cancer Care Research Group, Department of Applied Health and Professional Development, Faculty of Health and Life Sciences, Oxford Brookes University, Marston, Oxford, OX3 0FL, UK
| | - Verna Lavender
- Cancer Care Research Group, Department of Applied Health and Professional Development, Faculty of Health and Life Sciences, Oxford Brookes University, Marston, Oxford, OX3 0FL, UK
| | - Andrew Protheroe
- University of Oxford Department of Oncology, Oxford Cancer and Haematology Centre, Oxford University Hospitals Trust, Headington, Oxford, OX3 7LJ, UK
| | - Sue Brand
- Bristol Testicular Cancer Service, Bristol Haematology and Oncology Centre, University Hospitals Bristol, Horfield Road, Bristol, BS2 8ED, UK
| | - Marta Wanat
- Cancer Care Research Group, Department of Applied Health and Professional Development, Faculty of Health and Life Sciences, Oxford Brookes University, Marston, Oxford, OX3 0FL, UK
| | - Eila Watson
- Cancer Care Research Group, Department of Applied Health and Professional Development, Faculty of Health and Life Sciences, Oxford Brookes University, Marston, Oxford, OX3 0FL, UK
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Violette PD, Agoritsas T, Alexander P, Riikonen J, Santti H, Agarwal A, Bhatnagar N, Dahm P, Montori V, Guyatt GH, Tikkinen KAO. Decision aids for localized prostate cancer treatment choice: Systematic review and meta-analysis. CA Cancer J Clin 2015; 65:239-51. [PMID: 25772796 DOI: 10.3322/caac.21272] [Citation(s) in RCA: 99] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 01/08/2015] [Accepted: 02/12/2015] [Indexed: 12/21/2022] Open
Abstract
Patients who are diagnosed with localized prostate cancer need to make critical treatment decisions that are sensitive to their values and preferences. The role of decision aids in facilitating these decisions is unknown. The authors conducted a systematic review of randomized trials of decision aids for localized prostate cancer. Teams of 2 reviewers independently identified, selected, and abstracted data from 14 eligible trials (n = 3377 men), of which 10 were conducted in North America. Of these, 11 trials compared decision aids with usual care, and 3 trials compared decision aids with other decision aids. Two trials suggested a modest positive impact on decisional regret. Results across studies varied widely for decisional conflict (4 studies), satisfaction with decision (2 studies), and knowledge (2 studies). No impact on treatment choices was observed (6 studies). In conclusion, scant evidence at high risk of bias suggests the variable impact of existing decision aids on a limited set of decisional processes and outcomes. Because current decision aids provide information but do not directly facilitate shared decision making, subsequent efforts would benefit from user-centered design of decision aids that promote shared decision making.
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Affiliation(s)
- Philippe D Violette
- Endourology Fellow, Division of Urology, Department of Surgery, Western University, London, ON, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Woodstock General Hospital, Woodstock, ON, Canada
| | - Thomas Agoritsas
- Research Fellow, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada, Division of General Internal Medicine and Division of Clinical Epidemiology, University Hospitals of Geneva, Geneva, Switzerland
| | - Paul Alexander
- Doctoral Candidate, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Jarno Riikonen
- Consultant, Department of Urology, Tampere University Hospital, Tampere, Finland
| | - Henrikki Santti
- Consultant, Department of Urology, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Arnav Agarwal
- Medical Student, Faculty of Medicine, University of Toronto, Toronto, ON, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada
| | - Neera Bhatnagar
- Medical Librarian, Health Sciences Library, McMaster University, Hamilton, ON, Canada
| | - Philipp Dahm
- Professor, Department of Urology, University of Minnesota and Minneapolis Veterans Affairs Health Care System, Minneapolis, MN
| | - Victor Montori
- Professor, Knowledge and Evaluation Research Unit, Division of Endocrinology and Diabetes, Departments of Medicine and Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Gordon H Guyatt
- Distinguished Professor, Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Kari A O Tikkinen
- Adjunct Professor, Departments of Urology and Public Health, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Couper J, Collins A, Bloch S, Street A, Duchesne G, Jones T, Olver J, Love A. Cognitive existential couple therapy (CECT) in men and partners facing localised prostate cancer: a randomised controlled trial. BJU Int 2015; 115 Suppl 5:35-45. [DOI: 10.1111/bju.12991] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Jeremy Couper
- Psycho-oncology Research Unit; Peter MacCallum Cancer Centre; Melbourne Australia
- Department of Psychiatry; St Vincent's Hospital; Melbourne Australia
| | - Anna Collins
- Psycho-oncology Research Unit; Peter MacCallum Cancer Centre; Melbourne Australia
- Centre for Palliative Care; St Vincent's Hospital; Melbourne Australia
| | - Sidney Bloch
- Department of Psychiatry; St Vincent's Hospital; Melbourne Australia
| | - Annette Street
- Department of Public Health, Faculty of Health Sciences; LaTrobe University; Melbourne Australia
| | - Gillian Duchesne
- Department of Radiation Oncology; Peter MacCallum Cancer Centre; Melbourne Australia
| | - Tessa Jones
- Department of Clinical Psychology and Psychiatry; Peter MacCallum Cancer Centre; Melbourne Australia
| | - James Olver
- Department of Psychiatry, Austin Health; University of Melbourne; Melbourne Australia
| | - Anthony Love
- Centre for Cultural Diversity and Wellbeing, College of Arts; Victoria University; Melbourne Australia
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Parahoo K, McDonough S, McCaughan E, Noyes J, Semple C, Halstead EJ, Neuberger MM, Dahm P. Psychosocial interventions for men with prostate cancer: a Cochrane systematic review. BJU Int 2015; 116:174-83. [PMID: 25429987 DOI: 10.1111/bju.12989] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
To evaluate the effectiveness of psychosocial interventions for men with prostate cancer in improving quality of life (QoL), self-efficacy and knowledge and in reducing distress, uncertainty and depression. We searched for trials using a range of electronic databases including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and PsycINFO to October 2013, together with hand searching of journals and reference lists. Randomised controlled trials were eligible if they included psychosocial interventions that explicitly used one or a combination of the following approaches: cognitive behavioural, psycho-educational, supportive and counselling. Interventions had to be delivered or facilitated by trained or lay personnel. Our outcomes were an improvement in QoL, self-efficacy and knowledge and a reduction in distress, uncertainty and depression. Pairs of review authors independently extracted data and assessed risk of bias. We analysed data using standardised mean differences (SMDs), random-effects models and 95% confidence intervals (CIs). In all, 19 studies with a total of 3 204 men, with a diagnosis of prostate cancer, comparing psychosocial interventions vs usual care were included in this review. Men in the psychosocial intervention group had a small, statistically significant improvement in the physical component of general health-related QoL (GHQoL) at end of intervention (SMD 0.12, 95% CI 0.01-0.22) based on low quality evidence. There was no clear evidence of benefit associated with psychosocial interventions for the mental component of GHQoL at end of intervention (SMD -0.04, 95% CI -0.15 to 0.06) based on moderate quality evidence. At end of intervention, cancer-related QoL showed a small improvement after psychosocial interventions (SMD 0.21, 95% CI 0.04-0.39). For prostate cancer-specific and symptom-related QoL, the differences between intervention and control groups were not significant. There was no clear evidence that psychosocial interventions were beneficial in improving self-efficacy at end of intervention (SMD 0.16, 95% CI -0.05 to 0.38) based on very low quality evidence. Men in the psychosocial intervention group had a moderate increase in prostate cancer knowledge at end of intervention (SMD 0.51, 95% CI 0.32-0.71) based on very low quality evidence. A small increase in knowledge with psychosocial interventions was noted at 3 months after intervention (SMD 0.31, 95% CI 0.04-0.58). The results for uncertainty (SMD -0.05, 95% CI -0.35 to 0.26) and distress (SMD 0.02, 95% CI -0.11 to 0.15) at end of intervention were compatible with both benefit and harm based on very low quality evidence. Finally, there was no clear evidence of benefit associated with psychosocial interventions for depression at end of intervention (SMD -0.18, 95% CI -0.51 to 0.15) based on very low quality evidence. The overall risk of bias in the included studies was unclear or high, primarily as the result of performance bias. No data about stage of disease or treatment with androgen-deprivation therapy were extractable for subgroup analysis. Only one study addressed adverse effects. Overall, this review shows that psychosocial interventions may have small, short-term beneficial effects on certain domains of wellbeing, as measured by the physical component of GHQoL and cancer-related QoL when compared with usual care. Prostate cancer knowledge was also increased. However, this review failed to show a statistically significant effect on other domains such as symptom-related QoL, self-efficacy, uncertainty, distress or depression. Moreover, when beneficial effects were seen, it remained uncertain whether the magnitude of effect was large enough to be considered clinically important. The quality of evidence for most outcomes was rated as very low according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system, reflecting study limitations, loss to follow-up, study heterogeneity and small sample sizes. We were unable to perform meaningful subgroup analyses based on disease stage or treatment method. Although some findings of this review are encouraging, they do not provide sufficiently strong evidence to permit meaningful conclusions about the effects of these interventions in men with prostate cancer. Additional well executed and transparently reported research studies are necessary to establish the role of psychosocial interventions in men with prostate cancer.
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Affiliation(s)
- Kader Parahoo
- Institute of Nursing and Health Research, University of Ulster, Coleraine, Co. Londonderry, UK
| | - Suzanne McDonough
- Institute of Nursing and Health Research, University of Ulster, Newtownabbey, Co. Antrim, UK
| | - Eilis McCaughan
- Institute of Nursing and Health Research, University of Ulster, Coleraine, Co. Londonderry, UK
| | - Jane Noyes
- Centre for Health-Related Research, Bangor University Fron Heulog, Bangor, Gwynedd, UK
| | - Cherith Semple
- Cancer Services, South Eastern Health & Social Care Trust, Belfast, UK
| | - Elizabeth J Halstead
- School of Healthcare Sciences, Bangor University Fron Heulog, Bangor, Gwynedd, UK
| | | | - Philipp Dahm
- Minneapolis VA Health Care System, Minneapolis, MN, USA.,Department of Urology, University of Minnesota, Minneapolis, MN, USA
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Chambers SK, Lowe A, Hyde MK, Zajdlewicz L, Gardiner RA, Sandoe D, Dunn J. Defining young in the context of prostate cancer. Am J Mens Health 2015; 9:103-14. [PMID: 24780936 PMCID: PMC4361457 DOI: 10.1177/1557988314529991] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
The experience of prostate cancer is for most men a major life stress with the psychological burden of this disease falling more heavily on those who are younger. Despite this, being young as it applies to prostate cancer is not yet clearly defined with varied chronological approaches applied. However, men's responses to health crises are closely bound to life course and masculinities from which social roles emerge. This paper applied qualitative methodology (structured focus groups and semistructured interviews with expert informants) using interpretative phenomenological analysis to define what it means to be young and have prostate cancer. Structured focus groups were held with 26 consumer advisors (men diagnosed with prostate cancer who provide support to other men with prostate cancer or raise community awareness) and health professionals. As well, 15 men diagnosed with prostate cancer and in their 40s, 50s, or 60s participated in semi-structured interviews. Participants discussed the attributes that describe a young man with prostate cancer and the experience of being young and diagnosed with prostate cancer. Chronological definitions of a young man were absent or inconsistent. Masculine constructions of what it means to be a young man and life course characteristics appear more relevant to defining young as it applies to prostate cancer compared with chronological age. These findings have implications for better understanding the morbidities associated with this illness, and in designing interventions that are oriented to life course and helping young men reconstruct their identities after prostate cancer.
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Affiliation(s)
- Suzanne K Chambers
- Griffith Health Institute, Griffith University, Gold Coast Campus, Queensland, Australia Cancer Council Queensland, Brisbane, Queensland, Australia Prostate Cancer Foundation of Australia, Sydney, New South Wales, Australia Health and Wellness Institute, Edith Cowan University, Joondalup, Perth, Queensland, Australia Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia
| | - Anthony Lowe
- Griffith Health Institute, Griffith University, Gold Coast Campus, Queensland, Australia Prostate Cancer Foundation of Australia, Sydney, New South Wales, Australia
| | - Melissa K Hyde
- Griffith Health Institute, Griffith University, Gold Coast Campus, Queensland, Australia
| | | | - Robert A Gardiner
- Health and Wellness Institute, Edith Cowan University, Joondalup, Perth, Queensland, Australia Centre for Clinical Research, University of Queensland, Brisbane, Queensland, Australia Department of Urology, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| | - David Sandoe
- Prostate Cancer Foundation of Australia, Sydney, New South Wales, Australia
| | - Jeff Dunn
- Griffith Health Institute, Griffith University, Gold Coast Campus, Queensland, Australia Cancer Council Queensland, Brisbane, Queensland, Australia School of Social Science, University of Queensland, Brisbane, Queensland, Australia
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Kamen C, Mustian KM, Heckler C, Janelsins MC, Peppone LJ, Mohile S, McMahon JM, Lord R, Flynn PJ, Weiss M, Spiegel D, Morrow GR. The association between partner support and psychological distress among prostate cancer survivors in a nationwide study. J Cancer Surviv 2015; 9:492-9. [PMID: 25603949 DOI: 10.1007/s11764-015-0425-3] [Citation(s) in RCA: 65] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Accepted: 01/03/2015] [Indexed: 10/24/2022]
Abstract
PURPOSE Up to 38% of prostate cancer survivors experience significant psychological distress; 6-16% are diagnosed with depression or anxiety disorders. Support from a relationship partner can ameliorate psychological distress, but many studies treat relationship status as a dichotomous predictor without accounting for level of support provided by the partner. METHODS The current study is a secondary analysis of a sample of 292 prostate cancer survivors recruited by nine Community Clinical Oncology Program (CCOP) sites around the USA to a larger randomized controlled trial. Self-reported distress was measured at a baseline visit using the Profile of Mood States (POMS) and partner support was measured using the Social Network and Support Assessment (SNSA). Post hoc groups consisting of unmarried survivors, married survivors with low partner support (SNSA scores below the median), and married survivors with high partner support (SNSA scores above the median) were compared on distress using univariate and analysis of covariance (ANCOVA) analyses. RESULTS Married prostate cancer survivors with high partner support reported significantly lower levels of psychological distress than the other two groups on the total distress scale (16.20-19.19 points lower, p < 0.001). After adjusting for multiple comparisons, this pattern was also seen for subscales of distress. CONCLUSIONS This study highlights the importance of assessing both partner support and marital status when evaluating a survivor's psychosocial functioning and support network. IMPLICATIONS FOR CANCER SURVIVORS Assessing support could improve understanding of the association between partner support and prostate cancer survivors' psychological distress and could lead to interventions to bolster support and reduce distress.
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Affiliation(s)
- Charles Kamen
- James P. Wilmot Cancer Institute, University of Rochester Medical Center, 265 Crittenden Boulevard, Box 420658, Rochester, NY, 14642, USA,
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Wenger LM, Oliffe JL, Bottorff JL. Psychosocial Oncology Supports for Men: A Scoping Review and Recommendations. Am J Mens Health 2014; 10:39-58. [PMID: 25389212 DOI: 10.1177/1557988314555361] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
Although men's cancer experiences have received limited attention within the field of psychosocial oncology, increasing attention is being devoted to the development and evaluation of men-centered programs. This scoping review describes this emergent body of literature, detailing the focus, participation, and impact of interventions designed to help men with cancer build illness-specific knowledge, adapt to illness, manage side effects, distress, and uncertainty, sustain relationships, and more. Striving to build on existing knowledge, research gaps and opportunities are discussed, including a need for stronger methodologies, more tailored and targeted supports, attention to the experiences of men with nonprostate cancers, and the explicit integration of gender analyses in the research process.
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Affiliation(s)
- Lisa M Wenger
- University of British Columbia, Vancouver, British Columbia, Canada
| | - John L Oliffe
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Joan L Bottorff
- University of British Columbia, Okanagan Campus, Kelowna, British Columbia; Australian Catholic University, Melbourne, Australia
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Chambers SK, Girgis A, Occhipinti S, Hutchison S, Turner J, McDowell M, Mihalopoulos C, Carter R, Dunn JC. A Randomized Trial Comparing Two Low-Intensity Psychological Interventions for Distressed Patients With Cancer and Their Caregivers. Oncol Nurs Forum 2014; 41:E256-66. [DOI: 10.1188/14.onf.e256-e266] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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McDowell ME, Occhipinti S, Chambers SK. Classifying the reasons men consider to be important in prostate-specific antigen (PSA) testing decisions: evaluating risks, lay beliefs, and informed decisions. Ann Behav Med 2014; 46:322-35. [PMID: 23653418 DOI: 10.1007/s12160-013-9508-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Despite uncertainty regarding the benefits of prostate cancer screening, many men have had a prostate-specific antigen (PSA) test. PURPOSE This study aims to identify classes of reasons guiding men's decisions about prostate cancer screening and predict reasoning approaches by family history and prior screening behaviour. METHODS First-degree relatives of men with prostate cancer (n = 207) and men from the general population (n = 239) of Australia listed reasons they considered when deciding whether to have a PSA test. RESULTS Responses were coded into 31 distinct categories. Latent class analysis identified three classes. The evaluation of risk information cues class (20.9 %) contained a greater number of men with a family history (compared with control and overcome cancer/risk class; 52.7 %). Informed decisions and health system class (26.5 %) included a lower proportion of men who had had a PSA test and greater proportions of highly educated and married men. CONCLUSION Understanding the reasons underlying men's screening decisions may lead to a more effective information provision and decision support.
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Affiliation(s)
- Michelle E McDowell
- Griffith Health Institute, School of Applied Psychology, Griffith University, Mount Gravatt, QLD, 4111, Australia,
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Adopting a survivor identity after cancer in a peer support context. J Cancer Surviv 2014; 8:427-36. [PMID: 24706364 DOI: 10.1007/s11764-014-0355-5] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 03/18/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The term cancer survivor can refer to individuals from diagnosis through the rest of their life. However, not all people with cancer identify as a survivor, and underlying factors and correlates are yet to be well-explored empirically. METHODS Study 1 surveyed men in a prostate cancer peer support network (n = 514), exploring psychosocial variables related to adopting a survivor identity. Study 2 interviewed 160 women with breast cancer in an online support group and collected observational data, assessing how survivor identity relates to perceptions of and participation in online support groups. RESULTS For men, survivor identity (35 %) was related to lower levels of threat appraisal (p = .000), more deliberate rumination (p = .042), gaining greater understanding of cancer experience through peers (p = .041) and a higher, though marginally significant, level of posttraumatic growth (p = .052). Women adopting a survivor identity (50 %) had higher rates of online support group posts (p = .048), a greater feeling of mattering to the group (p = .002), rated the group as more helpful (p = .004 to .01) and had less difficulty in relating to the group (p = .002) than women not identifying as a survivor. CONCLUSIONS Survivor identity was related to active and positive engagement with peers, and cognitive processing. IMPLICATIONS FOR CANCER SURVIVORS While the cancer survivor metaphor may be salient for some people diagnosed with cancer, many did not associate with the term, highlighting the complexity surrounding survivorship discourse and the need to be sensitive to unique individual needs in psychosocial interventions that involve groups.
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Improving sexual health in men with prostate cancer: randomised controlled trial of exercise and psychosexual therapies. BMC Cancer 2014; 14:199. [PMID: 24641777 PMCID: PMC3995188 DOI: 10.1186/1471-2407-14-199] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 02/28/2014] [Indexed: 11/17/2022] Open
Abstract
Background Despite being a critical survivorship care issue, there is a clear gap in current knowledge of the optimal treatment of sexual dysfunction in men with prostate cancer. There is sound theoretical rationale and emerging evidence that exercise may be an innovative therapy to counteract sexual dysfunction in men with prostate cancer. Furthermore, despite the multidimensional aetiology of sexual dysfunction, there is a paucity of research investigating the efficacy of integrated treatment models. Therefore, the purpose of this study is to: 1) examine the efficacy of exercise as a therapy to aid in the management of sexual dysfunction in men with prostate cancer; 2) determine if combining exercise and brief psychosexual intervention results in more pronounced improvements in sexual health; and 3) assess if any benefit of exercise and psychosexual intervention on sexual dysfunction is sustained long term. Methods/Design A three-arm, multi-site randomised controlled trial involving 240 prostate cancer survivors will be implemented. Participants will be randomised to: 1) ‘Exercise’ intervention; 2) ‘Exercise + Psychosexual’ intervention; or 3) ‘Usual Care’. The Exercise group will receive a 6-month, group based, supervised resistance and aerobic exercise intervention. The Exercise + Psychosexual group will receive the same exercise intervention plus a brief psychosexual self-management intervention that addresses psychological and sexual well-being. The Usual Care group will maintain standard care for 6 months. Measurements for primary and secondary endpoints will take place at baseline, 6 months (post-intervention) and 1 year follow-up. The primary endpoint is sexual health and secondary endpoints include key factors associated with sexual health in men with prostate cancer. Discussion Sexual dysfunction is one of the most prevalent and distressing consequences of prostate cancer. Despite this, very little is known about the management of sexual dysfunction and current health care services do not adequately meet sexual health needs of survivors. This project will examine the potential role of exercise in the management of sexual dysfunction and evaluate a potential best-practice management approach by integrating pharmacological, physiological and psychological treatment modalities to address the complex and multifaceted aetiology of sexual dysfunction following cancer. Trial registration Australian New Zealand Clinical Trials Registry ACTRN12613001179729.
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Parahoo K, McDonough S, McCaughan E, Noyes J, Semple C, Halstead EJ, Neuberger MM, Dahm P. Psychosocial interventions for men with prostate cancer. Cochrane Database Syst Rev 2013:CD008529. [PMID: 24368598 DOI: 10.1002/14651858.cd008529.pub3] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND As the incidence and prevalence of prostate cancer continue to rise, the number of men needing help and support to assist them in coping with disease and treatment-related symptoms and their psychosocial effects is likely to increase. OBJECTIVES To evaluate the effectiveness of psychosocial interventions for men with prostate cancer in improving quality of life (QoL), self-efficacy and knowledge and in reducing distress, uncertainty and depression. SEARCH METHODS We searched for trials using a range of electronic databases including the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and PsycINFO to October 2013, together with handsearching of journals and reference lists. SELECTION CRITERIA Randomised controlled trials of psychosocial interventions for men at any stage of prostate cancer. We included psychosocial interventions that explicitly used one or a combination of the following approaches: cognitive behavioural, psychoeducational, supportive and counselling. Interventions had to be delivered or facilitated by trained or lay personnel. DATA COLLECTION AND ANALYSIS Pairs of review authors independently extracted data and assessed risk of bias. We analysed data using standardised mean differences (SMDs), random-effects models and 95% confidence intervals (CIs). MAIN RESULTS Nineteen studies comparing psychosocial interventions versus usual care in a total of 3204 men with prostate cancer were included in this review. All but three of these studies were conducted in the United States.Men in the psychosocial intervention group had a small, statistically significant improvement in the physical component of general health-related quality of life (GHQoL) at end of intervention (1414 participants, SMD 0.12, 95% CI 0.01 to 0.22) based on low-quality evidence. A small improvement in favour of psychosocial interventions (SMD 0.24, 95% CI 0.02 to 0.47) was also seen in the physical component of GHQoL at end of intervention for group-based interventions. No clear evidence of benefit was found for GHQoL scores at end of intervention with individual-based interventions compared with controls. Also, no clear evidence suggested that psychosocial interventions were beneficial in improving the physical component of GHQoL at four to six and at eight to 12 months post-intervention. In addition, no clear evidence showed benefit associated with psychosocial interventions for the mental component of GHQoL at end of intervention (1416 participants, SMD -0.04, 95% CI -0.15 to 0.06) based on moderate-quality evidence. Results for the mental component of GHQoL at four to six and at eight to 12 months post-intervention were compatible with benefit and harm. At end of intervention, cancer-related QoL showed a small improvement following psychosocial interventions (SMD 0.21, 95% CI 0.04 to 0.39), but at eight and 12 months, the effect was compatible with benefit and harm. For prostate cancer-specific and symptom-related QoL, the differences between groups were not significant.No clear evidence indicated that psychosocial interventions were beneficial in improving self-efficacy at end of intervention (337 participants, SMD 0.16, 95% CI -0.05 to 0.38) based on very low-quality evidence in three studies that assessed individual-based interventions. The results for self-efficacy at six to eight and at 12 months post-intervention were compatible with benefit and harm. Men in the psychosocial intervention group had a moderate increase in prostate cancer knowledge at end of intervention (506 participants, SMD 0.51, 95% CI 0.32 to 0.71) based on very low-quality evidence in two studies; this increase was also observed in the subgroups of group-based and individual-based interventions. A small increase in knowledge with psychosocial interventions was noted at three months post-intervention (SMD 0.31, 95% CI 0.04 to 0.58).The results for uncertainty (916 participants, SMD -0.05, 95% CI -0.35 to 0.26) and distress (916 participants, SMD 0.02, 95% CI -0.11 to 0.15) at end of intervention were compatible with both benefit and harm based on very low-quality evidence. No clear evidence suggests that psychosocial interventions were beneficial in reducing uncertainty and distress between groups at six to eight and at 12 months post-intervention. Finally, no clear evidence of benefit is associated with psychosocial interventions for depression at end of intervention (434 participants, SMD -0.18, 95% CI -0.51 to 0.15) based on very low-quality evidence. Individual-based interventions significantly reduced depression when compared with usual care groups. The results for depression at six and at 12 months post-intervention were compatible with benefit and harm.The overall risk of bias in the included studies was unclear or high, primarily as the result of performance bias.No data regarding stage of disease or treatment with androgen deprivation therapy (ADT) were extractable for subgroup analysis. Only one study addressed adverse effects. High attrition could indicate that some participants may not have been comfortable with the interventions. AUTHORS' CONCLUSIONS Overall, this review shows that psychosocial interventions may have small, short-term beneficial effects on certain domains of well-being, as measured by the physical component of GHQoL and cancer-related QoL when compared with usual care. Prostate cancer knowledge was also increased. However, this review failed to demonstrate a statistically significant effect on other domains such as symptom-related QoL, self-efficacy, uncertainty, distress or depression. Moreover, when beneficial effects were observed, it remained uncertain whether the magnitude of effect was large enough to be considered clinically important. The quality of evidence for most outcomes was rated as very low according to GRADE, reflecting study limitations, loss to follow-up, study heterogeneity and small sample sizes. We were unable to perform meaningful subgroup analyses based on disease stage or treatment modality. Although some findings of this review are encouraging, they do not provide sufficiently strong evidence to permit meaningful conclusions about the effects of these interventions in men with prostate cancer. Additional well-done and transparently reported research studies are necessary to establish the role of psychosocial interventions in men with prostate cancer.
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Affiliation(s)
- Kader Parahoo
- Institute of Nursing and Health Research, University of Ulster, Coleraine, UK, BT52 1SA
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Beck AM, Robinson JW, Carlson LE. Sexual values as the key to maintaining satisfying sex after prostate cancer treatment: the physical pleasure-relational intimacy model of sexual motivation. ARCHIVES OF SEXUAL BEHAVIOR 2013; 42:1637-1647. [PMID: 24045902 DOI: 10.1007/s10508-013-0168-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2012] [Revised: 05/24/2013] [Accepted: 05/27/2013] [Indexed: 06/02/2023]
Abstract
Sexual dysfunction is the most significant long lasting effect of prostate cancer (PrCa) treatment. Despite the many medical treatments for erectile dysfunction, many couples report that they are dissatisfied with their sexual relationship and eventually cease sexual relations altogether. We sought to understand what distinguishes successful couples from those who are not successful in adjusting to changes in sexual function subsequent to PrCa treatment. Ten couples who maintained satisfying sexual intimacy after PrCa treatment and seven couples that did not were interviewed conjointly and individually. Interviews were transcribed and analyzed using grounded theory methodology. The theory that resulted suggests that individuals are motivated to engage in sex primarily because of physical pleasure and relational intimacy. The couples who valued sex primarily for relational intimacy were more likely to successfully adjust to changes in sexual function than those who primarily valued sex for physical pleasure. The attributes of acceptance, flexibility, and persistence helped sustain couples through the process of adjustment. Based on these findings, a new theory, the Physical Pleasure-Relational Intimacy Model of Sexual Motivation (PRISM) is presented. The results elucidate the main motives for engaging in sexual activity-physical pleasure and/or relational intimacy-as a determining factor in the successful maintenance of satisfying sexual intimacy after PrCa treatment. The PRISM model predicts that couples who place a greater value on sex for relational intimacy will better adjust to the sexual challenges after PrCa treatment than couples who place a lower value on sex for relational intimacy. Implications of the model for counselling are discussed. This model remains to be tested in future research.
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Affiliation(s)
- Andrea M Beck
- Tom Baker Cancer Centre - Holy Cross Site, 2202 2nd Ave. SW, Calgary, AB, T2S 3C1, Canada,
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Chambers SK, Zajdlewicz L, Youlden DR, Holland JC, Dunn J. The validity of the distress thermometer in prostate cancer populations. Psychooncology 2013; 23:195-203. [PMID: 24027194 PMCID: PMC4282590 DOI: 10.1002/pon.3391] [Citation(s) in RCA: 89] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Revised: 08/01/2013] [Accepted: 08/12/2013] [Indexed: 11/09/2022]
Abstract
Background The Distress Thermometer (DT) is widely recommended for screening for distress after cancer. However, the validity of the DT in men with prostate cancer and over differing time points from diagnosis has not been well examined. Method Receiver operating characteristics analyses were used to evaluate the diagnostic accuracy of the DT compared with three commonly used standardised scales in two prospective and one cross-sectional survey of men with prostate cancer (n = 740, 189 and 463, respectively). Comparison scales included the Impact of Event Scale – Revised (IES-R, Study 1), the Hospital Anxiety and Depression Scale (HADS, Study 2) and the Brief Symptom Inventory-18 (BSI-18, Study 3). Results Study 1: the DT showed good accuracy against the IES-R at all time points (area under curves (AUCs) ranging from 0.84 to 0.88) and sensitivity was high (>85%). Study 2: the DT performed well against both the anxiety and depression subscales for HADS at baseline (AUC = 0.84 and 0.82, respectively), but sensitivity decreased substantially after 12 months. Study 3: validity was high for the anxiety (AUC = 0.90, sensitivity = 90%) and depression (AUC = 0.85, sensitivity = 74%) subscales of the BSI-18 but was poorer for somatization (AUC = 0.67, sensitivity = 52%). A DT cut-off between ≥3 and ≥6 maximised sensitivity and specificity across analyses. Conclusions The DT is a valid tool to detect cancer-specific distress, anxiety and depression among prostate cancer patients, particularly close to diagnosis. A cut-off of ≥4 may be optimal soon after diagnosis, and for longer-term assessments, ≥3 was supported.
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Affiliation(s)
- Suzanne K Chambers
- Griffith Health Institute, Griffith University, Brisbane, Australia; Cancer Council Queensland, Brisbane, Australia; Prostate Cancer Foundation of Australia, Sydney, Australia; Edith Cowan University, Joondalup, Australia
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Hampton AJD, Walker LM, Beck A, Robinson JW. A brief couples' workshop for improving sexual experiences after prostate cancer treatment: a feasibility study. Support Care Cancer 2013; 21:3403-9. [PMID: 23934226 DOI: 10.1007/s00520-013-1922-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2013] [Accepted: 07/24/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE The most difficult survivorship issue reported by prostate cancer patients is the dramatic changes in their sexual relationships. The purpose of this study was to investigate the feasibility of a workshop designed to improve patients' and partners' sexual relationships. METHOD Participants attended one 3.5-h workshop. A total of three separate workshops were held over a 12-month period. Patients and partners complete the Sexual Functioning Questionnaire (SFQ) prior, 2 months following, and if couples registered early enough, 2 months before the workshop. Change scores were calculated. RESULTS Over the three workshops, 77 participants attended. All targets were met for feasibility and acceptability. Patients and partners both demonstrated significant gains on the medical impact subscale of the SFQ, and partners also demonstrated significant gains in sexual interest, problems, and total sexual function. CONCLUSIONS The results suggest that attending one 3.5-h workshop that is offered every 4 months is feasible and acceptable to patients and their partners. Furthermore, the SFQ proves to be a sensitive assessment instrument of sexual function for patients and their partners.
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Affiliation(s)
- Amy J D Hampton
- Department of Psychology, University of Regina, 3737 Wascana Parkway - AH 345, Regina, SK, S4S 0A2, Canada,
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Sperm banking is of key importance in patients with prostate cancer. Fertil Steril 2013; 100:367-72.e1. [DOI: 10.1016/j.fertnstert.2013.03.049] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2013] [Revised: 03/10/2013] [Accepted: 03/29/2013] [Indexed: 01/01/2023]
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Chambers SK, Schover L, Nielsen L, Halford K, Clutton S, Gardiner RA, Dunn J, Occhipinti S. Couple distress after localised prostate cancer. Support Care Cancer 2013; 21:2967-76. [PMID: 23756617 DOI: 10.1007/s00520-013-1868-6] [Citation(s) in RCA: 56] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2013] [Accepted: 05/21/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND The experience of the diagnosis of prostate cancer is distressing for both men and their partners. The present study describes the prevalence of psychological distress in men with prostate cancer and their partners, and the predictors of adjustment outcomes. METHODS/DESIGN A cross-sectional survey of 189 prostate cancer patients who were scheduled for or had undergone surgery for localised prostate cancer and their partners assessed socio-demographic variables, masculine self-esteem and social intimacy, psychological adjustment and quality of life. RESULTS Overall, patients and partners reported low distress; however, female partners were more anxious with 36 % reporting mild to severe anxiety. For men, masculine self-esteem and time since diagnosis were most strongly related to mental health status; urinary bother most influenced physical quality of life. For female partners, the man's psychological distress and his sexual bother were most strongly related to her mental health status; higher social intimacy was most strongly associated with physical quality of life. CONCLUSION The correlates of distress after the diagnosis of prostate cancer differ between patients and female partners. For men, masculine self-esteem may be most crucial, whereas for women, her partner's level of distress may matter most. Research to better understand these interactions is needed.
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Dunn J, Ng SK, Breitbart W, Aitken J, Youl P, Baade PD, Chambers SK. Health-related quality of life and life satisfaction in colorectal cancer survivors: trajectories of adjustment. Health Qual Life Outcomes 2013; 11:46. [PMID: 23497387 PMCID: PMC3648454 DOI: 10.1186/1477-7525-11-46] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2012] [Accepted: 02/11/2013] [Indexed: 01/16/2023] Open
Abstract
Background This longitudinal study describes the five year trajectories of health-related quality of life (HR-QOL) and life satisfaction in long term colorectal cancer survivors. Patients and methods A population-based sample of 1966 colorectal cancer survivors were surveyed at six time points from five months to five years post-diagnosis. Predictor variables were: socio-demographic variables, optimism; cancer threat appraisal; perceived social support. Quality of life was assessed with the Functional Assessment of Cancer Therapy-Colorectal (HR-QOL); and the Satisfaction with Life Scale. Growth mixture models were applied to identify trajectory classes and their predictors. Results Distinct adjustment trajectories were identified for HR-QOL and life satisfaction. Lower optimism, poorer social support, a more negative cognitive appraisal, and younger age were associated with poorer life satisfaction, while survivors with less than 8 years of education had higher life satisfaction. This pattern was similar for overall HR-QOL except that educational level was not a significant predictor and later stage disease and female gender emerged as related to poorer outcomes. One in five survivors reported poorer constant HR-QOL (19.2%) and a small group had poor life satisfaction (7.2%); 26.2% reported constant high HR-QOL and 48.8% had high constant life satisfaction. Socioeconomic disadvantage and remoteness of residence uniquely predicted poorer outcomes in the colorectal cancer specific HR-QOL sub domain. Conclusion Although HR-QOL and subjective cognitive QOL share similar antecedents their trajectory patterns suggested they are distinct adjustment outcomes; with life satisfaction emerging as temporally stable phenomenon. Unique patterns of risk support suggest the need to account for heterogeneity in adjustment in longitudinal QOL studies with cancer survivors.
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