Psychosocial adjustment of female partners of men with prostate cancer: a review of the literature

Impact of Social Media on Oncology Care

This review examines the evolving role of social media (SM) in oncology, highlighting its impact on patient support, professional collaboration, and public health communication. SM platforms enable cancer patients, survivors, caregivers, and oncology professionals to share information, seek support, connect with one another, and engage in education. However, the widespread use of SM introduces challenges, including misinformation and privacy concerns. The article discusses current practices, emerging trends, and the potential of SM in enhancing oncology care, with a focus on its impact across various stakeholders, while emphasizing the need for strategies to manage associated risks and fully harness SM's benefits.

The effectiveness of dyadic interventions for health outcomes of prostate cancer patients and informal caregivers: a systematic review and meta-analysis

BACKGROUND

Prostate cancer is a worldwide health issue, and current prostate cancer care extends to the patient‒caregiver dyadic setting, where individuals are interdependent and interact with each other as well as possible negative psychological and behavioural outcomes. However, the impact of dyadic care interventions on health outcome indicators for prostate cancer patients and their informal caregivers has yet to be examined.

AIM

To describe the characteristics of dyadic interventions involving patients with prostate cancer and their informal caregivers and investigate their effects on psychosocial health, sexual health, and dyadic relationships.

METHODS

Ten electronic databases (Web of Science, Cochrane Library, PsycINFO, PubMed, Embase, CINAHL, CNKI, Wanfang, VIP, and SinoMed) were thoroughly searched for related publications published between the database's founding and April 2024. The risk of bias for the included studies was evaluated using the Cochrane risk-of-bias tool, and a meta-analysis was performed using RevMan 5.4.

RESULTS

This study identified and evaluated 19 RCTs reporting 22 different interventions, as well as outcome indicators for the three aspects of psychosocial health, sexual health, and dyadic relationships in prostate cancer patients and informal caregivers. A meta-analysis of pooled data revealed that for prostate cancer patients, the intervention improved dyadic coping (SMD95% CI [95% CI] = 0.22 [0.01;0.42], p = 0.04), and for informal caregivers the dyadic care intervention reduced anxiety (SMD95% CI [95% CI] = -0.35 [-0.65;-0.06], p = 0.02), enhanced self-efficacy (SMD [95% CI] = 0.22 [0.01;0.43], p = 0.04), and improved sexual functioning (SMD [95% CI] = 0.29 [0.05;0.54], p = 0.02). No statistically significant overall effects were observed for the other outcome indicators.

CONCLUSION

The results of this review indicate that dyadic care interventions benefit prostate cancer patients and informal caregivers. However, given features such as research quality and sample size, further randomized controlled trials with excellent study designs are needed in the future to evaluate and validate the efficacy of dyadic care treatments for patients with prostate cancer.

TRIAL REGISTRATION

The protocol for this study is registered in PROSPERO with registration number (CRD42024567542).

Risks of depression, anxiety, and suicide in partners of men with prostate cancer: a national cohort study

BACKGROUND

A diagnosis of prostate cancer (PC) may cause psychosocial distress not only in a man but also in his intimate partner. However, long-term risks of depression, anxiety, or suicide in partners of men with PC are largely unknown.

METHODS

A national cohort study was conducted of 121 530 partners of men diagnosed with PC during 1998-2017 and 1 093 304 population-based controls in Sweden. Major depression, anxiety disorder, and suicide death were ascertained through 2018. Cox regression was used to compute hazard ratios (HRs) while adjusting for sociodemographic factors.

RESULTS

Partners of men with high-risk PC had increased risks of major depression (adjusted HR = 1.34, 95% confidence interval [CI] = 1.30 to 1.39) and anxiety disorder (adjusted HR = 1.25, 95% CI = 1.20 to 1.30), which remained elevated 10 or more years later. Suicide death was increased in partners of men with distant metastases (adjusted HR = 2.38, 95% CI = 1.08 to 5.22) but not other high-risk PC (adjusted HR =1.14, 95% CI = 0.70 to 1.88). Among partners of men with high-risk PC, risks of major depression and anxiety disorder were highest among those 80 years of age or older (adjusted HR = 1.73; 95% CI = 1.53 to 1.96; adjusted HR = 1.70, 95% CI = 1.47 to 1.96, respectively), whereas suicide death was highest among those younger than 60 years of age (adjusted HR = 7.55, 95% CI = 2.20 to 25.89). In contrast, partners of men with low- or intermediate-risk PC had modestly or no increased risks of these outcomes.

CONCLUSIONS

In this large cohort, partners of men with high-risk PC had increased risks of major depression and anxiety disorder, which persisted for 10 or more years. Suicide death was increased 2-fold in partners of men with distant metastases. Partners as well as men with PC need psychosocial support and close follow-up for psychosocial distress.

Qualitative evaluation of the life experiences of spouses of prostate cancer patients receiving androgen deprivation therapy

PURPOSE

This study was conducted to qualitatively evaluate the life experiences of women whose spouses had been receiving androgen deprivation therapy.

METHODS

The purposive sample of the research, in which a descriptive phenomenological design was used, consisted of 15 women. The data were evaluated according to Colaizzi's phenomenological analysis steps.

RESULTS

The views of the participants were classified into 7 themes: loss and grief, physical difficulties, socioeconomic difficulties, psychological difficulties, relational changes, strengths, and benefits.

CONCLUSION

It was determined that women whose husbands had been receiving ADT experienced grief responses and physical, socioeconomic, and psychological difficulties. Psychological difficulties were found to include care burden, hospital stress, sexuality, and burnout. It was observed that the patients and their spouses experienced some positive and negative relational changes. Satisfaction with health services and resilience were facilitating factors for female spouses to adapt to the treatment process. It was determined that during the adaptation to the disease and treatment process, the participants had some needs such as family support, economic support, reduction of negative representations in the media, and enhancement of communication skills of health professionals. Moreover, they were found to have some benefits related to post-traumatic growth. Uro-oncology nurses can develop services intended to improve the well-being of the wives of men receiving ADT and use the knowledge and experience of uro-oncology nursing for the benefit of both patients and caregivers.

Psychological recovery and well-being of spouses of patients with prostate cancer 5 years after primary treatment in Finland: a follow-up survey

OBJECTIVE AND SETTING

To study longitudinally cancer-related experiences of spouses of patients with prostate cancer and the predictors of their psychological recovery and quality of life (QOL) by following the participants of our previous survey at primary cancer treatment in a university hospital.

DESIGN

A 5-year longitudinal cohort design.

PARTICIPANTS AND PROCEDURE

A follow-up questionnaire was mailed to the female spouses/partners who participated in our previous survey (n=104). We quantitatively explored the spouses' prostate cancer-related experiences since the previous survey and measured their current psychological symptom distress and well-being/QOL. Seventy-seven (74%) of the initial participants responded.

OUTCOMES

The main outcome measures were the spouses' psychological recovery (psychological symptoms at the initial survey vs currently) and well-being/QOL (depressive symptoms, domains of QOL) at 5 years. We analysed their predictors with regression analyses.

RESULTS

The treatment had been prostatectomy in 70% of the patients. Psychological distress had alleviated in 76% of spouses (p<0.001) and emotional changes decreased (p=0.02), but a deteriorating impact on the partnership (from 4% to 16%) and on sex life ('strong impact' from 23% to 37%) had increased. The outcomes were inversely associated with negative depression-related psychological symptoms and emotional changes either initially or at follow-up. However, some early experiences also predicted the outcomes when other factors were controlled for. Prostate cancer-related information received by the spouses from several sources (leaflets/handouts, TV/radio, internet) predicted better recovery and well-being/QOL, whereas the patients' prostate cancer and treatment-related symptoms (pain, irritability/anger, bowel dysfunction) predicted poorer recovery and well-being/QOL in spouses.

CONCLUSIONS

A major negative impact of prostate cancer was experienced by the spouses still 5 years after primary treatment. Early prostate cancer-related experiences predicted long-term psychological recovery and QOL. Responding to the early information needs of spouses and effective symptom management for the patients are likely to enhance the spouses' long-term recovery and well-being.

A randomized comparison of group mindfulness and group cognitive behavioral therapy vs control for couples after prostate cancer with sexual dysfunction

BACKGROUND

Sexual dysfunction is the most common and most distressing consequence of prostate cancer (PCa) treatment and has been shown to directly affect the sexual function and quality of life of survivors' partners. There are currently no established therapies to treat the emotional and psychological burden that sexual issues impose on the couple after PCa.

AIM

Our study examined the impact of 2 therapies-cognitive behavioral therapy (CBT) and mindfulness therapy-on sexual, relational, and psychological outcomes of PCa survivor and partner couples.

METHODS

PCa survivors (n = 68) who self-reported current sexual problems after PCa treatments and their partners were randomized to 4 consecutive weeks of couples' mindfulness therapy, couples' CBT, or no treatment (control).

OUTCOMES

Couples' sexual distress, survivors' sexual satisfaction, and couples' relationship satisfaction, quality of life, psychological symptoms (anxiety and depression), and trait mindfulness were measured at baseline, 6 weeks after treatment, and 6 months after treatment.

RESULTS

Sexual distress and sexual satisfaction were significantly improved 6 weeks after the CBT and mindfulness interventions as compared with the control group, but only sexual distress remained significantly improved at 6 months. Relationship satisfaction decreased and more so for partners than survivors. There were increases in domains of quality of life for survivors vs their partners 6 months after treatments and an overall increase in general quality of life for couples 6 weeks after mindfulness. There were no significant changes in psychological symptoms and trait mindfulness. Qualitative analysis showed that the mindfulness intervention led to greater personal impact on couple intimacy after the study had ended.

CLINICAL IMPLICATIONS

CBT and mindfulness can be effective treatments for helping couples adapt to and cope with changes to their sexual function after PCa treatments and could help improve the most common concern for PCa survivors-that is, couples' sexual intimacy-after cancer, if added to routine clinical care.

STRENGTHS AND LIMITATIONS

We used established standardized treatment manuals and highly sensitive statistical methodology and accounted for covariable factors and moderators of primary outcomes. Due to difficulty in recruitment, we had a smaller control group than treatment, reducing our power to detect between-group differences. Our sample was mostly White, heterosexual, and affluent, thereby limiting the generalizability.

CONCLUSION

This is the first randomized clinical trial to test and demonstrate benefits among PCa survivors and partners' sexual outcomes after CBT and mindfulness as compared with a nontreatment control group.

The long-term experience of being a family caregiver of patients surgically treated for oesophageal cancer

AIM

This qualitative study aimed to explore the experience of being family caregivers of patients treated for oesophageal cancer 2 years after treatment. To better understand the family caregiver's situation, a conceptual model was used in the analysis. The results of the study can guide future interventions to support family caregivers of patients treated for oesophageal cancer.

DESIGN

A qualitative descriptive study using semi-structured telephone interviews. An abductive approach was used in the analysis to reach deeper knowledge about the family caregivers' experiences and to better understand deeper patterns.

METHODS

A qualitative study was conducted and included 13 family caregivers of patients surgically treated for oesophageal cancer in Sweden in 2018 who participated in a population-based nationwide cohort study. Individual telephone interviews were held in 2020, 2 years after the patients' surgery. The analysis of the interviews started with an inductive approach using thematic analysis. Thereafter, a deductive approach was used to interpret the findings in relation to the conceptual model, The Cancer Family Caregiving Experience.

RESULTS

The most essential/evident stress factors for the family caregivers were distress regarding the patients' nutrition, fear of tumour recurrence and worry about the future. In addition, a transition was experienced, going from a family member to a caregiver, and the many psychosocial aspects of this transition were highlighted during the disease trajectory.

CONCLUSION

Despite, the long-term survival of the patient, family caregivers were still struggling with psychosocial consequences because of the patient's cancer diagnosis and treatment. Furthermore, there is a need to improve supportive interventions for family caregivers during the whole disease trajectory.

IMPACT

The current study includes comprehensive information about the family caregivers' experiences when caring for a patient treated for oesophageal cancer. Family caregivers struggle with the psychosocial consequences of the patient's cancer and worry about tumour recurrence even 2 years after surgery. These findings can be useful in the development of supportive interventions, which may facilitate life for family caregivers.

PATIENT OR PUBLIC CONTRIBUTION

The study was discussed and planned together with our research partnership group including patients and family caregivers. In addition, the manuscript was reviewed by some of the members to cross-check the results and discussed them to avoid misinterpretation.

Perception of disease, dyadic coping, and the quality of life of oncology patients in the active treatment phase and their life partners: an approach based on the actor-partner interdependence model

Objective

The aim of this study based on the Systemic Transactional Model was to examine the relationship between dyadic coping and (1) disease perception and (2) quality of life of a sample of cancer patients and their life partners.

Method

This cross-sectional study included 138 oncological dyads. The following questionnaires were used: Stress Appraisal Measure, Dyadic Coping Inventory, and European Organisation for Research and Treatment of Cancer QLQ-C30. Data collected was analysed by applying the actor-partner interdependence model.

Results

The perception of the disease as a threat as well as its centrality significantly negatively influences the positive forms of dyadic coping whilst the perception of the disease as a challenge has a significant positive influence on them. Dyadic coping does not influence symptoms but has significant influences on global health/quality of life.

Conclusion

This study has highlighted new information regarding how couples cope with cancer. The results encourage the inclusion of the perception of the disease and dyadic coping in interventions that aim to improve the quality of life of cancer patients and their life partners.

Social ecological influences on treatment decision-making in men diagnosed with low risk, localised prostate cancer

OBJECTIVE

Individuals diagnosed with low risk, localised prostate cancer (PCa) face a difficult decision between active surveillance (AS) and definitive treatment. We aimed to explore perceived influences on treatment decision-making from the patient and partner's perspectives.

METHODS

Patients (and partners) who met AS criteria and had chosen their treatment were recruited. Semi-structured individual interviews were conducted via telephone to explore experiences of diagnosis, impact on patient lifestyle, experiences with physicians, treatment preferences/choice, treatment information understanding and needs, and overall decision-making process. Interviews were audio recorded, transcribed verbatim, and analysed using Reflexive Thematic Analysis.

RESULTS

Twenty-four male patients (18 chose AS) and 12 female partners participated. Five themes relating to social-ecological influences on treatment choice were identified: (1) partner support and direct influence on patient treatment choice, (2) patient and partner vicarious experiences may influence treatment decisions, (3) the influence of the patient's life circumstances, (4) disclosing to wider social networks: friends, family, and co-workers, and (5) the importance of a good relationship and experience with physicians. Additionally, two themes were identified relating to information patients and partners received about the treatment options during their decision-making process.

CONCLUSIONS

A range of individual and social influences on treatment decision-making were reported. Physicians providing treatment recommendations should consider and discuss the patient and partner's existing beliefs and treatment preferences and encourage shared decision-making. Further research on treatment decision-making of partnered and non-partnered PCa patients is required. We recommend research considers social ecological factors across the personal, interpersonal, community, and policy levels.

Comparing patient acceptability of MR-guided radiotherapy to conventional CBCT on two Elekta systems: a questionnaire-based survey

Background and Purpose:

The magnetic resonance linear accelerator system (MR Linac) is a novel piece of radiotherapy (RT) equipment allowing the routine application of daily MR-guided treatment adaptation. The hardware design required for such technical capabilities and the increased complexity of the treatment workflow entails a notable departure from cone beam computed tomography (CBCT)-based RT. Patient tolerability of treatment is paramount to RT practice where high compliance is required. Presented is a comparative analysis of how such modality specific characteristics may ultimately impact the patient experience of treatment.

Materials and Methods:

Forty patients undergoing RT for prostate cancer (PCa) on either the MR Linac (n = 20) or a CBCT-based linac (n = 20) were provided with a validated patient reported outcomes measures (PROM’s) questionnaire at fraction 1 and fraction 20. The 18-item questionnaire provided patient responses recorded using a 4-point Likert scale, 0 denoting a response of ‘Not at all’, 1 ‘Slightly’, 2 ‘Moderately’ and 3 signifying ‘Very’. The analysis provided insight into both comparisons between modalities at singular time points (fractions 1 and 20), as well as a temporal analysis within a single modality, denoting changing patient experience.

Results:

Patients generally found the MR Linac treatment couch more comfortable, however, found the increase in treatment duration harder to tolerate. Responses for all items remained stable between first and last fraction across both cohorts, indicating minimal temporal variation within a single modality. None of the responses were statistically significant at the 0·01 level.

Conclusion:

Whether radiotherapy for PCa is delivered on a CBCT linac or the MR Linac, there is little difference in patient experience with minimal experiential variation within a single modality.

Experiences of female partners of prostate cancer survivors: A systematic review and thematic synthesis

The purpose of this systematic review and synthesis of studies reporting qualitative data was to understand the gendered experiences of female partners of prostate cancer survivors to inform psychosocial support for women. We searched Medline, PsycINFO, EMBASE, AMED, CINAHL, Cochrane Database of Systematic Reviews, and Sociological Abstracts for articles on 15 and 16 April 2019, and again on 30 November 2020. English language articles published in peer-reviewed journals were included if they reported solely on findings describing the perspectives of the female partners. Extracted data were analysed using line-by-line coding, organisation of codes into descriptive themes, and development of analytical themes. A theoretical framework was then selected to organise the relationships between issues that were found to be central to the experiences of female partners. Of 4839 articles screened, 14 met inclusion criteria, reporting 13 studies with a total sample of 359 female partners. Ussher and Sandoval's theory to describe the gendered positionings of cancer caregivers accommodated the thematic findings. The overarching theme reflected the substantive psychosocial impact of prostate cancer on female partners. Women's experiences were influenced by self-positioning (as part of a couple; provider of support to their male partner; resilient; and guided by faith and spirituality), being positioned by their partners' response (manager of male partner's psychological distress or strengthened by male partner's positive response) and by their broader contexts (family members and social networks; clinicians and the health system; and cultural values and customs). Findings highlight the need to avoid reductionist approaches to gender. Greater consideration of 'contextualised femininities', or conceptualising the influence of gender roles, relations, and identities within the wider life course contexts of female partners is required in the design and delivery of psychosocial support services.

Health-related quality of life of advanced prostate cancer patients and spouses: results from actor-partner interdependence models

Background

Patients with prostate cancer (PC) and their spouses are confronted with several treatment-related and psychosocial challenges that can reduce their health-related quality of life (HRQoL). Patients with advanced PC (aPC) and their spouses are at highest risk for psychological distress and show lower HRQoL compared with couples in other phases. The aim of this study was to investigate the psychological interdependencies between HRQoL and anxiety, fear of progression (FoP), and depression in patients with aPC and their spouses.

Methods

Ninety-six heterosexual couples with aPC participated in this cross-sectional study. Patients and spouses provided information about anxiety and depression (Patient Health Questionnaire-4), fear of progression (short form of the Fear of Progression Questionnaire), and HRQoL (EORTC QoL-C30, version 3). Psychological interdependencies were analyzed with various actor-partner interdependence models using structural equation modeling.

Results

Anxiety, FoP, and depression were significant predictors of HRQoL for patients with aPC and their spouses (actor effects). Spouses’ anxiety and FoP were negatively associated with patients’ HRQoL (partner effects), showing that patients’ HRQoL is associated with their own and their spouses’ anxiety and FoP. No partner effect was revealed between depression and HRQoL in the patients or spouses.

Conclusions

The resulted partner effects between spouses and patients underline the importance of considering HRQoL in patients with aPC from a dyadic perspective. It is important that physicians explore patients’ and spouses’ needs and psychological burden to offer support and access to psycho-oncological services. Future studies are needed to investigate the effects of suitable interventions on spouses’ anxiety and FoP.

Supplementary Information

The online version contains supplementary material available at 10.1007/s00520-022-07100-8.

Designing Supportive e-Interventions for Partners of Men With Prostate Cancer Using Female Partners' Experiences: Qualitative Exploration Study

BACKGROUND

Partners of men living with prostate cancer (PCa) can experience a variety of unmet needs that are largely unaddressed by health care professionals. There is limited evidence to suggest which approach may be most effective in supporting partners' unmet needs and further research is required to determine how to provide support to caregivers and how technology solutions can be designed.

OBJECTIVE

This study aims to explore the experience of partners of men living with PCa and their perceptions of the potential role of information technology in supporting their needs.

METHODS

A qualitative descriptive methodology using focus groups and phone interviews was used. Purposive sampling was used to recruit people attending a national conference supported by a national PCa organization. Interview guides were adapted from an existing evidence-based smartphone app for caregivers of people with colorectal cancer. Sessions were audio recorded and transcribed verbatim. A coding framework was developed, and transcripts were coded line by line into the framework. Codes within the framework were grouped into descriptive categories that were then developed into analytical themes.

RESULTS

A total of 17 female partners participated in the study, with an average age of 64 (SD 8.5) years. The following two main themes emerged: In the first theme, that is, How technology can be shaped to support female partners of prostate cancer survivors, the content and design of the smartphone app was discussed in addressing female partners' needs. The following four subthemes were developed: getting support from social networks and resources, the lack of relevant information, demystifying future care expectations during and following a PCa diagnosis, and delivering the smartphone app-to whom and from whom. In the second theme, that is, The benefits and barriers of technology, the suitability of smartphone apps as a supportive modality for female partners was described. This included three subthemes: the smartphone app as an appropriate modality for supporting female partners, the future anticipated benefits of using the smartphone app, and concerns for storing and accessing information on the internet.

CONCLUSIONS

A smartphone app may be a suitable modality for providing information and peer support to female partners of men living with PCa. There is a need to provide peer support for female partners in future interventions to ensure that female partners' intimacy and daily practical needs are met.

Developing a Patient-Centered Model of Prostate Cancer Care: Patient Satisfaction With a Survivorship Program Embedded in Urologic-Oncologic Care

OBJECTIVE

To evaluate patients' and partners' satisfaction with a prostate cancer survivorship program embedded in urologic-oncologic care. As a part of quality improvement activity, we developed a patient and partner-centered, biopsychosocial support program for men and partners coping with the urinary and sexual side-effects of surgical treatment for prostate cancer. The program became a part of usual care for all prostate cancer patients.

METHODS

Patients who saw both an advanced practice provider and a sex therapist between August 1, 2018 and July 31, 2019 were eligible. Surveys packets were sent to 146 patients with surveys included for partners (N = 292). We used descriptive statistics to characterize participant responses.

RESULTS

Responses were received from 88 patients and 70 partners (56% response rate for the group). Patients and partners reported very high or fairly high satisfaction with the rehabilitation activities of the program (86-97% and 90%-100%, respectively); 91% of patients and 84% of partners thought having pre-operative education and post-operative rehabilitation was a good or fairly good idea; 83% of patients and 79% of partners would very much or somewhat recommend the program to a friend who was considering surgical treatment for prostate cancer.

CONCLUSION

Embedding a patient and partner-centered prostate cancer survivorship support program in oncologic care can positively impact patients' and partners' engagement in and satisfaction with post-operative rehabilitation.

An integrated multicomponent care model for men affected by prostate cancer: A feasibility study of TrueNTH Australia

OBJECTIVE

To evaluate the feasibility of implementing an integrated multicomponent survivorship care model for men affected by prostate cancer.

METHODS

Using a single arm prospective cohort study design, men with prostate cancer were recruited from two regional public hospitals in Australia for a 6-months program that provided information and decision support, exercise and nutrition management, specialised clinical support, and practical support through localised and central care coordination. Carers of the men were also invited to the program. Data were collected from multiple sources to evaluate: (1) recruitment capability and participant characteristics; (2) appropriateness and feasibility of delivering the specific intervention components using an electronic care management tool; and (3) suitability of data collection procedures and proposed outcome measures.

RESULTS

Of the 105 eligible men, 51 (consent rate 49%) participated in the program. Of the 31 carers nominated by the men, 13 consented (consent rate 42%). All carers and 50 (98%) men completed the program. Most (92%) men were newly diagnosed with localised prostate cancer. All men attended initial screening and assessment for supportive care needs; a total of 838 episodes of contact/consultation were made by the intervention team either in person (9%) or remotely (91%). The intervention was implemented as proposed with no adverse events. The proposed outcome measures and evaluation procedures were found to be appropriate.

CONCLUSIONS

Our results support the feasibility of implementing this integrated multicomponent care model for men affected by prostate cancer.

The Relationship of Dyadic Coping With Emotional Functioning and Quality of the Relationship in Couples Facing Cancer-A Meta-Analysis

Objective: This study is a meta-analysis that considers the association between dyadic coping and emotional functioning, and between dyadic coping and the quality of the relationship as perceived by cancer patients and their life partners. Methods: A systematic search was conducted in the electronic databases PsycINFO, PubMed, ScienceDirect and those peer-reviewed cross-sectional and longitudinal studies published up until April 2020 that investigated these relationships were selected. Results: A total of 1,168 studies were identified, of which 10 met the inclusion criteria (N = 1,727 couples). These evidenced statistically significant positive relationships between common dyadic coping and emotional functioning and between common dyadic coping and the quality of the relationship as perceived by patients and their partners. There was also a statistically significant positive association between stress communication (by oneself), supportive dyadic coping (by oneself and by partner), and the quality of the relationship. In addition, a statistically significant negative association was found between negative dyadic coping (by oneself and by partner) and the quality of the relationship as perceived by patients' partners and also between negative dyadic coping (by oneself) and the quality of the relationship as perceived by patients. Conclusions: The results suggest the existence of a significant association between dyadic coping and emotional functioning and between dyadic coping and the quality of the relationship as perceived by members of couples facing cancer. However, these results must be interpreted with caution due to the small number of studies included in the analysis. Clinically, an understanding of the existence of such relationships is helpful for the implementation, and study of the effectiveness of, interventions aimed at improving dyadic coping in order to improve both quality of life and quality of relationship in couples where there is an oncological diagnosis.

Perception of disease, dyadic coping and the quality of life of oncology patients in the active treatment phase and their life partners: Study protocol of an approach based on the actor-partner interdependence model

OBJECTIVES

Coping with cancer is a challenge for both patients and their life partners. Although there is evidence in the literature that supports the patient/partner mutual influence at the level of various psychological variables, it is still limited. This study, based on the Systemic Transactional Model, aims to investigate: 1) how the perception of disease of patients and their life partners influences their own dyadic coping and that of the other member of the couple; 2) the influence of the dyadic coping of patients and their partners on the quality of their own life and that of the other member of the couple.

METHODOLOGY

This cross-sectional study aims to recruit 131 dyads consisting of oncology patients in the active treatment phase and their life partners. Perception of disease, dyadic coping and quality of life will be evaluated for each participant. The collected data will be analysed by applying the actor-partner interdependence model (APIM).

CONCLUSION

The results highlighted in this study have the potential to help define future couple interventions that aim to improve quality of life of those facing cancer.

Antidepressant prescriptions and associated factors in men with prostate cancer and their female partners

Purpose

To estimate the risk of first-time antidepressant prescriptions as a proxy for depression or anxiety and associated risk factors in patients with prostate cancer and their female partners.

Methods

We followed all men (n = 25,126) and their female cohabiting partners (n = 8785) without a history of cancer or antidepressants from the Danish Diet, Cancer and Health cohort from 1997 to 2014 or 2010, respectively. We estimated the cumulative incidence of first-time antidepressant prescriptions in men with prostate cancer compared with cancer-free men and their respective female partners, using the Danish National Prescription Registry. Sociodemographic, lifestyle-related, and clinical risk factors were assessed using Cox regression models.

Results

A total of 1828 men were diagnosed with prostate cancer of whom 15% received antidepressants. The unadjusted hazard ratio of antidepressant prescription was 2.18 (95%CI, 1.92, 2.48) for men with prostate cancer and 1.27 (95%CI, 0.87, 1.85) for their partners, compared with cancer-free men and their partners, respectively. After adjusting for sociodemographic, lifestyle-related, and comorbidity factors, this risk was 2-fold to 4-fold increased among patients, but not significantly increased among partners. Significant risk factors among patients were curative and palliative treatment (vs. active surveillance and watchful waiting), nonlocalized disease, and short education.

Conclusions

Men with prostate cancer have a higher risk of receiving antidepressant medication than cancer-free men. Clinical characteristics can help clinicians in identifying patients at a high risk of depression or anxiety.

Implications for Cancer Survivors

Men with prostate cancer who experience symptoms of depression or anxiety should seek professional help early on. Patient education could aid in raising awareness and reducing the stigma associated with mental disorders.

Electronic supplementary material

The online version of this article (10.1007/s11764-020-00947-y) contains supplementary material, which is available to authorized users.

The experiences of giving and receiving social support for men with localised prostate cancer and their partners

Objective

To explore how men and their partners utilise social support in the first 12 months following a localised prostate cancer diagnosis.

Design

A longitudinal qualitative design.

Methods

Eighteen couples were recruited from two outpatient clinics following a localised prostate cancer diagnosis. Participants took part in semi-structured interviews at three time-points following diagnosis. Data were analysed using thematic analysis.

Results

Support networks for couples became smaller as time progressed. Stigma was seen to have a role in men’s disclosure decisions. Partners generally provided higher levels of support than they received back. By Time 3, men who had previously attended social support groups rejoined to seek informational and emotional support. For partners, there appeared to be a fine line between disclosing their true feelings and protecting their partner, and they appeared to struggle to access meaningful emotional support and accept instrumental support from trusted others.

Conclusions

The findings expand our understanding of the support between couples in the months following diagnosis. Social support groups were highlighted as an important source of support. Further research is now needed to help identify which couples may benefit from professional encouragement to attend these groups and which couples may benefit from alternative support provision.

Prostate cancer survivorship priorities for men and their partners: Delphi consensus from a nurse specialist cohort

AIMS & OBJECTIVES

To describe the prostate cancer survivorship experience and priorities from the perspective of prostate cancer specialist nurses.

BACKGROUND

Specialist nurses are providing long-term survivorship care to men and their partners however, few prostate cancer survivorship interventions are effective and priorities for nurse-led survivorship care are poorly understood.

DESIGN

A three-round modified Delphi approach.

METHODS

The study was conducted between 1 December 2018 and 28 February 2019 to develop a consensus view from an expert nurse cohort (43 prostate cancer specialist nurses: 90% response). First, participants described men's prostate cancer survivorship experience and priorities for improving care for men and partners. In subsequent rounds, participants identified key descriptors of the survivorship experience; rated priorities for importance and feasibility; and identified a top priority action for men and for partners. Thematic analysis and descriptive statistics were applied. Guidelines for Reporting Reliability and Agreement Studies informed the conduct of the study.

RESULTS

Prostate cancer specialist nurses characterised the prostate cancer survivorship experience of men as under-resourced, disjointed and distressing. In all, 11 survivorship priorities for men and three for partners were identified within five broad areas: capacity building; care coordination; physical and psychosocial care; community awareness and early detection; and palliative care. However, feasibility for individual items was frequently described as low.

CONCLUSION

Internationally, prostate cancer survivorship care for men and their partners requires urgent action to meet future need and address gaps in capacity and care coordination. Low feasibility of survivorship priorities may reflect translational challenges related to capacity. Prostate cancer survivorship care guidelines connected to practice priorities are urgently needed.

RELEVANCE TO CLINICAL PRACTICE

These findings address key gaps in the evidence for developing national nurse-led prostate cancer survivorship priorities. These priorities can be used to inform survivorship guidelines including nursing care for men with prostate cancer and their partners.

A core competency framework for prostate cancer peer navigation

PURPOSE

Trained peer navigators can offer valuable peer support and mentorship to cancer patients and caregivers due to their highly relevant and unique perspective about the disease experience. In order to define the role of prostate cancer (PC) peer navigators within the cancer care system, it is important to establish the essential competencies of a PC peer navigator. We systematically identified and verified a set of core competencies for PC peer navigators and present a competency framework for PC peer navigators.

METHODS

In phase 1, we conducted formative research consisting of a literature review and environmental scan as well as a secondary analysis of qualitative interviews. In phase 2, we drafted and mapped competencies. Finally in phase 3, expert stakeholders completed an anonymous survey to indicate whether they endorsed the competencies and to rank the importance of each competency to the peer navigator role. Open-ended feedback was also provided for each competency.

RESULTS

Six core competency domains emerged: (1) self as navigator, (2) communication, (3) knowledge/information, (4) facilitate patient-centred care, (5) eHealth/technology, and (6) caregiver needs. Forty-seven core competency statements were mapped to these domains. Expert stakeholders (n = 27) included cancer survivors, caregivers, and healthcare providers. Most (89%) of core competency statements were endorsed by stakeholders and received high priority ratings, whereas only five of the competencies were less uniformly endorsed.

CONCLUSIONS

This is the first attempt to list core competencies for PC peer navigators and may offer guidance for standardizing the PC peer navigator role and training.

Factors Associated with Anxiety and Depression among Family Caregivers of Patients Undergoing Palliative Radiotherapy

Objective:

The family caregivers of patients receiving palliative care experience high levels of anxiety and depression. The aim of the present study was to investigate the factors associated with family caregivers’ anxiety and depression when caring for patients with advanced cancer in Greece.

Methods:

The sample consisted of 100 patients undergoing palliative radiotherapy and their respective caregivers. Patients completed the Hospital Anxiety and Depression Scale (HADS) and the MD Anderson Symptom Inventory. Their respective caregivers completed the Oberst Caregiving Burden Scale, the Bakas Caregiving Outcomes Scale, and the HADS. Correlational and multiple regression analyses were conducted to identify potential predictors of anxiety and depression.

Results:

The majority of patients were male (63.0%), whereas the majority of their caregivers were female (76.0%). The mean ages of patients and caregivers were 63.9 ± 10.8 and 53.3 ± 12.6 years, respectively. Caregiving anxiety and depression were associated with patients’ variables, such as gender (P < 0.0005), primary cancer (P = 0.008), and past surgery (P = 0.002), and caregiver's variables, such as gender (P = 0.001), co-residence (P = 0.05), previous care experience (P = 0.04), and means of transport (P = 0.038). In multiple regression analyses, caregiving anxiety and depression were significantly predicted by caregivers’ and patients’ characteristics, in a model that accounted for 48% of the anxiety variance (P < 0.0005) and 39% of the depression variance (P < 0.0005).

Conclusion:

The caregivers who experienced more anxiety and depression shared the following traits: they were women, cared for men with lung cancer, cared for patients not undergoing surgery, lived together, were younger, went to the hospital by private means of transport, had previous care experience, and perceived an increased degree of general burden. Further investigation of the factors that may affect caregivers’ psychological state is required to better identify parameters that may predict it.

Patterns and predictors of registration and participation at a supportive care program for prostate cancer survivors

PURPOSE

To examine registration rates, and the timing/intensity of follow-up with a prostate cancer supportive care (PCSC) program, and to explore clinical and sociodemographic factors associated with participation and non-participation.

METHODS

We used electronic medical records for a cohort of men diagnosed with prostate cancer (PC) who attended a PC-related appointment at the Vancouver Prostate Centre, January 2013-December 2016. We used multivariate logistic regression to quantify the effect of diagnostic treatment and sociodemographic characteristic PCSC program registration and subsequent attendance. We produced Kaplan-Meier estimators to assess the probability of program attendance over the disease trajectory for those who registered.

RESULTS

Almost 15% of the men who registered for the program did not end up using any services. An additional 23% attended only one session/clinical appointment. Surgical and radiation treatments increased the odds and intensity of participation. Long travel distance decreased the odds of registering and participating. Low income decreased the odds of registration but not subsequent participation.

CONCLUSIONS

While the use of supportive care services can help address the detrimental effects of prostate cancer diagnosis and treatment, one in six men who register for supportive care do not end up using any. Offering these services at no cost and alongside treatment appears to be insufficient to ensuring access for all patients. Additional research is needed to understand barriers and facilitators of accessing supportive care in this population.

Treatment-Related Sexual Side Effects From the Perspective of Partners of Men With Prostate Cancer

A cross-sectional survey was performed among partners and men who received treatment for prostate cancer to investigate whether demographic and clinical characteristics are associated with the extent of how difficult partners found it dealing with sexual side effects and the degree of having experienced sexual problems after treatment. Moreover, an aim was to determine whether sexual side effects have an impact on the relationship. A total of 171 partners were included. In all, 104 men (70.7%) experienced an increase in erectile complaints after treatment. Almost half of partners of men with an increase in erectile complaints (63.6%, n = 63) found it difficult to deal with sexual side effects and 63.5% (n = 66) experienced sexual problems. Partners with lower education levels experienced fewer sexual problems than partners with higher education levels (p < .001). Furthermore, no significant associations were found on demographic characteristics, number of comorbidities, clinical characteristics (prostate-specific antigen level; tumor, node, and metastasis staging; Gleason grading), and type of treatment. The majority of men (58.4%, n = 59) and partners (62.5%, n = 65) indicated to not have experienced the impact of sexual side effects on their relationship.

Self-Management in Long-Term Prostate Cancer Survivors: A Randomized, Controlled Trial

PURPOSE

This randomized clinical trial compared a personally tailored, automated telephone symptom management intervention to improve self-management among long-term survivors of prostate cancer with usual care enhanced with a nontailored newsletter about symptom management. We hypothesized that intervention-group participants would have more confident symptom self-management and reduced symptom burden.

METHODS

A total of 556 prostate cancer survivors who, more than 1 year after treatment, were experiencing symptom burden were recruited from April 2015 to February 2017 across four Veterans Affairs sites. Participants were randomly assigned to intervention (n = 278) or usual care (n = 278) groups. We compared differences in the primary (symptom burden according to Expanded Prostate Cancer Index Composite-26 [EPIC], confidence in self-management) and secondary outcomes between groups using intent-to-treat analyses. We compared domain-specific changes in symptom burden from baseline to 5 and 12 months among the intervention group according to the primary symptom focus area (urinary, bowel, sexual, general) of participants.

RESULTS

Most of the prostate cancer survivors in this study were married (54.3%), were white (69.2%), were retired (62.4%), and underwent radiation therapy (56.7% v 46.2% who underwent surgery), and the mean age was 67 years. There were no baseline differences in urinary, bowel, sexual, or hormonal domain EPIC scores across groups. We observed higher EPIC scores in the intervention arm in all domain areas at 5 months, though differences were not statistically significant. No differences were found in secondary outcomes; however, coping appraisal was higher (2.8 v 2.6; P = .02) in intervention-arm patients at 5 months. In subgroup analyses, intervention participants reported improvement from baseline at 5 and 12 months in their symptom focus area domains.

CONCLUSION

This intervention was well received among veterans who were long-term survivors of prostate cancer. Although overall outcome differences were not observed across groups, the intervention tailored to symptom area of choice may hold promise to improve associated burden.

Couple-focused interventions for men with localized prostate cancer and their spouses: A randomized clinical trial

OBJECTIVES

Few couple-focused interventions have improved psychological and relationship functioning among men diagnosed with localized prostate cancer and their spouses. This study compared the impact of intimacy-enhancing therapy (IET), a general health and wellness intervention (GHW), and usual care (UC) on the psychological and relationship functioning of localized prostate cancer patients and their partners. Relationship length, relationship satisfaction, and patient masculinity were evaluated as moderators.

DESIGN

This study was a randomized clinical trial with three study arms and four assessment time points.

METHODS

A total of 237 patients and partners were randomly assigned to receive IET, GHW, or UC. Participants completed measures of psychological functioning and relationship satisfaction at baseline, 5 weeks, 3 months, and 6 months post-baseline. Primary outcomes were psychological adjustment, depression, cancer-specific distress, cancer concerns, and relationship satisfaction.

RESULTS

Spouses in IET showed greater increases in relationship satisfaction than spouses in GHW and UC between the baseline and 5-week follow-up. Among patients in longer relationships, significant increases in psychological adjustment were found in both treatments compared to UC. Among spouses in longer relationships, psychological adjustment increased in both IET and UC but declined in GHW.

CONCLUSIONS

Intimacy-enhancing therapy did not show an impact on general or cancer-specific distress, but did show an early impact on relationship satisfaction among spouses. IET was superior to UC for patients in longer relationships. It will be important for researchers to understand which couple-focused interventions benefits both patients and spouses and to identify characteristics of patients, partners, and couples who may not benefit from psychological treatments. Statement of contribution What is already known on this subject? Men diagnosed with localized prostate cancer report lower health-related quality of life and both patients and spouses report elevated distress. Relationship communication plays a role in couples' psychological adaptation to prostate cancer. Couple-focused interventions have illustrated an impact on relationship communication. There are no studies comparing different couple-focused interventions. What does this study add? Intimacy-enhancing therapy was not superior to no treatment or a comparison treatment for the broad range of psychological and relationship outcomes. Intimacy-enhancing therapy was superior to no treatment for patients in longer-term relationship. The general health and wellness intervention was not beneficial for men in shorter relationships and for men who did not endorse traditional masculine norms.

The validity of the Distress Thermometer in female partners of men with prostate cancer

Female partners of prostate cancer (PCa) survivors experience heightened psychological distress that may be greater than that expressed by PCa patients. However, optimal approaches to detect distressed, or at risk of distress, partners are unclear. This study applied receiver operating characteristics analysis to evaluate diagnostic accuracy, sensitivity and specificity of the Distress Thermometer (DT) compared to widely used measures of general (Hospital Anxiety and Depression Scale) and cancer-specific (Impact of Events Scale-Revised) distress. Participants were partners of men with localised PCa (recruited around diagnosis) about to undergo or had received surgical treatment (N = 189), and partners of men diagnosed with PCa who were 2-4 years post-treatment (N = 460). In both studies, diagnostic utility of the DT overall was not optimal. Although area under the curve scores were acceptable (ranges: 0.71-0.92 and 0.83-0.94 for general and cancer-specific distress, respectively), sensitivity, specificity and optimal DT cut-offs for partner distress varied for general (range: ≥2 to ≥5) and cancer-specific (range: ≥3 to ≥5) distress both across time and between cohorts. Thus, it is difficult to draw firm conclusions about the diagnostic capabilities of the DT for partners or recommend its use in this population. More comprehensive screening measures may be needed to detect partners needing psychological intervention.

Lung Cancer Stigma across the Social Network: Patient and Caregiver Perspectives

OBJECTIVE

To examine the personal experiences of people with lung cancer and their caregivers and how stigma is manifested throughout a patient's social network.

METHODS

A qualitative thematic analysis of interviews with 28 patients with lung cancer and their caregivers was conducted. Telephone interviews were conducted and transcribed verbatim. Data analysis was guided by contemporary stigma theory.

RESULTS

Patients and caregivers reported feeling high levels of felt stigma and concomitant psychological distress in response to the diagnosis of lung cancer. Three overarching themes emerged: the nexus of lung cancer and smoking, moralization, and attacking the link between lung cancer and smoking. Stigma was inevitably linked to smoking, and this formed the hub around which the other themes were organized. Caregivers reported feeling invisible and noted a lack of support systems for families and caregivers. In addition, there was evidence that caregivers experienced stigma by association as members of the patients' close networks. Both groups responded ambivalently to stigmatizing antismoking advertisements.

CONCLUSIONS

The qualitative analysis demonstrated the complex interplay of the social and personal domains in the experience and outcomes of stigma in lung cancer. There is a significant potential for caregivers of patients with lung cancer to experience exacerbations of psychosocial distress as a consequence of widely shared negative views about lung cancer and its prognosis. It remains for researchers and practitioners to incorporate such complexity in addressing stigma and psychosocial distress in both patients and caregivers.

The influence of marital intimacy on urinary and sexual symptom experience among patients with prostate cancer: a cross-sectional study

BACKGROUND

Little is known about the influence of how patients with prostate cancer perceive emotional support from their spouses on their treatment-related symptoms.

AIMS

To explore the influence of marital intimacy on urinary and sexual symptoms.

METHODS

The research participants were 42 men diagnosed with prostate cancer recruited from a convenience sample from a university hospital in South Korea. The Expanded Prostate Cancer Index Composite, the Korean Marital Intimacy Scale, and the Hospital Anxiety and Depression Scale were used to measure variables of interest.

RESULTS

In the hierarchical multiple regression analysis, higher marital intimacy was associated with more favorable symptom in the urinary domain. In the sexual domain, none of the models were significant, and no influence was found for marital intimacy.

CONCLUSIONS

Marital intimacy, measured as perceived emotional support from spouses, was found to positively influence only the experience of urinary symptoms among South Korean men with prostate cancer.

Evaluating a psychosocial intervention for men with prostate cancer and their partners: Outcomes and lessons learned from a randomized controlled trial

AIM

This study evaluated the process and outcome of a psychosocial intervention for men with prostate cancer and their partners. As more men survive prostate cancer, they and their partners need help and support to help them cope with the physical and psychosocial effects of the disease and treatment. There is a lack of psychosocial interventions for men with prostate cancer and their partners.

METHODS

A randomized controlled trial was conducted with 34 participants to measure the effects of the intervention on selected psychosocial outcomes, post-intervention and at one month' follow-up. The nine-week program (CONNECT) consisted of three group and two telephone sessions. It focused on symptom management, sexual dysfunction, uncertainty management, positive thinking and couple communication. The outcomes, measured by validated tools were: self-efficacy, quality of life, symptom distress, communication, uncertainty and illness benefits.

RESULTS

The men in the intervention group did better on two outcomes (communication and support) than controls. Partners in the intervention group did better than controls on most outcomes. Less participants than expected participated in the trial. The reasons for non-participation included partners not wishing to participate, men not interested in group work, and not understanding the core purpose of the intervention. The cost of training facilitators and for delivering the intervention appeared to be low.

CONCLUSION

The knowledge generated from this study will be beneficial for all those grappling with the challenges of developing, implementing and evaluating complex psychosocial interventions. This study has also highlighted the difficulties in recruiting men and their partners in clinical trials.

Long-Term and Latent Side Effects of Specific Cancer Types

Although many cancer survivors diagnosed with early-stage disease will outlive their cancer, they may continue to experience long-term and/or latent side effects due to cancer treatment. Many of these side effects are common and contribute to worse quality of life, morbidity, and mortality for cancer survivors. This article summarizes the treatment side effects for several of the most prevalent cancers in the United States.

Crossing the perspectives of patients, families, and physicians on cancer treatment: A qualitative study

Purpose

Patients, family members, and physicians participate in cancer care, but their perspectives about what is helpful during cancer treatment have rarely been compared. The aim of this study was to compare these three perspectives.

Methods

Multicenter qualitative study (with previously published protocol) based on 90 semi-structured interviews. Participants (purposively selected until data saturation) came from three different subsamples: (i) patients with cancer (n=30), (ii) their relatives (n=30), and (iii) their referring physicians (n=10, interviewed more than once).

Results

Our analysis found 3 main axes (perceived positive effects of cancer treatment, perceived negative effects of cancer treatment, doctor-physician relationship), each composed of 2 main themes. The findings showed that patients, families, and physicians shared the long-term objective of increasing survival (while reducing side effects). However, patients and relatives also pointed out the importance of living with cancer each day and thus of factors helping them to live as well as possible in daily life. The physicians difficulty in coping with patients suffering may limit their access to elements that can improve patients capacity to live as well as possible.

Conclusions

During cancer treatment (and not only at the end of life), attention should be given to enhancing the capacity of patients to live as well as possible (not only as long as possible) to meet the goals of patient-centered care and satisfy this important need of patients and families.

The Sexual Adjustment Process of Cancer Patients and Their Partners: A Qualitative Evidence Synthesis

When confronted with cancer, a prominent challenge for patients and their partners is their changed sexual relationship. An empirically based theoretical model of the sexual adaptation process during cancer might be helpful in guiding the development of adequate interventions for couples who struggle with their sexual relationship. Therefore, the purpose of this study was to synthesize evidence from primary qualitative research studies and to arrive at a detailed description of the process of sexual adjustment during cancer. We conducted a qualitative evidence synthesis of a purposeful sample of 16 qualitative papers, using the meta-ethnography approach to synthesis. We found that the subsequent studies used different theoretical approaches to describe the sexual adaptation process. This led to three divergent sexual adaptation processes: (1) the pathway of grief and mourning, depicting sexual changes as a loss; (2) the pathway of restructuring, depicting the adjustment process toward sexual changes as a cognitive process with a strong focus on the social and cultural forces that shape the values and experiences of sexuality; and (3) the pathway of sexual rehabilitation, depicting sexual changes as a bodily dysfunction that needs treatment and specific behavioral strategies. All three pathways have their own opportunities and challenges. A greater awareness of these different pathways could help healthcare providers to better understand the ways a particular couple might cope with changed sexuality, offering them opportunities to discover alternative pathways for sexual adjustment.

Masculine norms about emotionality and social constraints in young and older adult men with cancer

Beliefs that men should restrict their display of emotions, or restrictive emotionality, might contribute to adjustment to cancer and this might be sensitive to social receptivity to disclosure. The present research examined relationships of restrictive emotionality, social constraints, and psychological distress in young adults with testicular cancer (N = 171; Study 1) and older men with prostate cancer (N = 66; Study 2). Study 1: positive associations were observed for social constraints and restrictive emotionality with depressive symptoms. Social constraints moderated the relationship, such that high restrictive emotionality was associated with higher depressive symptoms in those with high constraints. Study 2: only social constraints (and not restrictive emotionality) was positively associated with depressive symptoms and cancer-related intrusive thoughts. The social constraints × restrictive emotionality interaction approached significance with depressive symptoms, such with high social constraints low restrictive emotionality was associated with higher depressive symptoms compared to those with less constraints. No significant associations were found for intrusive thoughts in either study. Findings demonstrate unique relationships with psychological distress across the lifespan of men with cancer given perception of constraints and adherence to masculine norms about emotionality.

Informal caregiving and intimate relationships: the experiences of spouses of UK military personnel

AIM

Currently, there is no research available on the experiences of spouses providing informal care to wounded, injured or sick (WIS) UK military personnel. The aim of this study was to fill this gap by investigating the relationship experiences of non-military partners caring for WIS UK military personnel.

METHODS

Spouses of WIS military personnel (n=25) completed telephone interviews with the research team. The data were transcribed and analysed using thematic analysis. The transcripts were cross-coded and checked for inter-rater reliability.

RESULTS

Six major themes were identified: (1) communication between couples, (2) adverse family environment, (3) reintegration, (4) intimacy, (5) financial uncertainty and (6) transition from partner to caregiver.

CONCLUSIONS

Partners caring for injured/ill military personnel appear to be at risk of experiencing personal distress caused by impaired relationship functioning, which may lead to diminished physical and mental well-being. Partners of WIS military personnel experience significant levels of distress and burden associated with caregiving in the form of arguments with the military partner, problems in reintegration and a lack of physical and emotional intimacy.

Maintaining intimacy for prostate cancer patients on androgen deprivation therapy

PURPOSE OF REVIEW

Androgen deprivation therapy (ADT) causes erectile dysfunction and increases patients' emotionality while diminishing their sexual interest. ADT has been linked to erosion of spousal bonds; however, this is not an invariant outcome. Understanding the factors that lead to these various outcomes may help couples deal with ADT.

RECENT FINDINGS

A subset of couples report that they became closer as a result of the patients going on ADT. Recent data suggest that what helps couples most is preemptive awareness of ADT's side-effects and congruence in how patients and their partners understand and accept the psychosexual impact of ADT. Sex therapy for prostate cancer patients divides along gendered lines, with distinctly 'male' (recovery of erections) and 'female' (promoting sexual practices that are not erection dependent) approaches. Unfortunately, neither is very effective for couples when the patient is on ADT. Options beyond the standard gendered framework, such as use of an external penile prosthesis, may be worth offering to ADT patients trying to find a 'new normal' that is sexually rewarding for them.

SUMMARY

Intimacy is sharing something with someone that one shares with no one else. Exploring novel sexual practices can help couples stay intimate, even when the patient is on ADT.

An Exploratory Study on the Information Needs of Prostate Cancer Patients and Their Partners

The aim of this study is to explore the information needs of men with prostate cancer and their partners retrospectively at various points in the treatment process. An online questionnaire was used to collect information from men with prostate cancer and their partners about information needs, and when these developed. Readers of a Prostate Care Cookbook and members of a Prostate Cancer Charity were invited to participate: 73 men with prostate cancer and 25 partners completed the questionnaire. Responses showed that participants develop their information needs close to diagnosis. Less educated men with prostate cancer and partners developed their needs closer to the time after diagnosis than those with higher education. Partners develop an interest on information related to treatment and interaction earlier than patients. Patients prioritised treatment and disease-specific information. Patients and partners differ in how their information needs develop. Medical information is prioritized by patients as opposed to practical information by partners. Health care provision can be tailored to meet the different needs of prostate cancer patients and their partners at different times in the treatment process.

Couple-Based Psychosexual Support Following Prostate Cancer Surgery: Results of a Feasibility Pilot Randomized Control Trial

INTRODUCTION

Surgery for prostate cancer can result in distressing side effects such as sexual difficulties, which are associated with lower levels of dyadic functioning. The study developed and tested an intervention to address sexual, relational, and emotional aspects of the relationship after prostate cancer by incorporating elements of family systems theory and sex therapy.

AIMS

To develop and test the feasibility and acceptability of relational psychosexual treatment for couples with prostate cancer, determine whether a relational-psychosexual intervention is feasible and acceptable for couples affected by prostate cancer, and determine the parameters for a full-scale trial.

METHODS

Forty-three couples were recruited for this pilot randomized controlled trial and received a six-session manual-based psychosexual intervention or usual care. Outcomes were measured before, after, and 6 months after the intervention. Acceptability and feasibility were established from recruitment and retention rates and adherence to the manual.

MAIN OUTCOME MEASURES

The primary outcome measurement was the sexual bother subdomain of the Expanded Prostate Cancer Index Composite. The Hospital Anxiety and Depression Scale and the 15-item Systemic Clinical Outcome and Routine Evaluation (SCORE-15) were used to measure emotional and relational functioning, respectively.

RESULTS

The intervention was feasible and acceptable. The trial achieved adequate recruitment (38%) and retention (74%) rates. The intervention had a clinically and statistically significant effect on sexual bother immediately after the intervention. Small decreases in anxiety and depression were observed for the intervention couples, although these were not statistically significant. Practitioners reported high levels of adherence to the manual.

CONCLUSION

The clinically significant impact on sexual bother and positive feedback on the study's feasibility and acceptability indicate that the intervention should be tested in a multicenter trial. The SCORE-15 lacked specificity for this intervention, and future trials would benefit from a couple-focused measurement.

The prostate cancer journey: results of an online survey of men and their partners

BACKGROUND

The initial impact of treatments for men with prostate cancer is well reported in the literature. Less is known about the psychosocial needs of these men as their journey after diagnosis and treatment continues into the months and years.

OBJECTIVE

The objective of this study was to examine and understand the supportive care needs of men diagnosed and treated for prostate cancer at key identifiable periods of their cancer journey.

METHODS

An international Web-based survey was conducted in 2012, investigating men's prostate cancer pathways. The survey was based on substantial qualitative research and assessed for validity and reliability before piloting. To provide a unique insight into men living with prostate cancer, the views of partners were also elicited.

RESULTS

Completed questionnaires were obtained from 193 men and 40 partners from 6 nations. The physical and psychosocial impact of treatment and need for support varied along the cancer journey. Fear, distress, loss, regret, anxiety, low self-esteem, depression, changes in sexuality, masculinity, and relationships were also described by both men and partners as adverse effects of the diagnosis and treatment for prostate cancer.

CONCLUSIONS

Wives and partners are a key psychosocial support to men with prostate cancer. They may also provide valuable insight into men's supportive care needs that men are often unable to recognize themselves.

IMPLICATIONS FOR PRACTICE

Findings suggest that wives and partners of men with prostate cancer can provide nurses and healthcare authorities with a powerful and unique resource in providing supportive care for men who are challenged by prostate cancer.

The Effects of Social Support on Health-Related Quality of Life of Patients with Metastatic Prostate Cancer

Patients with metastatic prostate cancer (PC) live longer than patients with metastatic tumours of other sites. Consequently, their social network can influence their quality of life (QoL) during a remarkable life span. The aim of this article is to present the findings of a systematic review of the studies that focused on social network supporting the quality of life of these patients. A systematic review for studies meeting specific criteria was undertaken on three databases. Some level of unmet psychological needs was present in 54 % of the patients. Depression and fatigue are highly prevalent, and the dyads, patient and partner, are at higher risk for distress symptoms. The efforts of individuals to cope with metastatic PC appear influenced by adaptative skills and specific types of family support. Psychological and relational problems predominate in the hormone-sensitive stage and are increasingly replaced by physical symptoms, social and spiritual needs in the later stages. In the early castration-resistant stage, patients will discuss with their doctors information about drugs, control of side effects and treatment strategies. In metastatic PC patients, needs change during the course of the disease. Social support plays a major role in maintaining or disrupting QoL and in the efficacy of psychosocial treatments. The trajectory of disease and its effect on the reduced QoL over the entire life expectancy should be kept in mind by health system providers and social workers.

Challenges to treat hypogonadism in prostate cancer patients: implications for endocrinologists, urologists and radiotherapists

The literature suggests that the serum testosterone level required for maximum androgen receptor (AR) binding may be in the range of nanomolar and above this range of concentrations; this sexual hormone may not significantly affect tumour biology. This assumption is supported by clinical studies showing that cell proliferation markers did not change when serum T levels increased after exogenous T treatment in comparison to subjects treated with placebo. However, a considerable part of the global scientific community remains sceptical regarding the use of testosterone replacement therapy (TRT) in men suffering from hypogonadism and prostate cancer (Pca). The negative attitudes with respect to testosterone supplementation in men with hypogonadism and Pca may be justified by the relatively low number of clinical and preclinical studies that specifically dealt with how androgens affect Pca biology. More controversial still is the use of TRT in men in active surveillance or at intermediate or high risk of recurrence and treated by curative radiotherapy. In these clinical scenarios, clinicians should be aware that safety data regarding TRT are scanty limiting our ability to draw definitive conclusions on this important topic. In this review we critically discuss the newest scientific evidence concerning the new challenges in the treatment of men with hypogonadal condition and Pca providing new insights in the pharmacological and psychological approaches.

Couples-based interventions following prostate cancer treatment: a narrative review

Background

Sexual dysfunction following prostate cancer (PC) treatment often results in sexual avoidance and a loss of sexual intimacy, which can lead to relationship distress. This review aims to evaluate six studies intended to address relational and sexual intimacy following PC treatment and discuss methodological concerns which may help produce more effective interventions.

Methods

Electronic databases used to conduct literature searches included Medline, PsychINFO, and Web of Science. Studies were included if they were: randomized controlled trials (RCTs) using samples of men diagnosed with PC of any stage, had a psychosocial intervention, and addressed at least one sexual and relational outcome.

Results

As a whole, the literature has produced mixed results. While significant findings were reported, many of the primary hypotheses were not achieved. The six studies show that men with PC may benefit from education and support related to treatment options for erectile dysfunction (ED), whereas their partners may benefit more from interventions focused on relational issues. Important methodological limitations included: selection of general outcome measures as opposed to measures specific to sexuality or intimacy outcomes, lack of assessing distress or bother of the patient/couples as study entry criteria, heterogeneity of study populations, and lack of innovative intervention content as the current studies tested standard educational interventions, sex therapies techniques, and couples therapy strategies with only marginal success.

Conclusions

Interventions based on innovative theoretical approaches as well as study designs that address the outlined methodological limitations are needed in this area.