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Winter N, Jongebloed H, Green A, Ugalde A, Livingston PM. Supportive interventions for carers of men with prostate cancer: systematic review and narrative synthesis. BMJ Support Palliat Care 2023:spcare-2022-004034. [PMID: 37263759 DOI: 10.1136/spcare-2022-004034] [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: 10/24/2022] [Accepted: 04/27/2023] [Indexed: 06/03/2023]
Abstract
PURPOSE The objective of this study was to summarise the literature on current interventions available for carers of men with prostate cancer and analyse the outcomes of these interventions in supporting carers' needs. METHODS A systematic review was conducted, searching databases MEDLINE, PsycINFO, CINAHL, Scopus and Cochrane, using terms related to prostate cancer, carers and interventions. Randomised controlled trials and non-randomised controlled trials of interventions for informal carers with or without patients were included. Data were analysed using descriptive and frequency statistics; interventions and their impact on carers' outcomes were reported on narratively. The SwiM guidelines were applied to guide data synthesis. RESULTS Overall, 24 articles were included in the review. On average, participants were spouses (92%) and women (97%). Interventions largely rwere delivered face-to-face (42%) or used a combination of face to face and online modalities (38%). Two-thirds (63%) showed a significant improvement in carer's outcomes including psychological, sexual, physical and relationship/marital. The majority of studies (79%) tailored contents to carers' circumstances, most within a couples counselling format. Over one-third (42%) of studies focused on a range of supportive care needs, most commonly were psychological (58%), sexual (42%) and informational (25%). CONCLUSIONS Interventions for carers of men with prostate cancer were largely face to face, patient-spouse focused and two-thirds had some measurable impact on carer's outcomes. Research continues to underserve other patient-carer roles, including non-spousal carers. Interventions delivered solely for carers are required to meet gaps in care, and determine the impact on carer outcomes. Further research and more targeted interventions are needed. PROSPERO REGISTRATION NUMBER CRD42021249870.
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Affiliation(s)
- Natalie Winter
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
| | - Hannah Jongebloed
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
| | - Anna Green
- Centre for Health Research, Faculty of Sciences, University of Southern Queensland, Springfield, Queensland, Australia
| | - Anna Ugalde
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research in the Institute for Health Transformation, Deakin University, Burwood, Victoria, Australia
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Walker LM, Wiebe E, Turner J, Driga A, Andrews-Lepine E, Ayume A, Stephen J, Glaze S, Booker R, Doll C, Phan T, Brennan K, Robinson JW. The Oncology and Sexuality, Intimacy, and Survivorship Program Model: An Integrated, Multi-disciplinary Model of Sexual Health Care within Oncology. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:377-385. [PMID: 31797198 DOI: 10.1007/s13187-019-01641-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Cancer-related sexual dysfunction is documented as one of the most distressing and long-lasting survivorship concerns of cancer patients. Canadian cancer patients routinely report sexuality concerns and difficulty getting help. In response to this gap in care, clinical practice guidelines were recently published in the Journal of Clinical Oncology. A sweeping trend is the creation of specialized clinics for patients' sexual health concerns. However, this much-needed attempt to address this service gap can be difficult to sustain without addressing the cancer care system from a broader perspective. Herein, we describe the implementation of a tiered systemic model of cancer-related sexual health programming in a tertiary cancer center. This program follows the Permission, Limited Information, Specific Suggestions, Intensive Therapy (PLISSIT) model, used previously for guiding individual practitioners. Visually, the model resembles a pyramid. The top 2 levels, corresponding to Intensive Therapy and Specific Suggestions, are comprised of group-based interventions for common cancer-related sexual concerns and a multi-disciplinary clinic for patients with complex concerns. The bottom 2 levels, corresponding to Permission and Limited Information, consist of patient education and provider education and consultation services. We describe lessons learned during the development and implementation of this program, including the necessity for group-based services to prevent inundation of referrals to the specialized clinic, and the observation that creating specialized resources also increased the likelihood that providers would inquire about patients' sexual concerns. Such lessons suggest that successful sexual health programming requires services from a systemic approach to increase sustainability.
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Affiliation(s)
- Lauren M Walker
- University of Calgary, Calgary, AB, Canada.
- Tom Baker Cancer Centre, Calgary, AB, Canada.
| | - Ericka Wiebe
- University of Alberta, Edmonton, AB, Canada
- Cross Cancer Institute, Edmonton, AB, Canada
| | - Jill Turner
- University of Alberta, Edmonton, AB, Canada
- Cross Cancer Institute, Edmonton, AB, Canada
| | - Amy Driga
- University of Alberta, Edmonton, AB, Canada
- Cross Cancer Institute, Edmonton, AB, Canada
| | | | | | | | - Sarah Glaze
- University of Calgary, Calgary, AB, Canada
- Tom Baker Cancer Centre, Calgary, AB, Canada
| | | | - Corinne Doll
- University of Calgary, Calgary, AB, Canada
- Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Tien Phan
- University of Calgary, Calgary, AB, Canada
- Tom Baker Cancer Centre, Calgary, AB, Canada
| | | | - John W Robinson
- University of Calgary, Calgary, AB, Canada
- Tom Baker Cancer Centre, Calgary, AB, Canada
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Syrjala KL, Schoemans H, Yi JC, Langer SL, Mukherjee A, Onstad L, Lee SJ. Sexual Functioning in Long-Term Survivors of Hematopoietic Cell Transplantation. Transplant Cell Ther 2020; 27:80.e1-80.e12. [PMID: 33002641 DOI: 10.1016/j.bbmt.2020.09.027] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 09/18/2020] [Accepted: 09/22/2020] [Indexed: 12/21/2022]
Abstract
This investigation characterized sexual activity and sexual function in hematopoietic cell transplantation (HCT) survivors, compared them with norms, and examined factors associated with sexual dysfunction, with the goal of identifying targets for intervention to improve sexual health. Surviving adults from a large transplantation center were asked to complete an annual survey with a core of health questions and a module on sexual activity and function. Participants completed the Sexual Function Questionnaire, Cancer and Treatment Distress form, and Revised Dyadic Adjustment Scale. Clinical data were collected from the transplantation medical database. Multivariate logistic regressions identified factors associated with sexual activity and function. Participating survivors (n = 1742) were a mean of 11.9 years (range, .4 to 43.1 years) after HCT, mean age 57.6 years, and 53% male. Women were more likely than men to report being sexually inactive in the past year (39% versus 27%) and, among those sexually active, to report low sexual function (64% versus 32%). Male and female survivors reported lower rates of sexual activity and function than comparison norms (all P < .01). In regressions, factors associated with being sexually inactive included older age, having <4 years of college education, low performance status, and not being in a committed relationship. Additional factors for men included receipt of nonmyeloablative conditioning and not being employed or in school. Low sexual functioning for men and women was associated with low performance status, and, for women, a committed relationship of lower quality, while for men the association was with older age. Sexual dysfunction is common in both men and women after HCT, regardless of time since treatment. Survivors need routine evaluation and access to multimodal interventions.
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Affiliation(s)
- Karen L Syrjala
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Psychiatry and Behavioral Science and Department of Medicine, University of Washington School of Medicine, Seattle, Washington.
| | - Hélène Schoemans
- Department of Hematology, University Hospitals Leuven and KU Leuven, Leuven, Belgium
| | - Jean C Yi
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Shelby L Langer
- Center for Health Promotion and Disease Prevention, Edson College of Nursing and Health Innovation, Arizona State University, Phoenix, Arizona
| | - Ahona Mukherjee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Lynn Onstad
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington
| | - Stephanie J Lee
- Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, Washington; Department of Psychiatry and Behavioral Science and Department of Medicine, University of Washington School of Medicine, Seattle, Washington
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4
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Bossio JA, Miller F, O'Loughlin JI, Brotto LA. Sexual Health Recovery For Prostate Cancer Survivors: The Proposed Role Of Acceptance And Mindfulness-Based Interventions. Sex Med Rev 2019; 7:627-635. [PMID: 31029619 DOI: 10.1016/j.sxmr.2019.03.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 02/22/2019] [Accepted: 03/07/2019] [Indexed: 12/17/2022]
Abstract
INTRODUCTION 1 in every 7 Canadian men is affected by prostate cancer. Given impressive advances in detection, treatment, and survival rates, there is a considerable focus on survivors' supportive care needs. Among the top unmet supportive care needs for prostate cancer survivors are concerns related to sexual health and intimacy. AIM To provide a rationale for introducing mindfulness- and acceptance-based approaches into the role of psychosexual interventions aimed at improving sexual satisfaction among prostate cancer survivors (and their partners). METHODS A literature review was performed to examine the prevalence of sexual difficulties after prostate cancer treatment and the efficacy of current pharmacologic and psychological treatment approaches. MAIN OUTCOME MEASURE The main outcome measure was focused on sexual satisfaction in prostate cancer survivors. RESULTS Current pharmacologic interventions for sexual difficulties after prostate cancer treatment are not fully meeting the needs of prostate cancer survivors and their partners. Conclusions cannot be drawn from existing psychological interventions because of methodologic inconsistencies. Additionally, the focus on erectile function as a measure of treatment effectiveness is likely to instill a greater sense of hopelessness and loss for prostate cancer survivors, which may exacerbate issues around sexual intimacy and satisfaction. An impressive body of evidence supports the role of mindfulness in improving women's sexual functioning and there is preliminary evidence suggesting the efficacy of this approach for improving men's sexual functioning. CONCLUSION We propose that psychosexual interventions that prioritize mindfulness and acceptance-based frameworks may help men to tune into sensations while challenging the foci on performance and erections, thereby increasing the potential for improvement to sexual satisfaction among prostate cancer survivors. Bossio JA, Miller F, O'Loughlin JI, et al. Sexual Health Recovery for Prostate Cancer Survivors: The Proposed Role of Acceptance and Mindfulness-Based Interventions. Sex Med Rev 2019;7:627-635.
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Affiliation(s)
- Jennifer A Bossio
- Queen's University, Departments of Gynecology, and Urology, Kingston, Ontario, Canada
| | - Faith Miller
- University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Lori A Brotto
- University of British Columbia, Vancouver, British Columbia, Canada.
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Elliott S, Matthew A. Sexual Recovery Following Prostate Cancer: Recommendations From 2 Established Canadian Sexual Rehabilitation Clinics. Sex Med Rev 2017; 6:279-294. [PMID: 29199096 DOI: 10.1016/j.sxmr.2017.09.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2017] [Revised: 09/12/2017] [Accepted: 09/23/2017] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Supportive sexual health care is much-needed adjuvant care to oncologic management for men with prostate cancer (PCa). AIM To inspire the initiation of biopsychosocial sexual health programming where it does not exist and to inform program enhancement in existing sexual rehabilitation clinics (SRCs). METHODS This article reviews the combined 30-year experience of 2 well-established Canadian SRCs for men and their partners after PCa treatments, interwoven with empirical evidence. MAIN OUTCOME MEASURE To comprehensively review the biopsychosocial approach to sexual health assessment of men with PCa and their partners to direct the practicalities of running a successful and sustainable SRC. RESULTS A full description of the biomedical and psychosocial approaches, inclusive of comprehensive sexual function, the penile rehabilitation controversy, and other medical and relationship issues affecting sexual adjustment, is provided to highlight the relevance of proper assessment and follow-through for sexual adaptation and adjustment. 10 recommendations for a successful SRC are discussed, including the principles behind developing a sustainable business plan, staff acquisition and training, budget, integration of treatment and research priorities, respectful and multidisciplinary approaches to care, and suggestions of visit formats, protocols, and questionnaires. We recommend a phased approach of an SRC into usual care with the option to provide accessible and equitable care to patients not within proximal access of treating institutions. CONCLUSION Sexual rehabilitation after treatment for PCa requires a complex treatment process. Providing sustainable sexual rehabilitation programming under the financially strained environment of the Canadian medical system is a challenge; therefore, to provide Canadian patients and their partners with comprehensive cancer care, they deserve a biopsychosocial approach combined with a creative and systematic implementation strategy. Elliott S, Matthew A. Sexual Recovery Following Prostate Cancer: Recommendations From 2 Established Canadian Sexual Rehabilitation Clinics. Sex Med Rev 2018;6:279-294.
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Affiliation(s)
- Stacy Elliott
- Prostate Cancer Supportive Care Program, Prostate Center, Vancouver Hospital, Department of Urological Sciences, University of British Columbia, Vancouver, BC, Canada; BC Center for Sexual Medicine, Vancouver Coastal Health Authority, Department of Psychiatry, University of British Columbia, Vancouver, BC, Canada.
| | - Andrew Matthew
- Cancer Clinical Research Unit, Princess Margaret Cancer Centre, University Health Network, Department of Surgery (Division of Urology) and Psychiatry, University of Toronto, Toronto, ON, Canada
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Jonsdottir JI, Jonsdottir H, Klinke ME. A systematic review of characteristics of couple-based intervention studies addressing sexuality following cancer. J Adv Nurs 2017; 74:760-773. [DOI: 10.1111/jan.13470] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2017] [Indexed: 01/18/2023]
Affiliation(s)
- Jona Ingibjorg Jonsdottir
- Faculty of Nursing; School of Health Sciences; University of Iceland; Reykjavik Iceland
- Landspitali - The National University Hospital of Iceland; Reykjavik Iceland
| | - Helga Jonsdottir
- Faculty of Nursing; School of Health Sciences; University of Iceland; Reykjavik Iceland
- Landspitali - The National University Hospital of Iceland; Reykjavik Iceland
| | - Marianne E. Klinke
- Faculty of Nursing; School of Health Sciences; University of Iceland; Reykjavik Iceland
- Landspitali - The National University Hospital of Iceland; Reykjavik Iceland
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7
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Primeau C, Paterson C, Nabi G. A Qualitative Study Exploring Models of Supportive Care in Men and Their Partners/Caregivers Affected by Metastatic Prostate Cancer. Oncol Nurs Forum 2017; 44:E241-E249. [DOI: 10.1188/17.onf.e241-e249] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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8
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Wittmann D, Mehta A, Northouse L, Dunn R, Braun T, Duby A, An L, Arab L, Bangs R, Bober S, Brandon J, Coward M, Dunn M, Galbraith M, Garcia M, Giblin J, Glode M, Koontz B, Lowe A, Mitchell S, Mulhall J, Nelson C, Paich K, Saigal C, Skolarus T, Stanford J, Walsh T, Pollack CE. TrueNTH sexual recovery study protocol: a multi-institutional collaborative approach to developing and testing a web-based intervention for couples coping with the side-effects of prostate cancer treatment in a randomized controlled trial. BMC Cancer 2017; 17:664. [PMID: 28969611 PMCID: PMC5625773 DOI: 10.1186/s12885-017-3652-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 09/22/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Over half of men who receive treatment for prostate suffer from a range of sexual problems that affect negatively their sexual health, sexual intimacy with their partners and their quality of life. In clinical practice, however, care for the sexual side effects of treatment is often suboptimal or unavailable. The goal of the current study is to test a web-based intervention to support the recovery of sexual intimacy of prostate cancer survivors and their partners after treatment. METHODS The study team developed an interactive, web-based intervention, tailored to type of treatment received, relationship status (partnered/non-partnered) and sexual orientation. It consists of 10 modules, six follow the trajectory of the illness and four are theme based. They address sexual side effects, rehabilitation, psychological impacts and coaching for self-efficacy. Each includes a video to engage participants, psychoeducation and activities completed by participants on the web. Tailored strategies for identified concerns are sent by email after each module. Six of these modules will be tested in a randomized controlled trial and compared to usual care. Men with localized prostate cancer with partners will be recruited from five academic medical centers. These couples (N = 140) will be assessed prior to treatment, then 3 months and 6 months after treatment. The primary outcome will be the survivors' and partners' Global Satisfaction with Sex Life, assessed by a Patient Reported Outcome Measure Information Systems (PROMIS) measure. Secondary outcomes will include interest in sex, sexual activity, use of sexual aids, dyadic coping, knowledge about sexual recovery, grief about the loss of sexual function, and quality of life. The impact of the intervention on the couple will be assessed using the Actor-Partner Interaction Model, a mixed-effects linear regression model able to estimate both the association of partner characteristics with partner and patient outcomes and the association of patient characteristics with both outcomes. DISCUSSION The web-based tool represents a novel approach to addressing the sexual health needs of prostate cancer survivors and their partners that-if found efficacious-will improve access to much needed specialty care in prostate cancer survivorship. TRIAL REGISTRATION Clinicaltrials.gov registration # NCT02702453 , registered on March 3, 2016.
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Affiliation(s)
- D Wittmann
- University of Michigan, 2800 Plymouth Road, Bldg. 16, Rm 110E, Ann Arbor, MI, 48109-2800, USA.
| | - A Mehta
- Emory University, Atlanta, GA, USA
| | - L Northouse
- University of Michigan, 2800 Plymouth Road, Bldg. 16, Rm 110E, Ann Arbor, MI, 48109-2800, USA
| | - R Dunn
- University of Michigan, 2800 Plymouth Road, Bldg. 16, Rm 110E, Ann Arbor, MI, 48109-2800, USA
| | - T Braun
- University of Michigan, 2800 Plymouth Road, Bldg. 16, Rm 110E, Ann Arbor, MI, 48109-2800, USA
| | - A Duby
- University of Michigan, 2800 Plymouth Road, Bldg. 16, Rm 110E, Ann Arbor, MI, 48109-2800, USA
| | - L An
- University of Michigan, 2800 Plymouth Road, Bldg. 16, Rm 110E, Ann Arbor, MI, 48109-2800, USA
| | - L Arab
- University of California-Los Angeles, California, Los Angeles, USA
| | - R Bangs
- University of Michigan, 2800 Plymouth Road, Bldg. 16, Rm 110E, Ann Arbor, MI, 48109-2800, USA
| | - S Bober
- Dana Farber Cancer Center and Harvard University, Boston, MA, USA
| | - J Brandon
- University of Michigan, 2800 Plymouth Road, Bldg. 16, Rm 110E, Ann Arbor, MI, 48109-2800, USA
| | - M Coward
- University of North Carolina, Chapel Hill, NC, USA
| | - M Dunn
- University of North Carolina, Chapel Hill, NC, USA
| | - M Galbraith
- University of Colorado-Denver, Denver, CO, USA
| | - M Garcia
- University of California-San Francisco, San Francisco, CA, USA
| | - J Giblin
- Emory University, Atlanta, GA, USA
| | - M Glode
- University of Colorado-Denver, Denver, CO, USA
| | - B Koontz
- Duke University, Durham, NC, USA
| | - A Lowe
- Prostate Cancer Foundation-Australia, St Leonards, Australia
| | - S Mitchell
- University of Michigan, 2800 Plymouth Road, Bldg. 16, Rm 110E, Ann Arbor, MI, 48109-2800, USA
| | - J Mulhall
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - C Nelson
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - K Paich
- TrueNTH Movember Foundation, Michigan, USA
| | - C Saigal
- University of California-Los Angeles, California, Los Angeles, USA
| | - T Skolarus
- University of Michigan, 2800 Plymouth Road, Bldg. 16, Rm 110E, Ann Arbor, MI, 48109-2800, USA
- VA Ann Arbor Healthcare System, HSRD Center for Clinical Management Research, Ann Arbor, USA
| | - J Stanford
- Fred Hutchinson Comprehensive Cancer Center, Seattle, Washington, USA
- University of Washington, Seattle, Washington, USA
| | - T Walsh
- University of Washington, Seattle, Washington, USA
| | - C E Pollack
- Johns Hopkins University, Baltimore, MD, USA
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Evidence Supporting Couple-Based Interventions for the Recovery of Sexual Intimacy After Prostate Cancer Treatment. CURRENT SEXUAL HEALTH REPORTS 2017. [DOI: 10.1007/s11930-017-0095-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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10
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Walker LM, King N, Kwasny Z, Robinson JW. Intimacy after prostate cancer: A brief couples' workshop is associated with improvements in relationship satisfaction. Psychooncology 2016; 26:1336-1346. [PMID: 27197037 DOI: 10.1002/pon.4147] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2015] [Revised: 02/16/2016] [Accepted: 03/30/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Prostate cancer (PCa) treatments often leave men with erectile dysfunction (ED). Even when ED treatments are effective in restoring men's ability to have an erection sufficient for intercourse, couples continue to struggle sexually. Effective treatments to help couples recover sexually are needed. METHOD PCa patients and partners (N = 59 couples) attending a one-time couples' intimacy workshop, participated in an evaluation. The workshop, offered eight times over a 2-year period, emphasized a couples-based approach to treatment that enhances direct communication about sexuality and implementation of sexual recovery strategies that are consistent with the couple's values. Couples completed pre and post questionnaires (at baseline and 2 months later) assessing the primary outcome of relationship adjustment (Revised Dyadic Adjustment Scale) and secondary outcome of sexual function (Sexual Function Questionnaire). T-tests were employed to examine pre-post changes in scores. A small qualitative sub-study was conducted on the use of a Commitment to Change goal-setting exercise, completed during the workshop. RESULTS Results provide insight into the specific nature of improvements. Patients and partners showed improvements in relationship satisfaction. Improvements with small-to-medium effect sizes were observed for patients and partners sexual function; however, after adjusting for multiple comparisons, these changes were no longer statistically significant. The specific goals set by couples, and their achievement status, are presented. CONCLUSIONS The workshop offers a comprehensive, one-session intervention to help couples implement a treatment plan to promote sexual recovery after PCa treatment. Given the observed improvements, progression to a randomized control trial is warranted. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- Lauren M Walker
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Tom Baker Cancer Centre, Psychosocial & Rehabilitation Oncology, Calgary, AB, Canada
| | - Ngaire King
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Zoe Kwasny
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - John W Robinson
- Division of Psychosocial Oncology, Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada.,Tom Baker Cancer Centre, Psychosocial & Rehabilitation Oncology, Calgary, AB, Canada.,Department of Psychology, University of Calgary, Calgary, AB, Canada
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12
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Core principles of sexual health treatments in cancer for men. Curr Opin Support Palliat Care 2016; 10:38-43. [PMID: 26814146 DOI: 10.1097/spc.0000000000000183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The considerable prevalence of sexual health problems in men after cancer treatment coupled with the severity of impact and challenges to successful intervention make sexual dysfunction one of the most substantial health-related quality of life burdens in all of cancer survivorship. Surgeries, radiation therapies, and nontreatment (e.g., active surveillance) variously result in physical disfigurement, pain, and disruptions in physiological, psychological, and relational functioning. Although biomedical and psychological interventions have independently shown benefit, long-term, effective treatment for sexual dysfunction remains elusive. RECENT FINDINGS Recognizing the complex nature of men's sexual health in an oncology setting, there is a trend toward the adoption of a biopsychosocial orientation that emphasizes the active participation of the partner, and a broad-spectrum medical, psychological, and social approach. Intervention research to date provides good insight into the potential active ingredients of successful sexual rehabilitation programming. SUMMARY Combining a biopsychosocial approach with these active intervention elements forecasts an optimistic future for men's sexual rehabilitation programming within oncology. However, significant gaps remain in our understanding of patient experience and appropriate sexual health intervention for gay men and men of diverse race and culture.
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Oliffe JL, Mróz LW, Bottorff JL, Braybrook DE, Ward A, Goldenberg SL, Goldenberg LS. Heterosexual couples and prostate cancer support groups: a gender relations analysis. Support Care Cancer 2014; 23:1127-33. [PMID: 25527241 DOI: 10.1007/s00520-014-2562-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 12/07/2014] [Indexed: 12/25/2022]
Abstract
INTRODUCTION Men diagnosed with prostate cancer (PCa) can receive supportive care from an array of sources including female partners and prostate cancer support groups (PCSGs). However, little is known about how heterosexual gender relations and supportive care play out among couples who attend PCSGs. Distilling such gender relation patterns is a key to understanding and advancing supportive care for men who experience PCa and their families. PURPOSE This study describes connections between heterosexual gender relations and PCa supportive care among couples who attend PCSGs. METHOD In-depth, individual interviews with 30 participants (15 men treated for PCa and their female partners) were analyzed using interpretive descriptive methods. Couples were asked about their relationships, supportive care needs, and attendance at PCSGs. A heterosexual gender relations framework was used to theorize the findings. RESULTS Findings showed that traditional heterosexual gender relations guided most couples' PCa-related support both in and out of PCSGs. Three themes were inductively derived: "Not pushing too hard"-balancing women's support with men's autonomy, "Confreres"-men supporting men at PCSGs, and "Women are better at reassuring"-support from and for women. CONCLUSIONS Couples both aligned to and resisted traditional gender roles to accommodate, explain, and rationalize how, as a couple, they approached PCa supportive care needs.
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Affiliation(s)
- John L Oliffe
- School of Nursing, University of British Columbia, T201-2211 Wesbrook Mall, Vancouver, BC, V6T 2B3, Canada,
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Dowsett GW, Lyons A, Duncan D, Wassersug RJ. Flexibility in Men's Sexual Practices in Response to Iatrogenic Erectile Dysfunction after Prostate Cancer Treatment. Sex Med 2014; 2:115-20. [PMID: 25356308 PMCID: PMC4184491 DOI: 10.1002/sm2.32] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
INTRODUCTION Prostate cancer (PCa) treatments are associated with a high incidence of erectile dysfunction (ED). Interventions to help men with iatrogenic ED have largely focused on penile tumescence adequate for vaginal penetration. Less research has been undertaken on sex practices other than penile/vaginal intercourse. AIM The aim of this study was to explore forms of sexual practice engaged in by men following treatment for PCa. We focused in particular on anal intercourse (AI) as practiced by both nonheterosexual (i.e., gay-identified men and other men who have sex with men) and heterosexual men. We sought to determine how common AI was subsequent to PCa treatment and how flexible AI practitioners were in their modes (e.g., from insertive to receptive) when faced with iatrogenic ED. METHODS An international online survey was conducted in 2010-2011 of men treated for PCa, where participants (N = 558) were asked explicitly about their sexual practices before and after PCa treatment. MAIN OUTCOME MEASURES The outcome measures were the numbers and percentages of men who practiced AI before and after PCa treatment as well as the percentage who changed AI practice after PCa treatment. RESULTS Five hundred twenty-six men (90 nonheterosexual men; 436 heterosexual men) answered questions on AI practices. A proportion of nonheterosexual (47%) and heterosexual men (7%) practiced AI following PCa treatment, and did so in all modes (insertive, receptive, and "versatile"). Many nonheterosexual men continued to be sexually active in the face of iatrogenic ED by shifting from the insertive to receptive modes. A few men, both heterosexual and nonheterosexual, adopted AI for the first time post-PCa treatment. CONCLUSIONS Flexibility in sexual practice is possible for some men, both nonheterosexual and heterosexual, in the face of iatrogenic ED. Advising PCa patients of the possibilities of sexual strategies that include AI may help them in reestablishing a sex life that is not erection dependent. Dowsett GW, Lyons A, Duncan D, and Wassersug RJ. Flexibility in men's sexual practices in response to iatrogenic erectile dysfunction after prostate cancer treatment. Sex Med 2014;2:115-120.
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Affiliation(s)
- Gary W Dowsett
- Australian Research Centre in Sex, Health and Society, La Trobe University Melbourne, Victoria, Australia
| | - Anthony Lyons
- Australian Research Centre in Sex, Health and Society, La Trobe University Melbourne, Victoria, Australia
| | - Duane Duncan
- Australian Research Centre in Sex, Health and Society, La Trobe University Melbourne, Victoria, Australia
| | - Richard J Wassersug
- Australian Research Centre in Sex, Health and Society, La Trobe University Melbourne, Victoria, Australia
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Psychosocial interventions to support partners of men with prostate cancer: a systematic and critical review of the literature. J Cancer Surviv 2014; 8:472-84. [PMID: 24752701 DOI: 10.1007/s11764-014-0361-7] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2013] [Accepted: 03/31/2014] [Indexed: 12/12/2022]
Abstract
PURPOSE Prostate cancer poses many challenges for both the man and his partner. Partners have reported a range of issues that impact their own mental health following their partner's diagnosis of prostate cancer. The aim of this review is to summarise and critically evaluate the current literature reporting psychosocial intervention studies for partners of prostate cancer patients. METHODS An extensive literature search of electronic databases was conducted (OvidMEDLINE 1946, 26th September 2013, and psychINFO 1967, 26th September 2013) using the keywords prostate cancer AND intervention* OR therapy* OR psychosocial intervention* OR support* AND couple* or Spouse* or Partner* or Intimate partner* matched to the title as well as secondary scanning of reference lists. Studies were included if they described interventions for partners of prostate cancer patients, either solely for the partners or as a couple, intended to alleviate distress and enhance the partner's or couple's quality of life, and reported a measurable outcome for partners. RESULTS A total of 11 prostate cancer-specific intervention studies that included partners and reported separate results for the partners were found. Only one of these interventions was partner specific, the other eight involved the patient-partner dyad. The studies identified primarily focussed on two areas: emotional distress and sexual intimacy, and mixed findings were reported for efficacy of interventions. CONCLUSIONS Despite strong evidence that partners of men with prostate cancer experience difficulties associated with the impact of prostate cancer, there is limited research that has investigated the efficacy of psychosocial interventions for partners. Of the reviewed studies, it is evident that interventions targeting the reduction of emotional distress, improved communication and sexual intimacy between the couple and utilisation of strategies that enable partners to express their distress, learn new strategies and implement behavioural change show the most promising results in enhancing partner well-being. IMPLICATIONS FOR CANCER SURVIVORS Significant progress is required in developing and evaluating appropriate and effective psychosocial support interventions for partners of prostate cancer survivors as partners appear to have significant unmet needs in this area.
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