Psychological functioning associated with prostate cancer: cross-sectional comparison of patients treated with radiotherapy, brachytherapy, or surgery

Effect of nurse-physician collaboration on the incidence of complications, negative emotions and quality of life in cervical cancer patients: a randomized controlled study

The aim of this study was to evaluate the effect of nurse-physician collaboration on the incidence of complications, anxiety and depression, quality of life, and satisfaction with nursing care among cervical cancer patients undergoing three-dimensional intracavitary brachytherapy. In this randomized, single-blinded, placebo-controlled trial, 92 eligible cervical cancer patients were equally divided into two groups upon admission. The control group was given routine nursing, and the intervention group received a nurse-physician collaboration in addition to routine care. Anxiety, depression, and health-related quality of life in both groups were assessed and compared at baseline and discharge. The intervention group had significantly fewer complications and showed marked improvements in mental health and quality of life compared to the control group. Satisfaction with nursing care was substantially greater in the intervention group. These results support the clinical adoption of a nurse-physician collaborative care model in the management of cervical cancer with three-dimensional intracavitary brachytherapy.

Determinants of Cancer-Related Fatigue among Cancer Patients: A Systematic Review

Objectives: This systematic review aims to assess and explore various determinants of cancer- related fatigue. Methods: A systematic search of various determinants of Cancer-related fatigue (CRF) was performed in different databases like PubMed, Google Scholar, Science Direct and Clinical Key dating from 1990 to September 2020. Results: A total of 6115 studies were screened and 95 articles related to determinants of fatigue were retained. Various modifiable and non-modifiable determinants including socio-demographic, clinical, treatment related, plasma biomarker related, genetic, behavioural, concurrent symptoms related and psychological determinants were identified. Depression was one of the significant factors reported in 28% of studies, followed by pain, (17%), performance status (16%), chemotherapy and anxiety (15%). Conclusion: It is recommended that nurses and clinicians should anticipate, identify and take appropriate interventions to manage those modifiable factors. Ultimately, managing the modifiable factors helps in the comprehensive care of cancer patients.

Understanding Sleep Disturbances in Prostate Cancer-A Scientometric Analysis of Sleep Assessment, Aetiology, and Its Impact on Quality of Life

Prostate cancer is the most commonly diagnosed cancer in the United Kingdom. While androgen-deprivation therapy is the most common treatment for prostate cancer, patients undergoing this treatment typically experience side effects in terms of sleep disturbances. However, the relation between prostate cancer and sleep and the way in which sleep interventions may benefit oncological patients is underinvestigated in the literature. The current study aims to review in a data-driven approach the existing literature on the field of prostate cancer and sleep to identify impactful documents and major thematic domains. To do so, a sample of 1547 documents was downloaded from Scopus, and a document co-citation analysis was conducted on CiteSpace software. In the literature, 12 main research domains were identified as well as 26 impactful documents. Research domains were examined regarding the link between prostate cancer and sleep, by taking into account variations in hormonal levels. A major gap in the literature was identified in the lack of use of objective assessment of sleep quality in patients with prostate cancer.

Role of prehabilitation following major uro-oncologic surgery: a narrative review

PURPOSE

Functional status and physical independence play a key role in terms of quality of life, access to treatment, and continuity of care. Surgery, a central component of cancer treatments, leads to detrimental effects on functional capacity, which can be peculiarly relevant in vulnerable patients undergoing major procedures. Prehabilitation is a multidisciplinary intervention that uses the preoperative period to prevent or attenuate treatment-related functional decline and its subsequent consequences. This paper narratively reviews the rationale and the evidence of prehabilitation for uro-oncologic surgery.

METHODS

A narrative review was conducted in August 2020, aiming to: (1) identify and discuss the impact of modifiable determinants of postoperative outcomes in urology and (2) review randomized controlled trials (RCT) exploring the role of preoperative exercise, nutrition, and psychological interventions in uro-oncologic surgery.

RESULTS

Eight RCTs on preoperative conditioning interventions met the inclusion criteria, focusing on radical cystectomy for bladder cancer (RC) and radical prostatectomy for prostate cancer (RP). There is strong evidence that poor physical, nutritional and psychosocial status negatively impacts on surgical outcomes. Single modality interventions, such as preoperative exercise or nutrition alone, had no effect on 'traditional' surgical outcomes as length of stay or complication. However, multimodal approaches targeting postoperative functional status have shown to be effective and safe.

CONCLUSION

There is initial evidence on the effectiveness and safety of multimodal prehabilitation in preserving functional capacity following RC and RP. However, to date, outcomes such as complications and length of stay seem to be not affected by prehabilitation.

Prostate Cancer and Sleep Disorders: A Systematic Review

Simple Summary

Longer survival times for prostate cancer patients due to efficient treatments consisting of local radiotherapy, prostatectomy and androgen-deprivation therapy, as well as androgen-receptor-targeted agents, increases the importance of side effect management. Sleep disturbances are higher in this group than the general population and no clear mechanism(s) explains this. This systematic review finds a reported effect in 14 of 16 included studies on sleep quality changes for these patients. All reported treatments showed some kind of negative effect on sleep quality, including ADT. Limitations are discussed and recommendations made for progressing the understanding and then for mitigation strategies of these side effects.

Abstract

Prostate cancer (PCa) treatment involves multiple strategies depending on the disease’s stage. Androgen deprivation therapy (ADT) remains the gold standard for advanced and metastatic stages. Sleep quality has been suggested as being additionally influenced also by local radiotherapy, prostatectomy and androgen-receptor (AR)-targeted agents. We performed a systematic review exploring the landscape of studies published between 1 January 1990 and 31 July 2021, investigating sleep disturbances in PCa patients receiving active treatments, including the influence of hormonal therapy on sleep quality as a factor affecting their quality of life. Out of 45 articles identified, 16 studies were selected, which recruited patients with PCa, undergoing active treatment in either a prospective longitudinal or cross-sectional study. Development of sleep disorders or changes in sleep quality were reported in 14 out of 16 trials included. Only five trials included objective measurements such as actigraphy, mostly at one time point and without a baseline assessment. Limitations to be addressed are the small number of existing trials, lack of randomized trials and heterogeneity of methodologies used. This systematic review outlines the lack of prospective trials investigating sleep disorders, with a rigorous methodology, in homogeneous cohorts of PCa patients. Future trials are needed to clarify the prevalence and impact of this side effect of PCa treatments.

The relationship between sleep hygiene, mood, and insomnia symptoms in men with prostate cancer

PURPOSE

Insomnia symptoms are commonly experienced by men after prostate cancer (PCa) treatment. Here we explored how sleep hygiene behaviours and psychological symptoms are associated with insomnia symptoms in PCa patients.

METHODS

An online survey was posted on social media and sent to mailing lists of PCa and general cancer organisations. The survey collected information on demographic, sleep hygiene, and psychological symptoms using validated questionnaires.

RESULTS

Data from 142 participants were compared based on the absence (age = 68.3 ± 8.9 years) and presence (age = 66.6 ± 9.0 years) of insomnia symptoms. Participants with insomnia symptoms had significantly higher levels of anxiety, depression, fatigue, and sleepiness as well as poorer sleep hygiene than those without insomnia symptoms. Control variables (age, number of comorbidities, and BMI) accounted for 11.9% of the variance in insomnia symptoms. Including treatment history contributed to an additional 1.6% of the variance in insomnia symptoms. Adding sleepiness, fatigue, anxiety, and depressive symptoms to the model explained an additional 44.6% of the variance in insomnia symptoms. Furthermore, including the sleep hygiene item 'I think, plan, or worry when I am in bed' and 'I sleep in an uncomfortable bedroom' explained an additional 3.6% of the variance in insomnia symptoms.

CONCLUSIONS

Poor sleep hygiene, fatigue, sleepiness, anxiety, and depressive symptoms were all associated with worse insomnia symptoms in PCa patients. Improving sleep hygiene and treating psychological conditions may potentially help prevent and/or alleviate insomnia symptoms in PCa patients.

Post-Treatment Adverse Health Correlates among Prostate Cancer Survivors in a Sample of Men Residing in Atlantic Canada

BACKGROUND

Recent large population-based studies have shed light on an association between prostate cancer (PCa) survivorship and mental health, which emerged when the comparison group was either men without a history of cancer or those with any other type of cancer except prostate. Here we examine the role of surgery alone, compared to other types of treatment modalities in this association in a population-based sample of men with prostate or other types of cancer.

METHODS

A cross-sectional analysis was conducted on a subsample of 632 male participants aged 36-69 from the 2009-2015 survey cycle of the Atlantic PATH cohort study. The primary outcomes were the presence of mild, moderate or severe depression or anxiety indicators and were assessed using the seven-item generalized anxiety disorder (GAD-7) scale and the nine-item Patient Health Questionnaire (PHQ-9), respectively. The presence of a lifetime history of PCa or other form of cancer (except PCa) was the main predictor variable and was assessed in cancer treatment modality (surgery or other types of treatment modalities) stratified analyses. Covariates included age, marital status, household income, comorbidity, and survivorship time.

RESULTS

The presence of depression in this sample was prevalent among 17.7% of men, and of anxiety among 9.3% of men. Survivors who were treated with surgery for their PCa diagnosis had 7.55 statistically significantly higher odds of screening positive for current depression symptoms compared with those of other forms of cancer in controlled analyses. These differences were not observed for anxiety.

CONCLUSIONS

These findings emphasize the need for multidisciplinary survivorship care plans among PCa patients, especially those who undergo surgery. Targeted programming aimed at prioritizing and delivering comprehensive mental health support to PCa survivors early in the survivorship journey is justified.

Prevalence of Fatigue in Patients With Cancer: A Systematic Review and Meta-Analysis

CONTEXT

Fatigue is a particularly common and troubling symptom that has a negative impact on quality of life throughout all phases of treatment and stages of the illness among patients with cancer.

OBJECTIVES

The objective of this meta-analysis is to examine the present status of fatigue prevalence in patients with cancer.

METHODS

The following databases were searched: PubMed, MEDLINE, EMBASE, PsycINFO, Cochrane Library, from inception up to February 2020. Prevalence rates were pooled with meta-analysis using a random-effects model. Heterogeneity was tested using I-squared (I²) statistics.

RESULTS

A total of 129 studies (N = 71,568) published between 1993 and 2020 met the inclusion criteria. The overall prevalence of fatigue was 49% (34,947 of 71,656 participants, 95% CI = 45-53) with significant heterogeneity between studies (P < 0.000; τ² = 0.0000; I² = 98.88%). Subgroup analyses show that the prevalence of fatigue related to type of cancer ranged from 26.2% in patients with gynecological cancer to 56.3% in studies that included mixed types of cancer. In advanced cancer stage patients, the highest prevalence of fatigue (60.6%) was reported. Fatigue prevalence rates were 62% during treatment and 51% during mixed treatment status. The prevalence of fatigue decreased from 64% in studies published from 1996 to 2000 to 43% in studies published from 2016 to 2020. Metaregression identified female gender as a significant moderator for higher prevalence of fatigue, whereas mean age is not associated with fatigue.

CONCLUSION

This meta-analysis highlights the importance of developing optimal monitoring strategies to reduce fatigue and improve the quality of life of patients with cancer.

Measuring psychosocial outcomes of men living with prostate cancer: feasibility of regular assessment of patient-reported outcomes

OBJECTIVE

To trial collecting patient-reported outcome measures (PROMs) to assess psychosocial outcomes in men with prostate cancer (PC).

METHODS

A cross-sectional postal survey was sent to three groups of 160 men with PC (6, 12 and 24 months post-initial treatment; n_total  = 480), through the South Australian Prostate Cancer Clinical Outcomes Collaborative (SAPCCOC) registry (2017). Outcomes were as follows: response rate, completeness, general and disease-specific quality of life, distress, insomnia, fear of recurrence, decisional difficulties and unmet need.

RESULTS

A response rate of 57-61% (n = 284) was achieved across groups. Data completeness was over 90% for 88% of survey items, with lower response (76-78%) for EPIC-26 urinary and sexual functioning subscales, sexual aid use (78%) and physical activity (68%). In general, higher socio-economic indicators were associated with higher completion of these measures (absolute difference 12-26%, p < 0.05). Lower unmet need on the sexuality domain (SCNS-SF34) was associated with lower completion of the EPIC-26 sexual functioning subscale [M (SD) = 12.4 (21.6); M (SD) = 26.3 (27.3), p < .001]. Worse leaking urine was associated with lower completion of urinary pad/diaper use question (EPIC-26) [M (SD) = 65.9 (26.5), M (SD) = 77.3 (23.9), p < .01].

CONCLUSION

Assessment of psychosocial PROMs through a PC registry is feasible and offers insight beyond global quality of life assessment, to facilitate targeting and improvements in services and treatments.

Sexual health needs and psychosocial well-being of patients with prostate cancer in a regional cancer Center

Prostate cancer is the most common cancer for men. The cancer diagnosis and treatment can affect patients' psychosocial and sexual health. The purpose of this research project was to identify the sexual health concerns of patients with prostate cancer. An anonymous survey was administered to patients while accessing Grand River Regional Cancer Center (GRRCC) that included measures of sexual health and perceived stress and social support, ratings for preferred modes of sexual health programming, and open-ended questions on sexual health and masculinity. Seventy-five patients completed the survey; their mean age was 73.9 years (SD 7.2), the majority were in a couple relationship and identified as heterosexual. The concerns most endorsed were physical changes in sexual functioning and being able to satisfy their partner sexually. These findings can inform sexual health programming and psychosocial oncology for men with prostate cancer.

Anxiety and depression symptoms in adult males in Atlantic Canada with or without a lifetime history of prostate cancer

OBJECTIVE

Prostate cancer (PCa) is the most prevalent form of cancer among men and has one of the most favorable survival rates among all cancers. Here we examine the association between depression and anxiety symptoms in a population-based sample of men.

METHODS

A cross-sectional analysis was conducted on a subsample of 6 585 male participants aged 49-69 from 2009 to 2015 survey cycle of the Atlantic PATH. Mild, moderate or severe depression or anxiety indicators were primary outcomes and were assessed using the Generalized Anxiety Disorder (GAD-7) scale and the Patient Health Questionnaire (PHQ-9). The presence of a lifetime history of PCa, other forms of cancer (except PCa) or absence of either was the main predictor variable.

RESULTS

An estimated 3.9% of men self-identified as having had a history of PCa diagnosis, 11.3% of men identified as having had a history of other forms of cancer and 84.9% reported never having had a diagnosis of cancer in their lifetime, respectively. Survivors of PCa had 2.45 or 2.05 statistically significantly higher odds of screening positive for current anxiety or depressive symptoms, respectively, compared with those who identified as without a lifetime history of any form of cancer in controlled analyses (including survivorship time).

CONCLUSIONS

Increased rates of anxiety and depression among men with a history of PCa highlight the need for mental health screening among PCa survivors. The findings highlight the importance of a multidisciplinary effort to prioritize and deliver comprehensive mental health support to PCa survivors.

A Phase 2 Randomized Pilot Study Comparing High-Dose-Rate Brachytherapy and Low-Dose-Rate Brachytherapy as Monotherapy in Localized Prostate Cancer

Purpose

To compare health-related quality of life (HRQOL) of high-dose-rate brachytherapy (HDRB) versus low dose-rate brachytherapy (LDRB) for localized prostate cancer in a multi-institutional phase 2 randomized trial.

Methods and Materials

Men with favorable-risk prostate cancer were randomized between monotherapy brachytherapy with either Iodine-125 LDRB to 144 Gy or single-fraction Iridium-192 HDRB to 19 Gy. HRQOL and urinary toxicity were recorded at baseline and at 1, 3, 6, and 12 months using the Expanded Prostate Cancer Index Composite (EPIC)-26 scoring and the International Prostate Symptom Score (IPSS). Independent samples t test and mixed effects modeling were performed for continuous variables. Time to IPSS resolution, defined as return to its baseline score ±5 points, was calculated using Kaplan-Meier estimator curves with the log-rank test. A multiple-comparison adjusted P value of ≤.05 was considered significant.

Results

LDRB and HDRB were performed in 15 and 16 patients, respectively, for a total of 31 patients. At 3 months, patients treated with LDRB had a higher IPSS score (mean, 15.5 vs 6.0, respectively; P = .003) and lower EPIC urinary irritative score (mean, 69.2 vs 85.3, respectively; P = .037) compared with those who received HDRB. On repeated measures at 1, 3, 6, and 12 months, the IPSS (P = .003) and EPIC urinary irritative scores (P = .019) were significantly better in the HDR arm, translating into a lower urinary toxicity profile. There were no significant differences in the EPIC urinary incontinence, sexual, or bowel habit scores between the 2 groups at any measured time point. Time to IPSS resolution was significantly shorter in the HDRB group (mean, 2.0 months) compared with the LDRB group (mean, 6.0 months; P = .028).

Conclusions

HDRB monotherapy is a promising modality associated with a lower urinary toxicity profile and higher HRQOL in the first 12 months compared with LDRB.

Effects of concentrated long-chain omega-3 polyunsaturated fatty acid supplementation before radical prostatectomy on prostate cancer proliferation, inflammation, and quality of life: study protocol for a phase IIb, randomized, double-blind, placebo-controlled trial

BACKGROUND

Prostate cancer is the most commonly diagnosed cancer in north-American men. Few dietary or lifestyle interventions have been tested to prevent prostate cancer progression. Omega-3 fatty acid supplementation represents a promising intervention for prostate cancer patients. The aim of the study is to evaluate the effects of long-chain omega-3 polyunsaturated fatty acids (LCn3), more precisely eicosapentaenoic acid monoacylglyceride (MAG-EPA) supplementation, on prostate cancer proliferation, inflammation mediators and quality of life among men who will undergo radical prostatectomy.

METHODS/DESIGN

We propose a phase IIb, randomized, double-blind placebo-controlled trial of MAG-EPA supplementation for 130 men who will undergo radical prostatectomy as treatment for a prostate cancer of Gleason score ≥ 7 in an academic cancer center in Quebec City. Participants will be randomized to 6 capsules of 625 mg of fish oil (MAG-EPA) per capsule containing 500 mg of EPA daily or to identically looking capsules of high oleic acid sunflower oil (HOSO) as placebo. The intervention begins 4 to 10 weeks prior to radical prostatectomy (baseline) and continues for one year after surgery. The primary endpoint is the proliferative index (Ki-67) measured in prostate cancer cells at radical prostatectomy. A secondary endpoint includes prostate tissue levels of inflammatory mediators (cytokines and proteins) at time of radical prostatectomy. Changes in blood levels of inflammatory mediators, relative to baseline levels, at time of radical prostatectomy and 12 months after radical prostatectomy will also be evaluated. Secondary endpoints also include important aspects of psychosocial functioning and quality of life such as depression, anxiety, sleep disturbances, fatigue, cognitive complaints and prostate cancer-specific quality of life domains. The changes in these outcomes, relative to baseline levels, will be evaluated at 3, 6, 9 and 12 months after radical prostatectomy.

DISCUSSION

The results from this trial will provide crucial information to clarify the role of omega-3 supplementation on prostate cancer proliferation, inflammation and quality of life.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02333435. Registered on December 17, 2014. Last updated September 6, 2016.

Prevalence and Correlates of Major Depressive Symptoms among Black Men with Prostate Cancer

Objectives

The objectives of our study were to determine the prevalence of major depressive symptoms and identify factors that are associated with major depressive symptoms among Black men with prostate cancer (PCa).

Design

This study consisted of 415 Black men aged 40-81 years that entered the North Carolina Central Cancer Registry during the years 2007-2008. The primary outcome variable was depressive symptoms (CES-D). Factors included age, income, education, insurance status, treatment received, time between diagnosis and treatment, Gleason score, medical mistrust and experience with racism/discrimination. Logistic regression models were used to assess factors associated with the odds of having major depressive symptoms.

Results

The prevalence of major depressive symptoms (≥16 on CES-D) among our sample of Black men with PCa was approximately 33%. Approximately 15% of the study participants underwent radiation beam treatment. Age was significantly associated with the odds of reporting major depressive symptoms (OR= .95, CI .91-.99) among Black men. In addition, compared with all other forms of treatment, Black men who underwent radiation beam treatment had higher odds (OR=2.38, CI 1.02- 5.51) of reporting major depressive symptoms.

Conclusion

Nearly one-third of Black men with PCa in this study reported major depressive symptoms. Clinicians should pay closer attention to the mental health status of Black men with PCa, especially those who are younger and those who have undergone radiation beam treatment. Cancer survivorship, particularly quality of life, may be enhanced by opportunities for assessment, evaluation and intervention of depressive symptoms among these men disproportionately affected by PCa.

Psychosocial screening for patients with prostate cancer: The development and validation of the psychosocial distress questionnaire-prostate cancer

We describe the psychosocial distress questionnaire-prostate cancer (PDQ-PC), a psychosocial screening list developed and validated specifically for prostate cancer patients. An existing screening list, the psychosocial distress questionnaire-breast cancer (PDQ-BC), was used as a starting point. Two focus groups were then implemented to investigate which items of the PDQ-BC were relevant for the PDQ-PC and which new items were needed. Validity and reliability of the questionnaire were assessed on 278 prostate cancer patients. Factor analysis showed that the 36-item PDQ-PC comprises eight subscales, for which the internal consistency ranged from α = 0.48-0.88. Moreover, moderate to high convergent validity was found.

A longitudinal study on anxiety, depressive and adjustment disorder, suicide ideation and symptoms of emotional distress in patients with cancer undergoing radiotherapy

BACKGROUND

The aim of this study is to evaluate the presence of anxiety, depressive and adjustment disorders, suicide ideation, and symptoms of anxiety and depression in patients with cancer before (T1), and after radiotherapy (T2) and at the 1-month follow-up (T3).

METHODS

A longitudinal study on 103 patients with cancer treated as outpatients undergoing radiotherapy was carried out, evaluating them three times (T1-T2-T3) according to DSM-IV criteria with the Mini-International Neuropsychiatric Interview and the Hospital Anxiety and Depression Scale.

RESULTS

Prevalence of the depressive disorders was: T1=6.8%, T2=3.9% and T3=3.9%; for anxiety disorders: T1=16.5%, T2=18.4% and T3=16.5%; for adjustment disorder: 10.7%, 5.8% and 7.8%; and for suicide ideation: T1=11.7%, T2=7.8% and T3=7.8%. In all, the presence of disorders was: T1=35%, T2=26.2%0.4% and T3=29.1%. At least one mental disorder was diagnosed in 46.6% of patients in one of the three times of the study. In relation to the symptoms, the prevalence of the possible cases of clinical anxiety was: T1=35.9%, T2=18.4% and T3=22.3%; the prevalence of possible cases of clinical depression was 19.4%, 16.5% and 10.7%, respectively; and the prevalence of emotional distress was 27.2%, 17.5% and 18.4%, respectively. All symptoms decreased significantly from T1 to T2 and from T1 to T3, with moderate effect sizes. No changes were observed between the end of the radiotherapy and the follow-up period.

CONCLUSIONS

High prevalence of mental disorders and symptoms of anxiety, depression and distress were observed in the patients with cancer before finishing radiotherapy treatment and during the follow-up.

FUNDING

Basurto University Hospital and Basque Foundation for Innovation and Research in Health-BIOEF.

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.

Mode of prostate cancer detection is associated with the psychological wellbeing of survivors: results from the PiCTure study

PURPOSE

Many men with prostate cancer are asymptomatic, diagnosed following prostate specific antigen (PSA) testing. We investigate whether mode of detection, i.e. 'PSA detected' or 'clinically detected', was associated with psychological wellbeing among prostate cancer survivors.

METHODS

A cross-sectional postal questionnaire was administered in 2012 to 6559 prostate cancer (ICD10 C61) survivors up to 18 years post-diagnosis, identified through population-based cancer registries in Ireland. Psychological wellbeing was assessed using the Depression Anxiety Stress Scale-21. Logistic regression was used to investigate associations between mode of detection and depression, anxiety and stress, adjusting for socio-demographic and clinical confounders.

RESULTS

The response rate was 54 % (3348/6262). Fifty-nine percent of survivors were diagnosed with asymptomatic PSA-tested disease. Prevalence of depression (13.8 vs 20.7 %; p < 0.001), anxiety (13.6 vs 20.9 %; p < 0.001) and stress (8.7 vs 13.8 %; p < 0.001) were significantly lower among survivors diagnosed with PSA-detected, than clinically detected disease. After adjusting for clinical and socio-demographic factors, survivors with clinically detected disease had significantly higher risk of depression (odds ratio (OR) = 1.46 95 % CI 1.18, 1.80; p = 0.001), anxiety (OR = 1.36 95 % CI 1.09, 1.68; p = 0.006) and stress (OR = 1.43 95 % CI 1.11, 1.85; p = 0.006) than survivors with PSA-detected disease.

CONCLUSIONS

These findings contribute to the ongoing debate on benefits and risks of PSA testing and may be considered by policy makers formulating population-based prostate cancer screening policies. The relatively high prevalence of negative psychological states among survivors means that a 'risk-adapted approach' should be implemented to screen survivors most at risk of psychological morbidity for psychological health, and mode of detection could be considered as a risk stratum.

Sleep quality and depressive symptoms after prostate cancer: The mechanistic role of cortisol

A substantial portion of men treated for prostate cancer report clinically significant sleep problems and disturbance in sleep quality constitutes significant risk for the development of depressive symptoms in survivors. Dysregulation in biological stress processes underlies the impact of poor sleep on the onset and/or progression of depressive symptoms, yet few studies have sought to identify potential neurobiological mechanisms (e.g., HPA axis activation) underlying this association in PC survivors. The present study examines the relationships between sleep disturbance, depressive symptoms, and indices of diurnal cortisol patterns among men treated for prostate cancer. In total, 66 men (84.8% White; mean age = 65.8 years, SD = 9.04) treated in the prior 2 years for localized prostate cancer were recruited. They completed questionnaires to measure sleep quality and depressive symptoms at study entry (T1) and 4 months later (T2). They also provided 4 saliva samples per day, over 3 days, at T1. Three cortisol indices were computed: diurnal slope, area under the curve (AUCg), and cortisol awakening response (CAR). Analyses indicate that, controlling for body mass index and age, worse sleep quality at T1 was significantly associated with higher levels of depressive symptoms at T2. Significant indirect effects were observed for cortisol slope (indirect effect = -.17, 95% CI [-.61, -.01]) and AUCg (indirect effect = -.14, 95% CI [-.43, -.01]), but not CAR. Results suggest that dysregulation in HPA activity acts as a neurobiological mechanism of the impact of sleep disruption on depressive symptoms in men with prostate cancer. (PsycINFO Database Record

Consultation audio-recording reduces long-term decision regret after prostate cancer treatment: A non-randomised comparative cohort study

INTRODUCTION

The life expectancy of prostate patients is long and patients will spend many years carrying the burdens & benefits of the treatment decisions they have made, therefore, it is vital that decisions on treatments are shared between patient and physician. The objective was to determine if consultation audio-recording improves quality of life, reduces regret or improves patient satisfaction in comparison to standard counselling.

PATIENTS AND METHODS

In 2012 we initiated consultation audio-recordings, where patients are given a CD of their consultation to keep and replay at home. We conducted a prospective non-randomised study of patient satisfaction, quality of life (QOL) and decision regret at 12 months follow-up using posted validated questionnaires for the audio-recording (AR) patients and a control cohort. Qualitative and thematic analyses were used.

RESULTS

Forty of 59 patients in the AR group, and 27 of 45 patients in the control group returned the questionnaires. Patient demographics were similar in both groups with no statistically significant differences between the two groups. Decision regret was lower in the audio-recording group (11/100) vs control group (19/100) (p = 0.04). The risk ratio for not having any long-term decision regret was 5.539 (CI 1.643-18.674), with NNT to prevent regret being 4. Regression analysis showed that receiving audio-recording was strongest predictor for absence of regret even greater than potency and incontinence.

CONCLUSION

The study has shown that audio-recording clinic consultation reduces long-term decision regret, increases patient information recall, understanding and confidence in their decision. There is great potential for further expansion of this low-cost intervention.

Preliminary results of a randomised controlled trial of an online psychological intervention to reduce distress in men treated for localised prostate cancer

BACKGROUND

Prostate cancer (PCa) poses many emotional and physical challenges for men following treatment. The unmet support needs of these men are well documented, and access to psychosocial support remains problematic.

OBJECTIVES

To assess the efficacy of an online psychological intervention for men who have localised PCa.

DESIGN, SETTING, AND PARTICIPANTS

We undertook a randomised controlled trial to evaluate the intervention. Participants were randomly allocated to one of three conditions: My Road Ahead (MRA) alone (MRA Only), MRA plus access to an online forum (MRA+Forum), and access to the forum alone (Forum).

INTERVENTION

The intervention was a 10-week self-guided online psychological intervention called My Road Ahead that consisted of six themed modules designed to facilitate improved emotional well-being in the context of PCa as well as a moderated peer forum.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

Pre- and postintervention assessments of psychological distress (the 21-question Depression, Anxiety and Stress Scale) [1] and the Prostate Cancer-related Quality of Life scale [2] were conducted. Multivariate analysis of variance, regression, and structural equation modelling were used to analyse the data.

RESULTS AND LIMITATIONS

In total, 142 participants were randomly allocated to one of the three intervention arms. The mean age of participants was 61 yr of age (standard deviation: 7), and 88% had undergone radical prostatectomy. A significant improvement in psychological distress was observed for participants who had access to the combined condition (MRA+Forum) with a moderate effect size (p=0.02; partial η(2)=0.07). In particular, the decline in the mean level of psychological distress was 8.8 units larger for the MRA+Forum group than the Forum group (95% confidence interval [CI], 0.9-16.7). Although the decline in the mean level of psychological distress was 7.0 units larger for the MRA+Forum group than for the MRA Only group, this difference was not significant (95% CI, 1.1-15.1). Structural equation modelling indicated that reductions in health worry and regret contributed significantly to the reductions in psychological distress for the MRA+Forum condition.

CONCLUSIONS

This study is the first, to our knowledge, that has evaluated a self-guided online psychological intervention tailored to the specific needs of men who have PCa. The findings of this study indicate the potential for this programme to deliver support that men may not otherwise receive.

PATIENT SUMMARY

This study found that men who have localised prostate cancer who received access to the online psychological intervention called My Road Ahead combined with the online peer discussion forum had significantly improved reductions in distress compared with those who received access to the online intervention alone or the forum alone.

Impact of counselling on quality of life and sleep in cancer patients

It has been acknowledged that poor quality of sleep significantly correlates with poor quality of life; evidence suggests that counselling has a positive impact not only on the cancer patient's quality of life, but also on family members and friends. The aim of this service evaluation was to determine if there was an improvement in clients' quality of life and sleep patterns following counselling as offered by a local cancer charity. A total of 60 matched pre- and post-counselling questionnaires were completed and subjected to statistical analysis. When considering quality of life, in the domains of Role Emotional, Mental Health and Mental Component Summary Score, it can be concluded that counselling has a positive effect on emotional health and mental wellbeing. The mean total number of hours sleep per night significantly increased from 6 hours sleep per night at baseline to 6.8 hours sleep per night at the completion of counselling (p=0.005) showing clients gained an extra 48 minutes sleep per night. The improved emotional and mental wellbeing alongside the extra 48 minutes sleep per night provides evidence that there is a positive outcome for those patients and families who use counselling services. Nurses and other members of the multidisciplinary team should be encouraged to discuss supportive therapies with patients and those affected by cancer at all stages of the cancer trajectory, regardless of social status, gender or cancer type.

Failure to address potential bias in non-randomised controlled clinical trials may cause lack of evidence on patient-reported outcomes: a method study

OBJECTIVES

We conducted a workup of a previously published systematic review and aimed to analyse why most of the identified non-randomised controlled clinical trials with patient-reported outcomes did not match a set of basic quality criteria.

SETTING

There were no limits on the level of care and the geographical location.

PARTICIPANTS

The review evaluated permanent interstitial low-dose rate brachytherapy in patients with localised prostate cancer and compared that intervention with alternative procedures such as external beam radiotherapy, radical prostatectomy and no primary therapy.

PRIMARY OUTCOME MEASURE

Fulfilment of basic inclusion criteria according to a Participants, Interventions, Comparisons, Outcomes (PICO) framework and accomplishment of requirements to contain superimposed risk of bias.

RESULTS

We found that 21 of 50 excluded non-randomised controlled trials did not meet the PICO inclusion criteria. The remaining 29 studies showed a lack in the quality of reporting. The resulting flaws included attrition bias due to loss of follow-up, lack of reporting baseline data, potential confounding due to unadjusted data and lack of statistical comparison between groups.

CONCLUSIONS

With respect to the reporting of patient-reported outcomes, active efforts are required to improve the quality of reporting in non-randomised controlled trials concerning permanent interstitial low-dose rate brachytherapy in patients with localised prostate cancer.

Measuring psychosocial functioning in the radiation oncology clinic: a systematic review

BACKGROUND

This paper aimed to systematically review the (1) prevalence, (2) risk factors, (3) interventions, and (4) measurement instruments associated with psychosocial function decline in radiation therapy (RT) patients.

METHODS

A MEDLINE systematic literature review was performed to identify studies monitoring psychosocial function among RT patients as a primary endpoint.

RESULTS

Fifty-seven and 22 risk factors for RT-related psychosocial function decline were identified and refuted, respectively, in 93 eligible studies representing 12,808 patients. Median prevalences of psychosocial function decline prior to, during, and following RT were 20%, 36%, and 25%. Prior to RT, anxiety was more prevalent than depression (20% vs 15%), but dropped following completion of RT, whereas median depression levels remained elevated (17% vs. 27%). Of the 79 identified risk factors, 17 were reported as predictive of psychosocial decline by two or more more studies, and five had robust support: (1) physical symptoms, (2) time point during RT, (3) chemotherapy reception, (4) female gender, and (5) younger age. Three interventions were consensually reported to improve psychosocial function: psychotherapy, nursing consultation/patient education, and self-management training. Eighty-six different assessment tools were used to monitor RT-related psychosocial function decline with the Hospital Anxiety and Depression Scale (25.8%) and the psychiatric interview (22.6%) being the most utilized. The distress thermometer has been used in 5 studies (5.4%) to date.

CONCLUSION

Psychosocial function declines in approximately one-third of RT patients. Anxiety can dissipate after initiation of RT, whereas depression can persist throughout and after RT. Severe physical symptoms and time-related factors most robustly predict psychosocial function decline, which can be improved by psychotherapy and interventions aimed to improve patient education.

Cancer-related fatigue in patients before and after radical prostatectomy. Results of a prospective multi-centre study

PURPOSE

A multi-centre, longitudinal study was conducted to assess the prevalence of fatigue amongst men with localized prostate cancer, to describe several dimensions of fatigue and to explore the predictability of fatigue by psychological distress and physical function.

METHODS

The prevalence of fatigue was evaluated using the Multidimensional Fatigue Inventory in 329 prostate cancer patients before, 3, 6 and 12 months after surgery. Psychological distress was assessed using the Hospital Anxiety and Depression Scale. Physical function was measured using the EORTC QLQ-C30.

RESULTS

After surgery, about 14 % of the patients were screened with chronic fatigue. For all dimensions of fatigue, only small longitudinal changes could be observed. Psychological distress could be identified as a good predictor of fatigue after but not before surgery.

CONCLUSIONS

Radical prostatectomy has no or little impact on the prevalence of fatigue. However, about 14 % of patients with chronic fatigue could possibly benefit from psychosomatic interventions. Interventions should consider the simultaneous appearance of fatigue and psychological distress and a reduced physical function.

Depression and anxiety in prostate cancer: a systematic review and meta-analysis of prevalence rates

OBJECTIVES

To systematically review the literature pertaining to the prevalence of depression and anxiety in patients with prostate cancer as a function of treatment stage.

DESIGN

Systematic review and meta-analysis.

PARTICIPANTS

4494 patients with prostate cancer from primary research investigations.

PRIMARY OUTCOME MEASURE

The prevalence of clinical depression and anxiety in patients with prostate cancer as a function of treatment stage.

RESULTS

We identified 27 full journal articles that met the inclusion criteria for entry into the meta-analysis resulting in a pooled sample size of 4494 patients. The meta-analysis of prevalence rates identified pretreatment, on-treatment and post-treatment depression prevalences of 17.27% (95% CI 15.06% to 19.72%), 14.70% (95% CI 11.92% to 17.99%) and 18.44% (95% CI 15.18% to 22.22%), respectively. Pretreatment, on-treatment and post-treatment anxiety prevalences were 27.04% (95% CI 24.26% to 30.01%), 15.09% (95% CI 12.15% to 18.60%) and 18.49% (95% CI 13.81% to 24.31%), respectively.

CONCLUSIONS

Our findings suggest that the prevalence of depression and anxiety in men with prostate cancer, across the treatment spectrum, is relatively high. In light of the growing emphasis placed on cancer survivorship, we consider that further research within this area is warranted to ensure that psychological distress in patients with prostate cancer is not underdiagnosed and undertreated.

My Road Ahead study protocol: a randomised controlled trial of an online psychological intervention for men following treatment for localised prostate cancer

Background

There is a need for psychosocial interventions for men with prostate cancer to promote adaptive coping with the challenges and distress associated with diagnosis, treatment and recovery. In addition, interventions are needed that help to overcome barriers to psychosocial treatment such as limited face-to-face psychosocial support services, a shortage of adequately trained professionals, geographical distance, perceived and personal stigma and a preference for consumer-centric and self-directed learning. My Road Ahead is an online cognitive behaviour therapy (CBT) intervention for prostate cancer. This protocol describes a randomised controlled trial (RCT) that will evaluate the efficacy of this online intervention alone, the intervention in combination with a moderated online forum, and the moderated online forum alone.

Methods/design

This study utilises a RCT design with three groups receiving: 1) the 6-module My Road Ahead intervention alone; 2) the My Road Ahead intervention plus a moderated online forum; and 3) the moderated online forum alone. It is expected that 150 men with localised prostate cancer will be recruited into the RCT. Online measures will assess men’s psychological distress as well as sexual and relationship adjustment at baseline, post-intervention, 3 month follow-up and 6 month follow-up. The study is being conducted in Australia and participants will be recruited from April 2012 to Feb 2014. The primary aim of this study is to evaluate the efficacy of My Road Ahead in reducing psychological distress.

Discussion

To our knowledge, My Road Ahead is the first self-directed online psychological intervention developed for men who have been treated for localised prostate cancer. The RCT will assess the efficacy of this intervention in improving psychological well-being, sexual satisfaction, relationship satisfaction and overall quality of life. If successful, this intervention could provide much needed support to men receiving treatment for localised prostate cancer in a highly accessible manner.

Trial registration

Australian New Zealand Clinical Trials Registry Identifier: ACTRN12611000278932

The effects of low- and high-dose-rate brachytherapy on depressive symptoms in prostate cancer patients

OBJECTIVE

To compare the prevalence of depressive symptoms between prostate cancer (PCa) patients who have received low-dose-rate brachytherapy (LDRB) and those receiving high-dose-rate brachytherapy (HDRB).

METHOD

Direct comparisons were made between the prevalence of the DSM-IV-TR symptoms of major depressive disorder (MDD) based upon Zung Self-Rating Depression Scale responses and patients' records on 164 PCa patients from Queensland, Australia.

RESULTS

HDRB patients had significantly greater frequency of self-reported symptoms of crying (or feeling like it) (MDD criterion 1), and restlessness and inability to sit still (MDD criterion 5), and a nonsignificant trend towards more frequent fatigue (MDD criterion 7). There was no significant association between fatigue and having received hormone therapy.

CONCLUSION

These three MDD symptoms, which include one of the two alternative key required symptoms (criterion 1), suggest that HDRB PCa patients may present with clinically significantly different depression profiles from their peers who receive LDRB. Treatment choices need to be focused upon possible serotonergic dysfunction as well as somatic complaints of depression. The presence of subsyndromal depression in HDRB patients also warrants consideration.

Association of symptoms and cytokines in prostate cancer patients receiving radiation treatment

INTRODUCTION

Men with prostate cancer undergoing radiation treatment frequently report fatigue, insomnia, depression, anxiety and urinary, bowel, sexual, and hormonal symptoms. Plasma concentrations of cytokines may be related to these symptoms, but few studies have examined these relationships. The study purpose was to explore the association between prostate cancer symptoms and cytokine levels at pretreatment and posttreatment.

METHOD

In this longitudinal, correlational study, 29 men with nonmetastatic prostate cancer completed symptom questionnaires at preradiation and postradiation treatment. Blood drawn at these same time points was used to determine levels of tumor necrosis factor-alpha (TNF-α) and interleukins-1β, 6, 10, and 4 (IL-1β, IL-6, IL-10, and IL-4).

RESULTS

Men reported symptom severity at pretreatment and posttreatment as low to moderate. There were significant differences from pretreatment to posttreatment in fatigue, insomnia, urinary irritative and incontinence, bowel, sexual, and hormonal problems. There were no significant differences in TNF-α, IL-6, IL-10, or IL-4. At pretreatment, TNF-α was associated with depression, anxiety, urinary irritative, and bowel problems, and IL-4 was related to urinary irritative symptoms. At posttreatment, IL-4 was associated with urinary irritative symptoms. Findings suggest that, in men with prostate cancer, there is no strong association between symptom reporting and cytokine levels. Ongoing research focused on neuroendocrine and genetic markers and their associations with symptoms is promising and may result in the provision of better markers for quantifying the symptom experience in patients with cancer.

A randomised, wait-list controlled trial: evaluation of a cognitive-behavioural group intervention on psycho-sexual adjustment for men with localised prostate cancer

OBJECTIVE

To examine the effectiveness of a cognitive-behavioural therapy (CBT) group intervention to facilitate improved psycho-sexual adjustment to treatment side effects in prostate cancer survivors post-radical prostatectomy.

METHODS

A randomised, wait-list controlled trial was conducted with a total of 60 men who participated in a manualised 8-week cognitive-behavioural group intervention 6 months to 5 years post-radical prostatectomy for localised prostate cancer. Participants completed standardised questionnaires pre-intervention and post-intervention, which assessed mood state, stress, general and prostate cancer anxiety, quality of life and areas of sexual functioning.

RESULTS

Paired samples t-tests identified a significant improvement in sexual confidence, masculine self-esteem, sexual drive/relationship and a significant decline in sexual behaviour from pre-intervention to post-intervention. Hierarchical regression analyses revealed that after controlling for covariates, participation in the group intervention significantly improved sexual confidence, sexual intimacy, masculine self-esteem and satisfaction with orgasm.

CONCLUSIONS

This group-based CBT intervention for men post-radical prostatectomy for localised prostate cancer shows promising results in terms of improving quality of life.

The prevalence and severity of fatigue in men with prostate cancer: a systematic review of the literature

BACKGROUND

Cancer-related fatigue is a significant clinical problem and is a symptom commonly experienced by patients with differing cancer types during and following treatment. It is a distressing symptom which interferes with functioning in daily life. However, much less is known about the prevalence and severity of fatigue in prostate cancer when compared to other cancer types, such as breast cancer.

METHODS

A systematic review was conducted to appraise the prevalence and severity of cancer-related fatigue in prostate cancer. Systematic searches of published quantitative research relating to the prevalence and severity of fatigue were conducted using databases, including Medline, PsychINFO, CINAHL and ISI Web of Knowledge (January 2012). Included papers measured the prevalence or severity of prostate-cancer-related fatigue and differentiated fatigue outcomes (prevalence, severity) between treatment modalities.

RESULTS

Nineteen studies were eligible for the review, of which 17 were cross-sectional and 2 longitudinal. Findings suggest that the prevalence of any fatigue is as high as 74%, whilst chronic fatigue prevalence was highest (39%) when hormone therapy was combined with radiotherapy. Fatigue severity is reported as worse in hormone therapy and treatment combining hormone therapy and radiotherapy.

CONCLUSIONS

Fatigue is a common symptom for men with prostate cancer, particularly those prescribed hormone therapy. A wide variety of tools were used to measure fatigue prevalence and severity, which made comparisons across studies difficult. The review is limited by methodological shortcomings in the studies included.

Quality of life issues in men undergoing androgen deprivation therapy: a review

Androgen deprivation therapy (ADT) has been an essential treatment option for treating prostate cancer (PCa). The role for hormonal treatment initially was restricted to men with metastatic and inoperable, locally advanced disease. Now it has been extended to neoadjuvant or adjuvant therapy for surgery and radiotherapy, for biochemical relapse after surgery or radiation, and even as primary therapy for non-metastatic disease. Fifty percent of PCa patients treated will receive ADT at some point. There is growing concern about the adverse effects and costs associated with more widespread ADT use. The adverse effects on quality of life (QoL), including physical, social and psychological well-being when men are androgen-deprived, may be considerable. This review examines the QoL issues in the following areas: body feminisation, sexual changes, relationship changes, cognitive and affective symptoms, fatigue, sleep disturbance, depression and physical effects. Further suggestions for therapeutic approaches to reduce these alterations are suggested.

Clinically relevant fatigue in recurrence-free prostate cancer survivors

BACKGROUND

Little is known about the prevalence and associations of clinically relevant fatigue (CRF) in recurrence-free prostate cancer survivors.

PATIENTS AND METHODS

Four hundred and sixteen recurrence-free prostate cancer survivors who were >1 year post-radiotherapy or radical prostatectomy were surveyed. The prevalence of CRF (defined as Brief Fatigue Inventory >3) was determined and compared with a noncancer control group. Other measures included the Hospital Anxiety and Depression Scale, International Prostate Symptom Score, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. Relationships between these factors and CRF were explored in univariate and multivariate analyses.

RESULTS

Analyzable data were obtained from 91% (377/416) of patients. The prevalence of CRF was 29% (108/377) versus 16% (10/63) in the controls (P=0.031). CRF was more common in post-radiotherapy than in post-prostatectomy 33% (79/240) versus 22% (29/133), P=0.024. However, when other factors (current depression, anxiety, urinary symptoms, medical comorbidities, pain and insomnia) were controlled for, previous treatment did not predict CRF. Current depression [Hospital Anxiety and Depression Scale≥8 was by far the strongest association [odds ratio 9.9, 95% confidence interval 4.2-23.5)].

CONCLUSIONS

Almost one-third of recurrence-free prostate cancer survivors report CRF. Depression, anxiety, urinary symptoms, pain and insomnia measured at outcome are more strongly associated than type of cancer treatment previously received.

The burden of depression in prostate cancer

OBJECTIVE

We sought to analyze the prevalence and incremental burden of depression among elderly with prostate cancer.

METHODS

We adopted a retrospective cohort design using the Surveillance, Epidemiology and End Results-Medicare linked database between 1995 and 2003. Patients with prostate cancer diagnosed between 1995 and 1998 were identified and followed retrospectively for 1 year pre-diagnosis and up to 8 years post diagnosis. In this cohort of patients with prostate cancer, depression during treatment phase (1 year after diagnosis of prostate cancer) or in the follow-up phase was identified using the International Classification of Diseases-Ninth Revision depression-related codes. Poisson, general linear (log-link) and Cox regression models were used to determine the association between depression status during treatment and follow-up phases and outcomes-health resource utilization, cost and mortality.

RESULTS

Of the 50,147 patients newly diagnosed with prostate cancer, 4285 (8.54%) had a diagnosis of depression. A diagnosis of depression during treatment phase was associated with higher odds of emergency room visits (odds ratio (OR) = 4.45, 95% CI = 4.13, 4.80), hospitalizations (OR = 3.22, CI = 3.08, 3.37), outpatient visits (OR = 1.71, CI = 1.67, 1.75) and excess risk of death over the course of the follow-up interval (hazard ratio = 2.82, CI = 2.60, 3.06). Health care costs associated with depression remained elevated compared with costs for men without depression, over the course of the follow-up.

CONCLUSIONS

Depression during the treatment phase was associated with significant health resource utilization, costs and mortality among men with prostate cancer. These findings emphasize the need to effectively identify and treat depression in the setting of prostate cancer.

Low-dose rate brachytherapy for men with localized prostate cancer

BACKGROUND

Localized prostate cancer is a slow growing tumor for many years for the majority of affected men. Low-dose rate brachytherapy (LDR-BT) is short-distance radiotherapy using low-energy radioactive sources. LDR-BT has been recommended for men with low risk localized prostate cancer.

OBJECTIVES

To assess the benefit and harm of LDR-BT compared to radical prostatectomy (RP), external beam radiotherapy (EBRT), and no primary therapy (NPT) in men with localized prostatic cancer.

SEARCH STRATEGY

The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (from 1950), and EMBASE (from 1980) were searched in June 2010 as well as online trials registers and reference lists of reviews.

SELECTION CRITERIA

Randomized, controlled trials comparing LDR-BT versus RP, EBRT, and NPT in men with clinically localized prostate cancer.

DATA COLLECTION AND ANALYSIS

Data on study methods, participants, treatment regimens, observation period and outcomes were recorded by two reviewers independently.

MAIN RESULTS

We identified only one RCT (N = 200; mean follow up 68 months). This trial compared LDR-BT and RP. The risk of bias was deemed high. Primary outcomes (overall survival, cause-specific mortality, or metastatic-free survival) were not reported. Biochemical recurrence-free survival at 5 years follow up was not significantly different between LDR-BT (78/85 (91.8%)) and RP (81/89 (91.0%)); P = 0.875; relative risk 0.92 (95% CI: 0.35 to 2.42).For severe adverse events reported at 6 months follow up, results favored LDR-BT for urinary incontinence (LDR-BT 0/85 (0.0%) versus RP 16/89 (18.0%); P < 0.001; relative risk 0) and favored RP for urinary irritation (LDR-BT 68/85 (80.0%) versus RP 4/89 (4.5%); P < 0.001; relative risk 17.80, 95% CI 6.79 to 46.66). The occurrence of urinary stricture did not significantly differ between the treatment groups (LDR-BT 2/85 (2.4%) versus RP 6/89 (6.7%); P = 0.221; relative risk 0.35, 95% CI: 0.07 to 1.68). Long-term information was not available.We did not identify significant differences of mean scores between treatment groups for patient-reported outcomes function and bother as well as generic health-related quality of life.

AUTHORS' CONCLUSIONS

Low-dose rate brachytherapy did not reduce biochemical recurrence-free survival versus radical prostatectomy at 5 years. For short-term severe adverse events, low-dose rate brachytherapy was significantly more favorable for urinary incontinence, but radical prostatectomy was significantly more favorable for urinary irritation. Evidence is based on one RCT with high risk of bias.

Falls and hospitalized patients with cancer: a review of the literature

Preventing falls continues to be a serious issue faced by hospitals. Several studies have demonstrated an increased need for safety in hospitalized patients with cancer compared to other hospitalized populations. In addition, several fall-prevention studies in hospital settings have reported high rates of falls and injuries in this population. A cancer diagnosis is a significant risk factor for falling; however, few hospital studies have examined patients with cancer independently to determine why they are at greater risk for falls and injuries. Patients with cancer are a unique population because cancer treatments can cause side effects that may increase fall risk. Falls also can cause significant morbidity and mortality. More research is needed to better understand what specific oncology risk factors contribute to falls in the hospital setting.

It's not over when it's over: long-term symptoms in cancer survivors--a systematic review

BACKGROUND

The number of cancer survivors is steadily increasing. Following completion of primary cancer treatment and many years thereafter, specific symptoms continue to negatively affect cancer survivors. The purpose of this article is to review the evidence of symptom burden following primary treatment for cancer in survivors of the most common types of cancer (breast, gynecological, prostate, and colorectal).

METHODS

A systematic review of literature published between the years 2000-2008 that reported late-effects and/or long-term psychosocial symptoms associated with cancer survivorship post-completion of primary cancer treatment was conducted. The symptoms include physical limitations, cognitive limitations, depression/anxiety, sleep problems, fatigue, pain, and sexual dysfunctions.

RESULTS

Symptom burden associated with cancer survivorship was consistent among the four most common types of cancer (breast, gynecological, prostate, and rectal/colon), despite various types of treatment exposure. Generally, across the cancer groups, depressive symptoms, pain, and fatigue were commonly found in cancer survivors.

CONCLUSIONS

Based on longitudinal and cross-sectional evidence, cancer survivors can experience symptoms for more than 10 years following treatment. These symptoms were present in survivors of all four cancer types who underwent a wide variety of treatment. The results indicate that these symptoms should be evaluated and managed to optimize long-term outcomes.

Unanticipated and underappreciated outcomes during management of local stage prostate cancer: a prospective survey

PURPOSE

Due to the complexity of factors that must be considered when choosing a therapy for prostate cancer, we hypothesized that many men will find that certain factors such as side effects gain or lose importance after therapy relative to their expectations before therapy.

MATERIALS AND METHODS

We conducted a prospective survey of men deciding on a therapy for local stage prostate cancer in 3 geographic regions. Men were asked to rate the importance of 11 personal factors before starting therapy and again 6 months after therapy.

RESULTS

Among 448 eligible men completing the most common treatment options, overall satisfaction with treatment choice was high across all therapies. While most men changed rankings of importance in at least 1 of the 11 factors, the majority of pre-post evaluations were highly consistent. In adjusted analyses the 2 factors that emerged as significantly underappreciated for all major prostate cancer treatments were 1) the impact of treatment on usual daily activities, and 2) the recommendations of friends and relatives who were affected with prostate cancer.

CONCLUSIONS

Initial patient expectations of the importance of the majority of factors related to prostate cancer treatment are generally accurate. Better counseling may improve the accuracy of patient expectations of the personal burden of treatment, and their evaluation of the advice of affected friends and relatives.