Prospective Study of Quality of Life of Patients Receiving Treatment for Prostate Cancer:

Percepción de la calidad de vida en pacientes con cáncer de próstata avanzado: un estudio cualitativo descriptivo

Objetivo Describir las percepciones de calidad de vida en una muestra de pacientes con cáncer de próstata avanzado de un hospital universitario.

Métodos Desde un enfoque cualitativo descriptivo, se realizaron entrevistas semiestructuradas y líneas de tiempo para explorar la percepción de calidad de vida de siete pacientes con cáncer de próstata desde su diagnóstico. Por medio de un análisis temático de corte inductivo-deductivo, se identificaron las dimensiones de la calidad de vida que se perciben con mayores cambios a partir de la enfermedad y su tratamiento.

Resultados Entre las dimensiones que se encuentran más frecuentemente afectadas están las funciones urinaria, sexual y hormonal. Así mismo, los participantes describen afectaciones relacionadas con los síntomas generales del cáncer y su tratamiento, el estado de ánimo y las limitaciones en la atención por el sistema de salud. Por otra parte, los participantes reportan que su calidad de vida se ve fortalecida gracias a nuevos hábitos y prácticas personales, así como la consolidación del apoyo social, en el que incluyen a la pareja, la familia y la relación con su médico tratante.

Conclusiones El fortalecimiento de la relación médico-paciente basada en el trato cordial, disposición afectiva y empatía al momento de la valoración médica, y la consolidación de una adecuada red de apoyo social como mecanismo de afrontamiento ante el proceso de enfermedad se establecen como las principales estrategias para incrementar la percepción de calidad de vida relacionada con la salud de los pacientes con cáncer de próstata avanzado.

Factors affecting health-related quality of life among prostate cancer patients: A systematic review

INTRODUCTION

Prostate cancer is recognized as the leading cause of malignancy-related incidence and mortality in the male population. The treatment regimens have long-term effects detrimental to the patient's quality of life. Hence, this review was aimed to determine the overall HRQOL and its associated among prostate cancer patients.

METHODS

The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The databases searched were PubMed, Embase, Google Scholar and Cumulative Index to the Nursing and Allied Literature (CINAHL), which provided articles that were critically examined, yielding 52 studies that met the inclusion criteria for the systematic review.

RESULTS

Out of 52 studies, 30 studies reported poor overall HRQOL in various domains after prostate cancer treatment. Contrastingly, 15 studies reported good overall quality of life after treatment. Among the various domains, sexual function was the most grossly affected functional score by the treatment modalities of prostate cancer. Nonetheless, seven studies showed that the absence of a significant change in the overall quality of life after treatment. According to the studies, older age, comorbidities, higher clinical stage, higher Gleason score, greater cancer severity, African American race, impaired mental health, neoadjuvant hormonal therapy and lower level of education were the major poor predictors of HRQOL among prostate cancer patients.

CONCLUSION

The overall HRQOL in prostate cancer patients was generally poor in various functional domains after treatment. Among the various domains, sexual function was the most grossly affected functional score by the treatment modalities of prostate cancer.

Describing Self-Care Self-Efficacy: Definition, Measurement, Outcomes, and Implications

PURPOSE

The pragmatic utility method of concept analysis was used to explore the usefulness of the concept self-care self-efficacy.

DATA SOURCES

Empirical studies across disciplines published between 1996 and 2015 were used as data.

DATA SYNTHESIS

A data matrix was developed. Analytical questions and responses were derived from the data to understand patterns, develop new knowledge and achieve synthesis.

CONCLUSION

Usefulness of the concept is contingent on how it is defined and measured. Self-care self-efficacy is associated with performance of self-care activities and positive health outcomes in diverse populations.

IMPLICATIONS

Research can guide development of targeted interventions to increase patients' self-care self-efficacy, thus reducing costs, and assisting people to achieve optimal health.

Stress and self-efficacy predict psychological adjustment at diagnosis of prostate cancer

Prostate cancer is the most frequently non-skin cancer diagnosed among men. Diagnosis, a significant burden, generates many challenges which impact on emotional adjustment and so warrants further investigation. Most studies to date however, have been carried out at or post treatment with an emphasis on functional quality of life outcomes. Men recently diagnosed with localised prostate cancer (N = 89) attending a Rapid Access Prostate Clinic to discuss treatment options completed self report questionnaires on stress, self-efficacy, and mood. Information on age and disease status was gathered from hospital records. Self-efficacy and stress together explained more than half of the variance on anxiety and depression. Self-efficacy explained variance on all 6 emotional domains of the POMS (ranging from 5–25%) with high scores linked to good emotional adjustment. Perceived global and cancer specific stress also explained variance on the 6 emotional domains of the POMS (8–31%) with high stress linked to poor mood. These findings extend understanding of the role of efficacy beliefs and stress appraisal in predicting emotional adjustment in men at diagnosis and identify those at risk for poor adaptation at this time. Such identification may lead to more effective patient management.

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.

Trajectories and predictors of symptom occurrence, severity, and distress in prostate cancer patients undergoing radiation therapy

CONTEXT

Radiation therapy (RT) is a common treatment for prostate cancer. Despite available research, prostate cancer patients report that information about side effects is their most important unmet need. Additional research is needed that focuses on specific dimensions of the patient's symptom experience.

OBJECTIVES

The study's purposes were to evaluate the trajectories of occurrence, severity, and distress of the six most prevalent symptoms reported by patients undergoing RT for prostate cancer and the effects of selected demographic and clinical characteristics on these trajectories.

METHODS

Patients completed the Memorial Symptom Assessment Scale 11 times before, during, and after RT. For problems with urination, pain, lack of energy, feeling drowsy, difficulty sleeping, and diarrhea, the trajectories of occurrence, severity, and distress were evaluated using multilevel generalized linear models.

RESULTS

Across all three dimensions, pain, lack of energy, feeling drowsy, and difficulty sleeping followed a decreasing linear trend. Problems with urination and diarrhea demonstrated more complex patterns of change over time.

CONCLUSION

Although longitudinal data on pain, lack of energy, feeling drowsy, and difficulty sleeping are limited, they are highly prevalent symptoms in these patients. In addition, diarrhea becomes a significant problem for these patients over the course of RT. A number of demographic and clinical characteristics affect the trajectories of these common symptoms differentially.

The development and testing of an instrument for perceived self-efficacy for fatigue self-management

BACKGROUND

Persons with chronic illness commonly report fatigue. Measurement of perceived self-efficacy for fatigue self-management (PSEFSM) is essential if fatigue is to be monitored and enhanced to improve physical functional status.

OBJECTIVE

The objective of the study was to describe the development and testing of the PSEFSM instrument.

METHODS

The PSEFSM instrument was incorporated into 2 randomized controlled trials for secondary analysis (N=298): 63 persons with lung cancer and 235 persons with other cancer diagnoses undergoing a course of chemotherapy.

RESULT

: Evidence for construct validity and generalizability was supported through hypotheses testing of the mediation pathway from fatigue to physical functional status through PSEFSM, with results indicating support for partial mediation. Structural modeling indicated a good model fit that further supported the construct validity of the PSEFSM instrument.

CONCLUSIONS

The instrument provides a reliable and valid measure of PSEFSM that could be used in research to facilitate the development of interventions to increase perceived self-efficacy to achieve optimal symptom self-management.

IMPLICATIONS FOR PRACTICE

The PSEFSM instrument is brief and easy to complete, which results in a low response burden for persons who are already fatigued, providing for regular use in transdisciplinary research and practice settings. This is important because the use of this instrument can impact how we partner with our patients to better understand how to manage this troublesome symptom, fatigue.

Unsolicited Written Comments: An Untapped Data Source

PURPOSE/OBJECTIVES

To explore methods for analysis of unsolicited comments written on forced-choice surveys related to health-related quality of life (HRQOL) among men treated for prostate cancer.

DATA SOURCES

Unsolicited comments written on surveys administered as part of a study investigating HRQOL for men receiving surgery, external beam radiation therapy, or brachytherapy for prostate cancer were abstracted from the parent study database at baseline (pretreatment) and 1, 2, 4, 8, 12, 18, and 24 months after treatment.

DATA SYNTHESIS

Researchers read through all of the comments for each timepoint. They coded each comment for the main idea expressed by each statement in each written comment. They grouped codes into categories and counted the number of participants writing comments in each category at each timepoint. They were displayed graphically. Of 375 subjects completing surveys, 87% wrote unsolicited comments on at least one of the surveys. Thirty-four codes were derived from 3,175 comments. Grouping of the codes resulted in eight categories.

CONCLUSIONS

Analyzing unsolicited comments proved to be feasible and useful in revealing additional information about respondent concerns.

IMPLICATIONS FOR NURSING

This type of analysis has value in its ability to reveal patterns in previously unused data that then can be used to explain or deepen survey findings or suggest avenues for more in-depth qualitative or quantitative nursing investigation.