Psychosocial Adjustment of Men During the First Year of Prostate Cancer

The value of information and support; Experiences among patients with prostate cancer

AIMS AND OBJECTIVES

To explore and analyse prostate cancer survivors` experiences and critical reflections of information received during their cancer trajectory.

BACKGROUND

Prostate cancer is one of the most prevalent cancers in men worldwide. Treatment causes side effects such as urinary incontinence, bowel changes and erection problems influencing sex life and manhood. Cancer pathways are designed to give patients and their relatives a predictable and as stress-free as possible treatment trajectory and minimise waiting time.

DESIGN

Qualitative, explorative research design.

METHODS

Focus groups with 16 prostate cancer survivors after having participated in an educational programme. The COREQ checklist was followed to ensure rigour in the study.

RESULTS

The main theme, 'Help me stay in control', and three subthemes, 'To be met with interest and support, enough knowledge to understand what is happening and a plan to build the new life on', emerged from qualitative analysis and highlighted the participants' need for information and support, specially scheduled at critical times in the treatment trajectory: the diagnostic phase, the treatment phase and the life after treatment. They also highlighted the need for empathy and interest from healthcare professionals and highlighted the need for arenas to discuss vulnerable topics. Contact with peers was perceived as supportive and encouraging.

CONCLUSION

Healthcare professionals must support prostate cancer survivors with empathy, interest and information tailored to their needs in three different phases. Continuity in information flow may increase trust and satisfaction among the prostate cancer survivors.

RELEVANCE TO CLINICAL PRACTICE

PCa patients' need for information varied at critical times in their treatment trajectory. HCP should meet them with empathy and interest to be able to tailor their need for information and support.

Quality of life assessment using EORTC QLQ questionnaires in the prostate cancer population treated with radical prostatectomy: a systematic review

CONTEXT

In recent years, quality of life has become an increasingly common outcome measure for assessing the effectiveness of treatment and surgical techniques.

OBJECTIVE

The aim of our systematic review is to explore changes in health-related quality of life in patients suffering from prostate cancer and treated by means of radical prostatectomy.

EVIDENCE ACQUISITION

We focus on studies in which EORTC QLQ-C30 and EORTC QLQ-PR25 questionnaires are used because these instruments have shown high internal and external validity in many studies and include questions grouped in cancer-specific scales. Following the application of exclusion and inclusion criteria, we select eight studies for qualitative synthesis.

CONCLUSIONS

Our results indicate that most quality of life scales do not present a large decline. However, prospective studies with detailed descriptions of methodology, and in particular descriptions of participants, are still needed before general conclusions can be drawn. Moreover, scoring of results in accordance with questionnaire guidelines is essential for the performance of meta-analysis.

The Ecology of Patients' Sexual Health Adjustment After Prostate Cancer Treatment: The Influence of the Social and Healthcare Environment

PURPOSE

Little empirical research identifies environmental influences on sexual recovery of men with prostate cancer. This secondary qualitative analysis aimed to describe the role of the patients' environment on their sexual recovery process following prostate cancer surgery.

PARTICIPANTS & SETTING

Transcripts of interviews with 8 heterosexual men were randomly selected and analyzed from a sample of 18 at three months postprostatectomy.

METHODOLOGIC APPROACH

The study was based on the social ecological model. Interpretative phenomenological analysis was applied to examine environmental factors affecting sexual recovery through the participant's perspective.

FINDINGS

The value of trusted connections and support extended beyond the partner to the patient's social and healthcare networks.

IMPLICATIONS FOR NURSING

These findings support the need for providers to assess the full constellation of patients' environmental experiences to better understand sexual recovery.

Adjusting to sex and intimacy: Gynecological cancer survivors share about their partner relationships

This study describes what gynecological (GYN) cancer survivors relate about their intimate partners and adjustments in their sexual lives following diagnosis and treatment. Conventional descriptive content analysis was used to examine participant responses about partner relationships following their diagnosis. Responses revealed three clusters and 15 codes of data. Findings report the influence of cancer treatment on sexual activity and functioning, women's sex lives, and their relationships. Health-care providers have a vital role in supporting women and their partners during the cancer care trajectory and should include both the survivor and the partner in conversations focused on sexual concerns and sexual well-being.

Health-Related Quality of Life, Psychological Distress, and Sexual Changes Following Prostate Cancer: A Comparison of Gay and Bisexual Men with Heterosexual Men

INTRODUCTION

Decrements in health-related quality of life (HRQOL) and sexual difficulties are a recognized consequence of prostate cancer (PCa) treatment. However little is known about the experience of gay and bisexual (GB) men.

AIM

HRQOL and psychosexual predictors of HRQOL were examined in GB and heterosexual men with PCa to inform targeted health information and support.

METHOD

One hundred twenty-four GB and 225 heterosexual men with PCa completed a range of validated psychosexual instruments.

MAIN OUTCOME MEASURE

Functional Assessment of Cancer Therapy-Prostate (FACT-P) was used to measure HRQOL, with validated psychosexual measures, and demographic and treatment variables used as predictors.

RESULTS

GB men were significantly younger (64.25 years) than heterosexual men (71.54 years), less likely to be in an ongoing relationship, and more likely to have casual sexual partners. Compared with age-matched population norms, participants in both groups reported significantly lower sexual functioning and HRQOL, increased psychological distress, disruptions to dyadic sexual communication, and lower masculine self-esteem, sexual confidence, and sexual intimacy. In comparison with heterosexual men, GB men reported significantly lower HRQOL (P = .046), masculine self-esteem (P < .001), and satisfaction with treatment (P = .013); higher psychological distress (P = .005), cancer related distress (P < .001) and ejaculatory concern (P < .001); and higher sexual functioning (P < .001) and sexual confidence (P = .001). In regression analysis, psychological distress, cancer-related distress, masculine self-esteem, and satisfaction with treatment were predictors of HRQOL for GB men (R2Adj = .804); psychological distress and sexual confidence were predictors for heterosexual men (R2Adj = .690).

CONCLUSION

These findings confirm differences between GB and heterosexual men in the impact of PCa on HRQOL across a range of domains, suggesting there is a need for GB targeted PCa information and support, to address the concerns of this "hidden population" in PCa care.

Dating concerns among women with breast cancer or with genetic breast cancer susceptibility: a review and meta-synthesis

OBJECTIVE

While dating is critical in the formation of a lifelong romantic relationship, women with breast cancer or a genetic susceptibility to developing this disease report a myriad of dating concerns. This review synthesises and discusses the perceived dating barriers and concerns in this population.

METHOD

A systematic search of CINAHL, Embase, MEDLINE, PsycINFO and PubMed was undertaken and yielded 19 published qualitative studies. Papers were subjected to critical appraisal to ensure the integrity of findings.

RESULTS

Six areas of concern were identified: Feeling unattractive due to treatment side effects; perceiving limited dating partners available; determining how, when and what to disclose; fear of cancer recurrence and reduced life expectancy; apprehension about entering into a new sexual relationship; and dating urgency and not wanting to 'waste time' on partners without long-term potential.

CONCLUSIONS

This paper provides a valuable synthesis of the complex issues, concerns and decisions that single women face at different stages of relationship formation following their breast cancer experience. Future research is warranted to explore the perceptions, appraisals and beliefs underlying these concerns, to help guide the future design and development of appropriate informational and supportive care offered to breast cancer patients.

Responding to a diagnosis of localized prostate cancer: men's experiences of normal distress during the first 3 postdiagnostic months

BACKGROUND

Men experience localized prostate cancer (PCa) as aversive and distressing. Little research has studied the distress men experience as a normal response to PCa, or how they manage this distress during the early stages of the illness.

OBJECTIVES

The objective of this study was to explore the experience of men diagnosed with localized PCa during their first postdiagnostic year.

METHODS

This constructivist qualitative study interviewed 8 men between the ages of 44 and 77 years, in their homes, on 2 occasions during the first 3 postdiagnostic months. Individual, in-depth semistructured interviews were used to collect the data.

RESULTS

After an initial feeling of shock, the men in this study worked diligently to camouflage their experience of distress through hiding and attenuating their feelings and minimizing the severity of PCa.

CONCLUSIONS

Men silenced distress because they believed it was expected of them. Maintaining silence allowed men to protect their strong and stoic self-image. This stereotype, of the strong and stoic man, prevented men from expressing their feelings of distress and from seeking support from family and friends and health professionals.

IMPLICATIONS FOR PRACTICE

It is important for nurses to acknowledge and recognize the normal distress experienced by men as a result of a PCa diagnosis. Hence, nurses must learn to identify the ways in which men avoid expressing their distress and develop early supportive relationships that encourage them to express and subsequently manage it.

Exploring the feasibility and acceptability of couple-based psychosexual support following prostate cancer surgery: study protocol for a pilot randomised controlled trial

BACKGROUND

Men who undergo surgery for prostate cancer frequently experience significant side-effects including urinary and sexual dysfunction. These difficulties can lead to anxiety, depression and reduced quality of life. Many partners also experience psychological distress. An additional impact can be on the couple relationship, with changes to intimacy, and unmet psychosexual supportive needs in relation to sexual recovery and rehabilitation. The aim of this exploratory randomised controlled trial pilot study is to determine the feasibility and acceptability of a novel family-relational-psychosexual intervention to support intimacy and reduce distress among couples following prostate cancer surgery and to estimate the efficacy of this intervention.

METHODS/DESIGN

The intervention will comprise six sessions of psychosexual and relationship support delivered by experienced couple-support practitioners. Specialist training in delivering the intervention will be provided to practitioners and they will be guided by a detailed treatment manual based on systemic principles. Sixty-eight couples will be randomised to receive either the intervention or standard care (comprising usual follow-up hospital appointments). A pre-test, post-test design will be used to test the feasibility of the intervention (baseline, end of intervention and six-month follow-up) and its acceptability to couples and healthcare professionals (qualitative interviews). Both individual and relational outcome measures will assess sexual functioning, anxiety and depression, couple relationship, use of health services and erectile dysfunction medication/technologies. An economic analysis will estimate population costs of the intervention, compared to usual care, using simple modelling to evaluate the affordability of the intervention.

DISCUSSION

Given the increasing incidence and survival of post-operative men with prostate cancer, it is timely and appropriate to determine the feasibility of a definitive trial through a pilot randomised controlled trial of a family-relational-psychosexual intervention for couples. The study will provide evidence about the components of a couple-based intervention, its acceptability to patients and healthcare professionals, and its influence on sexual and relational functioning. Data from this study will be used to calculate sample sizes required for any definitive trial.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT01842438.Registration date: 24 April 2013; Randomisation of first patient: 13 May 2013.

Patient Reported Outcome Measure (PROM) of Quality of Life After Prostatectomy - Results from a 5-Year Study

Prostate cancer is the most common cancer among men in Sweden, and treatment is negatively affecting the patients' quality of life. Even so, long term experiences are sparse and implications for nursing practice are little known. The aim of this study was to determine areas of functioning and factors impacting quality of life, QOL, during and five years after radical prostatectomy (RP) using a quality of life questionnaire and a specific module for prostate cancer. A longitudinal study was performed with consecutively included Swedish men from baseline and after RP treatment (n=222) from 2003 to 2011 to obtain their opinions on quality of life. Data was gathered through a mail out - mail in procedure at baseline, 3 months, 1-3 and 5 years after treatment with a response rate of 94.14% - 75.2%. One reminder was sent on each occasion. Identified areas with increased functioning after five years were emotional and social functioning. QOL ratings did not change over the years. Sexual activity and functioning decreased and hormonal treatment-related symptoms increased. Impact on QOL was found regarding emotional and social functioning, nausea/vomiting, pain and hormone-related symptoms. Increasing age, living with a partner and educational level had no significant impact on QOL. Implications for nursing are to initially focus on physical problems and at times for follow-up visits pay attention also to emotional and social aspects of life. To be able to make a difference in the patient’s life, nurses need to bridge the gap between in-hospital treatment and everyday life outside hospital.