Men managing cancer: a gender analysis

Prevalence of current suicidal thoughts and lifetime suicide attempts in individuals with cancer and other chronic diseases in Germany: Evidence for differential associations from a representative community cohort

BACKGROUND

Research indicates an elevated risk for suicidal thoughts and behaviors (STBs) among individuals with cancer, but community-based studies on the prevalence of STBs in comparison to the general population and other chronic diseases are lacking.

METHODS

Data was drawn from the representative population-based, prospective Gutenberg Health Study (GHS). Participants (N = 12,382; age: M = 59.5, SD = 10.8; 48.9 % women) completed highly standardized medical assessments and validated questionnaires such as the PHQ-9. In addition to prevalence estimates (stratified by STBs and gender), logistic regression models were calculated (controlling for confounders).

RESULTS

The sample included 1910 individuals with cancer, 8.2 % of whom reported current suicidal thoughts and 2.0 % reported lifetime suicide attempts. There was neither a significant association between a cancer diagnosis and suicidal thoughts (p = .077) nor suicide attempts (p = .17) in models adjusting for age, gender, and income. Other chronic diseases were linked to suicidal thoughts and attempts only in men.

LIMITATIONS

Although the investigation of the two kinds of STB are a strength of the study, the items' different time frames complicate comparisons. In addition, the cross-sectional design limits the ability to understand observed relationships and to identify periods of risk.

CONCLUSION

This study expands the evidence base regarding the vulnerability to STBs in individuals with cancer, including long-term survivors. It highlights their heterogeneity, differential risk factors underlying suicidal thoughts and attempts, and the relevance of other (contextual) factors shaping an individual's susceptibility to suicidal crises.

"In My Mind, It Was Just Temporary": A Qualitative Study of the Impacts of Cancer on Men and Their Strategies to Cope

Individuals who are diagnosed and treated for cancer use a variety of strategies to manage its impacts. However, there is currently a lack of research on men's experience with managing cancer impacts, which is necessary to better support them throughout the cancer care continuum. This study explored the experience of men diagnosed with cancer, focusing on the impacts of the illness and its treatment and men's strategies to cope. A qualitative descriptive design was used. Thirty-one men (Mage = 52.7 [26-82] years) diagnosed with various cancer types were recruited to take part in individual telephone interviews (n = 14) or online focus groups (n = 17) addressing the impacts of cancer and strategies they used to cope with these impacts. Directed content analysis was performed, using Fitch's (2008) supportive care framework to guide the analysis. Cancer impacts and strategies used to cope were classified into six categories: physical, psychological, interpersonal, informational, practical, and spiritual. Results indicate that the cancer experience is diverse and multifaceted rather than homogeneous. Medical and supportive care services could be more effectively personalized to meet the diversity of men's needs by adopting a comprehensive and holistic approach to supportive care. Working in partnership with patients, it appears promising to recognize and identify men's needs and match them to appropriate resources to provide truly supportive care.

Implementation Readiness and Initial Effects of a Brief Mindfulness Audio Intervention Compared With a Brief Music Control During Daily Radiation Therapy for Prostate Cancer: A Randomized Pilot Study

Background

The most common and debilitating side effects of radiation therapy (RT) for prostate cancer (PC) are fatigue, sleep disturbance, anxiety, and depression. Previous research has reported palliative benefits from certain self-management approaches, such as mindfulness meditation.

Objective

To develop, pre-test, and evaluate the feasibility, acceptability and initial benefit of brief, audio-based mindfulness delivered during daily RT for PC compared to a relaxing music control.

Methods

Following intervention development, participants were randomized to either brief guided mindfulness audio recordings or a relaxing music control during daily RT. A pre-testing phase was first conducted to determine optimal program start time, length, and content most associated with retention. A final program (n = 26) was delivered daily, starting on day one of week 2 of RT and lasting 4 consecutive weeks. Feasibility was defined as ≥70% on enrollment rate, retention, and audio program adherence. Acceptability was measured with a 12-item post-study survey. A secondary focus compared between group changes on patient reported outcomes of fatigue, anxiety, depression, sleep disturbance, and related outcomes at baseline and follow up assessments. Descriptive statistics and general linear models were used.

Results

Overall, 76% (n = 38) of approached men enrolled. Pre-testing retention rates were <70% while the final program's retention rate was 89%. The majority of acceptability criteria were met in both conditions, with relatively higher ratings in the mindfulness arm. Compared to music controls, mindfulness participants demonstrated significantly less uncertainty intolerance at 4-weeks (P = .046, d = .95); and significantly lower fatigue scores (P = .049, d = 1.3) and lower sleep disturbance scores (P = .035, d = 1.1) at the 3 months follow up.

Conclusion

The final intervention met feasibility and acceptability criteria. Pre-testing refinements played a key role for optimal program delivery and retention. Audio-based mindfulness delivered during RT for PC hold potential to help decrease RT-related physical and emotional side effects.

Decision making in the oesophageal cancer trajectory a source of tension and edginess to patients and relatives: a qualitative study

PURPOSE

The curative oesophageal cancer continuum-diagnosis, treatment and survivorship represents different phases with its own challenges for the involved parties. The process of treatment decisions and interactions between patients with oesophageal cancer (EC), relatives and health professionals is vital yet not well described. The purpose of the study was to explore patients' and relatives' experiences with the process of decision-making through the EC illness and treatment trajectory.

METHODS

Longitudinal explorative design was employed based on ethnographic fieldwork in the form of participant observations inspired by the American anthropologist James Spradley.

RESULTS

Sixteen patients and 18 relatives were recruited for participant observations. In total, 184 hours of participant observations were conducted. The study showed that decision-making was filled with tension and edginess. Four themes were identified: 1) The encounter with the medical authority, 2) The need to see the big picture in the treatment trajectory, 3) A predetermined treatment decision, and 4) Meeting numerous different health professionals.

CONCLUSION

The EC trajectory and decision-making were filled with anxiety. Patients and relatives lacked an overview of the treatment pathway, leading to their role in decision-making often being governed by the medical authority. Timing information and continuity are vital factors in decision-making.

With Fearful Eyes: Exploring Relatives' Experiences With Out-of-Hospital Cardiac Arrest: A Qualitative Study

BACKGROUND

Out-of-hospital cardiac arrest (OHCA) imposes significant consequences for a family, but little is known about relatives' experiences.

OBJECTIVE

Our aim was to explore relatives' experiences with the OHCA and the following months after.

METHOD

A qualitative approach using phenomenological-hermeneutic methodology was applied. Data consisted of semistructured interviews with 12 relatives of OHCA survivors. We analyzed data based on Paul Ricoeur's theory of interpretation.

RESULTS

Relatives experienced OHCA as an abrupt and stressful event filled with imposing concerns for the cardiac arrest survivor. Relatives were fellow sufferers confronted with the possibility of bereavement, watching from the sideline with fearful eyes. After the OHCA, relatives experienced a troubled time with anxiety and edginess, monitoring the survivor for signs of a new cardiac arrest and trying to adapt to a new normality. Relatives' previous identities and positions within their families were disrupted.

CONCLUSION

Relatives were challenged with the OHCA and the trajectory after it, experiencing a high level of distress and anxiety. Relatives took on an immense responsibility, always watching the survivor for potential symptoms of a new cardiac arrest. The cardiac arrest and the survivor's possible cognitive impairments gave rise to assuming a new authority as a relative. We advocate for a new family approach to relatives, acknowledging relatives' stress and central role in supporting cardiac arrest survivors.

"I pretty much followed the law, and there weren't any decisions to make": A qualitative study of self-advocacy experiences of men with cancer

Current conceptualizations of patient self-advocacy focus on women with cancer, leaving knowledge of male self-advocacy deficient. The purpose of this study is to describe the key components of self-advocacy among men with cancer. Adult (≥18 years old) men with a history of invasive cancer were recruited from cancer clinics and registries. Trained researchers led individual semi-structured interviews regarding participants' challenges, how they overcame those challenges, and barriers and facilitators to their self-advocacy. All interviews were analyzed using descriptive content analysis methods and synthesized into major themes. These themes were refined after receiving feedback from key stakeholders. Participants (N = 28) reported three major self-advocacy themes: (i) managing through information and planning; (ii) finding the best team and falling in line; and (iii) strategic social connections. These themes are richly described with representative quotations for each theme and subtheme. Based on these findings, existing models of patient self-advocacy should be adjusted to encompass how men self-advocate. Clinicians should consider how gender may impact how and why patients with cancer self-advocate so that they can best support their patients in achieving patient-centered care.

In their own words: A narrative analysis of illness memoirs written by men with prostate cancer

By drawing on a narrative analysis of 11 autobiographical illness memoirs, this article investigates the complexities of what it means to live with prostate cancer over a period of time. Acknowledging how cancer disrupts everyday life, we focus on the day-to-day experiences and struggles that take place inside and outside the hospital. By building on illustrative quotes from the memoirs, we discuss different facets of cancer as a lived experience. Our findings show that men reconstruct their identity in the memoirs in response to the disruptive nature of cancer by including various identities from previous times. They describe a relationship with their cancer that is fluid and fitful and often depends on place, time and circumstances. We also found that the 'not knowing' of prostate cancer creates uncertainty, which can take different forms, transcends time and is shaped through medical technologies, continual testing and disagreeing doctors. Prostate cancer is often seen as easily treatable, but our findings call for a different way of looking at its impact. We argue that memoirs, written by men themselves, make it palpable what it means to live with cancer. As such, illness memoirs offer a way to advance our sociological understanding of cancer-as-a-lived experience.

Gender Differences in Psychosocial, Religious, and Spiritual Aspects in Coping: A Cross-Sectional Study with Cancer Patients

Background: There is a growing awareness of religiosity and/or spirituality (R/S) as a possible resource in coping with cancer. Gender differences in religious coping have not yet been thoroughly examined. This study aimed to analyze differences in religious coping between men and women with cancer and compare the impact of R/S on anxiety and depression symptoms.

Methods: This cross-sectional study was conducted at the Divisions of Hematology and Oncology of the Medical University of Vienna. In total, 352 patients with a cancer diagnosis, who regarded themselves as religious and/or spiritual, were interviewed at Vienna's university hospital with standardized questionnaires. To answer our research questions, we used the Hospital Anxiety and Depression Scale (HADS), the Benefit Through Spirituality/Religiosity (Benefit) questionnaire, and collected demographic characteristics.

Results: Of 689 cancer patients, 51% (352) regard themselves as religious and/or spiritual. Women with cancer tend toward R/S more significantly (57%) than men (45%). In patients with an R/S belief, women scored higher in almost all items of the Benefit questionnaire and showed higher prevalence of anxiety (p < 0.001) and depression than men. Regarding the socioeconomic characteristics, more women were widowed, and had significantly lower income than men.

Conclusions: The results show a significant gender gap concerning the importance of R/S for cancer patients and the effect on psychological well-being.

Women in this study were more religious/spiritual than men and scored higher on anxiety and depression. We support the notion that the gender perspective is essential and can contribute to better patient care in identifying gender-specific concerns.

Systematic review of self-management interventions for older adults with cancer

AIM

The purpose of this systematic review was to determine the effectiveness of self-management interventions for older adults with cancer and to determine the effective components of said interventions.

METHODS

We conducted a systematic review of self-management interventions for older adults (65+) with cancer guided by the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. We conducted an exhaustive search of the following databases: Ageline, AMED, ASSIA, CINAHL, Cochrane, Embase, Medline, PsychINFO, and Sociological Abstracts. We assessed for quality using the Cochrane Risk of Bias tool and Down & Black for quasi-experimental studies, with data synthesized in a narrative and tabular format.

RESULTS

Sixteen thousand nine hundred and eight-five titles and abstracts were screened, subsequently 452 full-text papers were reviewed by two independent reviewers, of which 13 full-text papers were included in the final review. All self-management interventions included in this review measured Quality of Life; other outcomes included mood, self-care activity, supportive care needs, self-advocacy, pain intensity, and analgesic intake; only one intervention measured frailty. Effective interventions were delivered by a multidisciplinary teams (n = 4), nurses (n = 3), and mental health professionals (n = 1). Self-management core skills most commonly targeted included: problem solving; behavioural self-monitoring and tailoring; and settings goals and action planning.

CONCLUSIONS

Global calls to action argue for increased emphasize on self-management but presently, few interventions exist that explicitly target the self-management needs of older adults with cancer. Future work should focus on explicit pathways to support older adults and their caregivers to prepare for and engage in cancer self-management processes and behaviours.

The effectiveness of a men-only supportive expressive group therapy intervention for psychosocial health outcomes in gastrointestinal cancer patients: a 6-month longitudinal study

BACKGROUND

An increasing number of gastrointestinal cancer (GI) patients suffer from side effects of cancer treatment that can affect their mood states and quality of life. Despite its demonstrated effectiveness in female cancer patients, Supportive Expressive Group Therapy (SEGT) has not been tested in male cancer patients. The current study sought to examine the longitudinal effects of a professionally-led, men-only SEGT on mood states, coping, and quality of life (QoL) in male GI cancer patients.

METHODS

A sample of male GI cancer patients (n = 31), at different stages of cancer treatment, was recruited from an ongoing, men-only biweekly GI cancer SEGT. Data were collected at baseline (before or near the beginning of group attendance) and at three months and six months follow-up. All study outcomes were patient-reported and included socio-demographic data as well as validated questionnaires: Profile of Mood States (POMS) for mood states, Functional Assessment of Cancer Therapy-General (FACT-G) for QoL, and Ways of Coping-Cancer Version (WOC) for coping. Linear mixed models were used to examine the change in outcomes over time. Effect sizes were estimated using Cohen's d.

RESULTS

The Anxiety (p = .04; d = 0.70), Depression (p = .03; d = 0.93) and Anger (p = .04; d = 1.28) subscales of the POMS decreased between baseline and six months. Participants also reported improvements in coping through Distancing (distancing oneself from negative thoughts, being more accepting of the situation, and looking for positives) of the WOC (p = .04; d = 0.4) between baseline and six months. There was no change in any of the FACT subscales (QoL) over time.

CONCLUSIONS

This is the first study to investigate the effects of a SEGT intervention in male cancer patients. Participation in the intervention was associated with improved mood states and coping in male GI cancer patients; however, there was no change in measures of QoL.

Undertaking responsibility and a new role as a relative: a qualitative focus group interview study

BACKGROUND

Being a relative of a patient with oesophageal cancer can evoke strong emotions and uncertainty about the future. As a consequence of the treatment course for oesophageal cancer and an increase in outpatient treatment, relatives are becoming increasingly responsible for patients' physical and emotional care. There is a lack of research exploring relatives' experiences with illness, treatment and decision-making.

AIMS AND OBJECTIVES

To explore relatives' experiences with illness, treatment of the patient and decision-making in the context of oesophageal cancer.

DESIGN

A qualitative explorative design was chosen.

METHODS

We conducted two focus group interviews with 11 relatives. The analysis was based on Ricoeur's theory of interpretation.

RESULTS

Throughout illness and treatment, relatives faced the fear of loss, leading to distress and anxiety. Relatives were simultaneously taking responsibility and asserting a new role during treatment as they regarded treatment as a joint affair. Regarding decision-making, relatives positioned themselves on the sidelines, awaiting the authority of the patients and healthcare professionals to give them space for participation.

CONCLUSION

Relatives of patients with oesophageal cancer undergoing treatment are suppressing their anxiety and doubt about the future. As they are undertaking responsibility during treatment, they are claiming control in new areas, which leads to changing roles within the family. However, they do not feel empowered in decision-making because they recognise patients' decision-making authority. This study highlights the complexity of balancing patients' authority with acknowledgement of relatives' role as active collaborators.

A systematic review on social constraints in the context of cancer

This review aims to identify, summarise and critically evaluate studies that examined moderators or mediators of the relationship between social constraints and cancer adjustment. A database search was conducted to identify eligible studies published between inception and November 2019. A narrative synthesis of the included studies was conducted. We identified 18 papers, comprising 6933 participants (Mage = 55.70) with different types of cancer (mainly breast cancer). All of the studies used the Social Constraints Scale. Our synthesis shows that the association between social constraints and cancer adjustment is likely to be moderated or mediated by different cognitive (e.g. avoidant coping, intrusive thoughts) and emotional (e.g. emotionality, negative affect) variables. The importance of the moderators and mediators found in this study should be further examined by employing more sophisticated data analytic strategies to assess mediation and by collecting longitudinal data in order to better disentangle the complex associations among variables. However, some important variables were identified as potential targets of interventions for patients facing cancer.

Awareness of and preference for disease prognosis and participation in treatment decisions among advanced cancer patients in Myanmar: Results from the APPROACH study

AIM

To investigate prognostic awareness, preference for prognostic information, and perceived and preferred roles in decision making among patients with advanced cancer in Myanmar.

METHODS

A cross-sectional survey was administered at the Yangon General Hospital to stage 4 cancer patients who were at least 21 years old and aware of their cancer diagnosis. Patients were asked questions about their prognosis, participation in treatment decisions, sociodemographic and clinical information. Data from 131 patients were analyzed using descriptive statistics and logistic regressions.

RESULTS

Only 15% of patients surveyed were aware that their cancer was advanced and only a quarter (26%) of patients knew that treatment intent was noncurative. The likelihood of treatment-intent awareness was higher among patients who were male, high income, and aware that they had advanced cancer. Roughly 60% of patients reported playing an active or collaborative role in treatment decisions, with a strong preference (59%) for the latter. For the majority of patients (69%), perceived and preferred roles in decision making were the same. Sociodemographic characteristics did not predict perceived and preferred roles in decision making.

CONCLUSIONS

This is the first effort to analyze prognostic awareness and decision-making practices among advanced cancer patients in Myanmar. Patients had inadequate knowledge on their disease progression and intent of treatment. Yet, the majority of them were keen to be involved in treatment decisions.

Patients' Experiences With Illness, Treatment, and Decision-Making for Esophageal Cancer: A Qualitative Study in a Danish Hospital Setting

Patients with curable esophageal cancer or cancer in the esophageal junction face several challenges during the course of their treatment because of the burden of uncertainty in their prognoses and complexity and side effects of the treatment. The aim of this study is to explore patient experiences with illness, treatment, and decision-making in the context of esophageal cancer. A qualitative approach using phenomenological–hermeneutical methodology was used. Data consisted of participant observations and interviews. We analyzed the data based on Ricoeur’s theory of interpretation. The results show that patients with esophageal cancer are putting their ordinary lives on hold and experiencing the meal as a battleground during treatment. Patients strive to maintain autonomy, gain control, and take ownership. The results emphasize the need for a systematic approach to establish an ongoing dialogue with patients throughout the course of treatment.

"In the same boat"-a mixed-methods exploration of reasons why male gastrointestinal cancer patients joined a professionally led men-only cancer support group

PURPOSE

Gastrointestinal (GI) cancer patients often suffer high rates of distress and social isolation, partially due to symptoms that are embarrassing or difficult to discuss with family or friends. Group support therapies mitigate illness-related stigma and standardization; however, men, in particular, are more averse to joining. Through an ongoing men-only GI cancer support group, this study sought to understand who joined the groups, what facilitated group uptake, and explore men's reasons for enrolling in the group.

METHODS

A mixed-methods study design and analysis were used. A qualitative design utilizing open-ended, semi-structured interviews and thematic analysis were used; Theory of Planned Behavior (TPB) directed the inquiry towards facets of group uptake. Standardized measures were also used to assess distress, coping, and quality of life (QoL) and compared with normative values for cancer and general population. Data from qualitative and quantitative findings were triangulated.

RESULTS

Participants included 35 male GI cancer patients, aged 28-72, at varying stages of illness and treatment. Themes related to group uptake and enrollment were endorsement; composition; and attitudes, and reasons for joining were learning new coping techniques and affiliations with similar others. Men's QoL and psychological distress scores were on par with cancer patient norms. The scores obtained from quantitative scales corroborated with our qualitative findings.

CONCLUSIONS

Despite psychosocial, demographic, and clinical variations, participants were keen on joining a male-only Supportive-Expressive Therapy (SET) group to address their emotional, informational, and supportive care needs and express their solidarity for other patients.

IMPLICATIONS FOR CANCER SURVIVORS

Findings bear clinical relevance for designing GI male-centered group formats that endorse men's needs and facilitate their accessibility to group support interventions.

'Very difficult for an ordinary guy': Factors influencing the quality of treatment decision-making amongst men diagnosed with localised and locally advanced prostate cancer: Findings from a UK-wide mixed methods study

OBJECTIVES

To explore experiences of treatment decision-making (TDM) amongst men diagnosed with stage 1-3 prostate cancer.

METHODS

Mixed-methods study incorporating UK-wide cross-sectional postal survey of men 18-42 months post-diagnosis and semi-structured interviews with a subsample (n = 97), including men who received both radical treatments and active surveillance. Interview data was analysed using a Framework approach.

RESULTS

Within the context of TDM, 'drivers' included men's intra-personal preferences for decision-making responsibility or clinical direction, relative treatment intrusiveness or desire for excision, and work, personal and social life priorities; 'facilitators' were inter-personal mechanisms such as information and communication with clinicians to enact, but also sometimes challenge drivers. Drivers and facilitators can conflict, challenging patient empowerment. Men frequently undertook greater TDM responsibility than desired, without clinical recommendations; others received conflicting recommendations. Information on potential side-effects was often reportedly inadequate. Unchallenged preferences, absence of clinical recommendations and inadequate preparation for side-effects sometimes led to decision regret.

CONCLUSIONS

Men are not empowered when expected to take more TDM responsibility than desired, when provided with conflicting recommendations, or when their potentially inappropriate preferences are unchallenged.

PRACTICE IMPLICATIONS

TDM should involve men exercising preferences and priorities in discussion with clinicians. Clinicians should ensure patients do not receive conflicting recommendations.

Masculinity, Mental Health, and Desire for Social Support Among Male Cancer and Infertility Patients

By surveying men who are currently infertile ( N = 251) and men who are potentially infertile (i.e., men with cancer; N = 195), the mental health consequences of reproductive masculinity, or the cultural assumption that men are virile and should be fathers, were investigated. There was no difference in depression levels between these two groups when controlling for demographic variables, suggesting that both groups of men have similar mental health needs. Since gendered notions of masculinity also suggest that men do not want to discuss their fertility health, their desire for online fertility-related social support was assessed. These findings suggest that most men do want to talk to others about fertility, which indicates that there is a need for more fertility-related social support. This research challenges some conceptions regarding masculinity, as men revealed an interest in accessing online social support related to fertility.

Masculinity, Social Connectedness, and Mental Health: Men's Diverse Patterns of Practice

Men’s mental health has remained undertheorized, particularly in terms of the gendered nature of men’s social relations. While the importance of social connections and strong supportive networks for improving mental health and well-being is well documented, we know little about men’s social support networks or how men go about seeking or mobilizing social support. An in-depth understanding of the gendered nature of men’s social connections and the ways in which the interplay between masculinity and men’s social connections can impact men’s mental health is needed. Fifteen life history interviews were undertaken with men in the community. A theoretical framework of gender relations was used to analyze the men’s interviews. The findings provide rich insights into men’s diverse patterns of practice in regards to seeking or mobilizing social support. While some men differentiated between their social connections with men and women, others experienced difficulties in mobilizing support from existing connections. Some men maintained a desire to be independent, rejecting the need for social support, whereas others established support networks from which they could actively seek support. Overall, the findings suggest that patterns of social connectedness among men are diverse, challenging the social science literature that frames all men’s social relationships as being largely instrumental, and men as less able and less interested than women in building emotional and supportive relationships with others. The implications of these findings for promoting men’s social connectedness and mental health are discussed.

The sociology of cancer: a decade of research

Biomedicine is often presented as the driving force behind improvements in cancer care, with genomics the latest innovation poised to change the meaning, diagnosis, treatment, prevention and lived experience of cancer. Reviewing sociological analyses of a diversity of patient and practitioner experiences and accounts of cancer during the last decade (2007-17), we explore the experiences of, approaches to and understandings of cancer in this period. We identify three key areas of focus: (i) cancer patient experiences and identities; (ii) cancer risk and responsibilities and (iii) bioclinical collectives. We explore these sociological studies of societal and biomedical developments and how sociologists have sought to influence developments in cancer identities, care and research. We end by suggesting that we extend our understanding of innovations in the fields of cancer research to take better account of these wider social and cultural innovations, together with patients, activists' and sociologists' contributions therein.

Experiences of Head and Neck Cancer Patients in Middle Adulthood: Consequences and Coping

The head and neck cancer (HNC) rate is rising among the middle-aged adult population. This trend has been attributed primarily to human papillomavirus exposure. An HNC diagnosis and its complex treatments may trigger life-changing physical, emotional, and social consequences. An interpretive descriptive study was conducted to describe the experiences of a purposive sample of 10 middle-aged adults who had experienced HNC. Two main themes were identified: consequences of HNC and coping with HNC. Subthemes of consequences of HNC included: voicelessness; being or looking sick; shifts in family dynamics; and sexual practices, sexual feelings, and stigma. Subthemes of coping with HNC included seeking information, discovering inner strengths, relying on a support network, establishing a sense of normalcy, and finding meaning within the experience. Supportive nursing interventions were identified by considering results from the standpoint of King's theory of goal attainment.

What Facilitates "Patient Empowerment" in Cancer Patients During Follow-Up: A Qualitative Systematic Review of the Literature

Empowerment is a concept of growing importance in cancer care, but little is known about cancer patients' experiences of empowerment during follow-up. To explore this area, a qualitative systematic literature review was conducted in PubMed, CINAHL, and PsycINFO. A total of 2,292 papers were identified and 38 articles selected and included in the review. The thematic synthesis of the papers resulted in seven analytical themes being identified: empowerment as an ongoing process, knowledge is power, having an active role, communication and interaction between patients and health care professionals, support from being in a group, religion and spirituality, and gender. Very few articles explicitly explored the empowerment of cancer patients during follow-up, and the review identified a lack of attention to patients' own understandings of empowerment, a lack of specific focus on empowerment during follow-up, and insufficient attention to collective empowerment, as well as ethnic, social, and gender differences.

Do Correlates of Pain-Related Stoicism and Cautiousness Differ in Younger and Older People With Advanced Cancer?

Age differences are not evident in pain-related stoicism and cautiousness in people with cancer pain. Little is known about the factors associated with these pain-related attitudes or age-related patterns in these associations. The present cross-sectional study investigated the biopsychosocial correlates of the attitudes in younger and older patients with advanced cancer. Pain-related stoicism (fortitude, concealment, superiority) and cautiousness (self-doubt, reluctance) were assessed using the Pain Attitudes Questionnaire-Revised (PAQ-R). Participants, 155 younger (younger than 60 years old) and 114 older (60 years old or older) patients with advanced cancer completed the PAQ-R and measures of sociodemographic and medical characteristics, pain intensity, cognitive-affective pain-related responses, physical functioning, psychological distress and well-being, and psychosocial functioning. Backwards regression analyses identified correlates for each PAQ-R factor separately for younger and older patients. Activity engagement was a frequent correlate, but its relationship with concealment was the only association common to both age groups. Younger and older patients exhibited different avoidance-related constructs suggesting relational challenges in the former group (avoidant attachment) and intrapersonal fear in the latter (cognitive avoidance). Medical correlates also showed age differences: younger patients showed symptom-focused correlates, whereas older patients showed aging-related correlates. Findings support a biopsychosocial framework of cancer-pain adaptation incorporating a lifespan-developmental perspective.

PERSPECTIVE

To our knowledge, this article is the first to identify biopsychosocial correlates of stoic and cautious attitudes toward cancer pain in younger and older patients with advanced cancer. Findings highlight possible age-related motivations for greater pain-related stoicism or cautiousness and can potentially inform interventions addressing challenges in cancer-pain adaptation in advanced cancer.

Ambiguity in a masculine world: Being a BRCA1/2 mutation carrier and a man with prostate cancer

OBJECTIVE

Increased risk of prostate cancer (PCa) is observed in men with BRCA1/BRCA2 mutations. Sex and gender are key determinants of health and disease although unequal care exists between the sexes. Stereotypical male attitudes are shown to lead to poor health outcomes.

METHODS

Men with BRCA1/2 mutations and diagnosed with PCa were identified and invited to participate in a qualitative interview study. Data were analysed using a framework approach. "Masculinity theory" was used to report the impact of having both a BRCA1/2 mutation and PCa.

RESULTS

Eleven of 15 eligible men were interviewed. The umbrella concept of "Ambiguity in a Masculine World" was evident. Men's responses often matched those of women in a genetic context. Men's BRCA experience was described, as "on the back burner" but "a bonus" enabling familial detection and early diagnosis of PCa. Embodiment of PCa took precedence as men revealed stereotypical "ideal" masculine responses such as stoicism and control while creating new "masculinities" when faced with the vicissitudes of having 2 gendered conditions.

CONCLUSION

Health workers are urged to take a reflexive approach, void of masculine ideals, a belief in which obfuscates men's experience. Research is required regarding men's support needs in the name of equality of care.

Sex differences in the association between a previous cancer diagnosis and the use of medication

We aimed to quantify the association between a previous cancer diagnosis and medication use, depicting possible sex differences. We analysed data from a representative sample of the Portuguese adult population (n=32 610), which was collected through face-to-face interviews, using a structured questionnaire. The effect of a previous diagnosis of cancer was quantified through prevalence ratios (PR), adjusted for age, education and region of residence. Cancer survivors (CS) reported higher use of prescribed medication, with greater adjusted PR among men (1.25 vs. 1.13, P for interaction=0.001). Compared with the general population, male CS reported higher use of drugs for sleep problems, allergies and antibiotics, whereas female CS reported greater consumption of drugs for depression, anxiety, sleep problems and pain. This study contributes towards understanding sex disparities in the impact of cancer survival on medication use.

Coping and adjustment in men with prostate cancer: a systematic review of qualitative studies

Purpose

Prostate cancer (PCa) is one of the most common forms of cancer amongst males. Men’s coping responses are an important determinant of functioning and adjustment to this disease. Previous qualitative research exists in this area, but the current review sought to systematically review and summarise these studies.

Methods

A systematic review was conducted to identify studies concerned with men’s coping strategies in their attempts to live with PCa. A search of relevant electronic databases was conducted to identify studies that met inclusion criteria for this review. Methodological quality assessment was also undertaken for each included study.

Results

One hundred twenty-one publications were identified for initial screening, and 18 studies were included in the review. A total of five coping strategy categories or ‘meta-themes’ were identified across included studies. These categories were labelled ‘avoidance, minimisation, and withdrawal’, ‘directing cognition and attention’, ‘reframing masculinity and seeking support’, ‘retain pre-illness identity and lifestyle’, and ‘symptom/side-effect management’.

Conclusions

A range of coping strategies were reported by men with PCa. Some of these strategies appear to be partially influenced by gender roles and masculinities. Coping meta-themes reported in this review have also been found in other research on men’s coping. Strategies relating to flexible interpretation of gender roles/masculinities may be a particularly relevant category of coping responses due to the hypothesised beneficial impact of flexibility on psychological well-being.

Implications for cancer survivors

PCa survivors utilise a range of coping strategies, and the types of strategies used may have implications for men’s well-being. The ability to be flexible in both coping responses used, and in the view of oneself as a man may be particularly important skills in meeting the challenges associated with this disease.

'It's like taking a bit of masculinity away from you': towards a theoretical understanding of men's experiences of infertility

In the UK, nearly half of all cases of infertility involve a 'male-factor'. Yet, little empirical work has explored how men as men negotiate this terrain. Three interrelated concepts; 'hegemonic masculinity', 'embodied masculinity' and the linkages between 'masculinities' and male help-seeking, provide the theoretical framework that guided a qualitative study conducted with 22 men experiencing infertility. The paper explores men's propensity to delay their help-seeking in relation to infertility despite their desire for children. It also demonstrates how, in the context of infertility, the male body can be defined as both a failed entity in itself (unable to father a child) and a subordinated social entity (unable to measure up to hegemonic ideals) that characterises men's masculine identities. The paper also illustrates how men appear willing to accept responsibility for their infertility and adopt aspects of hitherto subordinate masculine practice. This does not, however, constitute the total unravelling of well understood and accepted expressions of masculinity. Finally, the paper demonstrates how infertility is perceived as having the potential to fracture current and even future relationships. Moreover, regardless of how well men measured up to other hegemonic ideals, ultimately they can do little to counteract the threat of other (fertile) men.

Experiences of partners of prostate cancer survivors: A qualitative study

Prostate cancer, Australia's leading cancer, has treatment side effects that reduce the quality of life for both survivors and partners. Limited partner research exists. This study aimed to address this gap in the literature by gathering data directly from partners to obtain a deeper understanding of their experiences of prostate cancer survivorship that helps inform healthcare service providers. A qualitative approach was taken to explore participant views (N = 16) through three focus groups and two in-depth interviews. Five themes emerged relating to caregiver burden, knowledge deficit, isolation, changes of sexual relations, and unmet needs. Possible implications for practice may include the need for specific partner-related information and interventions to assist couples to cope with the emotional distress caused by treatment side effects.

Cancer-related fatigue in post-treatment cancer survivors: application of the common sense model of illness representations

BACKGROUND

Cancer-related fatigue (CrF) is a common and disruptive symptom that may be experienced during and after cancer. Research into the subjective experience of fatigue in this group is required. The common sense model of self-regulation of health and illness (SRM) addresses personal beliefs or mental representations-whether medically sound or unsubstantiated- that a person holds about a health issue. The current study assesses if the SRM could be used as a theoretical framework for organizing the experiences of people with CrF, with a view to identifying methods to address fatigue in cancer survivors.

METHOD

Four focus groups were held with a total of 18 cancer survivors who reported they experienced 'significant fatigue or reduced energy.' A thematic analysis was conducted within the framework of the SRM.

RESULTS

Findings were aligned with the SRM, with participants discussing fatigue with reference to representation, coping, and appraisal of symptoms. In particular, the wider social context of CrF was frequently addressed. Perceived inadequacies in support available to those with lingering fatigue after the completion of cancer treatment were highlighted by the participants.

CONCLUSION

This study explored the subjective experience of fatigue after cancer using the SRM. CrF should be approached as a complex psychosocial issue and considered from the patient perspective to facilitate better understanding and management of symptoms. The SRM is an applicable framework for identifying modifiable factors that could lead to improved coping with CrF in post-treatment cancer survivors.

Cognitive and Affective Representations of Active Surveillance as a Treatment Option for Low-Risk Prostate Cancer

Benefits of early diagnosis and treatment remain debatable for men with low-risk prostate cancer. Active surveillance (AS) is an alternative to treatment. The goal of AS is to identify patients whose cancer is progressing rapidly while avoiding treatment in the majority of patients. The purpose of this study was to explore cognitive and affective representations of AS within a clinical environment that promotes AS a viable option for men with low-risk prostate cancer. Participants included patients for whom AS and active treatment were equally viable options, as well as practitioners who were involved in consultations for prostate cancer. Data were generated from semistructured interviews and audits of consultation notes and were analyzed using thematic analysis. Nineteen patients and 16 practitioners completed a semistructured interview. Patients generally viewed AS as a temporary strategy that was largely equated with inaction. There was variation in the degree to which inaction was viewed as warranted or favorable. Patient perceptions of AS were generally malleable and able to be influenced by information from trusted sources. Encouraging slow deliberation and multiple consultations may facilitate greater understanding and acceptance of AS as a viable treatment option for low-risk prostate cancer.

Experiences of Uncertainty in Men With an Elevated PSA

A significant proportion of men, ages 50 to 70 years, have, and continue to receive prostate specific antigen (PSA) tests to screen for prostate cancer (PCa). Approximately 70% of men with an elevated PSA level will not subsequently be diagnosed with PCa. Semistructured interviews were conducted with 13 men with an elevated PSA level who had not been diagnosed with PCa. Uncertainty was prominent in men's reactions to the PSA results, stemming from unanswered questions about the PSA test, PCa risk, and confusion about their management plan. Uncertainty was exacerbated or reduced depending on whether health care providers communicated in lay and empathetic ways, and provided opportunities for question asking. To manage uncertainty, men engaged in information and health care seeking, self-monitoring, and defensive cognition. Results inform strategies for meeting informational needs of men with an elevated PSA and confirm the primary importance of physician communication behavior for open information exchange and uncertainty reduction.

"I Had a Little Bit of a Bloke Meltdown…But the Next Day, I Was Up": Understanding Cancer Experiences Among Aboriginal Men

BACKGROUND

Although cancer in indigenous populations is receiving increased research attention, there is a gap in understanding the particular experiences of Aboriginal men.

OBJECTIVE

The aim of this study is to integrate a range of primary and secondary accounts of the experiences of Aboriginal men in engaging with a cancer diagnosis and treatment in Australia.

METHODS

Secondary analysis of qualitative interviews (n = 54) conducted between 2008 and 2011 revealed recurrent themes regarding the cancer experiences of Aboriginal men in a subset of participant interviews (n = 23). The analysis reports themes that spanned the accounts of Aboriginal men with cancer (n = 6) and those of their carers (n = 12) and clinicians (n = 5).

RESULTS

Recurrent beliefs about the cancer experiences of Aboriginal men included that they "avoid seeking help" for health matters, including cancer symptoms, and to "get on with it," "not talk about it," and "manage without fuss" after a cancer diagnosis. Although some men described having to "accept vulnerability," emphasis was placed on appreciating men's desire to "protect cultural roles" and "connect with family and culture" throughout care and treatment, including through humor.

CONCLUSIONS

Men's accounts of the experiences of cancer diagnosis and care reveal more than simply individual challenge, extending to encompass the very real social and economic implications of illness and vulnerability for Aboriginal men today.

IMPLICATIONS FOR PRACTICE

Aboriginal men could be better engaged with cancer diagnosis and treatment if greater attention was paid to recognizing preferred approaches, including pragmatism and humor, and supporting connections to family and culture throughout the cancer journey.

Genetic Testing and Post-Testing Decision Making among BRCA-Positive Mutation Women: A Psychosocial Approach

Through an analysis of an online survey of women who tested positive for the BRCA genetic mutation for breast cancer, this research uses a social constructionist and feminist standpoint lens to understand the decision-making process that leads BRCA-positive women to choose genetic testing. Additionally, this research examines how they socially construct and understand their risk for developing breast cancer, as well as which treatment options they undergo post-testing. BRCA-positive women re-frame their statistical medical risk for developing cancer and their post-testing treatment choices through a broad psychosocial context of engagement that also includes their social networks. Important psychosocial factors drive women's medical decisions, such as individual feelings of guilt and vulnerability, and the degree of perceived social support. Women who felt guilty and fearful that they might pass the BRCA gene to their children were more likely to undergo risk reducing surgery. Women with at least one daughter and women without children were more inclined toward the risk reducing surgery compared to those with only sons. These psychosocial factors and social network engagements serve as a "nexus of decision making" that does not, for the most part, mirror the medical assessments of statistical odds for hereditary cancer development, nor the specific treatment protocols outlined by the medical establishment.

Medical Help-Seeking for Sexual Concerns in Prostate Cancer Survivors

INTRODUCTION

Although sexual dysfunction is common after prostate cancer, men's decisions to seek help for sexual concerns are not well understood.

AIM

Describe predictors of actual prior help-seeking and intended future medical help-seeking for sexual dysfunction in prostate cancer survivors.

METHODS

A cross-sectional survey of 510 prostate cancer survivors assessed masculine beliefs, attitudes, support/approval from partner/peer networks (subjective norm), and perceived control as predictors of medical help-seeking for sexual concerns. A theory of planned behavior (TPB) perspective was used to examine actual prior and planned future behavior and contributing factors. Statistical analyses included multiple and logistic regressions.

MAIN OUTCOME MEASURES

Intention to see a doctor for sexual advice or help in the next 6 months was measured using the intention subscale adapted from the Attitudes to Seeking Help after Cancer Scale. Prior help-seeking was measured with a dichotomous yes/no scale created for the study.

RESULTS

Men were Mage 71.69 years (SD = 7.71); 7.54 years (SD = 4.68) post-diagnosis; received treatment(s) (58.1% radical prostatectomy; 47.1% radiation therapy; 29.4% hormonal ablation); 81.4% reported severe ED (IIED 0-6) and 18.6% moderate-mild ED (IIED 7-24). Overall, 30% had sought sexual help in the past 6 months, and 24% intended to seek help in the following 6 months. Prior help-seeking was less frequent among men with severe ED. Sexual help-seeking intentions were associated with lower education, prior sexual help-seeking, sexual importance/ priority, emotional self-reliance, positive attitude, and subjective norm (R(2) = 0.56).

CONCLUSION

The TPB has utility as a theoretical framework to understand prostate cancer survivors' sexual help-seeking decisions and may inform development of more effective interventions. Masculine beliefs were highly salient. Men who were more emotionally self-reliant and attributed greater importance to sex formed stronger help-seeking intentions. Subjective norm contributed most strongly to help-seeking intentions suggesting that health professionals/partners/peers have a key role as support mechanisms and components of psycho-sexual interventions.

Within-Gender Differences in Medical Decision Making Among Male Carriers of the BRCA Genetic Mutation for Hereditary Breast Cancer

An intersectional approach was used to understand sex/gender differences in men's health decisions with regard to hereditary breast cancer (BRCA). A sequential explanatory mixed method design was employed consisting of an online survey with a convenience sample of 101 men who tested positive for the breast cancer mutation following up with an in-depth interview with a subsample of 26 males who participated in the survey. The survey results revealed that 70.3% ( n = 45) considered "Family Risk" as the primary reason for getting BRCA tested; 21.9% ( n = 14) considered "Medical Considerations," and 7.8% ( n = 5) considered "Social Support" as their primary reason. Male participants who were 50 years old or younger or who did not have children were more likely to consider medical reasons as the primary reason to get tested. In terms of self-concept, younger men were more stigmatized than their older counterparts; married men felt a greater loss of control with regard to their BRCA-positive mutation diagnosis than single men; and professional men as a whole felt more vulnerable to the negative influences of the disease than those who had already retired. Regression analysis results indicated that negative self-concept was strongly related to sampled males' BRCA involvement 6 months after testing. Applying an intersectional approach to health care, decision-making outcomes among BRCA-positive mutation males provides an important lens for ascertaining the within-sex/gender demographic and psychosocial factors that affect the diversity of men's pretesting and posttesting medical decisions.

Understanding male cancer patients' barriers to participating in cancer rehabilitation

The aim was to describe male cancer survivors' barriers towards participation in cancer rehabilitation as a means to guiding future targeted men's cancer rehabilitation. Symbolic Interactionism along with the interpretive descriptive methodology guided the study of 35 male cancer survivors representing seven cancer types. Data were generated through a 5-month fieldwork study comprising participant observations, semi-structured individual interviews and informal conversations. The analyses revealed two overarching findings shedding light on male cancer survivors' barriers to rehabilitation: 'Fear of losing control' and 'Striving for normality'. While 'Fear of losing control' signified what the men believed rehabilitation would invoke: 'Reduced manliness', 'Sympathy and dependency' and 'Confrontation with death', 'Striving for normality' was based on what the men believed rehabilitation would hinder: 'Autonomy and purpose', 'Solidarity and fellowship' and 'Forget and move on'. This study of male cancer survivors' and cancer rehabilitation documents how masculine ideals may constitute barriers for participation in rehabilitation and provides insights about why men are underrepresented in rehabilitation. The findings can guide practice to develop research-based rehabilitation approaches focused on preserving control and normality. Further empirical evidence is needed to: (1) explore the conduct of health professionals' towards male cancer patients and (2) address gender inequalities in cancer rehabilitation.

Gender differences in hypertension and hypertension awareness among young adults

Previous research has shown that men have higher levels of hypertension and lower levels of hypertension awareness than women, but it remains unclear if these differences emerge among young adults. Using the National Longitudinal Study of Adolescent to Adult Health (Add Health), this study examines gender differences in hypertension and hypertension awareness among U.S. young adults, with special focus on factors that may contribute to observed disparities (N = 14,497). Our results show that the gender disparities in hypertension status were already evident among men and women in their twenties: women were far less likely to be hypertensive compared to men (12% vs. 27%). The results also reveal very low levels of hypertension awareness among young women (32% of hypertensive women were aware of their status) and even lower levels among men (25%). Finally, this study identifies key factors that contribute to these observed gender disparities. In particular, health care use, while not related to the actual hypertension status, fully explains the gender differences in hypertension awareness. The findings thus suggest that regular medical visits are critical for improving hypertension awareness among young adults and reducing gender disparities in cardiovascular health.

Psychosocial Oncology Supports for Men: A Scoping Review and Recommendations

Although men's cancer experiences have received limited attention within the field of psychosocial oncology, increasing attention is being devoted to the development and evaluation of men-centered programs. This scoping review describes this emergent body of literature, detailing the focus, participation, and impact of interventions designed to help men with cancer build illness-specific knowledge, adapt to illness, manage side effects, distress, and uncertainty, sustain relationships, and more. Striving to build on existing knowledge, research gaps and opportunities are discussed, including a need for stronger methodologies, more tailored and targeted supports, attention to the experiences of men with nonprostate cancers, and the explicit integration of gender analyses in the research process.

Community-based recreational football: a novel approach to promote physical activity and quality of life in prostate cancer survivors

As the number of cancer survivors continues to increase, there is an increasing focus on management of the long-term consequences of cancer including health promotion and prevention of co-morbidity. Prostate cancer is the most frequent type of cancer type in men and causes increased risk of heart disease, diabetes and osteoporosis. Epidemiological evidence points to a positive effect of regular physical activity on all-cause and prostate cancer mortality and current clinical evidence supports the use of exercise in cancer rehabilitation. However, the external validity of existing exercise studies is limited and the majority of prostate cancer survivors remain sedentary. Hence, novel approaches to evaluate and promote physical activity are warranted. This paper presents the rationale behind the delivery and evaluation of community-based recreational football offered in existing football clubs under the Danish Football Association to promote quality of life and physical activity adherence in prostate cancer survivors. The RE-AIM framework will be applied to evaluate the impact of the intervention including outcomes both at the individual and organizational level. By introducing community-based sport environments, the study offers a novel approach in the strive towards sustained physical activity adherence and accessibility in prostate cancer survivors.

The impact of prostate cancer on partners: a qualitative exploration

OBJECTIVE

Prostate cancer and its treatment can result in numerous physical and psychological morbidities for the patient as well as his partner. This qualitative study aimed to explore the experiences of intimate spouses or partners of men diagnosed and/or treated for prostate cancer to better understand the personal impact of prostate cancer on the partner.

METHODS

Twenty-seven partners participated in this study. Six focus groups were convened, and one in-depth interview was undertaken to explore the practical impact of prostate cancer on the intimate spouse/partner. All discussions were audio-recorded and transcribed and then coded using a thematic approach.

RESULTS

Six themes emerged: (a) The influence of the man's response to prostate cancer on the partner, (b) The need to be involved in treatment and medical decision making, (c) Supporting a man who is experiencing a loss of masculinity, (d) Degree of congruence between each partner's coping responses, (e) Constrained communication, and (f) Changed roles and increased practical management.

CONCLUSIONS

It is clear that prostate cancer impacts substantially on many areas of partner well-being. An effective intervention provided to this population seems warranted and may lead to improvements in partner well-being, assist the couple in lessening the impact of prostate cancer and its treatment on their relationship, and assist in the man's recovery.