Masculinities of prostate cancer survivors: a qualitative metasynthesis

[Male vulnerabilities and stereotypes in the social representations of prostate cancer]

In society, cancer is commonly associated with an incurable and disabling disease that causes damage beyond the biological scope, impacting the psychological and sociocultural dimensions of cancer patients. From a cultural point of view, men construct narratives about prostate cancer based on their experiences and social contexts, expressing moral, ethical, and sociopolitical elements attributed to the cause of this type of cancer. We sought to understand the causes of prostate cancer as represented by men living with this type of cancer and its repercussions on self-care. A descriptive, qualitative study based on the Theory of Social Representations was conducted with 31 men diagnosed with prostate cancer treated at a High Complexity Oncology Unit. Data were collected from April to June 2022 by in-depth, individual, and semi-structured interviews. The corpus was inserted into the ALCESTE software. Alcohol intake, smoking, sexual promiscuity, and not taking care of oneself were the main behaviors understood as causes of cancer, which generates self-responsibility and guilt for the illness. Social representations of these causes, translated into behaviors not aligned with what social morality dictates as right, have repercussions on the moralizing notion of cancer as punishment, in which the disease expresses the patient's character, anchored in the Judeo-Christian religious discourse, which reduces the sociopolitical burden of male vulnerabilities and reinforces stereotypes from patriarchal society.

Body image, self-esteem, and sense of masculinity in patients with prostate cancer: a qualitative meta-synthesis

PURPOSE

Body image, self-esteem, and masculinity are three interconnected constructs in men with prostate cancer, with profound effects on quality of life. This meta-synthesis aimed to evaluate all known qualitative studies published studying the effect of prostate cancer on these constructs.

METHODS

A systematic review utilising PubMed, Embase, MEDLINE, and PsycINFO databases up to May 2020 was conducted in line with PRISMA and ENTREQ guidelines. All qualitative studies of men's experiences with body image, self-esteem, and masculinity whilst living with prostate cancer were included. A thematic meta-synthesis was conducted to identify emergent descriptive and analytical themes under the main study constructs.

RESULTS

Of 2188 articles identified, 68 were included. Eight descriptive themes were identified under two analytical themes: 'Becoming a Prostate Cancer Patient' and 'Becoming a Prostate Cancer Survivor'. These described the distress caused by changes to body image, sexual functioning, sense of masculinity, and self-esteem, and the subsequent discourses men engaged with to cope with and manage their disease. A key element was increased flexibility in masculinity definitions, and finding other ways to re-affirm masculinity.

CONCLUSIONS

Prostate cancer has an important effect on men's health post-diagnosis, and we identified strong relationships between each construct evaluated. The role of hegemonic masculinity is important when considering men's coping mechanisms and is also a key factor when addressing these constructs in counselling post-treatment.

IMPLICATIONS FOR CANCER SURVIVORS

This meta-synthesis provides key topics that uniquely affect prostate cancer survivors, enabling these patients to be effectively counselled, and have their concerns recognised by clinicians.

Prevalence and severity levels of post-radical prostatectomy incontinence: different assessment instruments

OBJECTIVES

to analyze urinary incontinence prevalence and severity in prostatectomized men assessed by three different instruments.

METHODS

a cross-sectional study was conducted with 152 men. The pad test, pad used, and International Consultation on Incontinence Questionnaire - Short Form (self-report) were considered. Data were analyzed using Spearman's correlation, Kappa index, considering a significance level of 0.05.

RESULTS

urinary incontinence prevalence was 41.4%, 46.7% and 80.3% according to pad used, pad test and self-report. Positive correlations and moderate to poor agreement were found between the instruments. As for severity, most participants had mild incontinence. The largest number of cases of mild and severe incontinence was identified by self-report.

CONCLUSIONS

the self-report showed higher values for prevalence of mild and severe severity levels. Through the identified differences, we propose that the objective assessment (pad used and pad test) be associated with individuals' perception (self-report) to better estimate prevalence and severity.

Promoting Sexual Well-being for Men and Their Partners Affected by Prostate Cancer

OBJECTIVE

To present an overview of the issues related to the sexual well-being of people affected by prostate cancer and their partners, and propose ways to manage and address these by oncology nurses and the wider multi-disciplinary team.

DATA SOURCES

Electronic databases such as PubMed and Cinahl were used to retrieve relevant literature published between 2010 and 2020.

CONCLUSION

Sexual well-being in patients with prostate cancer and their partners is multifaceted, comprising physical, emotional, social, and cultural aspects.

IMPLICATIONS FOR NURSING PRACTICE

A combination of pharmacologic and non-pharmacologic interventions, together with enhanced communication, can be successful in providing culturally competent, person-centered care by oncology nurses and the wider multi-disciplinary team.

Transitory masculinities in the context of being sick with prostate cancer

Objective:

to interpret the meanings attributed by men with prostate cancer to the experience regarding their bodies and masculinities during illness.

Method:

ethnographic research with 17 men, guided by the narrative method and theoretical framework of medical anthropology and masculinities. The information was collected through recorded interviews, direct observation and field diary records, which were analyzed by inductive thematic analysis.

Results:

men undergo body and identity transformations when they get sick with prostate cancer, transiting through multiple masculinities, resigning their actions, and occupying subordinate positions in relation to other healthy bodies, which are marginalized in their social relationships and allied with regard to establishing their affective relationships.

Conclusion:

this evidence enhances and deepens the knowledge disclosed in the literature and contributes to the strengthening of nursing care actions when dealing with the sick.

"What I was and what I am": A qualitative study of survivors' experience of urological cancer

PURPOSE

Most qualitative studies do not explore experience throughout the urologic cancer survival trajectory. Moreover, the evidence of the experience of cancer survivors that focuses on the contextual aspects of culture is scarce in oncology literature. This study aimed to analyze the survival experience of urological cancer from the perspective of men.

METHOD

This was a narrative research based on the concepts of culture derived from the interpretative medical anthropologic approach. Semi-structured interviews were conducted with 10 male survivors of urological cancer at different survival seasons. Seven participants agreed to a second interview, which resulted in 17 interviews. The data were analyzed using a five-phase thematic analysis approach. The findings are presented as narrative syntheses. The standards for reporting qualitative research (SPQR) was used in this study.

RESULTS

Two narrative syntheses were constructed: "The journey of urological cancer: discovering oneself as a survivor" and "What I was and what I am today": the disruption on the body and life. The narrative synthesis shows that survivors undergo transitions of identity from being healthy men to wrecked men. The survivors tried to present themselves as normal men to keep their masculinity intact. However, the experience of survival constituted a process of liminality and biographical disruption.

CONCLUSION

The experience of surviving urological cancer has highlighted the physical, emotional, and social challenges experienced by these male survivors. It is recommended to oncology nurses that nursing care should be planned along survival seasons considering the survivors' individual and subjective experiences.