Social support and quality of life of prostate cancer patients after radiotherapy treatment

QUEENAN J.A., FELDMAN‐STEWART D., BRUNDAGE M. & GROOME P.A. (2010) European Journal of Cancer Care 19 , 251–259
Social support and quality of life of prostate cancer patients after radiotherapy treatment Research suggests that social support can have an impact on health‐related quality of life (HRQOL). Social support can be structural support (SSS) or functional support (FSS). Our study was designed to clarify the relationships between HRQOL, FSS and SSS. We conducted a cross‐sectional survey and a detailed chart review. The study population was men attending a follow‐up clinic after receiving radiotherapy for prostate cancer. Functional social support was measured by using the MOS Social Support Survey. Structural social support was measured by using questions adapted from the 1994–1995 National Population Health Survey conducted by Statistics Canada. Health‐related quality of life was measured by using the European Organization for Research and Treatment of Cancer's QLQ‐C30. We found a statistically significant positive correlation between FSS and HRQOL but no association between overall SSS and HRQOL. Worsening urinary symptoms were significantly associated with lower levels of FSS and with lower HRQOL. This study underscores that the perception of support (functional) is more important than the amount or size of support (structural). We also identified a subgroup of men who have lower FSS and lower HRQOL that suffer from urinary side effects of their treatment. Further research to clarify the relationship between FSS and urinary symptoms will also clarify how an intervention could improve the HRQOL of these men.     

Effects of pelvic floor muscle exercise on faecal incontinence in rectal cancer patients after stoma closure

The purpose of this study was to examine the effects of pelvic floor muscle exercise (PFME) on the faecal incontinence (FI) of rectal cancer patients following stoma closure. Participants were randomly distributed into an exercise group (n = 27) and non‐exercise group (n = 26). An experimental design and longitudinal approach were implemented for data collection. Baseline data were collected at 1 day before discharge, and then PFME was taught before the patients were discharged from the hospital. We collected data and followed up with the patients at their pre‐discharge visit and at 1, 2, 3, 6 and 9 months after discharge. The Cleveland Clinic Faecal Incontinence (CCI) score was used to measure patient outcome. PFME proved to effectively decrease the degree of FI in stoma closure recipients. The FI score of the exercise group significantly decreased from 8.37 to 2.27 after PFME compared with that of the non‐exercise group (from 8.54 to 2.58). The generalised estimation equation tests showed that both group and time were significantly different. The tests also indicated that although PFME appeared to hasten the decline of incontinence, this effect was no longer detectable at 9 months; thus, it may be an effective intervention for FI when implemented up to half a year after discharge.     

Psychosocial and sociodemographic correlates of benefit-finding in men treated for localized prostate cancer

BACKGROUND: Prostate cancer (PCa) treatment involves decrements in quality of life such as decreased sexual functioning and urinary/bowel incontinence. Prior work in other cancers has identified positive consequences (e.g. personal growth) following diagnosis and treatment, a phenomenon that has been referred to as benefit-finding (BF) and positively related to quality of life. METHOD: The present study evaluated demographic and psychosocial correlates of BF in men treated for localized PCa. Participants were 250 men who were 6-18 months post treatment, who completed measures of coping strategies, perceived social support, and BF. RESULTS: In regression models both coping and social support were positively related to BF scores, even after controlling for income, education and ethnic identification. CONCLUSION: Active coping strategies and greater perceived social support are important correlates of greater BF following localized PCa treatment.     

Faecal incontinence following radiotherapy for prostate cancer: A systematic review

Background

Faecal incontinence (FI) after radiotherapy is a known phenomenon, but has received little attention to date. This article aimed to review current knowledge on faecal incontinence related to radiotherapy for prostate cancer.

Methods

PubMed was searched for English-language articles published from January 1966 to December 2009 using the primary keywords ‘faecal incontinence’, ‘prostate cancer’ and ‘radiotherapy’. Prospective, retrospective and controlled trials reporting FI as a complication of radiotherapy for prostate cancer were included. The retrieved titles and abstracts were screened permissively and evaluated as to whether they satisfied the predefined inclusion and exclusion criteria.

Results

Nine hundred and ninety four articles were identified from the search. After step-wise review, 213 papers were selected for full article review of which 40 were selected for this review. The incidence of faecal incontinence following radiotherapy for prostate cancer varied from 1.6% to 58%. The mechanism of faecal incontinence was not entirely clear but it is most likely due to injury to the nerve plexus of the rectal muscular layer. Correlation between rectal dose-volume parameters and incidence is equivocal, although some studies suggest parameters confined to the lower rectum and/or anal canal may be of value to predict the extent of the injury and could be used as constraints in the dose planning process.

Conclusions

Interpretation of data is limited due to lack of large cohort studies with data on pre-treatment continence status and because variable instruments have been used to assess the severity of the condition. Well-designed prospective studies are needed to investigate dosimetric parameters focusing on the anal canal and sphincter apparatus. Considering the spatial distribution of radiation to the rectum may identify a more direct linkage between radiation damage and faecal incontinence.     

Social-cognitive correlates of adjustment to prostate cancer

This study examined whether social support might enhance health-related quality of life in men (n=89) treated for localized prostate cancer by improving their ability to cognitively process their cancer experience. Data were collected using two, structured in-person interviews and abstracting medical records. The baseline interview was within several months (T1) after treatment for cancer, and follow-up was 3 months later (T2). Most men (61.8%) were treated by radical prostatectomy. Results showed that T1 social support was positively related to T2 mental functioning, and this relation appeared to be mediated by T1 indicators of cognitively processing, intrusive thoughts and searching for meaning. These findings suggest that supportive social relations may improve mental functioning by helping men cognitively process their prostate cancer experience.     

Determinants of participation in social support groups for prostate cancer patients

OBJECTIVE: This study aims at determining factors related to the intention to participate and actual participation in social support groups for prostate cancer patients, using the framework of the theory of planned behavior. The factors studied are background variables, medical variables, psychosocial variables and attitude, social norms and perceived control. METHODS: From various sources, 238 prostate cancer patients were recruited. The patients filled out a questionnaire, containing standardized instruments on several psychosocial problems and social support, besides questions on demographic and medical characteristics. A specific questionnaire was developed to assess attitude, social norms and perceived control concerning the participation in support groups. From the recruited men, 48 participated in one of the support groups organized by the researchers. RESULTS: Logistic regression revealed that age, lack of social support, a positive attitude and a high perceive control are predictive for the intention to participate in a social support group. Perceived control and the number of prostate-specific problems did predict the factual participation. CONCLUSION: Many prostate cancer patients report psychosocial problems. A more positive attitude towards group participation and the availability of support groups at short travel distance facilitates the interest in and the factual group participation. PRACTICAL IMPLICATIONS: Urologist and urological nurses can play a role in creating a more positive attitude towards group participation, especially if the social support system is weak. Groups should be organized close to patients' place of residence.     

Psychosocial issues related to sexual functioning among African‐American prostate cancer survivors and their spouses

Objective: Focus on cancer survivorship and quality of life (QOL) is a growing priority. The aim of this study was to identify and describe the most salient psychosocial concerns related to sexual functioning among African‐American (AA) prostate cancer survivors and their spouses. Methods: Twelve AA prostate cancer survivors and their spouses participated in semi‐structured individual interviews. The interviews assessed couples' experiences with psychosocial adjustment and sexual functioning posttreatment for localized prostate cancer. The data were analyzed using the constant comparison method and content analysis. Results: In this qualitative study of couples surviving prostate cancer, there were divergent views between the male prostate cancer survivors and their female partners, particularly regarding sexual functioning. For the males, QOL issues emerged as the primary area of concern, whereas survival of their husbands was considered most important among the female spouses. The male respondents expressed unease with the sexual side effects of their cancer treatment, such as erectile dysfunction and decreased sexual desire and satisfaction. Female spouses recognized decreased sexual desire in their partners following treatment, but this was not considered a primary concern. Conclusions: Patients and their spouses may have differing perceptions regarding QOL and the impact of sexual functioning on survivorship. This study points to the need for further research and intervention development to address these domains with a goal to improve QOL. Copyright © 2010 John Wiley & Sons, Ltd.     

Lower urinary tract symptoms and risk of prostate cancer: the HUNT 2 Cohort, Norway

Screening for early prostate cancer is frequently employed in the routine management of men with lower urinary tract symptoms (LUTS), but the evidence‐base linking LUTS with prostate cancer is limited. We assessed the association of LUTS with a subsequent prostate cancer diagnosis in a prospective cohort study based on 21,159 Norwegian men who completed baseline questionnaires, including the International Prostate Symptom Score (IPSS) questionnaire, between 1995 and 2007 as part of the second Nord‐Trøndelag Health Study (HUNT 2). Men were followed‐up for prostate cancer incidence and mortality from the date of clinical examination to end 2005. During a mean of 9 years follow‐up, 518 incident prostate cancers were diagnosed and 74 men died from prostate cancer. Men with severe LUTS (IPSS 20–35) had a 2.26‐fold (95% CI: 1.49–3.42) increased risk of prostate cancer compared to men reporting no symptoms. A positive association was observed for localized (hazard ratio, HR: 4.61; 2.23–9.54), but not advanced (HR: 0.51; 0.15–1.75), cancers (p for heterogeneity <0.001). There was no evidence that moderate/severe symptoms (IPSS 8–35) were associated with prostate cancer mortality (HR: 0.83; 0.42–1.64) vs. no symptoms. Amongst 518 men with prostate cancer, there was a 46% lower (10–68%) risk of death with moderate/severe symptoms vs. no symptoms. We conclude that LUTS are positively associated with localized, but not advanced or fatal, prostate cancer, suggesting that urinary symptoms are not caused by prostate cancer. Thus, screening for early cancers on the basis of LUTS may not be justified. © 2008 Wiley‐Liss, Inc.     

集束化护理干预对前列腺癌术后盆底功能锻炼依从性及尿失禁的影响

目的 探讨集束化护理干预对前列腺癌患者术后盆底功能锻炼依从性及尿失禁的影响.方法 选取2020年1月至2020年12月间上海中医药大学附属曙光医院收治的50例前列腺癌根治术患者作为研究对象.其中,围手术期采用常规护理的20例患者纳入对照组.围手术期采用集束化护理的30例患者纳入观察组.比较两组术后盆底功能锻炼的依从性及...     

Study of dyadic communication in couples managing prostate cancer: a longitudinal perspective

Objective: Cancer patients and partners often report inadequate communication about illness‐related issues, although it is essential for mutual support and informal caregiving. This study examined the patterns of change in dyadic communication between patients with prostate cancer and their partners, and also determined if certain factors affected their communication over time. Method: Using multilevel modeling, this study analyzed longitudinal data obtained from a randomized clinical trial with prostate cancer patients and their partners, to examine their communication over time. Patients and partners (N=134 pairs) from the usual‐care control group independently completed baseline demographic assessment and measures of social support, uncertainty, symptom distress, and dyadic communication at baseline, and 4‐, 8‐, and 12‐month follow‐ups. Results: The results indicated that (1) patients and partners reported similar levels of open communication at the time of diagnosis. Communication reported by patients and partners decreased over time in a similar trend, regardless of phase of illness; (2) phase of illness affected couples' open communication at diagnosis but not patterns of change over time; and (3) couples' perceived communication increased as they reported more social support, less uncertainty, and fewer hormonal symptoms in patients. Couples' demographic factors and general symptoms, and patients' prostate cancer‐specific symptoms did not affect their levels of open communication. Conclusions: Perceived open communication between prostate cancer patients and partners over time is affected by certain baseline and time‐varying psychosocial and cancer‐related factors. The results provide empirical evidence that may guide the development of strategies to facilitate couples' interaction and mutual support during survivorship. Copyright © 2010 John Wiley & Sons, Ltd.     

The influence of stigma on the quality of life for prostate cancer survivors

The purpose of the present study was to investigate the influence of stigma on prostate cancer (PCa) survivors' quality of life. Stigma for lung cancer survivors has been the focus of considerable research (Else-Quest & Jackson, 2014); however, gaps remain in understanding the experience of PCa stigma. A cross-sectional correlational study was designed to assess the incidence of PCa stigma and its influence on the quality of life of survivors. Eighty-five PCa survivors were administered survey packets consisting of a stigma measure, a PCa-specific quality of life measure, and a demographic survey during treatment of their disease. A linear regression analysis was conducted with the data received from PCa survivors. Results indicated that PCa stigma has a significant, negative influence on the quality of life for survivors (R² = 0.33, F(4, 80) = 11.53, p < 0.001). There were no statistically significant differences in PCa stigma based on demographic variables (e.g., race and age). Implications for physical and mental health practitioners and researchers are discussed.     

Morbidity of radical retropubic prostatectomy following previous prostate resection

A total of 153 patients with prior prostate surgery underwent a radical retropubic prostatectomy for carcinoma of the prostate. Ninety-seven patients had undergone transurethral resection of the prostate (TURP), and 56 patients had undergone suprapubic transvesical prostatectomy (SPP). In 115 patients, the diagnosis of malignancy was made at the time of transurethral resection or enucleation. No perioperative deaths occurred and no patient suffered rectal injury or ureteral transection. Operative time and blood loss were similar between the TURP and SPP groups and were not different in a group of patients who had not had prior prostate surgery. Early and late complications occurred in eight patients (5.2%), of whom seven had had previous TURP. Complete urinary control was achieved in 96% (147) of the patients; stress incontinence was present in 4% (6 patients); and no patient was totally incontinent. Postoperative complications and the occurrence of stress incontinence were not related to the time elapsed between the previous prostate surgery and the radical prostatectomy. Sexual function was preserved in 32 (71%) of the 45 patients in whom we performed a nerve-sparing radical prostatectomy. Residual cancer was found in the radical prostatectomy specimen in 77 (67%) of the stage A patients. Twenty-nine (25%) of the stage A and 13 (34%) of the stage B patients had pathological evidence of disease extension beyond the confined prostate. Follow-up was 6–92 months, with a mean of 32 months. Four patients died of prostatic cancer, two patients died without cancer, and five have evidence of disease progression; 142 (93%) are alive without evidence of disease. Although radical prostatectomy sometimes is more difficult after previous prostate surgery, operative complication rates, patient morbidity, and the opportunity for surgical cure are not different from those seen in patients with no history of previous prostate Operations. © Wiley-Liss, Inc.