The psychosocial dimensions of fatigue in men treated for prostate cancer

Prostate cancer is one of the most prevalent forms of cancer in men worldwide. Cancer‐related fatigue (CRF) is the most frequently reported side effect of all cancer treatments and occurs in up to 74% of men treated for prostate cancer, particularly those receiving combined hormone and radiation therapies. Patients report the devastating impact of CRF on their quality of life and psychosocial functioning, affecting work, social, emotional and cognitive performance. It can manifest during treatment and persist long after its completion. A diagnosis of CRF is achieved once all other treatable factors such as anaemia or anxiety and depression have been managed, but does not alleviate the fatigue. The Functional Assessment of Cancer Therapy‐Fatigue (FACT‐F) is a brief and easily administered valid and reliable tool recommended for the assessment of CRF. Non‐pharmacological interventions such as activity‐based programs and psychosocial interventions including prostate cancer specific education and cognitive behavioural therapy have shown benefits in reducing levels of CRF. A multidisciplinary approach to the management of CRF in prostate cancer patients is advocated. The NICE four‐tier model of psychological support can be used as a framework to assist nurses and other health care professionals to alleviate the psychosocial burden of CRF. More research studies using a solid methodological foundation are required in men with prostate cancer to provide robust evidence which can be applied in practice.     

The needs of men with prostate cancer: results of a focus group study

Prostate cancer is the most common type of cancer diagnosed in men in the United States and accounts for 43% of all newly diagnosed malignancies. This year, approximately 218,890 men were diagnosed with prostate cancer (American Cancer Society, 2007). Of all men diagnosed with cancer each year, more than 30% will be diagnosed with prostate cancer. Receiving a diagnosis of cancer can be very difficult and emotionally challenging for patients and their families. There is limited research surrounding the psychosocial and educational needs of men diagnosed with prostate cancer and the effectiveness of existing support services for this population. The purpose of this qualitative and grounded theory study was to explore the psychosocial needs of men with prostate cancer using a previously developed cancer model. Demographic questionnaires and focus groups were used with a sample of 16 men aged between 49 and 81 years. The results of the qualitative analysis revealed consistency with a previously tested breast cancer model and identified unique concerns of men within three stages of the prostate cancer experience. Implications for nursing research and practice are presented.     

An evaluation of a specialist nursing role for men with prostate cancer

The role of a specialist prostate nurse in the care of men with newly diagnosed prostate cancer has not been well documented. Therefore, the needs of men diagnosed with prostate cancer were individually assessed in this qualitative study. The nurse was an acceptable source of information, with time to listen and respond to the men's physical and psychosocial needs at diagnosis and throughout the continuum of care.     

Psychosocial and educational intervention trials in prostate cancer

OBJECTIVES: To describe the nature and focus of published educational intervention trials in prostate cancer in the last 10 years and to examine the state of the research in this particular area of knowledge. DATA SOURCES: Health science and psychosocial electronic databases were searched for studies reporting trials of educational or psychosocial interventions for men with prostate cancer and for the partners or families of these men. CONCLUSIONS: Interventions were characterized by the aspect of the illness trajectory that was targeted. The majority of the studies focused on managing the disease, treatments, and side effects. IMPLICATIONS FOR NURSING PRACTICE: Psychosocial stressors and uncertainty are pervasive throughout the prostate cancer trajectory. Knowledge of psychosocial and educational interventions that have been tested is critical for nurses working with these patients and their families.     

Evaluating a psychosocial intervention for men with prostate cancer and their partners: Outcomes and lessons learned from a randomized controlled trial

AimThis study evaluated the process and outcome of a psychosocial intervention for men with prostate cancer and their partners. As more men survive prostate cancer, they and their partners need help and support to help them cope with the physical and psychosocial effects of the disease and treatment. There is a lack of psychosocial interventions for men with prostate cancer and their partners.MethodsA randomized controlled trial was conducted with 34 participants to measure the effects of the intervention on selected psychosocial outcomes, post-intervention and at one month’ follow-up. The nine-week program (CONNECT) consisted of three group and two telephone sessions. It focused on symptom management, sexual dysfunction, uncertainty management, positive thinking and couple communication. The outcomes, measured by validated tools were: self-efficacy, quality of life, symptom distress, communication, uncertainty and illness benefits.ResultsThe men in the intervention group did better on two outcomes (communication and support) than controls. Partners in the intervention group did better than controls on most outcomes. Less participants than expected participated in the trial. The reasons for non-participation included partners not wishing to participate, men not interested in group work, and not understanding the core purpose of the intervention. The cost of training facilitators and for delivering the intervention appeared to be low.ConclusionThe knowledge generated from this study will be beneficial for all those grappling with the challenges of developing, implementing and evaluating complex psychosocial interventions. This study has also highlighted the difficulties in recruiting men and their partners in clinical trials.     

Metastatic castrate‐resistant prostate cancer: a discussion of the physical and psychosocial effects

Management options for metastatic castrate‐resistant prostate cancer (mCRPC) have increased in recent years resulting in more men living for longer with the disease. The implications for patients and health care services are considered through an examination of the literature in relation to the physical and psychosocial effects of mCRPC and its treatment, looking at quality of life (QoL) and service delivery implications. QoL in advanced prostate cancer has been well documented in the literature but studies involving those with mCRPC are sparse. There is a lack of evidence regarding psychological distress and effective psychological interventions for men with mCRPC. There is a need for research to understand the impact of new treatments on QoL of men and their partners, to establish effective psychological interventions for men with mCRPC and to quantify the increased demand for services with prolonged survival. The purpose of this discussion paper is to examine the physical and psychosocial effects of both disease and treatment, alongside QoL issues and consideration of the implications for service delivery.     

Psychosocial consequences of potential overdiagnosis in prostate cancer a qualitative interview study

Background Prostate cancer is a frequently diagnosed cancer and made up 6% of male cancer deaths globally in 2008. Its incidence varies more than 25-fold worldwide, which is primarily attributed to the implementation of the prostate-specific antigen (PSA) test in developed countries. To reduce harm of overdiagnosis, most international guidelines recommend surveillance programmes. However, this approach can entail negative psychosocial consequences from being under surveillance for an (over)diagnosed prostate cancer.Aim To explore men’s feelings and experiences in a surveillance programme.Design and setting Qualitative study with Danish men diagnosed with asymptomatic prostate cancer Gleason score ≤ 6, who are in a surveillance programmeMethods 12 semi-structured, individual interviews were conducted and analysed with systematic text condensation and selected theories.Results Most informants reported that they were astonished at the time of diagnosis. They were aware of the small likelihood of dying from cancer, but in some cases, the uncertainty created ambivalence between knowing and not knowing. The men expressed their risk awareness in different ways: a realization that life does not last forever, uncertainty towards the future, a feeling of powerlessness, and a need for control.Conclusions The men in this study had substantial psychosocial consequences from being labelled with a cancer diagnosis. Bearing these men’s high risk of overdiagnosis in mind, it is important to discuss whether the harms of this diagnosis outweigh the benefits. The psychosocial consequences of being in a prostate cancer surveillance programme should be explored further.

KEY POINTS

• Current awareness: The number of men living with an asymptomatic prostate cancer has increased the last 20 years after the implementation of the PSA test.
• Main Statements: Men living with an asymptomatic, low-risk prostate cancer experience negative psychocosial consequences
• GPs should consider the possible negative psychosocial consequences in their decision-making of measuring the PSA level

     

Transrectal ultrasound prostate biopsy (TRUS-Bx): patient perspectives

Prostate cancer continues to be a complex disease for which a cause or cure has not yet been identified. Many men are diagnosed each year and the incidence is likely to increase as greater numbers of men reach "old" age. The transrectal ultrasound prostate biopsy (TRUS-Bx) is the predominant method to diagnose prostate cancer, and varying levels of patient pain have been associated with the procedure. The purpose of this ethnographic research study was to describe TRUS-Bx from the patients' perspective. Results from this study indicated that TRUS-Bx pain was strongly influenced by psychosocial factors, as well as physical aspects of the procedure.     

Prostate cancer: a chronic illness

Prostate cancer is the most frequently diagnosed malignancy and the second-leading cause of cancer death in men. The 10-year survival rate for all stages of prostate cancer is 93%. Men with prostate cancer live with the disease for many years, and the side effects of the disease and treatments have physical and psychosocial implications for the patient, spouse, and family. This case study explores the evolution of a patient with prostate cancer, from time of diagnosis through treatment decision making and ultimately end of life. Discussion of the implications for practice and research is included.     

Managing cancer‐related fatigue in men with prostate cancer: A systematic review of non‐pharmacological interventions

The aim of this systematic review was to synthesize the best available evidence informing the effectiveness of non‐pharmacological interventions for managing cancer‐related fatigue in men treated for prostate cancer. This review considered experimental studies that included men with prostate cancer (regardless of staging, previous treatment or comorbidities), aged 18 years and over who were undergoing any treatment, or had completed any treatment for prostate cancer within the previous 12 months. Three interventions were identified for the management of cancer‐related fatigue in men with prostate cancer. Evidence from five studies including 447 participants demonstrates the effectiveness of physical activity, both aerobic and resistance exercise, and from three studies including 153 participants suggesting the benefits of psychosocial interventions including education and cognitive behavioural therapy. Health professionals require knowledge of a range of effective interventions aimed at reducing cancer‐related fatigue in men with prostate cancer and should incorporate those interventions into their patient management. Although physical activity appears to show the greatest benefit, other non‐pharmacological interventions such as education and cognitive behavioural therapy have demonstrated benefit and should also be considered as a strategy in treating this debilitating side effect of cancer and its treatment.     

Men, culture and hegemonic masculinity: understanding the experience of prostate cancer

Following a diagnosis of, and treatment for prostate cancer, there is an expectation that men will cope with, adjust to and accept the psychosocial impact on their lives and relationships. Yet, there is a limited qualitative world literature investigating the psychosocial experience of prostate cancer, and almost no literature exploring how masculinity mediates in such an experience. This paper will suggest that the experience of prostate cancer, the process by which it is investigated, and the way in which it is understood has been shaped by an essentialist interpretation of gender, exemplified by hegemonic masculinity as the archetypal mechanism of male adaptation. In response to this static and limiting view of masculinity, this paper will offer a reframe of hegemonic masculinity. This reframe, being more aligned with common experience, will portray masculinity as a dynamic and contextual construct, better understood as one of a number of cultural reference points around which each man organises and adopts behaviour. It will be suggested that the extant literature, in being organised around hegemonic masculinity, obfuscates the experience of prostate cancer and acts to render covert any collateral masculinities, public or private, that may also be operating.     

Prostate cancer: appraisal, coping, and health status

The purpose of this study was to identify how cognitive appraisal and types of coping affect the health status of men with prostate cancer. Lazarus and Folkman's model of stress and coping guided this correlational, cross-sectional study. The convenience sample was composed of 131 men with prostate cancer who completed the Cognitive Appraisal of Health Scale, the Ways of Coping Checklist, and the Short-Form Health Survey using mailed questionnaires. Participants who appraised more harm or loss experienced worse physical and mental health. When participants perceived their diagnosis as posing more harm or loss or a greater threat, they were more likely to use emotion-focused coping. When the diagnosis was perceived as a challenge, men were more likely to use more problem-focused coping. The findings of this study enable health care providers to be more attentive to the psychosocial needs of prostate cancer patients.     

Indwelling catheter treatment and health-related quality of life in men with prostate cancer in comparison with men with benign prostatic hyperplasia

Experiences from indwelling urinary catheter treatment periods were studied. Little is known of what is felt from a male perspective although catheter treatment is a common pre- and postoperative measure for men with prostate cancer and benign prostatic hyperplasia (BPH). Also studied were health-related quality of life (HRQOL) and sense of coherence (SOC). Men with catheter experience (prostate cancer n = 71, BPH n = 37) were selected from a larger questionnaire study. Assessment was made with study-specific questions together with the QLQ C-30 assessing HRQOL and the SOC questionnaire measuring sense of coherence. Data reduction method was applied to study specific variables to determine problem patterns. Correlation between HRQOL and SOC was determined. Results showed similar problem patterns in men with prostate cancer and BPH: discomfort in wearing catheter (e.g. uneasiness 48.2%), practical and psychosocial difficulties in handling and wearing catheter (e.g. attaching catheter 32.4%) and discomfort at installation (e.g. pain 29.7%). There was lack of knowledge about wearing and practical handling of the catheter. Having a cancer diagnosis did not add to uneasiness or practical problems. Life quality was correlated to SOC (p 相似文献   

Helping patients with localized prostate cancer reach treatment decisions

OBJECTIVE

To highlight the role of psychosocial variables in treatment decision making for patients with localized prostate cancer and how family physicians can be of most help to such patients in facilitating good treatment choices.

QUALITY OF EVIDENCE

PubMed was searched, and articles relevant to the psychosocial aspects of localized prostate cancer treatment decision making were included. Articles were excluded when they clearly specified inclusion of men with metastatic disease. This is not a systematic review, and recommendations made are drawn from studies of level II or III evidence.

MAIN MESSAGE

The optimal strategy for managing localized prostate cancer has not been established and currently includes a number of potential options: active surveillance, radical prostatectomy, external beam radiotherapy, brachytherapy, and cryoablation. Consequently, men often struggle during the decision-making process, and some later regret their decisions. With an increased awareness of the psychosocial aspects of patient decision making, family physicians can help patients make better decisions.

CONCLUSION

Family physicians can help minimize the decisional regret experienced by patients after treatment by encouraging patients to consider their values and social supports, as well as the accuracy and appropriateness of the information used in the decision-making process.     

Stability of self-reported family history of prostate cancer among African American men

The genome-wide search for the prostate cancer gene holds the promise of the availability of prostate cancer susceptibility testing in the near future. When this occurs, self-reported history of prostate cancer will be critical in determining who is eligible for cancer susceptibility testing. Little attention has been given to the reliability of self-reported family history of prostate cancer, particularly in African American men. This correlational study measured the stability of self-reported family history of prostate cancer over a one-year time period (between 1997 and 1998) with 96 African American men from a southern state. The men were asked on two separate occasions, 1 year apart, "Have any of your men blood relatives ever had prostate cancer?" The question had a prior test-retest reliability of 0.85 over a 2-week period. Forty-eight percent of the men changed their answers on the second administration. Men most likely to change their answers were low-income men and men who did not participate in a free prostate cancer screening. This research highlights the need for public genetic education and the recognition by health professionals that self-reported family history of cancer is a variable that changes as families have increased awareness and communication concerning family history of cancer.     

Racial disparities in traumatic stress in prostate cancer patients: secondary analysis of a National URCC CCOP Study of 317 men

Introduction

African American men have the highest rates of prostate cancer of any racial group, but very little is known about the psychological functioning of African American men in response to prostate cancer diagnosis and treatment.

Purpose

In this secondary analysis of a national trial testing a psychological intervention for prostate cancer patients, we report on the traumatic stress symptoms of African American and non-African American men.

Methods

This analysis includes 317 men (African American: n?=?30, 9%; non-African American: n?=?287, 91%) who were enrolled in the intervention trial, which included 12?weeks of group psychotherapy and 24?months of follow-up. Using mixed model analysis, total score on the Impact of Events Scale (IES) and its Intrusion and Avoidance subscales were examined to determine mean differences in traumatic stress across all time points (0, 3, 6, 12, 18, and 24?months). In an additional analysis, relevant psychosocial, demographic, and clinical variables were added to the model.

Results

Results showed significantly higher levels of traumatic stress for African American men compared to non-African American men in all models independently of the intervention arm, demographics, and relevant clinical variables. African Americans also had a consistently higher prevalence of clinically significant traumatic stress symptoms (defined as IES total score ??27). These elevations remained across all time points over 24?months.

Conclusions

This is the first study to show a racial disparity in traumatic stress specifically as an aspect of overall psychological adjustment to prostate cancer. Recommendations are made for appropriate assessment, referral, and treatment of psychological distress in this vulnerable population.     

Preoperative serum prostate-specific antigen (PSA) below 10 microg/l predicts neither the presence of prostate cancer nor the rate of postoperative PSA failure

Recent information on the relationship of serum prostate-specific antigen (PSA) to prostate cancer and new reports on death rates in men warrant a reassessment of how we diagnose and treat prostate cancer. We now know for the first time that the annual death rate from prostate cancer in men > or =65 years of age is only 226 per 100 000 men. At least 40 000 of 100 000 men over age 65 (40%) have invasive prostate cancer as judged by examination of prostates in 3- to 4-mm step-sections. Thus, only 1 of every 177 men 65 years of age or older (226 in 40 000) with invasive prostate cancer dies annually from his cancer. Serum PSA between 2 and 10 microg/L is used almost universally as an indication to biopsy the prostate. When 10-20 biopsies are commonly taken, it is not surprising that approximately 40% of men are biopsy-positive for prostate cancer. Despite this reliance on serum PSA as an indication for biopsy, data at Stanford show no clinically useful relationship between preoperative serum PSA (in the range 2-10 mg/L) and the volume of Gleason grade 4/5 cancer or the volume of Gleason grades 3, 2, and 1 cancer, nor can we show any useful relationship of such preoperative PSA concentrations (2-10 microg/L) to biochemical PSA failure rates after radical prostatectomy. We urgently need a better serum marker for prostate cancer. Because PSA biochemical failure rates after radical prostatectomy are directly proportional to the amount of Gleason grade 4/5 cancer in the prostate, a serum marker of Gleason grade 4/5 carcinoma could be ideal.     

Is there a link between BPH and prostate cancer?

BPH is one of the most common diseases of older men, with more than 70% of men over 70 years affected, and prostate cancer is the most common cancer in men in the UK. Prostate cancer generally presents in one of three ways: asymptomatic patients who are screened (usually by a PSA test); men with LUTS who are investigated and undergo prostate biopsy; or patients with symptoms of metastasis such as bone pain. Men can be reassured that the main cause of LUTS is BPH. Only a small proportion of men have LUTS that are directly attributable to prostate cancer. Digital rectal examination (DRE) gives an evaluation of prostate size, which is relevant in particular to BPH management, and along with PSA testing it is one of the only ways of differentiating clinically between BPH and prostate cancer. If a nodular abnormality is present there is around a 50% chance of a diagnosis of prostate cancer being made on biopsy. Raised levels of serum PSA may be suggestive of prostate cancer, but diagnosis requires histological confirmation in almost every case. A normal PSA, PSA density and DRE can give reasonable confidence with regards to excluding clinically significant prostate cancer. BPH is not a known risk factor for prostate cancer, although the two frequently coexist. Age is the strongest predictor of prostate cancer risk, along with family history. BPH is not considered to be a precursor of prostate cancer. It is likely that although BPH may not make prostate cancer more likely to occur, it may increase the chance of diagnosing an incidental cancer.     

Behavioral stress accelerates prostate cancer development in mice

Prostate cancer patients have increased levels of stress and anxiety. Conversely, men who take beta blockers, which interfere with signaling from the stress hormones adrenaline and noradrenaline, have a lower incidence of prostate cancer; however, the mechanisms underlying stress–prostate cancer interactions are unknown. Here, we report that stress promotes prostate carcinogenesis in mice in an adrenaline-dependent manner. Behavioral stress inhibited apoptosis and delayed prostate tumor involution both in phosphatase and tensin homolog–deficient (PTEN-deficient) prostate cancer xenografts treated with PI3K inhibitor and in prostate tumors of mice with prostate-restricted expression of c-MYC (Hi-Myc mice) subjected to androgen ablation therapy with bicalutamide. Additionally, stress accelerated prostate cancer development in Hi-Myc mice. The effects of stress were prevented by treatment with the selective β₂-adrenergic receptor (ADRB2) antagonist ICI118,551 or by inducible expression of PKA inhibitor (PKI) or of BCL2-associated death promoter (BAD) with a mutated PKA phosphorylation site (BAD^S112A) in xenograft tumors. Effects of stress were also blocked in Hi-Myc mice expressing phosphorylation-deficient BAD (BAD^3SA). These results demonstrate interactions between prostate tumors and the psychosocial environment mediated by activation of an adrenaline/ADRB2/PKA/BAD antiapoptotic signaling pathway. Our findings could be used to identify prostate cancer patients who could benefit from stress reduction or from pharmacological inhibition of stress-induced signaling.     

To screen or not to screen: ongoing debate in the early detection of prostate cancer

Debate about the use of prostate-specific antigen (PSA) tests to screen prostate cancer in men is ongoing. Prostate cancer is the most common cancer after skin cancer in men and the second most deadly after lung cancer. An elevated PSA level can lead to this cancer's diagnosis and treatment even before the onset of symptoms. However, other causes also can create a high PSA level, which may lead to men being unnecessarily treated for prostate cancer. This article will shed some light on the issue and discuss prostate cancer screening.