Effects of individual and partner factors on anxiety and depression in Taiwanese prostate cancer patients: A longitudinal study

Studies exploring the mediating and predictive factors of anxiety and depression for prostate cancer patients in Eastern countries are scant. Guided by the transactional model of stress and coping, this study determined the predictors and mediators of anxiety and depression in prostate cancer patients. The participants comprised 115 prostate cancer patients and 91 partners. The patients and partners completed questionnaires regarding physical symptoms, disease appraisals, coping behaviours, anxiety and depression in the period before confirmation of treatment decisions and 1, 3, 6 and 12 months after treatment. The results revealed that partner anxiety engendered a stressful situation and aggravated patient anxiety. Patients’ threat appraisals and affective‐oriented coping behaviours mediated the relationships between their anxiety levels and those of their partners. The patients’ most recent prostate‐specific antigen (PSA) levels and hormonal symptoms were key predictors of their anxiety and depression levels. The patients’ harm appraisals mediated the relationships between their most recent PSA levels and hormonal symptoms and depression. Their threat appraisals and affective‐oriented coping behaviours mediated the relationships between their hormonal symptoms and anxiety and depression. To manage those key factors, reframing, appraising disease and improving coping behaviours may reduce anxiety and depression levels in prostate cancer patients.     

African American prostate cancer survivorship: Exploring the role of social support in quality of life after radical prostatectomy

Purpose: The aim of this study was to explore the African American prostate cancer survivorship experience following radical prostatectomy and factors contributing to quality of life during survival. Design: African American men who were part of a larger prostate cancer cohort were invited to participate in a focus group. Eighteen open-ended questions were designed by the study team and an experienced moderator to elicit participants' survivorship experiences. Results: Twelve men consented to participate in the study. Emergent themes included views of prostate cancer in the African American community, perceptions of normalcy, emotional side effects following radical prostatectomy, and social support involvement and impact during recovery. Conclusions: Previous findings suggest that African American men may experience more distress than Caucasian men when facing typical prostate cancer side effects. Traditional masculine role norms and negative perceptions of “disease disclosure” in the African American community could be contributing to the distress reported by some in this study. Strengthening social support systems by promoting more prosocial coping and help-seeking behaviors early in the survivorship journey may help bypass the detrimental health effects associated with masculine role identification, resulting in improved quality of life throughout the lengthy survival period anticipated for these men.     

Appraisals and coping in people living with cancer: a meta-analysis

The present meta-analysis examined the relationship between primary appraisal dimensions and coping strategies in people with cancer. Primary appraisals were operationalized as appraisals of threat, challenge, and harm/loss. Coping was operationalized according to two coping taxonomies: the first based on coping efforts to manage the stressor itself and/or the distressful feelings associated with it (problem- or emotion-focused coping, respectively) and the second based on the general orientation of the coping efforts (approach or avoidance coping). Appraisals of threat were (counter-intuitively) related to use of problem-focused coping (r=0.20); appraisals of harm and/or loss were related to avoidance coping (r=0.23); and appraisals of challenge were related to both problem-focused (r=0.15) and approach coping (r=0.14). These findings suggest that individuals with cancer who appraise their illness as a threat are likely to use more problem-focused coping strategies. Individuals who appraise their cancer as a harm/loss, however, are likely to use more avoidance coping strategies. And finally, those who appraise their cancer as a challenge are likely to use approach coping strategies. Factors found to moderate the relationship between appraisals and coping included age of the participant, time since diagnosis, and type of cancer.     

Coping and health-related quality of life in men with prostate cancer randomly assigned to hormonal medication or close monitoring

Prostatic carcinoma and its treatment have been associated with adverse effects on health-related quality of life (HRQoL). Individual differences in appraisal and coping have been suggested to mediate these HRQoL outcomes. A randomized trial of 65 men with non-localized prostate cancer compared several treatments and tested associations between appraisal, coping, and HRQoL. These patients, and 16 community volunteers matched for age and general health, undertook psychosocial assessments before treatment and after 6 months of treatment. Compared with baseline assessments, men on hormonal treatments reported impaired sexual function. Groups did not differ on emotional distress, existential satisfaction, subjective cognitive function, physical symptoms, or social and role functioning. For individuals, hormonal treatments were more frequently associated with decreased sexual, social and role functioning, but were also associated with improved physical symptoms. In hierarchical regression analysis, HRQoL was lower for men who had more comorbid illnesses, a history of neurological dysfunction, higher threat appraisals, or higher use of coping strategies at baseline. These results showed that pharmacological hormonal ablation for prostate cancer can improve or decrease HRQoL in different domains. HRQoL in men with prostate cancer was associated more strongly with appraisal and coping than with medical variables.     

Neuropsychological functioning and quality of life during the first year after completing chemotherapy for breast cancer

Objective: Research has documented modest cognitive difficulties among women treated for breast cancer. The present study was designed to evaluate the effects of these subtle cognitive changes on quality of life after treatment. Methods: Data are presented from women breast cancer patients who completed neuropsychological tests and questionnaires regarding quality of life 6 and 12 months post‐chemotherapy (n's=39 and 33). Neuropsychological test scores were examined for evidence of cognitive difficulties at each time point; repeated measures ANOVAs were used to identify changes over time. Regression analyses assessed relationships of quality of life outcomes with cognitive functioning, social support seeking, and fatigue. Results: Small percentages of participants (<20% across tests) evidenced deficits in delayed memory, processing speed, response inhibition, and verbal fluency (VF) at each time point. Reliable change index analyses suggested statistically reliable improvements in each cognitive domain for a modest portion of participants. Regressions revealed hesitation to seek social support and fatigue as the most consistent predictors of quality of life at 6 and 12 months post‐chemotherapy. Cognitive complaints and VF difficulties were also significantly related to quality of life at 12 months. Conclusions: In addition to confirming the importance of fatigue and social support in quality of life, these data offer preliminary indications that weaker VF skills and self‐reported cognitive complaints may be associated with poorer functional outcomes among cancer survivors. Further research is needed to validate these potential relationships, which suggest that cognitive difficulties among cancer survivors may warrant monitoring and possible intervention. Copyright © 2009 John Wiley & Sons, Ltd.     

Coping in men with prostate cancer and their partners: a quantitative and qualitative study

GREEN H.J., WELLS D.J.N. & LAAKSO L. (2010) European Journal of Cancer Care 20 , 237–247 Coping in men with prostate cancer and their partners: a quantitative and qualitative study This study investigated coping and quality of life in men with prostate cancer (n= 105, 48–86 years of age) and their partners (n= 85, 48–84 years). Participants completed the Abbreviated Dyadic Adjustment Scale, Brief COPE, European Organisation for Research and Treatment of Cancer Core Quality of Life Questionnaire (QLQ‐C30) and open‐ended questions on appraisal and coping. Multivariate analyses showed that better quality of life was associated with higher education levels (role functioning and fatigue), lower avoidant coping (emotional, social, and physical functioning and fatigue), and higher relationship satisfaction (emotional functioning). Use of medication or combined treatments was associated with worse physical and role functioning. Partners reported similar quality of life for patients as the patient ratings, except that partners reported patients' emotional functioning as significantly worse and social functioning as significantly better than the patients' own ratings. Patients and partners reported both positive and negative aspects to prostate cancer, and mentioned a range of coping strategies. Similarities between patients and partners in their responses to prostate cancer were identified using both quantitative and qualitative methods. Some differences within dyads were also noted and previous suggestions to incorporate partners and significant others in education and treatment were supported.     

Depression,anxiety, post‐traumatic stress disorder and health‐related quality of life and its association with social support in ambulatory prostate cancer patients

MEHNERT A., LEHMANN C., GRAEFEN M., HULAND H. & KOCH U. (2010) European Journal of Cancer Care 19 , 736–745
Depression, anxiety, post‐traumatic stress disorder and health‐related quality of life and its association with social support in ambulatory prostate cancer patients The aim of this study is to identify anxiety, depression and post‐traumatic stress disorder in prostate cancer patients and to investigate the association with social support and health‐related quality of life. A total of 511 men who had undergone prostatectomy were surveyed during ambulatory follow‐up care for an average of 27 months after surgery using standardised self‐report measures (e.g. Hospital Anxiety and Depression Scale, Posttraumatic Stress Disorder Checklist – Civilian Version, Illness‐Specific Social Support Scale, Short‐Form Health Survey). Seventy‐six per cent of patients evaluated their disease as ‘not’ or a ‘little threatening’. The cancer diagnosis and uncertainty were most frequently reported as ‘distressing’, while medical treatment and doctor–patient interaction were most frequently evaluated as ‘most helpful’. The number of patients reporting increased levels of psychological distress was 16%, with 6% demonstrating signs of having severe mental health problems'. No higher levels of anxiety and depression were observed in cancer patients compared with age‐adjusted normative comparison groups. Lack of positive support, detrimental interactions and perceived threat of cancer were found to be predictors of psychological co‐morbidity (P < 0.001). Lack of positive support, detrimental interactions, threat of cancer, disease stage and age significantly predicted mental health (P < 0.001), whereas the impact of social support on physical health was rather weak. Findings emphasise the need for routine psychosocial screening.     

Predictors of affect following treatment decision-making for prostate cancer: conversations, cognitive processing, and coping

Objective: Research suggests that cancer patients who are more involved in treatment decision‐making (TDM) report better quality of life following treatment. This study examines the association and possible mechanisms between prostate cancer patient's discussions about TDM and affect following treatment. We predicted that the length of time patients spent discussing treatment options with social networks and physicians prior to treatment would predict emotional adjustment after treatment. We further predicted that cognitive processing, coping, and patient understanding of treatment options would mediate this association. Methods: Fifty‐seven patients completed questionnaires prior to treatment and at 1 and 6 months following treatment completion. Results: Findings from the present study suggest that discussing treatment options with others, prior to beginning treatment for prostate cancer, significantly contributed to improvements in affect 1 and 6 months following treatment. Residualized regression analyses indicated that discussing treatment options with patient's social networks predicted a decrease in negative affect 1 and 6 months following treatment, while discussions with physicians predicted an increase in positive affect 1 month following treatment. Patients who spent more time discussing treatment options with family and friends also reported greater pre‐treatment social support and emotional expression. Mediation analyses indicated that these coping strategies facilitated cognitive processing (as measured by a decrease in intrusive thoughts) and that cognitive processing predicted improvement in affect. Conclusions: Greater time spent talking with family and friends about treatment options may provide opportunities for patients to cope with their cancer diagnosis and facilitate cognitive processing, which may improve patient distress over time. Copyright © 2008 John Wiley & Sons Ltd.     

Impact of diagnosis and treatment of clinically localized prostate cancer on health‐related quality of life for older Americans

BACKGROUND:

Few studies have measured longitudinal changes in health‐related quality of life (HRQOL) among patients with prostate cancer starting before their cancer diagnosis or have provided simultaneous comparisons with a matched noncancer cohort. In the current study, the authors addressed these gaps by providing unique estimates of the effects of a cancer diagnosis on HRQOL accounting for the confounding effects of ageing and comorbidity.

METHODS:

Data from the Surveillance, Epidemiology, and End Results registry were linked with Medicare Health Outcomes Survey (MHOS) data. Eligible patients (n = 445) were Medicare beneficiaries aged ≥65 years from 1998 to 2003 whose first prostate cancer diagnosis occurred between their baseline and follow‐up MHOS. By using propensity score matching, 2225 participants without cancer were identified from the MHOS data. Analysis of covariance models were used to estimate changes in HRQOL as assessed with the Medical Outcomes Study Short Form‐36 survey and the activities of daily living scale.

RESULTS:

Before diagnosis, patients with prostate cancer reported HRQOL similar to that of men without cancer. After diagnosis, men with prostate cancer experienced significant decrements in physical, mental, and social aspects of their lives relative to controls, especially within the first 6 months after diagnosis. For men who were surveyed beyond 1 year after diagnosis, HRQOL was similar to that for controls. However, an increased risk for major depressive disorder was observed among men who received either conservative management or external beam radiation.

CONCLUSIONS:

The current findings illustrated the time‐sensitive nature of decline in HRQOL after a cancer diagnosis and enhanced understanding of the impact of prostate cancer diagnosis and treatment on physical, mental, and social well being among older men. Cancer 2012. © 2012 American Cancer Society.     

Two different sides of ‘chemobrain’: determinants and nondeterminants of self‐perceived cognitive dysfunction in a prospective,randomized, multicenter study

Objective: Complaints of cognitive dysfunction are frequent among cancer patients. Many studies have identified neuropsychological compromise associated with cancer and cancer therapy; however, the neuropsychological compromise was not related to self‐reported cognitive dysfunction. In this prospective study, the authors examined if confounding factors masked an underlying association of self‐perceived cognitive function with actual cognitive performance. Determinants of self‐perceived cognitive dysfunction were investigated. Methods: Self‐perceived cognitive function and cognitive performance were assessed before treatment, at the end of treatment, and 1 year after baseline in 101 breast cancer patients randomized to standard versus intensified chemotherapy. Linear mixed‐effects models were applied to test the relationships of performance on neuropsychological tests, patient characteristics, and treatment variables to self‐reported cognitive function. Change of cognitive performance was tested as a predictor of change in self‐reports. Results: Self‐perceived cognitive function deteriorated during chemotherapy and had partially recovered 1 year after diagnosis. The personality trait negative affectivity, current depression, and chemotherapy regimen were consistently related to cognitive self‐reports. No significant associations with performance in any of the 12 cognitive tests emerged. Change of cognitive performance was not reflected in self‐reports of cognitive function. Conclusions: Neuropsychological compromise and self‐perceived cognitive dysfunction are independent phenomena in cancer patients. Generally, cancer‐associated neuropsychological compromise is not noticed by affected patients, but negative affectivity and treatment burden induce pessimistic self‐appraisals of cognitive functioning regardless of the presence of neuropsychological compromise. Clinicians should consider this when determining adequate therapy for patients who complain of ‘chemobrain’. Copyright © 2010 John Wiley & Sons, Ltd.     

Predictors of breast cancer-related distress following mammography screening in younger women on a family history breast screening programme

Objective: This longitudinal study investigated pre‐screening factors that predicted breast cancer‐specific distress among 1286 women who were undergoing annual mammography screening as part of a UK programme for younger women (i.e., under 50) with a family history of breast cancer. Methods: Women completed questionnaires one month prior to screening, and one and six months after receiving screening results. Factors measured were breast cancer worry, perceived risk, cognitive appraisals, coping, dispositional optimism, and background variables relating to screening history and family history. Results: Pre‐screening cancer worry was the most important predictor of subsequent worry, explaining 56/61% and 54/57% of the variance at one and six months follow‐up, respectively. Other salient pre‐screening predictors included high perceived risk of breast cancer, appraisals of high relevance and threat associated with the family history, and low perceived ability to cope emotionally. Women who had previously been part of the screening programme and those with a relative who had recently died from breast cancer were also vulnerable to longer‐term distress. A false positive screening result, pessimistic personality, and coping efforts relating to religion and substance use predicted outcomes of screening at one month follow‐up, but were not predictive in the longer‐term. Conclusion: Early intervention to ameliorate high levels of cancer‐related distress and negative appraisals would benefit some women as they progress through the familial breast screening programme. Copyright © 2008 John Wiley & Sons, Ltd.     

Cognition and depression effects of androgen receptor axis-targeted drugs in men with prostate cancer: A systematic review

ContextNovel androgen receptor axis-targeting drugs (ARATs) have been shown to improve outcomes in men with prostate cancer. Central nervous system androgen blockade may be harmful for older adults who may be at increased risk of adverse cognitive and psychologic effects.ObjectiveTo systematically evaluate the effect of ARATs on cognition and depression in men with metastatic prostate cancer.Evidence acquisitionWe searched PubMed and EMBASE for articles published in English between September 2012 and September 2019 reporting cognition and depression outcomes in men receiving ARATs for metastatic prostate cancer using validated psychometric tools. The level of evidence and risk of bias were assessed using the GRADE approach for randomized clinical trials and observational studies.Results15 reports studying 8954 men with metastatic castration-sensitive and -resistant, or non-metastatic castration-resistant prostate cancer were identified. Data were available for abiraterone, enzalutamide and apalutamide but not darolutamide. The mean (and 95% confidence interval) and median (and min-max) of the absolute scores and changes from baseline were included, when available. There was heterogeneity in the psychometric tools used which obviated statistical pooling of results. Very limited data assessing cognition suggested that abiraterone was associated with improved cognitive functioning or perhaps less cognitive harm versus enzalutamide. Fourteen reports assessed emotional wellbeing. ARATs reduced depressive symptoms when compared to prednisone alone or placebo but not compared to bicalutamide. Abiraterone may improve short-term emotional functioning relative to enzalutamide. The quality of evidence was low when examining ARAT effect on cognitive function and moderate when examining ARAT effect on depression.ConclusionsDepression was assessed more frequently than cognition in men receiving ARATs. Self-reported depression measures favored abiraterone over enzalutamide and both abiraterone and enzalutamide over placebo. Data evaluating apalutamide and darolutamide are lacking. Further studies of ARATs using validated clinician-based psycho-cognition tools along with self-reported measures in men with metastatic prostate cancer are needed.     

Predictors of distress and quality of life in patients undergoing cancer therapy: impact of treatment type and decisional role

Purpose: The purpose of this secondary investigation was to examine the impact of the type of treatment received and the perceived role in treatment decision making in predicting distress and cancer‐specific quality of life in patients newly diagnosed with breast or prostate cancer. Method: Participants included 1057 newly diagnosed breast and prostate cancer patients from four Canadian cancer centers who partook in a randomized controlled trial examining the utility of providing patients with an audio‐recording of their treatment planning consultation. A MANCOVA was performed to predict distress and cancer‐specific quality of life at 12 weeks post‐consultation based on control variables (patient age, education, residence, tumor size (breast sample), gleason score (prostate sample), and receipt of an initial treatment consultation recording), predictor variables (treatment type—chemotherapy, hormone therapy, radiation therapy; decisional role—active, collaborative, passive), and interactions between these predictors. Results: Women who received chemotherapy and reported having played a more passive role in treatment decision making had significantly greater distress and lower cancer‐specific quality of life at 12‐week post‐consultation. There were no statistically significant predictors of these outcomes identified for men with prostate cancer. Conclusion: Receipt of chemotherapy places women with breast cancer at risk for distress and reduced quality of life, but only for the subset of women who report playing a passive role in treatment decision making. Prospective, longitudinal studies are needed to confirm the present findings and to explicate the antecedents, composition, and consequences of the ‘passive’ decisional role during the treatment phase of the cancer trajectory. Copyright © 2009 John Wiley & Sons, Ltd.     

Changes in neuronal activation patterns in response to androgen deprivation therapy: a pilot study

Background  

A common treatment option for men with prostate cancer is androgen deprivation therapy (ADT). However, men undergoing ADT may experience physical side effects, changes in quality of life and sometimes psychiatric and cognitive side effects.     

Social connectedness and mortality after prostate cancer diagnosis: A prospective cohort study

Men with prostate cancer experience side effects for which a supportive social environment may be beneficial. We examined the association between four measures of social connectedness and mortality after a prostate cancer diagnosis. Male participants in the Melbourne Collaborative Cohort Study in 1990–1994, who developed incident prostate cancer and attended follow-up in 2003–2007, were eligible for the study. Information on social connectedness, collected at follow-up, included (i) living arrangement; (ii) frequency of visits to friends/relatives and (iii) from friends/relatives; (iv) weekly hours of social activities. A total of 1,421 prostate cancer cases was observed (338 all-cause deaths, 113 from prostate cancer), including 867 after follow-up (150 all-cause deaths, 55 from prostate cancer) and 554 before follow-up (188 all-cause deaths, 58 from prostate cancer). Cox models stratified by tumour Gleason score and stage, and sequentially adjusted for socioeconomic, health- and lifestyle-related confounders, were used to calculate hazard ratios (HR) and 95% confidence intervals (95% CI) for the association between social connectedness and all-cause mortality after prostate cancer. Men who reported living alone before diagnosis had higher overall mortality (HR = 1.6, 95% CI: 1.0–2.5), after adjustment for socioeconomic, health and lifestyle confounders. Lower mortality was observed for men with more social activities (p-trend = 0.07), but not in comprehensively adjusted models. Consistent with these findings, men living alone after prostate cancer diagnosis had higher mortality (HR = 1.3, 95% CI: 0.9–1.9). Lower mortality was observed with increasing socializing hours in the age-adjusted model (p-trend = 0.06) but not after more comprehensive adjustment. Our findings suggest that living with someone, but not other aspects of social connectedness, may be associated with decreased mortality for men with prostate cancer.     

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.     

Health-Related Quality of Life in Dutch Men with Prostate Cancer

Abstract

Prostate cancer is the most prevalent solid malignancy in men in the Netherlands. With regard to treatment, the focus of attention has shifted in the last decade from pure survival rates to health—related quality of life. HRQOL is affected differently by different treatments. The objective of this study is to assess the HRQOL related to treatment regime and time since diagnosis in Dutch men with prostate cancer. We conducted a cross—sectional study among 238 men with prostate cancer in a heterogeneous sample who filled in a general health—related quality—of—life measure (EORTC-QLQ-C30) and a prostate cancer specific quality—of—life instrument (the EORTC-QLQ-PR25) and a Joy—of—Life questionnaire. Men on hormonal treatment are doing worse compared with other treatments with respect to physical functioning, role functioning, fatigue, pain and sexual functioning. No differences were found between radical prostatectomy and radiation therapy on any of the HRQOL dimensions nor for time since diagnosis. In hormonal therapy, men who are diagnosed longer than two years ago report a worse cognitive functioning and more burdens from urinary problems.     

Death from high‐risk prostate cancer versus cardiovascular mortality with hormonal therapy

BACKGROUND:

Randomized trials have demonstrated improved survival when hormonal therapy (HT) is added to radiation therapy (RT) for high‐risk prostate cancer. However, it is still unknown whether men who have a history of myocardial infarction (MI) or MI risk factors achieve a superior outcome from HT.

METHODS:

A Markov decision analysis model was used to compare quality‐adjusted life expectancy (QALE) in men aged 50, 60, and 70 years who received RT and no HT, 6 months of HT (short‐term), or 3 years of HT (long‐term) for high‐risk prostate cancer stratified by cardiac risk group.

RESULTS:

In men with a history of MI, there was a decrease of 0.1 to 0.2 quality‐adjusted life years and 0.5 to 0.6 quality‐adjusted life years across all ages with short‐term HT and long‐term HT, respectively, compared with no HT. In men without MI, receipt of short‐term or long‐term HT was associated with a QALE benefit versus no HT in all cohorts. Among men without MI, the optimal duration of HT was a function of age and the number of MI risk factors. Long‐term HT improved QALE (range, 1.4‐5.4 years) for men aged 50 or 60 years except those with MI; whereas, for men aged 70 years with 4 cardiac risk factors, short‐term and long‐term HT yielded identical QALE.

CONCLUSIONS:

Men who received RT for high‐risk prostate cancer and had a history of MI experienced net harm when they received HT. Men without MI gained a QALE benefit from HT, even if they had up to 4 cardiac risk factors. The optimal duration of HT is a function of patient age and the number of cardiac risk factors. Cancer 2013. © 2013 American Cancer Society.     

Analysis of SLX4/FANCP in non-BRCA1/2-mutated breast cancer families

Background

Androgen deprivation therapy (ADT) is the mainstay therapy for men with prostate cancer. However, there are musculoskeletal side effects from ADT that increase the risk for osteoporosis and fracture, and can compromise the quality of life of these individuals. The objectives of this study are to determine the efficacy of a home-based walking exercise program in promoting bone health, physical function and quality of life in men with prostate cancer receiving ADT.

Methods/Design

A 12-month prospective, single-blinded, randomized controlled trial will be conducted to compare the Exercise Group with the Control Group. Sixty men with prostate cancer who will be starting ADT will be recruited and randomly assigned to one of the two groups: the Exercise Group will receive instructions in setting up an individualized 12-month home-based walking exercise program, while the Control Group will receive standard medical advice from the attending physician. A number of outcome measures will be used to assess bone health, physical function, and health-related quality of life. At baseline and 12 months, bone health will be assessed using dual-energy X-ray absorptiometry. At baseline and every 3 months up to 12 months, physical function will be evaluated using the Functional Assessment of Chronic Illness Therapy - Fatigue Scale, Activities-specific Balance Confidence Scale, Short Physical Performance Battery, and Six-Minute Walk Test; and health-related quality of life will be assessed using the Functional Assessment of Cancer Therapy Prostate Module and the Medical Outcomes Study 12-item Short Form Health Survey Version 2. A mixed multiple analysis of variance will be used to analyze the data.

Discussion

Musculoskeletal health management remains a challenge in men with prostate cancer receiving ADT. This study addresses this issue by designing a simple and accessible home-based walking exercise program that will potentially have significant impact on reducing the risk of fracture, promoting physical function, and ultimately improving the health-related quality of life in men with prostate cancer receiving ADT.

Trial registration

ClinicalTrials.gov: NCT00834392.     

Spirituality and Coping Among Survivors of Prostate Cancer

Abstract

This pilot study explored the influence of religion and spirituality on coping among survivors of prostate cancer. Thirty-eight men (14 African Americans and 24 Caucasians) completed a self-administered survey; 29 of the men participated in five focus group sessions. Four major themes emerged from these sessions: (1) the beneficial effect of faith or religious belief on coping with the disease, (2) the multiple functions of church social and spiritual support and educational forum, (3) the durability of faith in God, and (4) the distinction between religion and spirituality (institutional versus personal). Consistent with the group sessions, the survey data indicated that a majority of participants reported a high degree of religiosity, measured by denominational affiliation and attendance at places of worship. The data also showed that having prostate cancer influenced greater religious attendance, with the change attributed to a desire to gain spiritual support. Racial comparisons showed that the African American men had higher levels of religiosity than the Caucasian men did, as measured by church attendance, quality of spiritual life, and importance of God in the recovery process.