Impact of Prostate Cancer on Sexual Relationships: A Longitudinal Perspective on Intimate Partners' Experiences

IntroductionIn this prospective study of localized prostate cancer patients and their partners, we analyzed how partner issues evolve over time, focusing on satisfaction with care, influence of cancer treatment, and its impact on relationship with patient, cancer worry, and personal activities.AimsOur study aims were twofold: (i) to determine whether the impact of treatment on patients and partners moderate over time and (ii) if receiving surgery (i.e., radical prostatectomy) influences partner issues more than other treatments.MethodsPatients newly diagnosed with localized prostate cancer and their female partners were recruited from three states to complete surveys by mail at three time points over 12 months.Main Outcome MeasuresThe four primary outcomes assessed in the partner analysis included satisfaction with treatment, cancer worry, and the influence of cancer and its treatment on their relationship (both general relationship and sexual relationship).ResultsThis analysis included 88 patient–partner pairs. At 6 months, partners reported that cancer had a negative impact on their sexual relationship (39%—somewhat negative and 12%—very negative). At 12 months, this proportion increased substantially (42%—somewhat negative and 29%—very negative). Partners were significantly more likely to report that their sexual relationship was worse when the patient reported having surgery (P = 0.0045, odds ratio = 9.8025, 95% confidence interval 2.076–46.296). A minority of partners reported significant negative impacts in other areas involving their personal activities (16% at 6 months and 25% at 12 months) or work life (6% at 6 months, which increased to 12% at 12 months).ConclusionFrom partners' perspectives, prostate cancer therapy has negative impact on sexual relationships and appears to worsen over time. Ramsey SD, Zeliadt SB, Blough DK, Moinpour CM, Hall IJ, Smith JL, Ekwueme DU, Fedorenko CR, Fairweather ME, Koepl LM, Thompson IM, Keane TE, and Penson DF. Impact of prostate cancer on sexual relationships: A longitudinal perspective on intimate partners' experiences. J Sex Med 2013;10:3135–3143.     

Is a longer time interval between recombinant human deoxyribonuclease (dornase alfa) and chest physiotherapy better?: A multi‐center,randomized crossover trial

BACKGROUND: Although the benefits of recombinant human deoxyribonuclease (dornase alfa) in patients with cystic fibrosis (CF) are established, its optimal timing in relation to physiotherapy is unknown. As its enzymatic effect lasts for 6-11 hr, dornase alfa may be more efficacious if the time interval between inhalation and chest physiotherapy is increased. The aim of this study was to investigate if a longer time interval between dornase alfa nebulization and chest physiotherapy improves clinical outcomes of subjects with CF. METHODS: A single-blind randomized cross-over trial was conducted on subjects with CF from outpatients of four hospitals. Subjects were in stable health and studied over 6 weeks (utilizing 14-day blocks of morning or evening dornase alfa administration with 14 days washout). Usual regimens for physiotherapy and exercise were unaltered. Thus changing the times altered the dwell time of dornase alfa prior to physiotherapy. Long interval was defined as dwell time of >6 hr and short as < or =6 hr. Outcomes were measured at pre and post each regimen. RESULTS: Twenty subjects aged 7-40 years completed the study. At end of long interval regimen, (median interval = 11.1 hr), FEF(25-75%) and CF-specific quality of life significantly improved compared to baseline values and to short interval regimen (median interval = 0.25 hr) outcomes. FVC, FEV(1), sputum weights, and adherence were similar in both regimens. CONCLUSIONS: A longer time interval between dornase alfa and physiotherapy is more efficacious than short interval. Administration timing of dornase alfa based on patient choice to incorporate longer interval time is likely to be the best regimen for patients previously established on dornase alfa nebulization.     

Adverse Events Associated With Bevacizumab and Chemotherapy in Older Patients With Metastatic Colorectal Cancer

BackgroundThe safety of bevacizumab in older mCRC patients is poorly understood. The purpose of this analysis was to determine the prevalence, incidence, and risk factors for treatment-related AEs in older bevacizumab recipients.Patients and MethodsPatients age ≥65 were identified from SEER–Medicare and categorized by mCRC diagnosis pre and post bevacizumab approval (2001-2003 vs. 2005-2007). Preexisting conditions known to increase bevacizumab-related AE risk were identified in the year before diagnosis. Factors associated with bevacizumab receipt were identified using logistic regression. Incidence rates for all AEs and specific serious AEs were determined. Risk factors for first AE were determined by competing risks regression.ResultsOf 6821 patients, 3282 (48%) were diagnosed in 2005-2007 of whom 19% received first-line bevacizumab. Likelihood of bevacizumab receipt was lower in patients age ≥ 75 (odds ratio [OR], 0.41; 95% confidence interval [CI], 0.36-0.47), nonwhite patients (OR, 0.67; 95% CI, 0.55-0.81), patients with higher comorbidity index (OR, 0.52; 95% CI, 0.43-0.62), and patients with preexisting cerebrovascular disease (OR, 0.49; 95% CI, 0.33-0.73). AE incidence rate was not increased among first-line bevacizumab recipients relative to first-line chemotherapy recipients. In a competing risk regression adjusting for potential confounders, bevacizumab receipt (2005-2007) was not associated with an increased risk of first AE compared with chemotherapy alone (2001-2007) (hazard ratio, 0.97; 95% CI, 0.87-1.08).ConclusionIn an older mCRC population, bevacizumab receipt was less likely in older (age ≥ 75) nonwhite patients with preexisting cerebrovascular comorbidities. First-line bevacizumab was not associated with increased AE incidence or risk of first AE compared with chemotherapy alone.     

Adelaide Healthy Food Basket: A survey on food cost, availability and affordability in five local government areas in metropolitan Adelaide, South Australia

Aim: There is evidence that some people in Australia do not have access to affordable, healthy foods. Information on food accessibility and affordability is essential in pubic health nutrition to assist in policy making and determining areas of intervention. The aim of the present study assess and compare the cost, availability and affordability of a standardised healthy food basket (HFB) in five local government areas (LGAs) in metropolitan Adelaide. Methods: Five LGAs in metropolitan Adelaide were selected based on ranges of socioeconomic status (SES). A reference family was used as the basis for the costing a HFB. Prices of food items were collected in selected suburbs in May, August and September in 2005. Cost of the Adelaide HFB was compared with welfare payment and average weekly earnings (AWE). Results: Average weekly cost of Adelaide HFB was $245.63 for the 11 suburbs: lowest in Coolabah, in low SES City of Fordlow ($224.17), and highest in Banksia, in high SES City of Sidehigh ($271.87). The proportion of AWE taken up by the average HFB was 35%, while that of the welfare payments was 31%. Conclusion: The study showed that the cost of HFB was lower in low‐SES suburbs. Items in the HFB were found in most supermarkets surveyed; therefore, availability of healthy food at this geographical level is not a concern. However, the study highlighted the proportionately high costs of a healthy diet for families on welfare or on a single income based on AWE, which needs to be considered in programs encouraging healthy food choices.     

Group visits in the management of diabetes and hypertension: Effect on glycemic and blood pressure control

Diabetes is a major public health problem that is reaching epidemic proportions in the United States and worldwide. Over 22 million Americans currently have diabetes and it is forecast that over 350 million people worldwide will be affected by 2030. Furthermore, the economic cost of diabetes care is enormous. Despite current efforts on the part of health care providers and their patients, outcomes of care remain largely suboptimal, with only 3% to 7% of the entire diabetes population meeting recommended treatment goals for glycemic, blood pressure, and lipid control. Therefore, alternative approaches to diabetes care are desperately needed. Group visits may provide a viable option for patients and health care providers, with the potential to improve outcomes and cost effectiveness. In this review, we highlight the magnitude of the diabetes epidemic, the barriers to optimal diabetes care, and the utility of the concept of group visits as a chronic disease management strategy for diabetes care.