ReviewA systematic review of psychosocial interventions for men with prostate cancer and their partners
Introduction
Prostate cancer is the most common invasive cancer in men in developed countries [1]. In Australia, 1 in 8 men will be diagnosed with prostate cancer in their lifetime and 1 in 89 will die from the disease [2]. Improved survival from prostate cancer has been demonstrated worldwide [1] such that the large cohort of men living with the consequences of diagnosis and treatment is increasing. Hence maintaining and enhancing the well-being of these men is of great importance in cancer care.
The diagnosis of prostate cancer is followed by well-described psychosocial difficulties [3]. Up to 38% of men with prostate cancer report ongoing high psychological distress [4]. Partners of men with prostate cancer sometimes report higher levels of cancer-related distress than are experienced by the men themselves [5], [6]. Many men experience unmet supportive care needs after prostate cancer. Smith et al. [7] found that more than half (54%) of men with prostate cancer expressed some level of unmet psychological need, and 47% expressed unmet sexuality needs. More than 20% of men reported a moderate to high need for help with addressing “uncertainty about the future”.
Men with advanced prostate cancer face additional challenges compared with men with localized disease. The iatrogenic effects of hormonal ablation, the main treatment for advanced disease, include mood disturbance, cognitive impairment, fatigue, and sexual dysfunction [8]. By comparison to men with localized prostate cancer, men with advanced disease report higher levels of psychological distress and poorer quality of life [3], [9]. Men with locally advanced or metastatic prostate cancer have an increased risk of suicide by comparison to men with localized disease [10]. Finally, as the disease progresses, it puts an increasing burden on family caregivers, who often must take on many of the roles in the family that the patient once assumed, including home maintenance, paying bills, and maintaining social connections. Guidance about evidence-based interventions to maximize quality of life and psychological adjustment is therefore especially crucial for these men.
A recent narrative review of randomized controlled trials of rehabilitative interventions for men with prostate cancer concluded that self-management may be a viable way to address men's survivorship needs [11]. In this review however, only studies that were deemed by the authors to offer a ‘self-management’ approach were included; and a series of exclusion criteria were applied including palliative and terminal stage disease; any interventions considered not sufficient for improved self-management (e.g. information delivery alone); and interventions to couples or spouses where primary outcomes concentrated on emotional relationships or only spouse-related factors. Dale et al. [12] examined the effectiveness of 11 post-treatment psychosocial interventions for adult men with cancer (samples at least 50% male for inclusion) and reported that heterogeneity between studies and a lack of detail in reporting made it difficult to compare intervention approaches. Critically, neither review undertook a systematic criterion-based quality assessment [13], examined partner outcomes, or specifically considered men with advanced prostate cancer who are at higher risk for poorer outcomes. Problematically, narrative reviews such as that by Dale et al. [12] and Cockle-Hearne and Faithfull [11] are subject to error and bias and can overestimate the efficacy of the trials [14]. Hence, a review that addresses the questions of trial quality in intervention studies for men with prostate cancer is needed to more clearly inform evidence-based practice.
In 2005 the Australian Cancer Network commenced a project to develop clinical practice guidelines to address the management of advanced prostate cancer. As a first step an expert multi-disciplinary panel with consumer representatives was formed (including SC and CP) to develop clinical questions for systematic review [8]. The questions conformed to guidelines in which the target population, intervention, comparator, and outcome are clearly stated to guide the review process [13]. Because so few psychosocial intervention studies were designed specifically for men with advanced prostate cancer, the review (led by DO’C) included intervention studies for prostate cancer survivors at any disease stage. The present study describes an update of this systematic review addressing two key psychosocial clinical questions:
- 1.
In men with prostate cancer do psychological and cognitive interventions improve psychological adjustment?
- 2.
In men with prostate cancer do interventions alleviating partner distress improve quality of life (QOL)?
Section snippets
Methods
A systematic review up until April 2006 was undertaken to examine the effects of psychosocial interventions for prostate cancer patients and their partners [8]. For the present study this review was updated to include publications from 2006 to 2009 for the two key clinical questions described previously. Medline, EMBASE, CINAHL and PsycINFO databases (2000–2009) were searched. The search contained keywords and subject headings, such as “exp psychosocial support/.” and “exp affective symptoms//”
Search results
The search identified over 8600 citations. Titles and abstracts were scanned and 195 articles examined in greater detail. Of these 195 articles, 25 articles describing 21 trials met the inclusion criteria for Question 1 and/or 2; 4 trials met the inclusion criteria for both Questions 1 and 2; 16 trials met the inclusion criteria for Question 1 only; and one trial met the inclusion criteria for Question 2 only (see Fig. 1).
Study quality
The methodological quality of the included trials is summarized in Table 1
Discussion
Group cognitive behavioral interventions and psycho-education appear to be helpful in promoting better psychological adjustment and QOL for men with localized prostate cancer. Scant evidence was found to support one approach for partner adjustment, although coping skills training delivered to the patient–spouse dyad may have promise. However, given the inconsistent results between and within studies, as well as the overall low study quality, our conclusions are made with caution and we suggest
Acknowledgements
We gratefully acknowledge Andrology Australia and the Prostate Cancer Foundation of Australia for providing funds to support this project. We also acknowledge the Australian Cancer Network and Professor Tom Reeves for their support.
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