Living with Prostate Cancer:

1
Living with Prostate Cancer

• Psychiatric morbidity,
• quality of life and coping styles of patients
  with early stage and advanced prostate cancer.
• Michelle L. Macvean David W. Kissane
• Centre for Palliative Care, University of
  Melbourne

2
Specific Objectives

• To determine the psychiatric disorders of
  patients with early stage and advanced CaP using
  the Composite International Diagnostic Interview
  (CIDI)
• To establish the accuracy of a self-report
  screening inventory for psychosocial distress
  (Brief Symptom Inventory) in men with CaP by
  comparing scores with the psychiatric diagnoses
  obtained using CIDI

3
Specific Objectives

• To assess the quality of life and preferred
  coping styles of men with CaP
• To identify patterns of change in psychosocial
  adjustment over time
• To identify those aspects of quality of life and
  preferred coping responses that help identify men
  who show poorer psychosocial adjustment over time

4
Design

• Observational
• Longitudinal baseline, 3, 6, 12, 18, 24 mo
• Three arms
• 200 early stage CaP (T1, T2, T3, N0, M0)
• 200 advanced CaP (N, M)
• 200 community-based, age-matched comparisons

5
Data Presented Today

• First 200 participants
• 132 (66) early stage, 68 (34) advanced cancer
• Age mean- 67 mode- 64 range 42- 90
• Baseline data
• primary treatment at time of interview
• urinary, bowel and sexual functions, and
  psychosocial distress

6
Instruments

• UCLA Prostate Cancer Index (Litwin et al., 1998)
• urinary function bother
• bowel function bother
• International Index of Erectile Function (Rosen
  et al., 1997)
• erectile function, orgasm function, sexual
  desire, intercourse satisfaction, overall
  satisfaction
• Brief Symptom Inventory (Derogatis, 1993)
• 53-item psychosocial distress
• subscales somatization, obsessive complusive
  disorder, interpersonal sensitivity, depression,
  anxiety, hostility, phobic anxiety, paranoid
  ideation, psychoticism
• global measure general severity index (GSI)

7
Baseline Primary Treatment
n104
Percent
n29
n22
n16
n16
n13
Treatment
8
UCLA- Urinary Function
93.54
84.25
80.07
81.77
72.77
78.96
56.48
Mean Score
Treatment
NB higher score equals better functioning.
Overall mode 100 (range 0- 100)
9
UCLA- Urinary Bother
85.94
81.07
83.33
81.90
79.67
76.92
64.77
Mean Score
Treatment
NB higher score equals better functioning.
Overall mode 100 (range 0- 100)
10
UCLA Prostatectomy
NB higher score equals better functioning
11
UCLA- Bowel Function
90.83
89.09
85.87
84.39
85.60
81.37
77.62
Mean Score
Treatment
NB higher score equals better functioning.
Overall mode 85 (range 15- 100)
12
UCLA- Bowel Bother
94.83
84.37
86.36
84.76
82.77
80.77
79.67
Mean Score
Treatment
NB higher score equals better functioning.
Overall mode 100 (range 0- 100)
13
IIEF- Erectile Function
13.76
Mean Score
12.50
10.44
7.95
6.53
3.42
1.38
Treatment
NB higher score equals better functioning. Max
score 30. Overall mode 1 (range 0- 30)
14
IIEF- Orgasm Function
5.21
4.83
Mean Score
3.94
2.77
2.17
0.86
0.00
Treatment
NB higher score equals better functioning. Max
score 10. Overall mode 0 (range 0- 10)
15
IIEF- Sexual Desire
6.36
5.04
4.75
5.00
Mean Score
3.84
2.46
2.95
Treatment
NB higher score equals better functioning. Max
score 10. Overall mode 2 (range 0- 10)
16
IIEF- Intercourse Satisfaction
Mean Score
3.59
4.50
4.55
3.87
2.31
1.13
0.23
Treatment
NB higher score equals better functioning. Max
score 15. Overall mode 0 (range 0- 15)
17
IIEF- Overall Satisfaction
6.33
6.42
5.80
5.33
5.18
4.72
4.48
Mean Score
Treatment
NB higher score equals better functioning. Max
score 10. Overall mode 2 (range 0- 10)
18
Sexual Functions Hormone Therapy
NB higher score equals better functioning
19
Sexual Functions Hormone Therapy
NB higher score equals better functioning
20
Sexual Functions Chemotherapy
NB higher score equals better functioning
21
Sexual Functions Chemotherapy
NB higher score equals better functioning
22
BSI- Depression Raw Means
0.35
0.33
0.31
0.29
0.24
0.19
0.15
Mean Raw Score
Treatment
NB higher score equals greater distress. Raw
score cut off- .65
23
BSI- Anxiety Raw Means
0.41
0.37
0.35
0.32
0.28
0.16
0.17
Mean Raw Score
Treatment
NB higher score equals greater distress. Raw
score cut off- .67
24
BSI- GSI Raw Means
0.39
0.40
0.33
0.33
0.27
0.22
0.20
Mean Raw Score
Treatment
NB higher score equals greater distress. Raw
score cut off- .57
25
Summary

• Few urinary and bowel problems
• correlation between urinary problems radical
  prostatectomy
• High incidence sexual problems- few men are
  active
• correlation between sexual problems hormones
  chemo
• need to compare to group without cancer- are they
  sexually active?
• Some distress on BSI depression anxiety GSI
• although mean raw scores within typical range,
  still need support
• rad. prostat. radiotherapy had low depression,
  anxiety, general severity index- but no
  significant difference between treatments
• need to compare BSI with CIDI psychiatric
  diagnoses at 3 month interviews- is BSI good
  distress screening tool in men with CaP?
• Data from follow-up interviews- info on changes
  over time

26
Acknowledgements

• Chief Investigators
• Prof. David Kissane
• Prof. Sidney Bloch
• Dr. Anthony Love
• Prof. Gillian Duchesne
• Prof. Anthony Costello
• Associate Investigators
• Dr. Mark Rosenthal
• Ms. Anita Clarke
• Dr. Jeremy Millar
• Dr. Hedy Mameghan
• A/Prof. Mark Frydenberg
• Ms. Helen Crowe
• Mr. Ross Snow
• Dr. Jeremy Shapiro

• Project Contributors
• Ms. Jenny Anderson
• Ms. Joan Ostaszkiewicz
• Ms. Lynda Hardy
• Clinicians, nurses, data managers, clinic staff,
  clinicians assistants
• Funding
• National Health and Medical Research Council
• Participants
• Men with CaP
• Comparison group