Living with Prostate Cancer

1
Living with Prostate Cancer

• A longitudinal study of the psychosocial
  adjustment of men and their partners to early
  stage and advanced prostate cancer
• Dr. Michelle L. Macvean
• Dr. Jeremy Couper
• Univeristy of Melbourne

2
Mens study main aims

• To follow two groups of prostate cancer patients,
  one newly-diagnosed and one late-stage, for a
  period of two years
• To observe, at various time points, the
  psychiatric disorders, quality of life, and the
  coping styles of the patients, comparing their
  responses with those of men from the community

3
Mens study specific objectives

• To determine the psychiatric disorders of
  patients with early and with late-stage prostate
  cancer using the CIDI
• To establish the accuracy of a self-report
  screening inventory for psychiatric distress
  (BSI) in patients with early and late-stage
  prostate cancer by comparing scores with the
  diagnoses made using the CIDI

4
Mens study specific objectives

• To assess the quality of life, including the
  quality of relationships with their partners, and
  the preferred coping styles of patients with
  early and late-stage prostate cancer
• To identify patterns of change in psychosocial
  adjustment at 3, 6, 12, 18 24 months following
  the initial baseline assessment conducted before
  treatment

5
Mens study specific objectives

• To identify those aspects of quality of life and
  of preferred coping responses that help identify
  patients who show poorer psychosocial adjustment
  over time.

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Mens study research instruments

• Self-administerd questionnaire kit
• SF-36- health related quality of life
• UCLA Prostate Cancer Index- bowel/bladder
• International Index of Erectile Function
• BSI-53- Brief Symptom Inventory- psychosocial
  distress
• Dyadic Adjustment Scale- marital satisfaction
• Family Relationship Index
• Mental Attitidues to Cancer (mini version)
• Perceived Aims of Treatment

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Mens study research instruments

• Researcher-administered questions
• Composite International Diagnostic Interview
  (CIDI)- psychiatric diagnoses.
• Open-ended questions
• Detailed demographics and medical history

8
Mens study recruitment sites

• ARMC
• Royal Melbourne
• The Alfred
• St Vincents
• Cabrini
• Peter Mac
• Box Hill
• Private practices

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Mens study eligibility

• Patient has diagnosis of CaP
• Patient has either
• early stage CaP- T1, T2, T3, N0, M0
  (pretreatment)
• OR
• advanced CaP- N, M
• Patient does not currently have other Ca
• Patient does not have intellectual disab.,
  dementia, psychotic disorder
• Patient can speak/understand English

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Mens study referrals and participants
11
Mens study referrals and participants
12
Mens study number of participants referred by
individual clinicians (min. 5)
Number of men participating (min. 5)
Referring clinicians
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Partners study main aim

• To describe and measure over time the
  psychosocial adjustment of a cohort of women who
  have partners diagnosed with prostate cancer and
  to determine what factors might contribute to the
  nature of their psychosocial adjustment

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Partners study specific objectives

• To describe the psychosocial adjustment of the
  women at the first point of contact with the
  study in terms of the womens psychiatric
  morbidity, psychosocial distress, quality of
  life, coping style, function in the couple and
  family context, and perception of the impact of
  their partners illness on their relationship

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Partners study specific objectives

• To reassess the womens psychosocial adjustment 6
  months later in order to measure change in those
  factors over time

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Partners study specific objectives

• To examine the potential contribution of the
  womens satisfaction with couple and family
  function, the perceived burden of the male
  partners illness and the womens coping styles
  at time 1 in predicting womens psychiatric
  morbidity and psychosocial distress 6 months later

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Partners study research instruments

• Self-administerd questionnaire kit
• UCLA Prostate Cancer Index-bowel/bladder
  (modified)
• International Index of Erectile Function
  (modified)
• Perceived Aims of Treatment (modified)
• BSI-53- Brief Symptom Inventory- psychosocial
  distress
• Dyadic Adjustment Scale- marital satisfaction
• Family Relationship Index
• Social Adjustment Scale (instead of SF-36 QoL)
• Ways of Coping Checklist (instead of MAC
  adjustmt)

18
Partners study research instruments

• Researcher-administered questions
• Composite International Diagnostic Interview
  (CIDI)- psychiatric diagnoses.
• Open-ended questions
• Detailed demographics and medical history

19
Partners study recruitment sites

• ARMC
• Royal Melbourne
• The Alfred
• St Vincents
• Peter Mac
• Private practices

20
Partners study eligibility

• All female partners of men eligible for the mens
  study are eligible for partners study
• Woman does not have currently active cancer
  herself or other severe debilitating illness
• Woman does not have intellectual disab.,
  dementia, psychotic disorder
• Woman can speak/understand English

21
Partners study referrals and participants
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Preliminary findings

• Significantly greater sexual dysfunction in men
  with cancer than men without cancer
• Significantly greater sexual dysfunction in men
  with advanced disease than men with early stage
  disease
• Significantly greater sexual dysfunction in men
  aged above 60 compared with men below 60 years of
  age

23
Preliminary findings

• Significantly greater urinary problems in men
  with cancer than men without cancer
• Significantly greater urinary problems in men
  receiving prostatectomies and EBRT/brachytherapy
  with hormones than men receiving
  EBRT/brachytherapy without hormones

24
Preliminary findings

• Significantly greater family conflict in younger
  men (under 60) compared with men over 70 years
• A predictive statistical relationship between
  dyadic adjustment and - global psychosocial
  distress, family relationship problems and sexual
  dysfunction

25
Preliminary findings

• From 20 matched couples, we found significantly
  greater global psychosocial distress for women
  compared to their matched partners
• We also found rates of DSM-IV depression and
  anxiety in female partners of men with prostate
  cancer that are higher than in the general female
  population in Australia

26
Referral process at ARMC

• Jeremy flags eligible patients in outpatients
• There are three steps for clinicians in process
• If patient is eligible, please give him an
• Invitation to Participate
• Then ask him if we can contact him
• If he agrees, please place his bradmar???
  sticker on sheet in clinic - jc where are they
• Clinic staff will fax sheets to us and we will
  contact men and partners to obtain consent

27
Living with Prostate Cancer

• A longitudinal study of the psychosocial
  adjustment of men and their partners to early
  stage and advanced prostate cancer
• Dr. Michelle L. Macvean
• Dr. Jeremy Couper
• University of Melbourne