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Self-management after prostate cancer treatment: Evaluating the feasibility of providing a cognitive and behavioural programme for lower urinary tract symptoms
BJU International
Abstract
• To test the feasibility of a self-management intervention to help men cope with lower urinary tract symptoms as a result of radiotherapy for prostate cancer.
• A quasi-experimental design was used incorporating a pre-post-test evaluation. In total, a population of 71 men were screened for moderate to severe urinary symptoms 3 months or longer post-radiotherapy. Of these mean, 22 were recruited into the intervention from an eligible population of 43 symptomatic men. • Urinary symptoms were measured before the intervention and again after 4 months of follow-up through International Prostate Symptom Scores (IPSS) and bladder diaries. • Health-related quality of life was measured in relation to cancer per se and prostate cancer specifically, and confidence to cope was measured by a self-efficacy questionnaire. • The self-management intervention comprised pelvic floor muscle exercises, bladder retraining, patient education and problem solving and coping strategies
• Lower urinary tract symptoms, as measured by the IPSS, showed a significant improvement, with a median score change of 5 (P < 0.005). • This was supported by objective changes in median bladder void volume of +7.5 mL (P < 0.05) and the median number of daily voids of -1 (P < 0.005). • In addition, decreases in emotional distress and problems associated with urinary function suggest that the intervention had a positive impact on health-related quality of life.
• The provision of such an intervention was feasible within the clinical setting and provided benefits for men. • Symptom change vs those of normative recovery values for IPSS showed an intervention effect. • This intervention could be applied in routine practice and further testing is required in a randomized controlled trial.
... A self-management intervention can improve prostate cancer patients' urinary symptoms, psychological distress [14], self-confidence in symptom management [15], and self-efficacy [16]. Various applications (apps) have also been used to assist in self-management interventions. ...
... Social cognitive theory is most commonly used to guide studies on self-management interventions for patients with prostate cancer [14,20,21]. Self-management interventions can be provided to patients with prostate cancer through face-to-face interaction [14,22,23], websites [20,21,[24][25][26], telephone calls [15], apps [17,27,28], and combined strategies [29][30][31]. ...
... Social cognitive theory is most commonly used to guide studies on self-management interventions for patients with prostate cancer [14,20,21]. Self-management interventions can be provided to patients with prostate cancer through face-to-face interaction [14,22,23], websites [20,21,[24][25][26], telephone calls [15], apps [17,27,28], and combined strategies [29][30][31]. Interventions typically last 4-19 weeks [14, 15, 17, 20, 21, 23-27, 29, 32]. ...
Background
Urinary incontinence is a common complication among patients with prostate cancer who have undergone radical prostatectomy. Guided by social cognitive theory and a framework for the recovery of health and well-being, we propose to develop and test a self-management intervention for patients with prostate cancer who experience urinary incontinence after undergoing radical prostatectomy.
Methods
In this study, a self-management intervention for urinary incontinence (SMI-UI) is developed, comprising a mobile self-management application, a self-management handbook, and professional support. The feasibility, acceptability, and effectiveness of this intervention will be assessed. Patient data from the urology departments of two hospitals will be collected through convenience sampling by adopting an experimental, parallel, and random assignment research design. Patients experiencing urinary incontinence after undergoing radical prostatectomy will be invited to participate. After completing the pretest questionnaire, patients will be randomly divided into the experimental and attention control groups. The experimental group will undergo a 12-week SMI-UI, whereas the attention control group will receive an intervention consisting of a single dietetic education information package. The two groups will be tested 12 and 16 weeks after the pretest. In this study, we recorded the sociodemographic and clinical variables; recruitment rate; retention rate; satisfaction with the intervention; cancer-related self-efficacy; urination symptoms and disturbance; social participation and satisfaction; resilience; and demoralization.
Trial Registration
ClinicalTrials.gov ID: NCT05335967 [date of registration 04-04-2022].
... Systematic reviews of the effectiveness of cancer selfmanagement support for cancer survivors have consistently led researchers to call for focused, disease-specific and patient-targeted programmes [22][23][24]. Previous to the study reported here, our feasibility work found that an augmented symptom management intervention including coaching, bladder retraining and PFME instruction delivered at 3-6 months post-radiotherapy treatment for PCa was feasible within the clinical setting [25]. We hypothesised that in comparison with care-as-usual, at 6 months post-intervention, men who took part in the SMaRT group intervention would report significantly less urinary symptoms, have better symptom-related quality-of-life, less emotional distress and improved confidence to deal with PCa and its associated problems. ...
... EORTC QLQ-C30 for assessing the quality-of-life of cancer patients which is a reliable and valid measure of qualityof-life of cancer patients in multicultural clinical research settings contains five functional scales, global quality-of-life scale and general symptom scales, Cronbach's alpha across scales 0.52-0.89. This tool is used extensively in clinical research studies worldwide and in our feasibility study [25]. ...
... In this study, the usual care group had 1 physician visit face to face 4 weeks after radiotherapy, whereas our care-as-usual group saw the physician at 6 months and had ongoing contact with a CNS. Despite this difference, the change in urinary scores was not at the same level as that found by Dieperink [20] or in our feasibility study [25]. The distinct difference between these studies is the intervention intensity; SMaRT was primarily group based and may not have provided the individualised approach provided by Dieperink [20] in the face-to-face multidisciplinary rehabilitation setting. ...
Purpose
To evaluate the effectiveness of the symptom management after radiotherapy (SMaRT) group intervention to improve urinary symptoms in men with prostate cancer.
Methods
The randomised controlled trial (RCT) recruited men from one radiotherapy centre in the UK after curative radiotherapy or brachytherapy and with moderate to severe urinary symptoms defined as scores ≥ 8 on the International Prostate Symptom Score (IPSS) questionnaire. Sixty-three men were randomised either; to SMaRT, a 10-week symptom-management intervention including group support, education, pelvic floor muscle exercises, or a care-as-usual group. The primary outcome was the IPSS at 6 months from baseline assessment. Secondary outcomes were IPSS at 3 months, and International Continence Society Male Short Form (ICS), European Organisation for Research and Treatment of Cancer Quality of Life prostate scale (EORTC QLQ-PR25), EORTC QLQ-30 and Self-Efficacy for Symptom Control Inventory (SESCI) at 3 and 6 months from baseline. Analysis of covariance (ANCOVA) was used to analyse the effect of the intervention.
Results
SMaRT group intervention did not improve urinary symptoms as measured by IPSS at 6-months. The adjusted difference was − 2.5 [95%CI − 5.0 to 0.0], p = 0.054. Significant differences were detected at 3 months in ICS voiding symptoms (− 1.1 [− 2.0 to − 0.2], p = 0.017), ICS urinary incontinence (− 1.0 [− 1.8 to − 0.1], p = 0.029) and SESCI managing symptoms domain (13.5 [2.5 to 24.4], p = 0.017). No differences were observed at 6 months.
Conclusions
SMaRT group intervention provided short-term benefit in urinary voiding and continence and helped men manage symptoms but was not effective long term.
... Systematic reviews of the effectiveness of cancer self-management support for cancer survivors have consistently led researchers to call for focused, disease-speci c and patient targeted programmes (22)(23)(24). Previous to the study reported here, our feasibility work found that an augmented self-management intervention including coaching, bladder retraining and PFME instruction delivered at 3-6 months post radiotherapy treatment for PCa, was feasible within the clinical setting (25). We hypothesised that in comparison with care-asusual, at six months post intervention men who took part in the SMaRT intervention would report signi cantly less urinary symptoms, have better symptom-related quality-of-life, less emotional distress and improved con dence to deal with PCa and its associated problems. ...
... Physical assessment and personal training for PFME (25). ...
... In this study the usual care group had 1 physician visit face to face 4 weeks after radiotherapy whereas our care-as-usual group saw the physician at 6 months and had ongoing contact with a CNS. Despite this difference the change in urinary scores were not at the same level as that found by Dieperink (20) or in our feasibility study (25). The distinct difference between these studies is the intervention intensity, SMaRT was primarily group based and may not have provided the individualised approach provided by Dieperink (20) in the face-to-face multidisciplinary rehabilitation setting. ...
Purpose
To evaluate the effectiveness of the self-management after radiotherapy (SMaRT) intervention to improve urinary symptoms in men with prostate cancer.
Methods
The randomised controlled trial (RCT) recruited men from one radiotherapy centre in the UK after curative radiotherapy or brachytherapy and moderate urinary symptoms defined as the International Prostate Symptom Score (IPSS) ≥ 8. 63 men were randomised either to SMaRT, a 10-week self-management intervention including group support, education, pelvic floor muscle exercises, or care-as-usual. The primary outcome was the IPSS at 6 months. Secondary outcomes were IPSS at 3 months, and International Continence Society Male Short Form (ICS), European Organisation for Research and Treatment of Cancer Quality of Life prostate scale (EORTC QLQ-PR25), EORTC QLQ-30 and Self-Efficacy for Symptom Control Inventory (SESCI) at 3 and 6 months. Analysis of covariance (ANCOVA) was used to analyse the effect of the intervention.
Results
SMaRT did not improve urinary symptoms as measured by IPSS at 6 months. The adjusted difference was − 2.5 [95%CI -5.0 to 0.0], p = 0.054. Significant differences were detected at 3 months in ICS voiding symptoms (-1.1 [-2.0 to -0.2], p = 0.017), ICS urinary incontinence (-1.0 [-1.8 to -0.1], p = 0.029) and SESCI managing symptoms domain (13.5 [2.5 to 24.4], p = 0.017). No differences were observed at 6 months.
Conclusions
SMaRT provided short-term benefit in urinary voiding and continence, and helped men manage symptoms but was not effective long-term. Face-to-face and supervised approaches may provide more benefit.
... Self-management, which entails individuals engaging in self-care activities to maintain a healthy lifestyle, evaluate and monitor symptoms, and respond to the effects of health-related crises with the assistance of medical personnel, is a continuous process (Lorig & Holman, 2003). Self-management programs can help alleviate the physical symptoms and psychological distress of cancer survivors (Agbejule et al., 2022;Faithfull et al., 2011;Howell et al., 2017;Somers et al., 2015). Scholars have proposed a conceptual framework for the recovery of health and well-being for cancer survivors. ...
Background
The reliability and validity of the traditional Chinese version of the Cancer Survivors’ Self-Efficacy Scale (CS-SES-TC) has not been assessed.
Objective
To assess the psychometric properties of the Traditional Chinese version of the CS-SES-TC.
Methods
Participants were recruited from the outpatient departments of a hospital in Taiwan. A single questionnaire was administered to 300 genitourinary cancer survivors. The scales included in the initial questionnaire were the CS-SES-TC, the General Self-Efficacy Scale, the Center for Epidemiologic Studies Depression Scale (CES-D), and the Functional Assessment of Cancer Therapy-General scale (FACT-G). Data obtained from 300 survivors were used to confirm the structure through confirmatory factor analysis (CFA).
Results
The CFA results indicate that the 11-item CS-SES-TC is consistent with the original scale. Furthermore, it was identified as a unidimensional scale, with the model showing acceptable goodness-of-fit (CFI = 0.99, TLI = 0.97). The factor loading of each item in the CS-SES-TC was above 0.6 and had convergent validity. Based on multiple-group CFA testing, the change (ΔCFI) between the unconstrained and constrained models was ≤ 0.01, indicating that measurement invariance holds for gender. The participants’ CS-SES-TC scores were positively correlated with their FACT-G scores and negatively correlated with their CES-D scores. The scales exhibited concurrent validity and discriminant validity. The CS-SES-TC had a Cronbach’s α in the range of .97–.98.
Conclusion
The CS-SES-TC had acceptable reliability and validity. Healthcare workers can use this scale for ongoing assessment of the cancer-related self-efficacy of cancer survivors.
... Considering LGNHLs are often incurable with a chronic disease trajectory accompanied with long-term survival it is an ideal condition to study self-management experiences to inform the development of relevant interventions and services. Most self-management support research has involved prostate and breast cancer survivors, with limited studies among NHL survivors (Boland et al., 2018;Cuthbert et al., 2019;Faithfull et al., 2011;Howell et al., 2017;Kazer et al., 2011;Lepore et al., 2003). While some previous research has explored lymphoma survivors' aftercare needs (Friesen--Storms et al., 2021;Hackett and Dowling, 2019;Hall et al., 2013;Parry et al., 2011;Swash et al., 2016) there are very few in-depth qualitative studies specifically focusing on LGNHL survivors' needs and preferences for self-management support. ...
Purpose:
Supporting self-management is one strategy to help cancer survivors optimise their quality of life. Low grade non-Hodgkin's lymphoma is often incurable with a chronic disease trajectory requiring lifelong self-management. This study explored the views on self-management and preferences for self-management support among survivors of low grade non-Hodgkin's lymphoma and their informal caregivers more than 6 months after completion of systemic anti-cancer therapy.
Method:
In-depth semi-structured telephone interviews were conducted. Key themes and subthemes were determined using inductive and deductive thematic analysis.
Results:
The sample included eight survivors of low grade non-Hodgkin's lymphoma and two family caregivers. There were four themes. 1) The chronic nature of low grade non-Hodgkin's lymphoma shapes perceptions of self-management; participants described their cancer as a chronic condition and self-management strategies reflected this. 2) Social networks enable self-management; participants emphasised the importance of making low grade non-Hodgkin's lymphoma survivors aware of social networks. 3) Support and monitoring are needed immediately after the initial treatment phase ends. 4) Preferred components of self-management support; this included regular review with monitoring, advice on diet, and strategies to manage the psychosocial consequences of low grade non-Hodgkin's lymphoma.
Conclusions:
Providing self-management support to those diagnosed with low grade non-Hodgkin's lymphoma is relevant given the chronic trajectory of the disease. Findings suggest that necessary components of a self-management support programme for those with low grade non-Hodgkin's lymphoma should include regular review with monitoring and practical support around facilitating engagement with social networks.
... SMA offers a strategy to reduce the effects of PCa and its treatment through prioritizing men's healthcare needs and boosting their motivation for participation in healthcare (McCorkle et al., 2011). The effectiveness of the SMA-based cognitive and behavioural programme on lower urinary tract symptoms in patients with PCa has been shown (Faithfull, Cockle-Hearne, & Khoo, 2011). Also, the SMA-based physical activity programme relieved symptoms among patients with lung cancer undergoing surgery (Granger et al., 2018) and in breast cancer survivors (Damush, Perkins, & Miller, 2006). ...
Aim
The aim of this study was to investigate the effect of the exercise programme on the quality of life of prostate cancer (PCa) survivors.
Methods
A randomized controlled, parallel trial was conducted from April 2017 to January 2018 on 80 PCa survivors. They were randomly assigned to intervention and control groups (n = 40 in each group). The exercise programme was designed based on the self‐management approach (SMA). The intervention group participated in a 12‐week exercise programme consisting of one session of group exercise and three sessions of individual exercise per week using exercise facilities in the community. Data were collected using the quality of life questionnaires and the follow‐up checklist.
Results
In the intervention group, statistically significant improvements in physical, role, emotional, social and sexual functions were reported. Also, the patients in this group reported reduced fatigue, insomnia, constipation, diarrhoea, urinary, bowel and hormonal treatment‐related symptoms in comparison with before the exercise programme (p < 0.05).
Conclusions
Nurses are suggested to plan for improving the participation of PCa survivors in exercise programmes using exercise facilities in the community in order to reduce the complications of treatment and improve their quality of life.
Simple Summary
Self-management interventions can improve clinical and psychosocial outcomes for cancer survivors. However, we do not know which intervention characteristics (i.e., how they are delivered) and components (i.e., what they deliver) are beneficial. This can influence the implementation of such interventions into routine cancer care. We aimed to identify existing self-management interventions for adult cancer survivors, describe their characteristics and components, and investigate associations with quality of life. We identified 32 interventions. Studies had varying quality. A total of 22 studies reported significant improvements in quality of life, associated most often with combined individual and group delivery. Self-management interventions showed promise for improving the quality of life in cancer survivors; however, caution is required because the intervention characteristics and self-management components delivered varied considerably. Still, we highlight what may be worth adapting from existing interventions. Overall, these findings provide the foundations to help inform the development and implementation of self-management interventions for cancer survivors.
Abstract
Self-management can improve clinical and psychosocial outcomes in cancer survivors. Which intervention characteristics and components are beneficial is unclear, hindering implementation into practice. We systematically searched six databases from inception to 17 November 2021 for studies evaluating self-management interventions for adult cancer survivors post-treatment. Independent reviewers screened for eligibility. Data extraction included population and study characteristics, intervention characteristics (TIDieR) and components (PRISMS), (associations with) quality of life (QoL), self-efficacy, and economic outcomes. Study quality was appraised, and narrative synthesis was conducted. We identified 53 papers reporting 32 interventions. Studies had varying quality. They were most often randomised controlled trials (n = 20), targeted at survivors of breast (n = 10), prostate (n = 7), or mixed cancers (n = 11). Intervention characteristics (e.g., provider, location) varied considerably. On average, five (range 1–10) self-management components were delivered, mostly “Information about condition and its management” (n = 26). Twenty-two studies reported significant QoL improvements (6 also reported significant self-efficacy improvements); these were associated most consistently with combined individual and group delivery. Economic evaluations were limited and inconclusive. Self-management interventions showed promise for improving QoL, but study quality was variable, with substantial heterogeneity in intervention characteristics and components. By identifying what to adapt from existing interventions, these findings can inform development and implementation of self-management interventions in cancer.
Enquadramento:
Os sobreviventes de cancro representam um grande desafio para os sistemas de saúde, pela escassez de planos assistenciais a estas pessoas.
Objetivo:
Validar a estrutura e o conteúdo de uma intervenção educacional em enfermagem (intervenção complexa) para promover a adaptação dos sobreviventes de cancro.
Metodologia:
Utilizou-se a técnica e-Delphi modificada, ao longo de três rondas, através de questionários online.
Resultados:
Um conjunto de 27 peritos validaram a inclusão de 33 itens relativos à estrutura e 177 itens relativos ao conteúdo. A intervenção educacional deve ser realizada ao longo de cinco a oito sessões, individualmente, com a possibilidade de integrar um familiar significativo, e de dinâmicas de grupo, integrando os quatro domínios propostos: Adaptação, Atitude/Coping, Emoção/Ansiedade e Recursos.
Conclusão:
O consenso alcançado é essencial para evidenciar o papel dos enfermeiros nesta fase da doença oncológica e para viabilizar a avaliação da eficácia da intervenção educacional em desenvolvimento.
Background and purpose
Significant improvements in the treatment of anal cancer have produced a growing population of anal cancer survivors. These patients often experience late adverse effects related to their treatment. Research has revealed substantial unmet needs because of long-term symptoms and functional impairments after treatment that may negatively affect health-related quality of life. The purpose of the present guidelines is to review the scientific evidence for the management of late adverse effects after (chemo)radiotherapy ([C]RT) for anal cancer and to extrapolate knowledge from other pelvic malignancies treated with pelvic (C)RT so that they may guide the clinical management of late adverse effects.
Materials and methods
Relevant studies were systematically searched in four databases from their inception to June 2020 (no language limitation) and guidelines were searched in 16 databases, focussing on bowel dysfunction, psychosocial aspects, pain, and sexual and urinary dysfunction. The guidelines were developed by a panel of experts using the Oxford Centre for Evidence-based Medicine, levels of evidence, and grades of recommendations.
Scientific evidence
Late adverse effects after (C)RT for anal cancer are associated with a low overall quality of life among survivors. The most pronounced late adverse effects are bowel dysfunction (present in up to 78%), urinary dysfunction (present in up to 45%), and sexual dysfunction (present in up to 90% of men and up to 100% of women). Only indirect data on adequate treatment options of these late adverse effects for anal cancer are available.
Conclusion
Quality of life and late adverse effects should be monitored systematically following treatment for anal cancer to identify patients who require further specialist evaluation or support. Increased awareness of the extent of the problem may serve to stimulate and facilitate multidisciplinary collaboration, which is often required.
Objectives: To understand and define four concepts that are often used synonymously with one another in the applied health science field and related literature: self-care, self-help, self-help groups, and self-management, in order improve physician-patient interactions and communication.
Study design: Non-experimental descriptive archival study using purposive sampling techniques.
Method: Concepts were analyzed through a systematic review of the literature within the field of applied health science. Data was collected from 01/2017 to 08/2017. Commonalities and differences were examined, and definitions were formed for each term and subsequently converted into plain language definitions.
Results: While there is some overlap amongst these terms, definitions were developed for each term individually, and relationships between them were established. The common theme was that the actions of self-help, self-care, self-management and self-help groups are initiated in some manner by the individual. Self-management exists as a subset of self-care and shares many commonalities with self-help. Meanwhile, self-help groups make up a smaller component within the self-help category.
Conclusions: A clearer understanding of each concept, including their overlaps and relationships to one another was established, which can provide specificity for the field. Creating plain language definitions can bridge the gap between academics, physicians, and patients.
Men who were recently treated for prostate cancer (N=250) were randomly assigned to a control group, a group education intervention (GE), or a group education-plus-discussion intervention (GED). Both GE and GED increased prostate cancer knowledge. In the year postintervention, men in the GED condition were less bothered by sexual problems than men in the control condition, and they were more likely to remain steadily employed (93.0%) than men in the GE (75.6%) or control (72.5%) conditions. Among noncollege graduates, GED and GE resulted in better physical functioning than the control condition, and GED resulted in more positive health behaviors than the control or GE condition. Among college graduates, controls were comparable with the GE and GED groups in physical functioning and positive health behaviors.
The diagnosis and subsequent treatment of prostate cancer is followed by a range of significant disease specific and iatrogenic sequelae. However, the supportive care needs of men with prostate cancer are not well described in the literature. The present study assesses the supportive care needs of men with prostate cancer who are members of prostate cancer self‐help groups in Queensland, Australia. In all, 206 men aged between 48 and 85 years (mean=68) completed the Supportive Care Needs Survey (SCNS) (62% response). The SCNS is a validated measure assessing perceived need in the domains of psychological needs, health system and information needs, physical and daily living needs, patient care and support, and sexuality. Items assessing need for access to services and resources were also included.
One third of the sample reported a moderate to high need for help for multiple items in the sexuality, psychological and health system and information domains. Younger men reported greater need in the sexuality domain; living in major urban centres was predictive of greater psychological need; being closer to the time of diagnosis was related to greater need for help in the physical and daily living domain; having prostate cancer that is not in remission, having received radiation therapy, and lower levels of education were predictive of greater need for help in patient care and support. Of the total sample, 55% of men had used alternative cancer treatments in the past 12 months, with younger and more educated men more likely to use alternative therapies. Interventions in sexuality, psychological concerns and informational support are priorities for men with prostate cancer. Copyright © 2001 John Wiley & Sons, Ltd.
Voiding and sexual function after treatment are major determinants of quality of life in prostate carcinoma patients. Erectile dysfunction, incontinence, and urinary symptoms, both obstructive and irritative, have a significant negative impact on patient quality of life. This prospective study was undertaken to evaluate voiding, sexual function, and their impact on patients with localized prostate carcinoma who were treated with radical retropubic prostatectomy (RP) and to compare these patients with patients who were undergoing hormonobrachytherapy with external bean radiotherapy (HBTC) and patients who were undergoing hormonobrachytherapy without external beam radiotherapy (HBT).
Objective To quantify the effect of radiotherapy (RT) on urodynamic function 3 months after RT in patients with prostate cancer undergoing definitive external beam RT.
Patients and methods Seventeen patients with clinically localized prostate cancer were accrued into a single‐arm prospective study. Sixteen of the patients completed a scheduled multichannel video‐urodynamic study at baseline and again 3 months after RT; the urodynamic variables were then compared to assess the nature and extent of urodynamic change caused by RT. Correlations were assessed between these quantitative changes and those in self‐assessed qualitative urinary function measured by International Prostate Symptom Score (IPSS), Quality of Life assessment index (QoL) and urinary functional enquiry.
Results There were significant changes detected by the urodynamic study 3 months after RT in bladder volume at capacity (mean decrease 70 mL) and bladder volume at first sensation when supine (mean decrease 85 mL), and a lower postvoid residual volume (mean 50 mL). There was no significant change in the remaining urodynamic variables (including maximum flow rate and voided volume), nor in bladder compliance, bladder instability or bladder outlet obstruction. The self‐assessed qualitative urological function measured by the IPSS, QoL and median urinary frequency/24 h showed no significant change after RT.
Conclusions This is the first quantitative study to prospectively evaluate the effect of RT on urodynamics in patients with prostate cancer. Only a few urodynamic variables changed significantly 3 months after RT, while most, including self‐assessed qualitative urinary function, did not. This finding corresponds well with the notion that most patients tolerate RT well and that acute RT‐induced urinary symptoms resolve successfully, with the return of lower urinary tract function to baseline levels by 3 months after RT.
BACKGROUND
Cancer survivors are at increased risk for developing secondary tumors, diabetes, osteoporosis, and cardiovascular disease, thus making them an important target population for health-related interventions. However, little is known regarding cancer survivors' behaviors and their interest in pursuing healthier diets, exercise, and smoking cessation.METHODSA 65-item survey was mailed to 1667 patients diagnosed with early stage carcinoma of the breast or prostate that requested data regarding demographics, health behaviors, stage of readiness for smoking cessation, exercise, increased fruit and vegetable (F&V) consumption, and decreased fat intake, as well as interest in specific health programs and when, relative to diagnosis, these programs should be offered.RESULTSResponses from 978 cancer survivors suggested that the overwhelming majority (85%) reported their health as good to excellent. The majority of respondents (55%) ate fewer than 5 daily servings of F&Vs, with prostate carcinoma patients reporting eating significantly fewer servings than patients with breast carcinoma (P < 0.001). In contrast, 69% of respondents reported adherence to a low fat diet, again with lower practice rates among prostate carcinoma patients than patients with breast carcinoma (P = 0.006). The majority of respondents (58%) reported routine exercise and 8% were current smokers. Significantly more breast carcinoma patients than prostate carcinoma patients were current smokers (P = 0.03). There was strong interest in health promotion programs across behaviors, and a fair amount of concordance between low fat dietary behaviors and exercise, as well as consumption of five daily servings of F&Vs. The majority of patients expressed a preference for programs that could be delivered via mailed brochure, with 57% of respondents indicating that programs should be initiated at the time of diagnosis or soon after (within 6 months).CONCLUSIONS
The results of the current study suggest that although many cancer survivors already practice healthy life-style behaviors, there is a substantial proportion who do not. Interventions especially are needed to increase daily F&V intake; however, given the fair degree of clustering between dietary and exercise behaviors, multiple risk factor interventions also may be warranted. Among cancer survivors, receptivity is high for health promotion programs, especially those that can be delivered by mail and soon after diagnosis. Cancer 2000;88:674–84. © 2000 American Cancer Society.
Background:
Few intervention studies have been conducted to help couples manage the effects of prostate cancer and maintain their quality of life. The objective of this study was to determine whether a family-based intervention could improve appraisal variables (appraisal of illness or caregiving, uncertainty, hopelessness), coping resources (coping strategies, self-efficacy, communication), symptom distress, and quality of life in men with prostate cancer and their spouses.
Methods:
For this clinical trial, 263 patient-spouse dyads were stratified by research site, phase of illness, and treatment; then, they were randomized to the control group (standard care) or the experimental group (standard care plus a 5-session family intervention). The intervention targeted couples' communication, hope, coping, uncertainty, and symptom management. The final sample consisted of 235 couples: 123 couples in the control group and 112 couples in the experimental group. Data collection occurred at baseline before randomization and at 4 months, 8 months, and 12 months.
Results:
At 4-month follow-up, intervention patients reported less uncertainty and better communication with spouses than control patients, but they reported no other effects. Intervention spouses reported higher quality of life, more self-efficacy, better communication, and less negative appraisal of caregiving, uncertainty, hopelessness, and symptom distress at 4 months compared with controls, and some effects were sustained to 8 months and 12 months.
Conclusions:
Men with prostate cancer and their spouses reported positive outcomes from a family intervention that offered them information and support. Programs of care need to be extended to spouses who likely will experience multiple benefits from intervention.
In the context of increasing prostate cancer survivorship, evidence of unmet supportive care needs and growing economic health-care restraints, this review examined and evaluated best approaches for developing self-management programmes to meet men's survivorship needs.
A search of international literature published in the last 12 years was conducted. Only randomised controlled trials were included in the analysis. Key components of the interventions were evaluated to determine what has been offered, and which elements are most beneficial in improving health outcomes. Methodological issues were also considered.
Targeting participant need and promoting motivation to participate and maintain programme adherence were the most important factors to emerge in ensuring positive health outcomes. Both need and motivation are multi-faceted, the components of which are identified and evaluated. Guidance was also identified in relation to delivery design, theoretical mechanisms for change, modes of delivery and facilitator issues.
Self-management is a viable and appropriate way of providing health-care solutions to ameliorate men's functional and emotional problems associated with increased prostate cancer survivorship. Integration into clinical practice will require training, resources and commitment and, in addition, economic viability will be difficult to assess since cost comparison with current provision is not straightforward. Nevertheless, from the psychosocial and behavioural studies reviewed there is convincing evidence that can be used to design, implement and evaluate future self-management programmes for men surviving prostate cancer.