Concordance in the Perception of Couples Recovering From Prostate Cancer
Concordance in the Perception of Couples Recovering From Prostate Cancer
Although prostate cancer affects men, research shows effects on both members of the couple. We analyzed concordance in couples recovering from primary surgical treatment of prostate cancer when surveyed on psychological domains including emotional status, relationship, self-image, partnership quality and support. Retrospective Sexual Surveys were utilized to survey physiological changes as well as psychological effects. In total, 28 heterosexual couples (56 people) were enrolled. Patients were treated between February 2002 and March 2007 with a median follow-up of 26 (range: 4–59) months. When polled on psychological aspects that may have been affected by treatment, overall concordance was 75.0%. Partnership had the highest concordance (92.2%) with treatment satisfaction questions following in second (90.7%). Subcategories focused on self-image (77.5%), relationship (67.3%), support (66.4%) and emotional status (55.6%), were less concordant. Although couples report relationships as strong and team-like, misconception between partners is widespread. Further research with regards to the effect of such disparities in couples might provide additional insight into improving recovery.
Prostate cancer (PCa), with an estimated 186 320 new cases and 28 660 cancer-related deaths in 2008, is the second most lethal cancer for men in the United States. PCa survivors may face three long-term medical problems as side effects after primary treatment: incontinence, bowel dysfunction and erectile dysfunction. The incidence of these side effects will vary depending on the primary therapy chosen and need for additional treatments. Numerous surgical and radiation series have assessed both the time course and incidence of post-treatment incontinence, erectile dysfunction and bowel dysfunction. Although these are important issues and many improvements have been utilized to hasten recovery and preserve physiological functions and quality of life, perceptions of the recovering male patient–female partner have been neglected.
Urologists and oncologists alike have long focused on cancer control, complications and patient outcomes; however, although PCa affects men, it has been labeled a 'relationship disease' as research shows effects on both members of the couple. Studies have found that psychological distress is equivalent regardless of the fact whether the person is the patient or partner. Clearly, once cancer is discovered in either partner, both experience an increased level of anxiety compared with healthy couples. Approximately 20–30% of spouses suffer from mood disturbances and psychological impairment and between 25 and 50% of newly diagnosed cancer patient's partners report sleep and eating disturbances, headache and nervousness.
Although numerous studies have devoted attention to impairment of erectile function after PCa treatment, few have assessed the global implications that impaired intimacy has on the sexual and psychological HRQOL (health-related quality of life) of the couple as a unit. This knowledge deficit exists because currently there is no comprehensive sexual function instrument applicable to both men and women. Current instruments for men are limited to incontinence, bowel, erectile, and hormonal domains and neglect areas specifically related to erectile pain, quality of orgasm or ejaculation discomfort, among others. Likewise, instruments that address arousal, hypoactive sexual desire, orgasm and dyspareunia exist for women but are not generalizable to men. Further, there is not an instrument that addresses how the cancer diagnosis itself and changing sexual performance, psyche or self-image impacts the sexuality and overall relationship of the couple. As all of these domains are pertinent to a heterosexual dyad, a culturally sensitive, partner-inclusive instrument capable of being administered to a couple would aid in pre-treatment education and better track PCa outcomes as it affects HRQOL domains.
Taking a cue from psychologists studying phenomena such as perception, cognition, emotion, personality, behavior and interpersonal relationships, further psychological investigation is needed in couples that are affected by PCa and its treatment. In this retrospective pilot trial, we created an instrument to bring attention to such psychological aspects involved in PCa and its treatment. Herein, we analyze the concordance in couples' perceptions recovering from primary surgical treatment of PCa when surveyed on psychological domains, including emotional status, relationship, self-image, partnership quality, and support to elucidate levels and topics of concordance.
Abstract and Introduction
Abstract
Although prostate cancer affects men, research shows effects on both members of the couple. We analyzed concordance in couples recovering from primary surgical treatment of prostate cancer when surveyed on psychological domains including emotional status, relationship, self-image, partnership quality and support. Retrospective Sexual Surveys were utilized to survey physiological changes as well as psychological effects. In total, 28 heterosexual couples (56 people) were enrolled. Patients were treated between February 2002 and March 2007 with a median follow-up of 26 (range: 4–59) months. When polled on psychological aspects that may have been affected by treatment, overall concordance was 75.0%. Partnership had the highest concordance (92.2%) with treatment satisfaction questions following in second (90.7%). Subcategories focused on self-image (77.5%), relationship (67.3%), support (66.4%) and emotional status (55.6%), were less concordant. Although couples report relationships as strong and team-like, misconception between partners is widespread. Further research with regards to the effect of such disparities in couples might provide additional insight into improving recovery.
Introduction
Prostate cancer (PCa), with an estimated 186 320 new cases and 28 660 cancer-related deaths in 2008, is the second most lethal cancer for men in the United States. PCa survivors may face three long-term medical problems as side effects after primary treatment: incontinence, bowel dysfunction and erectile dysfunction. The incidence of these side effects will vary depending on the primary therapy chosen and need for additional treatments. Numerous surgical and radiation series have assessed both the time course and incidence of post-treatment incontinence, erectile dysfunction and bowel dysfunction. Although these are important issues and many improvements have been utilized to hasten recovery and preserve physiological functions and quality of life, perceptions of the recovering male patient–female partner have been neglected.
Urologists and oncologists alike have long focused on cancer control, complications and patient outcomes; however, although PCa affects men, it has been labeled a 'relationship disease' as research shows effects on both members of the couple. Studies have found that psychological distress is equivalent regardless of the fact whether the person is the patient or partner. Clearly, once cancer is discovered in either partner, both experience an increased level of anxiety compared with healthy couples. Approximately 20–30% of spouses suffer from mood disturbances and psychological impairment and between 25 and 50% of newly diagnosed cancer patient's partners report sleep and eating disturbances, headache and nervousness.
Although numerous studies have devoted attention to impairment of erectile function after PCa treatment, few have assessed the global implications that impaired intimacy has on the sexual and psychological HRQOL (health-related quality of life) of the couple as a unit. This knowledge deficit exists because currently there is no comprehensive sexual function instrument applicable to both men and women. Current instruments for men are limited to incontinence, bowel, erectile, and hormonal domains and neglect areas specifically related to erectile pain, quality of orgasm or ejaculation discomfort, among others. Likewise, instruments that address arousal, hypoactive sexual desire, orgasm and dyspareunia exist for women but are not generalizable to men. Further, there is not an instrument that addresses how the cancer diagnosis itself and changing sexual performance, psyche or self-image impacts the sexuality and overall relationship of the couple. As all of these domains are pertinent to a heterosexual dyad, a culturally sensitive, partner-inclusive instrument capable of being administered to a couple would aid in pre-treatment education and better track PCa outcomes as it affects HRQOL domains.
Taking a cue from psychologists studying phenomena such as perception, cognition, emotion, personality, behavior and interpersonal relationships, further psychological investigation is needed in couples that are affected by PCa and its treatment. In this retrospective pilot trial, we created an instrument to bring attention to such psychological aspects involved in PCa and its treatment. Herein, we analyze the concordance in couples' perceptions recovering from primary surgical treatment of PCa when surveyed on psychological domains, including emotional status, relationship, self-image, partnership quality, and support to elucidate levels and topics of concordance.
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