Predictors for the symptomatic prostate cancer patient's delays in seeking care.

AIM: This study aims to determine the predictors for the symptomatic prostate cancer patient's delays in seeking care. METHODS: We followed a cohort of 931 men with prostate cancer from Stockholm County (Sweden) asking about socio-demographic and information-level characteristics as well as the length of delay in seeking care. RESULTS: Of the 511 patients who returned a completed questionnaire, 219 (43%) reported having clinical symptoms before prostate cancer was diagnosed. Of all men with clinical symptoms, self-employed men were more likely to make an early first contact with the health-care system than pensioners or men with other employment (relative risk (RR), 3.9; 95% confidence interval (CI), 1.4-11.0). Men who had obtained moderate or much information from the internet about prostate cancer were more likely to have made an early first contact with the health-care system (RR, 2.2; 95% CI, 1.3-3.9). Men who had obtained moderate or much information from health-care staff (RR, 1.4; 95% CI, 1.0-1.6), or from any doctor (RR, 1.4; 95% CI, 1.0-1.8) or from family members/acquaintances (RR, 1.3; 95% CI, 1.0-1.9) had an early first visit to the health-care system. Men who were 70 to 80 years old started treatment earlier than men who were 50 to 69 years old (RR, 2.3; 95% CI, 1.4-3.6). CONCLUSIONS: The patients' level of information about prostate cancer obtained from the internet and other sources such as the health-care system, doctors or family members/acquaintances coupled with their employment status were influential in leading to early first contact and first visit to the health-care system. Older patients started treatment earlier than younger patients.

The Internet and prostate cancer patients: searching for and finding information.

OBJECTIVE: To define the characteristics of prostate cancer patients who use the Internet. MATERIAL AND METHODS: In October 2002, 511 prostate cancer patients from Stockholm-Gotland County completed a postal questionnaire consisting of 146 questions regarding use of the Internet, demographic factors, level of information about the disease and its treatment, quality of life and trade-off possibilities. RESULTS: The response rate was 86.5% (n=511) and the mean age of the respondents was 71 years. A total of 210 men (41.1%) had access to the Internet. Eighty-two men (16.4%) had looked for information on prostate cancer, either by themselves or with the aid of others. Among men aged 50-60 years, 39% were Internet users, compared to 8% among men aged 75-80 years; the figures for university graduates versus those who had only attended elementary school were 33% and 3%, respectively. Fifty of the 82 men (61%) who searched for information regarded themselves as being satisfactorily informed by online information. CONCLUSIONS: Of the men in this cohort, 16% searched the Internet for information regarding their prostate cancer. Young and well-educated men utilized the Internet more frequently than others, but they did not find information more often than older and less well-educated men. It is possible that the Internet promotes social inequality in obtaining healthcare in favor of well-educated, highly paid individuals.

Economic conditions and marriage quality of men with prostate cancer.

OBJECTIVE: To explore the predictors of the quality of marriage of men with prostate cancer, as being diagnosed with prostate cancer affects the quality of life of the man and his partner, and while some aspects are known about the impact of the disease and its treatments on the man's quality of life, less is known about the marriage quality (MQ) in this new situation. PATIENTS AND METHODS: We followed 591 men from Stockholm County (Sweden) who had been diagnosed with prostate cancer in 1999, and who were 50-80-years old and alive on 1 October 2002. The men completed a questionnaire asking about their MQ, and several other sociodemographic, medical and economic characteristics. RESULTS: Of 426 men who provided information and who had a spouse or partner, 168 (39.4%) reported having a lower MQ due to their disease. Increased expenditure (46.2% vs 30.9%; relative risk, 1.5; 95% confidence interval, 1.1-2.0) and decreased income (55.4% vs 36.5%; 1.5, 1.1-2.0) as a consequence of prostate cancer reduced their MQ. Patients who had erectile dysfunction had a lower MQ (46.3% vs 11.8%; 3.9; 2.0-7.6). There was also a lower MQ in men who were depressed or had urinary leakage as a consequence of prostate cancer. Younger men (50-69 years old) with prostate cancer had a lower MQ than older men (70-80 years; 51.9% vs 33.1%; 1.6; 1.2-2.0). CONCLUSIONS: Men whose economic situation is worsened by prostate cancer reported having a reduced MQ. There was also such an effect for men with erectile dysfunction, urinary leakage and depression, and among men diagnosed with prostate cancer when young.

The choice between a therapy-induced long-term symptom and shortened survival due to prostate cancer.

OBJECTIVES: A patient with newly diagnosed localized prostate cancer can choose from an array of therapies. A patient's willingness to trade life for freedom from therapy-induced long-term symptoms is poorly investigated. METHODS: In October 2002, we attempted to collect information from the 591 men who had been diagnosed and registered with prostate cancer in 1999 in Stockholm County. In a postal questionnaire, men were asked to balance absence or presence of certain therapy-induced long-term symptoms against varying lengths of survival gain as a consequence of the therapy. RESULTS: Information was provided by 511 (86%) of the 591 men. A large majority of the men participating in this study ended up in one of two extreme categories: either they accepted the therapy-induced symptom to gain survival or they did not. For fecal leakage, 78% of the men chose one of two extreme categories compared with 74% for urinary leakage, 71% for tender enlarged breasts, 73% for erectile dysfunction, and 78% for restricted diet. Thirty-seven percent of the men in the study were willing to accept fecal leakage if there was only the slightest chance to gain survival, comparing percentages for urinary leakage, tender enlarged breasts, restricted diet, and erectile dysfunction and were 48%, 53%, 55%, and 64%, respectively. CONCLUSION: Willingness to accept therapy-induced long-term symptoms to avoid a shortened survival due to prostate cancer varies dramatically among men with localized prostate cancer and a large majority of men are in one of two extreme categories. Among symptoms, long-term fecal leakage was the one fewest men were willing to accept to gain survival.