Long-term quality of life in disadvantaged men with prostate cancer on androgen-deprivation therapy.

BACKGROUND: To explore the effects of androgen-deprivation therapy (ADT) on general, disease-specific and hormone-specific health-related quality of life (HRQOL) among minority men. METHODS: Men enrolled in a state-funded program, providing free prostate cancer treatment for underserved men, were recruited, if they had received at least 3 months of continuous ADT and/or other forms of primary treatment. HRQOL was assessed with validated measures including the RAND Medical Outcomes Study 12-item Health Short Form Survey (SF-12), the UCLA Prostate Cancer Index Survey and the Expanded Prostate Cancer Index Composite Survey. Repeated measures analysis was performed to evaluate the association between clinical and sociodemographic covariates with HRQOL. RESULTS: We enrolled 322 men, including 94 on ADT and 228 who received other forms of treatment. When controlling for patient characteristics, men receiving ADT had poorer outcomes relative to sexual function (P<0.01), sexual bother (P<0.01), hormonal function (P<0.01) and hormonal bother (P=0.02). ADT use was significantly associated with worsening sexual function (P<0.01) and sexual bother (P=0.01) over two years compared with non-ADT users. Analysis also demonstrated significant differences between whites, Hispanics and Others (African American (n=43, 16%), Asian (n=13, 5%), multiracial (n=1, 0.4%), Native American (n=1, 0.4%) and other (n=9, 3%)) relative to urinary bother (P=0.01), urinary function (P=0.01) and hormonal bother (P=0.03). ADT users had better urinary function and less bother than non-ADT users among the Other group, while the opposite was true for whites and Hispanics. For hormonal bother, ADT use was associated with worse outcomes across all three race/ethnicity groups; however, Hispanics were less bothered by their hormonal symptoms than whites or Others. CONCLUSION: Men of disadvantaged backgrounds on hormone therapy for prostate cancer experience declines in sexual and hormonal HRQOL. Whites and non-whites on ADT have significantly different HRQOL outcomes.

Education as a predictor of quality of life outcomes among disadvantaged men.

Higher educational levels along with other factors such as literacy and communication with physicians have been associated with better outcomes for men with prostate cancer, but little research has focused on the relationship of educational attainment to self-efficacy for interacting with physicians been conducted on its effect on self-efficacy and health-related quality of life (HRQOL) among low-income, uninsured men. Data from 425 low-income, uninsured men with prostate cancer enrolled in UCLA's Men's Health Study were examined. We found that men with higher and lower education levels, including those who did not complete high school, had similar HRQOL and self-efficacy outcomes. Because of the close relationship between income and education, broader studies into the associations of these variables and prostate cancer outcomes are needed.

Mastery of postprostatectomy incontinence and impotence: his work, her work, our work.

PURPOSE/OBJECTIVES: To describe couples' experiences of postprostatectomy incontinence and impotence. DESIGN: Descriptive, qualitative. SETTING: Northeastern U.S. metropolitan area. SAMPLE: Subsample of 20 (10 control and 10 intervention) couples from a large quantitative clinical trial of a Standardized Nursing Intervention Protocol (SNIP) postprostatectomy. METHODS: Interviews were conducted using a semistructured guide. Data were analyzed using grounded theory techniques. MAIN RESEARCH VARIABLE: Couples' experiences of coping with postprostatectomy incontinence and impotence. FINDINGS: Managing postprostatectomy incontinence and impotence required work. Men's work focused on regaining mastery and encompassed understanding incontinence as healing, mastering incontinence, networking, confronting impotence and putting it into perspective, and prioritizing. Wives were supportive by managing anxiety, encouraging mastery, putting impotence into perspective, and reassuring their spouses. Established routines brought couples through the experience together while strengthening intimacy. SNIP couples found the nurses to be sources of information, support, and affirmation. CONCLUSIONS: Couples worked to deal with postprostatectomy incontinence and impotence within the context of surviving cancer and maintaining a loving relationship. This gave unique meaning to their symptoms and led the couples to value the fact that the men were alive and work toward regaining mastery. Mastery emerged as a key concept from the findings. IMPLICATIONS FOR NURSING PRACTICE: Nurses can gain from an enhanced understanding of postprostatectomy incontinence and impotence as meaningful within the greater context of patients having had cancer. Nurses can hasten couples' abilities to regain a sense of mastery by providing information, supporting couples' work, providing positive affirmation, and being available.