Androgen-deprivation therapy and metabolic syndrome in men with prostate cancer.

PURPOSE/OBJECTIVES: To examine the trajectory of changes in body composition and metabolic profile in men who receive androgen-deprivation therapy (ADT) for prostate cancer. DESIGN: Prospective longitudinal design with repeated measures. SETTING: Urban medical center in the southwestern United States. SAMPLE: 55 men starting radiation therapy for prostate cancer. METHODS: Changes in the parameters of metabolic syndrome were estimated with ADT (n=31) and non-ADT (n=24) groups by repeated-measures analysis of variance implemented by general linear mixed-effects models. Models included interactions between groups and follow-up time to test differences between the groups. MAIN RESEARCH VARIABLES: Body composition and metabolic variables. FINDINGS: The ADT group demonstrated a transient increase in waist circumference at the nine-month time point and significant changes in measures of insulin resistance were noted at the three month point. Values for diastolic and systolic blood pressure, plasma glucose, high-density lipoprotein, and triglycerides were not altered for either group. Differences in metabolic variables or measures of body composition did not differ significantly between the groups. CONCLUSIONS: The findings demonstrate the development of insulin resistance in men receiving ADT as early as three months after starting ADT. IMPLICATIONS FOR NURSING: Addressing survivorship concerns can lead to the development of nursing interventions designed to reduce adverse effects associated with ADT.

Exercise preferences among men with prostate cancer receiving androgen-deprivation therapy.

PURPOSE/OBJECTIVES: To investigate acceptability of and preferences for physical activity participation in men receiving androgen-deprivation therapy (ADT) for prostate cancer, to identify influencing clinical and demographic factors, and to determine the percentage meeting national exercise guidelines. DESIGN: Cross-sectional, descriptive. SETTING: Ambulatory care clinic of a large medical center. SAMPLE: 135 men receiving ADT. METHODS: A structured interview with a systematic procedure was used to elicit preferences for physical activity. MAIN RESEARCH VARIABLES: Exercise preferences and acceptability; evidence-based exercise intervention. FINDINGS: Participants expressed high levels of acceptability of and willingness to participate in aerobic (64% and 79%) and muscle-strengthening (79% and 81%) programs. Preferences were expressed for muscle-strengthening activities performed at home, either alone or in the company of a family member. Flexible, spontaneous, and self-paced programs were preferred. Significant associations were identified for distance, age, obesity, duration of ADT, and meeting American College of Sports Medicine (ACSM) and American Heart Association (AHA) guidelines. Nineteen percent of the study population met the guidelines for weekly physical activity. CONCLUSIONS: High levels of expressed acceptance of and willingness to participate in physical activity programs as well as the small number of participants meeting ACSM and AHA guidelines suggest feasibility of and support the need for the development of exercise programs in this population. IMPLICATIONS FOR NURSING: Incorporating patient preferences and evidence-based practice is integral to providing high-quality patient-centered care and is the foundation for appropriate intervention programs. Insight from this study will facilitate the design of programs that better reflect actual preferences of prostate cancer survivors. KNOWLEDGE TRANSLATION: ADT-induced changes in body composition are believed to contribute to a reduction in insulin sensitivity and dyslipidemia that contribute to increased cardiovascular risk profile. Exercise has the potential to mitigate the harmful effects of ADT.

Who benefits from a psychosocial counselling versus educational intervention to improve psychological quality of life in prostate cancer survivors?

OBJECTIVE: We examined selected survivor characteristics to determine what factors might moderate the response to two psychosocial interventions. DESIGN: Seventy-one prostate cancer survivors (PCSs) were randomly assigned to either a telephone-delivered health education (THE) intervention or a telephone-delivered interpersonal counselling (TIP-C) intervention. MEASURES: Psychological quality of life (QOL) outcomes included depression, negative and positive affect, and perceived stress. RESULTS: For three of the psychological outcomes (depression, negative affect and stress), there were distinct advantages from participating in THE. For example, more favourable depression outcomes occurred when men were older, had lower prostate specific functioning, were in active chemotherapy, had lower social support from friends and lower cancer knowledge. Participating in the TIP-C provided a more favourable outcome for positive affect when men had higher education, prostate specific functioning, social support from friends and cancer knowledge. CONCLUSION: Unique survivor characteristics must be considered when recommending interventions that might improve psychological QOL in PCSs. Future research must examine who benefits most and from what components of psychosocial interventions to enable clinicians to recommend appropriate psychosocial care.

Interdependent psychological quality of life in dyads adjusting to prostate cancer.

OBJECTIVE: Prostate cancer negatively influences quality of life (QOL) in survivors and the people with whom they are close. The purpose of this investigation was to assess the degree of dyadic interdependence in psychological QOL in dyads adjusting to prostate cancer and its treatment. METHOD: Participants were 70 prostate cancer survivors and their partners, most of whom were spouses. Assessments of psychological QOL (i.e., depression, anxiety, fatigue, and positive affect) were made at three points in time, each separated by 8 weeks. RESULTS: Survivors' prostate specific function was associated with both their own and their partners' psychological QOL. There was evidence of longitudinal dyadic interdependence for psychological QOL, particularly from partners to survivors between the T2 and T3 assessments. CONCLUSIONS: Prostate cancer survivors' psychological QOL is affected substantially by their partners' psychological QOL, consistent with theories of emotional contagion.

Implications of treatment on body image and quality of life.

OBJECTIVES: To describe the changes in body image secondary to the treatment of prostate cancer, and to provide a review of the literature regarding body image assessment and its relationship to quality of life (QOL) among men with prostate cancer. DATA SOURCES: Review of current and classic literature. CONCLUSION: There is strong evidence for the existence of a relationship between body image perception and QOL in men with prostate cancer. IMPLICATIONS FOR NURSING PRACTICE: Understanding the effect of body image changes on QOL will allow us to develop targeted interventions designed to improve the QOL of survivors of prostate cancer.

Psychosocial interventions to improve quality of life in prostate cancer survivors and their intimate or family partners.

PURPOSE: The primary purpose was to test the effectiveness of two telephone-delivered psychosocial interventions for maintaining and improving quality of life (QOL) (psychological, physical, social, and spiritual well-being) among 71 prostate cancer survivors and the 70 intimate or family partners who were supporting them in their recovery. METHODS: This study used a three-wave repeated measures experimental design. Both the interpersonal counseling intervention (TIP-C) and health education attention condition (HEAC) were delivered using the telephone. RESULTS: Improvements in depression, negative affect, stress, fatigue, and spiritual well-being were significantly higher for survivors in the HEAC than for those in the TIP-C condition. Partners in the HEAC condition showed significantly greater improvements in depression, fatigue, social support from family members, social well-being, and spiritual well-being compared to partners in the TIP-C condition. The results revealed superior outcomes for those assigned to the HEAC intervention. CONCLUSIONS: The psychosocial interventions in this study were effective in maintaining or improving the QOL for prostate cancer survivors and their partners. Both the survivor and their intimate partner or family member benefitted from the interventions. Future research is needed to determine the optimal timing and client characteristics for each intervention.

Body image and quality of life in men with prostate cancer.

Each of the successful treatment options for men with prostate cancer is accompanied by its unique side effect profile. However, treatment with androgen deprivation therapy (ADT) and the resulting castrate level of testosterone lead to profound changes in one's physical appearance. The goal of this descriptive study was to describe the relationship between changes in body image and quality of life (QOL) among prostate cancer survivors based upon whether or not treatment was with ADT. A convenience sample of 132 men (aged > or =60 years) with prostate cancer were recruited from the oncology and urology outpatient departments at an urban Veterans Affairs Medical Center. The participants completed 2 established questionnaires, the Body Image Scale and the Quality of Life Index-Cancer Version. Descriptive and inferential statistics were used in the analysis. There was no difference in QOL based on ADT. There was a significant negative correlation between body image dissatisfaction and QOL. The findings add to our knowledge regarding body image and QOL among men with prostate cancer, provide a foundation for future research endeavors, and support the development of evidence-based interventions to mitigate body image dissatisfaction.

Body image perceptions in men with prostate cancer.

PURPOSE/OBJECTIVES: To describe changes in body image among men with prostate cancer who were either prescribed androgen-deprivation therapy (ADT) or were ADT naive and to explore the relationship of age, duration of therapy, and body mass index with body image perception. DESIGN: Exploratory and descriptive. SETTING: Ambulatory care clinic of a large urban Veterans Affairs medical center. SAMPLE: 132 men 60 years of age or older with prostate cancer recruited from the oncology and urology outpatient departments. METHODS: Participants completed a demographic survey and the Body Image Scale (BIS), an instrument developed to measure changes in body image. Descriptive and inferential statistics were used to explore body image dissatisfaction. MAIN RESEARCH VARIABLES: Body image and ADT. FINDINGS: A significant difference in body image dissatisfaction existed between men who had received ADT and men who were ADT naive. No relationship was identified between age and body image dissatisfaction or between duration of therapy and body image dissatisfaction. A significant positive relationship was found between body mass index and body image dissatisfaction for the sample overall. CONCLUSIONS: A greater degree of body image dissatisfaction existed in the men who received ADT as compared to those who were ADT naive. IMPLICATIONS FOR NURSING: Patients receiving ADT for prostate cancer may be at greater risk of body image dissatisfaction. The psychometric performance of the BIS lends support to its continued use in this population.

Phase I clinical study of a static magnetic field combined with anti-neoplastic chemotherapy in the treatment of human malignancy: initial safety and toxicity data.

We have completed the lowest level of exposure in a Phase I study, designed to establish the safety and toxicity of the combination of a static magnetic field (SMF) and antineoplastic chemotherapy in patients with advanced malignancy. The SMF application is carefully controlled by applying the magnet to the patient only in our clinic during chemotherapy administration. No increase in the severity of chemotherapy toxicity as measured by white blood cell count and platelet count was seen in the participants exposed to SMF compared to the historical control subjects. These data have permitted the next group of subjects to be treated at the next dose level.

Primary non-Hodgkin's lymphoma of the transverse colon presenting as dermatomyositis: case presentation and literature review.

Primary extranodal non-Hodgkin's lymphoma of the transverse colon is a rare presentation of non-Hodgkin's lymphoma or colonic neoplasm. Dermatomyositis is an autoimmune condition of the skin, muscle, and blood vessels that when associated with malignancy is a true paraneoplastic syndrome but is rarely associated with non-Hodgkin's lymphoma. We present a case of primary non-Hodgkin's lymphoma of the transverse colon diagnosed after the presentation of dermatomyositis and review the literature on dermatomyositis and hematologic neoplasm.