Objectives To determine the relationship between long-term prostate cancer survivors’ symptom burden and information needs. Subjects/patients and methods We used population-based data from the Michigan Prostate Cancer Survivor Study (n=2,499). We examined unadjusted differences in long-term information needs according to symptom burden and performed multivariable logistic regression to examine symptom burden and information needs adjusting for patient characteristics. Results High symptom burden was reported across all domains (sexual 44.4%, urinary 14.4%, vitality 12.7%, bowel 8.4%, emotional 7.6%) with over half of respondents (56%) reporting they needed more information. Top information needs involved recurrence, relationships, and long-term effects. Prostate cancer survivors with high symptom burden more often searched for information regardless of domain (p<0.05). High sexual burden was associated with greater need for information about relationships (OR=2.05; 95% CI 1.54–2.72) and long-term effects (OR=1.60; 95% CI 1.23–2.07). High bowel burden was associated with greater information need for long-term effects (OR=2.28; 95% CI 1.43–3.63). Conclusions Long-term prostate cancer survivors with high symptom burden need more supportive information. Tailoring information to these needs may be an efficient approach to support the growing population of long-term prostate cancer survivors.
Objective Psychosexual morbidity is common after prostate cancer treatment, however, long‐term prospective research is limited. We report 5‐year outcomes from a couples‐based intervention in dyads with men treated for localised prostate cancer with surgery. Methods A randomised controlled trial was conducted involving 189 heterosexual couples, where the man received a radical prostatectomy for prostate cancer. The trial groups were peer support vs. nurse counselling versus usual care. Primary outcomes were sexual adjustment, unmet sexual supportive care needs, masculine self‐esteem, marital satisfaction, and utilisation of erectile aids at 2‐, 3‐, 4‐ and 5‐year follow‐up. Results The effects of the interventions varied across the primary outcomes. Partners in the peer group had higher sexual adjustment than those in the usual care and nurses group at 2 and 3 years (P = 0.002‐0.035). Men in usual care had lower unmet sexual supportive care needs than men in the peer and nurse groups (P = 0.001; P = 0.01) at 3 years. Women in usual care had lower sexual supportive care needs than women in the peer group at 2 and 3 years (P = 0.038; P = 0.001). Men in the peer and nurse group utilised sexual aids more than men in usual care; at 5 years 54% of usual care men versus 87% of men in peer support and 80% of men in the nurse group. Conclusion Peer and nurse‐administered psychosexual interventions have potential for increasing men's adherence to treatments for erectile dysfunction. Optimal effects may be achieved through an integrated approach applying these modes of support.
Cancer-related distress impacts quality of care, resource use, and patient outcomes. Patients are increasingly screened for distress, yet many do not receive coping resources and psychosocial support services that may help to reduce their distress. Distress screening must be paired with attention to the different phases of the distress and coping process, with emphasis on barriers and facilitators of cancer patients' use of coping resources. This paper offers a conceptual model illustrating key pathways and modifying factors of distress and use of coping resources among cancer patients, and potential roles for cancer care providers and institutions in facilitating effective coping and distress reduction. Building on a review of relevant empirical and theoretical literature, we developed a conceptual model that integrates concepts from Stress and Coping Theory into the National Comprehensive Cancer Network's guidelines for Distress Management. We found that barriers and facilitating factors that may inhibit receipt of coping resources and services to reduce cancer-related distress include health and cancer beliefs, accessibility and acceptability, the role of caregivers in cancer treatment, coordination of care, and the quality of patient-provider relationships. Herein, we highlight largely modifable factors that can infuence the successful uptake of coping resources and services to reduce distress among cancer patients. We conclude with recommendations for how cancer care providers and systems can better identify and address barriers to the use of distress reduction resources and support services.
locked cut points of < 0.45, 0.45-0.6, > 0.6 for low, intermediate, and high, respectively. In this sub-analysis, the primary endpoint was freedom from biochemical progression (FFBP) according to PSA at randomization (≤0.5 vs > 0.5, a trial stratification variable). Cox multivariable analysis (MVA) adjusting for age, T-category, Gleason score, persistent PSA after RP, and randomization arm were performed. Secondary endpoints included clinical progression-free survival (CPFS) and time to salvage ADT. Results: Of 233 patients with tissue available, 1 was ineligible and 6 failed QC. The remaining 226 were included for analysis with a median followup of 6.3 years (IQR 6.0-7.2). High-vs. low/intermediate-GC had an HR of 2.22 (95% CI 1.37-3.58, P = 0.001) for FFBP, 2.29 (95% CI 1.32-3.98, P = 0.003) for CPFS, and 2.99 (95% CI 1.50-5.95, P = 0.002) for use of salvage ADT. In patients with PSA ≤0.5 ng/mL (165/226, 73%), the 5-year FFBP was 74% [95% CI 66-82] for low-intermediate GC compared to 59% [95% CI in patients with high-GC. High-GC patients had 5year FFBP of 13% [95% CI 0-32] when SRT was delivered at PSA > 0.5 ng/mL compared to 59% [95% CI 43-74] when PSA ≤0.5 ng/mL. Conclusion: In a contemporary phase 3 trial, patients with a high-GC were more than twice as likely than patients with low/intermediate-GC to experience biochemical and clinical progression and receive salvage ADT. High-GC patients who received SRT with PSA > 0.5 ng/mL had nearly 90% risk of recurrence by 5-years post-SRT. This data validates the clinical utility of the GC for tailoring treatment in the salvage setting.
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