Tuesday, January 27, 2009

Men Treated For Prostate Cancer Experience High Levels Of Psychological Distress After Treatment

Men treated for prostate cancer have high levels of psychological distress and many suffer ongoing sexual dysfunction and lower urinary tract symptoms, according to a survey of men in England designed to explore their supportive care needs.

Prostate cancer is the commonest solid cancer in men, accounting for one in every four cancers diagnosed in males in England in 2004. Fortunately, the survival rate for this cancer is improving, reflecting the slow growing nature of the disease and its successful treatment in many men. Nearly three-quarters (71%) of men are still alive five years after being diagnosed with prostate cancer. The main thing to remember, to avoid health problems need time to see a doctor, who will pick up your good health drugs.

A range of treatment options - include surgery, radiotherapy and hormonal treatments - are available for prostate cancer, with the choice being determined by a man's age, the stage of his cancer and any other conditions that he has. Some of the treatments can have long-term effects on sexual and urological function.

The primary aim of treatment is to optimize cancer control, but some doctors also take into account a man's urological and sexual function before treatment and the patient's views on the balance of treatment efficacy against side-effects.

Relatively little is known about the support care needs - the requirements for care arising during illness and treatment to manage symptoms and side-effects - in men treated for prostate cancer. To find out more about how the disease and its treatment affects men, nursing researchers surveyed men with prostate cancer in six areas of England.

The researchers invited 1848 men who had been diagnosed with prostate cancer in the previous three to 24 months, from across six NHS Trusts (geographical regions in the National Health Service) to take part in the research study. Those who replied (820 men) were sent a postal questionnaire asking about their supportive care needs, prostate symptoms, quality of life, their cancer and its treatment; 741 were returned.

Three-quarters of the men taking part in the survey were 65 years old or over, Half (51%) had received hormonal therapy, one-quarter (25%) had radical prostatectomy and 28% had radiotherapy to the prostate. Just under half (46%) of the men said their cancer was in remission.

The survey revealed that the men had significant unmet supportive care needs. The areas of greatest need were related to psychological distress, sexuality-related problems and the management of enduring lowering urinary tract symptoms. The researchers noted: "High levels of psychological distress were reported, and those reporting psychological distress reported greater unmet supportive care needs."

Men who were uncertain of their remission status had higher levels of psychological need, while those not in remission were more likely to have needs for information.

Nearly one-third (30%) of the men taking part in the survey reported moderate or extreme anxiety or depression. A similar number had difficulty with undertaking usual activities. Some or extreme pain was reported by 26% of the men and 22% had problems with mobility.

Virtually all (97%) of the men reported that they had experienced lower urinary tract symptoms, including frequency or needing to urinate during the night, during the month before the survey. Urinary symptoms were affected by treatment, remission status and time since last treatment. They were least severe in men who were in remission, in those who had undergone radical prostatectomy and/or in those who had completed their treatment 19-24 months before the survey.

Unmet needs related to sexuality were more common in younger men and in those who had undergone radical prostatectomy.

The researchers, led by Emma Ream, from the Florence Nightingale School of Nursing and Midwifery, King's College London, UK, said: "The survey identified high levels of psychological distress within the sample, even though the majority had completed treatment over a year previously." They suggested that need for psychological care was particularly high in men not in remission or whose remission status was uncertain. "The need for systematic assessment and better management of psychological distress in men with prostate cancer was evident in this study," they concluded, adding that sexual dysfunction and lower urinary tract system symptoms also required greater attention by prostate services.

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