Improving*Psychological*Outcomes* for*Men*with*Prostate*Cancer* ! - - PowerPoint PPT Presentation

Improving*Psychological*Outcomes* for*Men*with*Prostate*Cancer*

!

Professor!Suzanne!Chambers!

! !

Griffith!Health!Ins8tute!! Cancer!Council!Queensland! Prostate!Cancer!Founda8on!of!Australia! ARC!Future!Fellow! William!Rudder!Fellow!2013!

Background*

!

• Treatment!for!prostate!cancer!has!well!

described!nega8ve!effects!!

• However,!outcomes!are!likely!heterogeneous!!
• A!Phase!3!trial!of!a!psychoMeduca8onal*

interven8on!was!undertaken!aiming!to!reduce! cancerMspecific!and!decisionMrelated!distress! and!improve!quality!of!life!for!men!newly! diagnosed!with!localised!prostate!cancer!and!to! assess!for!effects!of!heterogeneity!!!

!

Methods*

!

• 740!(81.7%)!men!were!recruited!aWer!

diagnosis!and!before!treatment!and! randomised!to!a!teleMbased!nurse!delivered! five!session!psychoMeduca8onal*interven8on! (N=372)!or!usual!care!(N=368).!!

• Men!were!assessed!before!treatment;!and!2,!

6,!12,!and!24!months!postMtreatment.!! !

Interven=on*

!

• LowMintensity,!telephone!delivered!
• 5!sessions!delivered!by!nurse!counsellors!
• Elements!included!
• Decision!support!
• Challenging!unhelpful!cogni8ons!
• Stress!reduc8on!techniques!
• Coaching!for!problemMsolving!techniques!

!

Interven=on*

!

• 2!pretreatment!sessions!
• Focussed!on!decision!support!
• Stress!management!
• And!treatment!prepara8on!
• 1!session!at!3!weeks!and!1!at!7!weeks!
• Focussed!on!adjustment!to!cancer!
• Problem!solving!!
• Coping!with!treatment!
• Final!session!at!5!months!
• Addressing!side!effects!and!
• Preparing!for!the!future!

Methods*

!

Outcome!measures!included:!!

• cancerMspecific!and!decisionMrelated!distress!
• cogni8ve!judgmental!adjustment!
• subjec8ve!wellMbeing!
• domainMspecific!and!healthMrelated!quality!of!

life!!!

Results*

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No!uncondi8oned!effects!were!found.** * Classifica8on!analyses!on!preMrandomisa8on!measures!dis8nguished! 3!subgroups:!younger,!higher!educa8on!and!income!men!(N!=!290);! younger,!lower!educa8on!and!income!men!(N!=!106);!and!older!men! (N!=!344).!! ! Younger,!higher!educa8on!and!income!men!showed!posi8ve! interven8on!effects!for!cancerMspecific!distress!(P=.008);!and!mental! health!(P=.042).!! ! By!contrast,!for!younger,!lower!educa8on!men,!par8cipa8on!in!the! interven8on!was!associated!with!decreases!in!cogni8ve!judgmental! adjustment!over!8me!(P=.006).!

Predicted*Cancer*Specific*Distress*by*months,* class*and*treatment*group*

2 4 6 8 10 12 14 16 18 2 6 12 24 Months Predicted RIES Younger/Hi Edu/Control Younger/Hi Edu/Tx Younger/Lo Edu/Control Younger/Lo Edu/Tx Older control Older Tx

Predicted*SF36*Mental*Subscale*score*by* months,*class*and*treatment*group*

10 20 30 40 50 60 2 6 12 24 Months Predicted SF36 Mental Younger/Hi Edu/Control Younger/Hi Edu/Tx Younger/Lo Edu/Control Younger/Lo Edu/Tx Older Control Older Tx

Predicted*Cogni=ve*Judgement*Appraisal*total* scores*by*months,*Class*&*Treatment*Group*

20.5 21 21.5 22 22.5 23 23.5 24 24.5 2 6 12 24 Months Predicted CMS Younger/Hi Edu/Control Younger/Hi Edu/Tx Younger/Lo Edu/Control Younger/Lo Edu/Tx Older Control Older Tx

Conclusions*

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• Response!to!interven8on!and!adjustment!over!8me!varied!

according!to!previous!sexual!func8oning,!age,!educa8onal! level!and!income!!!

• How!to!best!intervene!with!younger,!low!educa8on,!low!

income!men!with!prostate!cancer!is!a!cri8cal!future!research! ques8on!

• Future!interven8on!research!needs!to!take!into!account!

sample!heterogeneity!