Living with Prostate Cancer

1. Living with Prostate Cancer A longitudinal study of the psychosocial adjustment of men and their partners to early stage and advanced prostate cancer Dr. Michelle L. Macvean Dr. Jeremy Couper Univeristy of Melbourne

2. Men’s study: main aims • To follow two groups of prostate cancer patients, one newly-diagnosed and one late-stage, for a period of two years • To observe, at various time points, the psychiatric disorders, quality of life, and the coping styles of the patients, comparing their responses with those of men from the community

3. Men’s study: specific objectives • To determine the psychiatric disorders of patients with early and with late-stage prostate cancer using the CIDI • To establish the accuracy of a self-report screening inventory for psychiatric distress (BSI) in patients with early and late-stage prostate cancer by comparing scores with the diagnoses made using the CIDI

4. Men’s study: specific objectives • To assess the quality of life, including the quality of relationships with their partners, and the preferred coping styles of patients with early and late-stage prostate cancer • To identify patterns of change in psychosocial adjustment at 3, 6, 12, 18 & 24 months following the initial baseline assessment conducted before treatment

5. Men’s study: specific objectives • To identify those aspects of quality of life and of preferred coping responses that help identify patients who show poorer psychosocial adjustment over time.

6. Men’s study: research instruments • Self-administerd questionnaire kit • SF-36- health related quality of life • UCLA Prostate Cancer Index- bowel/bladder • International Index of Erectile Function • BSI-53- Brief Symptom Inventory- psychosocial distress • Dyadic Adjustment Scale- marital satisfaction • Family Relationship Index • Mental Attitidues to Cancer (mini version) • Perceived Aims of Treatment

7. Men’s study: research instruments • Researcher-administered questions • Composite International Diagnostic Interview (CIDI)- psychiatric diagnoses. • Open-ended questions • Detailed demographics and medical history

8. Men’s study: recruitment sites • A&RMC • Royal Melbourne • The Alfred • St Vincent’s • Cabrini • Peter Mac • Box Hill • Private practices

9. Men’s study: eligibility • Patient has diagnosis of CaP • Patient has either: • early stage CaP- T1, T2, T3, N0, M0 (pretreatment) OR • advanced CaP- N+, M+ • Patient does not currently have other Ca • Patient does not have intellectual disab., dementia, psychotic disorder • Patient can speak/understand English

10. Men’s study: referrals and participants

11. Men’s study: referrals and participants

12. Men’s study: number of participants referred by individual clinicians (min. 5) Number of men participating (min. 5) Referring clinicians

13. Partners’ study: main aim • To describe and measure over time the psychosocial adjustment of a cohort of women who have partners diagnosed with prostate cancer and to determine what factors might contribute to the nature of their psychosocial adjustment

14. Partners’ study: specific objectives • To describe the psychosocial adjustment of the women at the first point of contact with the study in terms of the women’s psychiatric morbidity, psychosocial distress, quality of life, coping style, function in the couple and family context, and perception of the impact of their partner’s illness on their relationship

15. Partners’ study: specific objectives • To reassess the women’s psychosocial adjustment 6 months later in order to measure change in those factors over time

16. Partners’ study: specific objectives • To examine the potential contribution of the women’s satisfaction with couple and family function, the perceived burden of the male partner’s illness and the women’s coping styles at time 1 in predicting women’s psychiatric morbidity and psychosocial distress 6 months later

17. Partners’ study: research instruments • Self-administerd questionnaire kit • UCLA Prostate Cancer Index-bowel/bladder (modified) • International Index of Erectile Function (modified) • Perceived Aims of Treatment (modified) • BSI-53- Brief Symptom Inventory- psychosocial distress • Dyadic Adjustment Scale- marital satisfaction • Family Relationship Index • Social Adjustment Scale (instead of SF-36: QoL) • Ways of Coping Checklist (instead of MAC: adjustm’t)

18. Partners’ study: research instruments • Researcher-administered questions • Composite International Diagnostic Interview (CIDI)- psychiatric diagnoses. • Open-ended questions • Detailed demographics and medical history

19. Partners’ study: recruitment sites • A&RMC • Royal Melbourne • The Alfred • St Vincent’s • Peter Mac • Private practices

20. Partners’ study: eligibility • All female partners of men eligible for the men’s study are eligible for partner’s study • Woman does not have currently active cancer herself or other severe debilitating illness • Woman does not have intellectual disab., dementia, psychotic disorder • Woman can speak/understand English

21. Partner’s study: referrals and participants

22. Preliminary findings • Significantly greater sexual dysfunction in men with cancer than men without cancer • Significantly greater sexual dysfunction in men with advanced disease than men with early stage disease • Significantly greater sexual dysfunction in men aged above 60 compared with men below 60 years of age

23. Preliminary findings • Significantly greater urinary problems in men with cancer than men without cancer • Significantly greater urinary problems in men receiving prostatectomies and EBRT/brachytherapy with hormones than men receiving EBRT/brachytherapy without hormones

24. Preliminary findings • Significantly greater family conflict in younger men (under 60) compared with men over 70 years • A predictive statistical relationship between dyadic adjustment and - global psychosocial distress, family relationship problems and sexual dysfunction

25. Preliminary findings • From 20 matched couples, we found significantly greater global psychosocial distress for women compared to their matched partners • We also found rates of DSM-IV depression and anxiety in female partners of men with prostate cancer that are higher than in the general female population in Australia

26. Referral process at ARMC • Jeremy flags eligible patients in outpatients • There are three steps for clinicians in process: • If patient is eligible, please give him an Invitation to Participate • Then ask him if we can contact him • If he agrees, please place his bradmar??? sticker on sheet in clinic - jc where are they • Clinic staff will fax sheets to us and we will contact men and partners to obtain consent

27. Living with Prostate Cancer A longitudinal study of the psychosocial adjustment of men and their partners to early stage and advanced prostate cancer Dr. Michelle L. Macvean Dr. Jeremy Couper University of Melbourne