Both prostate cancer patients and their spouses benefit from family intervention counseling, but surprisingly spouses benefit more then the patients, this according to an article published in the December issue of Cancer!
Learning about the diagnosis and then the treatment itself often has very negative effects on both the patient and the spouse. Knowing and adjusting to being a cancer patient can have a devastating effect. Upon learning the diagnosis, men can become depressed and angry.
Men will suffer from many losses the most important is their health. Hearing the results of a positive biopsy makes a healthy man redefine himself as a sick man. Treatment causes many other losses including incontinence, sexual potency and possibly bowl control. They might find themselves dealing with pain, confusion and hot flashes, etc.
However, little discussed in the literature is the spouse. They too suffer when there is a prostate cancer diagnosis. Spouses experience directly the results of all the side effects experienced by the survivor. Their sexual life also changes; they are steeped in worry; they also feel hopeless, distressed, guilty and depressed. Often their relationship with their spouse declines because of a breakdown in communication between the two parties.
The objective of the study (A prospective randomized trial by Dr. Northouse ) was to assess whether a family-based intervention could improve family life. It looked at appraisal variables (appraisal of illness, caregiving, uncertainty, hopelessness), coping resources (coping strategies, self-efficacy, communication), symptom distress (general and prostate-specific), and quality of live in patients and their spouses during 3 phases of prostate cancer; newly diagnosed, biochemical recurrence and advanced. The phases of the cancer and risk for distress were evaluated as to whether they created a differential effect of the intervention on patient or spouse outcomes.
Patient and spousal assessments were performed at 4, 8, and 12 months after enrollment in the study. Specially trained nurses delivered the intervention and data collection nurses were blinded to the group assignment (intervention or control).
The intervention arm encouraged families to work as a team, communicate openly about the illness, and provide one another with support. The control arm was standard of care, or no treatment.
A total of 263 couples were enrolled and completed baseline evaluations. At 4 and 12 months 235 (90%) and 218 (83%) dyads completed the follow-up assessments, respectively. There were no differences between the intervention and control arms regarding follow-up participation.
Average patient age was 63 years and average spouse age was 59 years. The vast majority (84%) were Caucasian. The enrollment consisted of 65% in the newly diagnosed category (60% had surgery and 40% radiotherapy), 14% with biochemical recurrence, and 21% with advanced disease. It was noted that 25% of spouses had health problems.
There were no differences between the arms regarding quality of life variables. The intervention and control groups did not differ on appraisal variables but patients in the intervention group did report less uncertainty about their illness than controls at 4 months. Intervention patients reported more communication about the illness with their spouses than control men at 4 months. There were no differences between groups on general or prostate-specific symptom distress.
Intervention spouses reported better physical quality of life than control spouses at 8 and 12 months. They also had better mental quality of life scores. Intervention spouses had less negative appraisal of caregiving, less uncertainty about the illness, less hopelessness, higher self-efficacy about ways to manage the illness, and less general symptom distress. The phase of illness and risk for distress did not seem to moderate the effectiveness of the intervention.
Study Information – Northouse LL, Mood DW, Schafenacker A, Montie JE, Sandler HM, Forman JD, Hussain M, Pienta KJ, Smith DC, Kershaw T
Cancer. 110(12):2809-18, December 2007
The take home message- Find a support for yourself and for your spouse. If you can not find one see if you can encourage an existing support organization to respond to this need and start a group. Call Cancer Care, The American Cancer Society, etc. and ask them start a support group that includes spouses.
Malecare Inc. has started a group in New York City that is designed to respond to this need. We meet the first Monday of the month at the St. Vincents Cancer Care Center, 325 West 15th Street, New York, N.Y. Come on down and join us.
Joel T. Nowak MA, MSW