Jeremy Couper

Psychological adjustment of men with prostate cancer: a review of the literature

ObjectiveProstate cancer (PCA) is the most common malignancy and a major cause of death in men but, importantly, a substantial proportion will live for several years following diagnosis. However, they face the prospect of experiencing symptoms, side-effects of treatment and diminished quality of life. The patients psychological adjustment is particularly complex, given the potential trajectory of the disease, from the point of diagnosis, with its immediate impact, to the phase of palliative care, with its attendant issue of facing mortality. Since a comprehensive review of the literature on psychological adjustment of men with PCA has not yet been done, we have documented relevant research, integrated findings and drawn conclusions, where possible, in order to map out clinical and research implications.MethodWe searched 5 databases for the period 1994 – July 2006, during which most of the work in the field has been done.ResultsWe found few studies of substance among the 60 we examined to draw conclusions about psychological adjustment to prostate cancer and its treatment. This is in marked contrast to the picture in breast cancer. While some patterns have emerged, many gaps remain to be filled.DiscussionAspects of methodology need attention, particularly longitudinal, prospective designs, incorporation of control groups and the use of valid and reliable measures. There is scope for qualitative studies as a complement to quantitative research.

A longitudinal study of distress (depression and anxiety) up to 18 months after radiotherapy for head and neck cancer.

The aim of the study was to assess symptoms of depression and anxiety in patients with head and neck cancer up to 18 months after radiotherapy.

Psychosocial adaptation in female partners of men with prostate cancer

The objective was to explore the psychosocial adaptation of female partners living with men with a diagnosis of either localized or metastatic prostate cancer. Semi-structured qualitative interviews were conducted with 50 women at two time points (baseline and 6 months later). The interviews examined emotions, experiences, attitudes to sexual and continence issues and treatment decision making. As part of a larger prospective observational study, demographic data and scores for depression and anxiety were collected. Initial analysis demonstrated that the group of 11 women assessed as distressed on the anxiety and depression measures described reduced coping skills and poorer adaptation after 6 months. In contrast, the 39 women in the non-distressed group reported emotional adaptation that fitted the Lazarus and Folkman pattern of coping through appraisal of the impact of the diagnosis on their partner and themselves, appraisal of coping strategies and reappraisal of the situation. A surprise finding was the high level of resilience displayed by majority of these women. Results suggest that a psychosocial intervention could strengthen healthy adaptation and provide better coping skills for distressed couples.

Psychosocial adjustment in newly diagnosed prostate cancer.

Objective: To examine the psychological and social adjustment of men with early or advanced stage prostate cancer and to compare them with a matched group of cancer-free community volunteers. Methods: A longitudinal observational study in which 367 men recently diagnosed with early (n=211) or advanced stage (n=156) prostate cancer were compared to 169 cancer-free men from the community, of similar age and residential area, using self-report measures of psychosocial adjustment. Results: On the mental health subscales of the Short-Form 36-item Health Survey, men with advanced disease had lower vitality and social functioning than the other two groups, and lower mental health scores than the comparison group. Both patient groups had lower role-emotional scores than the comparison group. With regard to the Brief Symptom Inventory, the advanced disease group had higher somatization scores, and lower interpersonal sensitivity and paranoid ideation scores than the early stage group and the community comparison group. In terms of psychiatric morbidity, there were higher rates of anxiety disorders but not depressive disorders in both patient groups although overall diagnosis rates were low. No differences were found in terms of couple or family functioning. Conclusions: There is impairment in psychosocial function in men with prostate cancer, particularly those with advanced disease, but no increase in the rate of formal psychiatric disorder or adverse effects on the couples and families. This suggests directions for psychosocial interventions with these patient groups.

Cognitive Existential Couple Therapy for newly diagnosed prostate cancer patients and their partners: A descriptive pilot study

This paper aims to describe ‘Cognitive Existential Couple Therapy’ (CECT), a novel couples‐based intervention for men with early stage prostate cancer (PCa) and their partners, and to report preliminary findings from a pilot study that investigated the acceptability and feasibility of the intervention and the measures to be used in a subsequent randomised controlled trial.

A systematic review and meta-analysis of prescribing practices of antidepressants in cancer patients.

Antidepressants are commonly used for the pharmacological treatment of depression. We aimed to summarise the prevalence of antidepressant prescription to cancer patients, and differences by study or patient characteristics.

Cognitive existential couple therapy (CECT) in men and partners facing localised prostate cancer: A randomised controlled trial

To assess the efficacy of cognitive existential couple therapy (CECT) for relationship function, coping, cancer distress and mental health in men with localised prostate cancer and in their partners.

The assessment of disability in patients with psychotic disorders: an application of the ICIDH-2

Objectives: To describe the application of the International Classification of Functioning and Disability (ICIDH-2) in the assessment of disability in patients with psychotic disorders. Method: The study was conducted at the inpatient unit of St Vincents Mental Health Service, Melbourne. Twenty inpatients with psychotic disorders were concurrently assessed by two raters. An evaluation of the feasibility of the instrument was made during this process. Inter-rater agreement was determined using raw agreement percentages and weighted kappas. Results: The ICIDH-2 provides a comprehensive framework for the description and measurement of disability, including the dimensions of impairments in body structures and functions, activity limitations, participation restrictions and environmental factors. Certain codes are difficult for clinicians to rate because of the subjective manner in which they are defined. Our inter-rater reliability assessment varied across the dimensions from poor to almost perfect agreement. Conclusions: The ICIDH-2 is potentially useful in the clinical assessment of disability in patients with psychotic disorders although modifications are needed. These could include the use of anchor points defined for each dimension or code to assist the rating process and an alternative rating scale in which categories for rating are more broadly defined. Formal training may also be necessary to enable standardization of the rating process. There is also a need to augment measurements by clinicians with the assessment of the subjective experience of patients using self-rated disability and assessment of quality of life.

Unilateral Musical Hallucinations and All that Jazz

A 78-year-old hearing-impaired woman who presented to hospital with a stroke and a subsequent epileptic seizure later developed unilateral musical hallucinations in her better hearing (right) ear dShe was found to have a left-sided temporal epileptic focus and the music ceased after a second anti-convulsant was introduced. Comments are made on unusual features of the hallucination and its probable causation.

Comparison of the acceptability and benefits of two mindfulness-based interventions in women with breast or gynecologic cancer: a pilot study.

PurposeThe aim of this study was to compare the relative benefits and acceptability of two different group-based mindfulness psychotherapy interventions among women with breast and gynecologic cancer.MethodsData from 42 women who completed an 8-week mindfulness-based cognitive therapy (MBCT) program comprising 22 contact hours were compared to data from 24 women who completed a 6-week mindfulness meditation program (MMP) comprising 9 contact hours. Distress, quality of life (QOL), and mindfulness were evaluated pre- (T1) and post-intervention (T2). ANCOVA was used to analyse the relationship between intervention type and T1 score on outcome variable change scores. Participants’ perceptions of benefit and acceptability were assessed.ResultsThe participants did not differ on clinical or demographic variables other than MBCT participants were more likely than MMP participants to have a past history of anxiety or depression (p = .01). Scores on distress, QOL, and mindfulness improved from T1 to T2 with medium to large effect sizes for the MMP (p = .002, d = .07; p = .001, d = .08; p = .005, d = .06, respectively) and MBCT (p < .001, d = .06; p = .008, d = .04; p < .001, d = .09, respectively) interventions. ANCOVA showed no main effect for intervention type on outcome change scores and no interaction between intervention type and respective T1 score. Distress and mindfulness scores at T1 had a main effect on respective change scores (p = .02, ηp2 = .87; p = .01, ηp2 = .80, respectively). Both programs were perceived as beneficial and acceptable with no differences between the intervention types.ConclusionsWithin the limits of a small, non-randomized study, these findings provide preliminary support for the utility of a brief mindfulness intervention for improving distress and QOL in a heterogeneous group of women with cancer. Abbreviated interventions are less resource intensive and may be attractive to very unwell patients.