Karin Brochstedt Dieperink

Living alone, obesity and smoking: Important factors for quality of life after radiotherapy and androgen deprivation therapy for prostate cancer

Abstract Background. While effective treatment of prostate cancer with radiotherapy and hormones increase survival, adverse effects may reduce quality of life (QoL). The aim of this study was to investigate frequency and severity of self-assessed late adverse effects, and identify the patients most exposed. Material and methods. QoL of 317 cancer survivors with primary stage T1-T3 prostate cancer treated with conformal radiotherapy (70–78 Gy) and androgen deprivation therapy was analyzed by using SF-12 and EPIC-26 questionnaires. Patients were stratified into three groups, filling out the questionnaires 1–2, 2–3, and 3–4 years after radiotherapy. Differences between groups were tested with ANOVA and the χ2 test. The influence of marital status, severe obesity, smoking, stage of disease, and applied dose of radiotherapy on QoL was evaluated with multiple linear and logistic regression analyses. Results. Of 337 patients, 317 (94%) answered the questionnaire. The sexual and hormonal summary scores in the EPIC significantly improved during time since radiotherapy (p < 0.001). Current smoking had a negative effect on SF-12 Physical Component Summary (PCS) and the Mental Component Summary (MCS) scores, on EPIC bowel overall bother (OR 7.8; p = 0.003), on EPIC mean urinary incontinence scores, and on the sexual domain. Severe obesity had a negative influence on SF-12 PCS and vitality. Severe obesity also was a negative predictor for moderate-to-severe problems in the EPIC urinary incontinence, and in the hormonal domain. Living alone was associated with lower SF-12 PCS, MCS scores, and SF-12 general health, social functioning, and the EPIC hormonal domain. The stage of disease or the radiation dose had no statistically significant impact on QoL. Conclusion. Results showed significant negative associations between smoking, severe obesity and living alone on self-assessed late adverse effects after radiotherapy for prostate cancer. This information may guide rehabilitation.

The effects of multidisciplinary rehabilitation: RePCa—a randomised study among primary prostate cancer patients

Background:The objective of this study is the effectiveness of multidisciplinary rehabilitation on treatment-related adverse effects after completed radiotherapy in patients with prostate cancer (PCa).Methods:In a single-centre oncology unit in Odense, Denmark, 161 PCa patients treated with radiotherapy and androgen deprivation therapy were randomly assigned to either a programme of two nursing counselling sessions and two instructive sessions with a physical therapist (n=79) or to usual care (n=82). Primary outcome was Expanded Prostate Cancer Index Composite (EPIC-26) urinary irritative sum-score.Before radiotherapy, pre-intervention 4 weeks after radiotherapy, and after a 20-week intervention, measurements included self-reported disease-specific quality of life (QoL; EPIC-26, including urinary, bowel, sexual, and hormonal symptoms), general QoL (Short-form-12, SF-12), pelvic floor muscle strength (Modified Oxford Scale), and pelvic floor electromyography. Intension-to-treat analyses were made with adjusted linear regression.Results:The intervention improved, as compared with controls, urinary irritative sum-score 5.8 point (Cohen’s d=0.40; P=0.011), urinary sum-score (d=0.34; P=0.023), hormonal sum-score (d=0.19; P=0.018), and the SF-12 Physical Component Summary, d=0.35; P=0.002. Patients with more severe impairment gained most. Pelvic floor muscle strength measured by electromyography declined in both groups, P=0.0001.Conclusion:Multidisciplinary rehabilitation in irradiated PCa patients improved urinary and hormonal symptoms, and SF-12 physical QoL.

Marital rehabilitation after prostate cancer: a matter of intimacy

Prostate cancer is the most frequent male cancer disease in the western world. Sexual dysfunction is common after prostate cancer with radiation therapy and androgen deprivation therapy, but further research is needed to determine the lived experience of couples struggling with sexual dysfunction after treatment. The purpose of this study was to explore the lived experience of men and their partners experiencing sexual side effects after radiation therapy and androgen deprivation therapy for prostate cancer. In addition, to understand the role of a structured rehabilitation program on the couples experience. Couples with persistent sexual problems were recruited among patients treated with radiotherapy or/and androgen deprivation therapy. Descriptive statistics were collected including age, race, education and work. Focus groups with each gender were conducted using open ended questions to encourage participants to talk about their experiences. Data were analyzed using Giorgis phenomenological method. A total of eight couples were recruited, men age 67 years [standard deviation (SD) 6·3], women 65 years (SD 7·2). Results from the focus group interviews regarding marital relations were grouped in three themes: negative impact of sexual dysfunction on the relationship; other physical and psychological consequences of late adverse effects; communication issues and partner feelings of frustration. Results regarding the rehabilitation program were grouped in four themes: importance of peer support; importance of time and space for reflection; improved communication; optimism after rehabilitation. The couples in this study reported that the sexual side effects of prostate cancer treatment impacted their relationship and were problematic for both the men and their partners. The rehabilitation program improved the couples communication concerning sexual intimacy and issues related to prostate cancer treatment. It also offered a chance for peer support from others going through similar experiences and increased hope for navigating through sexual and intimacy issues in the future.

A qualitative exploration of oncology nurses' family assessment practices in Denmark and Australia.

BackgroundThe nurses’ ability to provide supportive care to the patient and the family is influenced by their family assessment skills, which provide them with understanding of the family needs and strengths. When a patient is diagnosed with cancer, it is the family who provides the long-term support for the patient, and nurses need to understand the family needs in order to provide holistic care.ObjectiveThe objective of the present study is to understand the factors that influence nurses’ family assessment practices in adult oncology setting in Denmark and Australia.MethodsAn interpretive qualitative study was conducted guided by the family systems theory. Focus groups were completed with 62 nurses working in adult oncology areas in Denmark and Australia. A thematic analysis and a computer-generated concept mapping were completed to identify themes within the data.ResultsOverall, the nurses valued family as part of the patient care and worked to understand the family concerns. However, the family assessment process was unstructured and did not enable holistic family support. Nurses from both countries discussed that experience and ability to engage with the family influenced the nurse’s role in family assessment.ConclusionThis study identified that nurses value family as part of patient care, however struggle to assess and support families during oncology care. There is a need for a structured assessment approach and education on family assessment, which could be used across the two countries and possibly internationally.

Strengths and resources used by Australian and Danish adult patients and their family caregivers during treatment for cancer

PURPOSE Family plays an essential role in supporting the patient with cancer, however, relatively little attention has been given to understanding the strengths and resources of the family unit across different settings and countries. This study aims to investigate the strengths and resources of patients and family members in Australia and Denmark. METHODS Using a descriptive, cross-sectional design, 232 patient and family participants from inpatient and outpatient oncology services in Australia and Denmark completed paper based surveys that included the Family Hardiness Index (FHI) and Family Crisis Orientated Personal Evaluation Scales (F-COPES), together with demographic and health information. RESULTS The familys appraisal of the cancer and ways the family worked together predicted the level of external resources used to manage their circumstances. CONCLUSION After a cancer diagnosis patients and family respond in different ways related to their family functioning. There is a need for nurses to work closely with the family to understand their strengths and resources, and tailor support and information for family to promote optimal patient outcomes.

Male coping through a long-term cancer trajectory. Secondary outcomes from a RTC examining the effect of a multidisciplinary rehabilitation program (RePCa) among radiated men with prostate cancer.

Abstract Background: The objective of this study was to examine if rehabilitation influenced self-reported male coping styles during and up to three years after treatment with radiotherapy for prostate cancer. Materials and methods: In a single-center oncology unit in Odense, Denmark, 161 prostate cancer patients treated with radiotherapy and androgen deprivation therapy were included in a randomized controlled trial from 2010 to 2012. The trial examined the effect of a multidisciplinary rehabilitation program within six months of treatment consisting of two nursing counseling sessions and two instructive sessions with a physical therapist (n = 79), or standard care (n = 82). As secondary outcomes coping was measured before radiotherapy, one month after radiotherapy (baseline), six month post-intervention (assessment) and three years after radiotherapy (follow-up) by the Mini-mental adjustment to cancer scale (Mini-MAC). The male coping styles towards the illness are expressed in five mental adjustment styles: Fighting Spirit, Helplessness-Hopelessness, Anxious Preoccupation, Fatalism and Cognitive Avoidance. Descriptive analysis and multiple linear regression analysis adjusting for the longitudinal design were conducted. Results: Most coping styles remained stable during the patient trajectory but Anxious Preoccupation declined from before radiotherapy to follow-up in both intervention and control groups. After six months the intervention group retained Fighting Spirit significantly (p = 0.025) compared with controls, but after three years this difference evened out. After three years the intervention group had lower Cognitive Avoidance (p = 0.044) than the controls. Factors as educational level, and depression influenced the use of coping styles after three years. Conclusion: Multidisciplinary rehabilitation in irradiated prostate cancer patients retained the adjustment style Fighting Spirit stable after six months of radiotherapy, and in the long term reduced Cognitive Avoidance. Thus, the rehabilitation program supported the patient’s active coping style and played down the passive coping style.

Exercise on Prescription: A Cross-sectional Study With Self-reported Outcome

BACKGROUND Exercise on prescription (EOP) is an attempt to increase physical activity among sedentary adults with signs of lifestyle diseases. Until now, no studies have focused on patients with chronic diseases and how they assess the long-term effect of participating in EOP consisting of supervised interventions of different intensities. This study aimed to describe and compare self-reported physical activity in the long term among participants in 3 EOP modules of different intensities. METHODS A cross-sectional survey was conducted among 1152 former participants in EOP between July 2005 and May 2007 in 2 Danish counties. Physical activity was measured as number of days with a minimum 30 minutes of moderate/vigorous activity. RESULTS Seventy-five percent (n = 854) returned the questionnaire. Of these, 36% reported being physically active ≥ 5 days/week. Comparing leisure-time activities before EOP 29% was sedentary vs. 15% (P < 0 .01) after, moderate + hard leisure-time activities was 7% before vs. 19% after EOP (P < 0 .01). Time postintervention did not influence the numbers reporting to be physical active negatively. CONCLUSIONS This study in community-dwelling adults with chronic diseases participating in EOP finds that approximately one-third reported being physically active in the long term postintervention, but no differences between the modalities were found.

Validity and reliability of the Danish version of the Ice Expressive Family Functioning and Ice Family Perceived Support questionnaires

AIM International research has only rarely examined the functioning of families experiencing chronic illness and the perception of nurses towards involving families in patient care. This has also been the case in Denmark. To undertake this kind of research, carefully translated questionnaires are needed. The purpose of this study was therefore to translate the Ice Expressive Family Functioning (ICE-EFFQ) and the Ice Family Perceived Support (ICE-FPSQ) into Danish, and to test the validity and reliability of the Danish versions. METHODS The study had a cross-sectional design. The questionnaires were translated into Danish using forward-backward translation. Then, they were tested empirically among adult patients with chronic diseases and their family members in three different settings. A total of 81 patients were included in the testing of ICE-EFFQ and 70 patients were included in the testing of ICE-FPSQ. Internal consistency reliability was assessed followed by confirmatory factor analysis. RESULTS Both questionnaires showed acceptable construct validity, reliability (Cronbachs alpha 0.93 and 0.94), internal consistency were confirmed, and there was good reproducibility (Cronbachs alpha 0.76 and 0.77). Furthermore, confirmatory factor analysis showed acceptable to good fit for both questionnaires. CONCLUSIONS The ICE-EFFQ and the ICE-FPSQ were both found to be valid and reliable instruments to measure family functioning and perceived support among families experiencing chronic illness in a Danish context.

Authors’ reply to Dr. Sabour

Authors’ response We appreciate the interest of Dr. Sabour in our recent published article BPrediction of rehabilitation needs after treatment of Cervical Cancer.What do late adverse effects tell us?^ andwe read his comments with interest. We can see from Dr. Sabour’s publications that he is interested in methodological issues in multiple research fields with more than 90 commentary papers published, including a high number of self-references. Dr. Sabour expressed concern that the paper statedmisleading results because we did not complete a prediction study with two separate cohorts. However, we believe that Dr. Sabour’s comments relate to the use of the word Bprediction^ in the title of our article. This is a common English word that, according to dictionary definition, means what someone thinks will happen or an informed guess. We sought to write an article that was relevant to clinical practice and chose the word Bprediction^ as a word to describe how the results could be used to identify cervical cancer patients who could need rehabilitation and not as a statistical term. Unfortunately, Dr. Sabour assessed the article as a prediction study, even though it was not described as such in either the purpose or methods sections. In the conclusion, we did not write that we had developed a prediction model, but suggested that young, obese survivors with locally advanced cervical cancer and survivors who received chemotherapy may be at serious risk of developing late adverse effects; thus, rehabilitation should target these needs. We do, however, agree that the word Bprediction^ could be misunderstood in this context and we will be more careful about the use of the word Bprediction^ in the future.

Living experiences with late effects after treatment for cervical cancer

Background: Oral mucositis (OM) is a common debiliating adverse effect following high dose chemotherapy prior to bone marrow transplantation. OM often interferes with food intake and lead to malnutrition, weight loss and impaired quality of life. These adverse effects may require intravenous morphine for pain alleviation, Although uncomfortable to the patient, oral cryotherapy with ice chips has been shown to reduce the grade and extent of OM. Purpose: The purpose of the present study is to evaluate whether an intraoral cooling device has the same effectiveness as ice chips when it comes to cooling the oral mucosa. Method: Five healthy volunteers (mean age 36.2 years) chewed ice under surveillance for 30 minutes. Before the start of and immediately after the termination of the ice chewing, the intraoral mucosal temperature was measured using a modified thermometer. The same protocol was used to asses the cooling efficacy obtained by the newly developed intraoral device. Results: No statistical significant differences in cooling of teh oral mucosa (p=0.12) were obtained. The mean surface temperature following cooling was 25.7 degrees Celcius with ice chips and 24.7 degrees Celcius with the cooling device. Conclucion: The cooling device is as effective as ice chips in terms of cooling the oral mucosa. The next step in this research is to use the cooling devise to establish the highest surface temperature of the oral mucosa, during infusion of chemotherapy, that will still result in prevention of oral mucositis.Introduction Lifestyle interventions might be useful in the management of adverse effects of androgen deprivation therapy (ADT) in men with prostate cancer. Objectives To examine the effects of dietary and exercise interventions on quality of life (QoL), metabolic risk factors and androgen deficiency symptoms in men with prostate cancer undergoing ADT. Methods CINAHL, Cochrane library, Medline and PsychINFO were searched to identify randomised controlled trials published from January, 2004 to October, 2014. Data extraction and methodological quality assessment was independently conducted by two reviewers. Meta-analysis was conducted using RevMan® 5.3.5. Results Of 2183 articles retrieved, 11 studies met the inclusion criteria and had low risk of bias.Nine studies evaluated exercise (resistance and/or aerobic and/or counselling) and three evaluated dietary supplementation. Median sample size =79 (33–121) and median intervention duration was 12 weeks (12–24). Exercise improved QoL measures (SMD 0.26, 95%CI −0.01 to 0.53) but not body composition, metabolic risk or vasomotor symptoms. Qualitative analysis indicated soy (or isoflavone) supplementation did not improve vasomotor symptoms; however, may improve QoL. Conclusions Few studies have evaluated the efficacy of lifestyle interventions in the management of adverse effects of ADT. We found inconclusive results for exercise in improving QoL and negative results for other outcomes. For soy-based products, we found negative results for modifying vasomotor symptoms and inconclusive results for improving QoL. Future work should investigate the best mode of exercise for improving QoL and other interventions such as dietary counselling should be investigated for their potential to modify these outcomes.