Martin A. Perez

Quality of life and sexuality following radical prostatectomy in patients with prostate cancer who use or do not use erectile aids

OBJECTIVES It is well established that prostate cancer patients undergoing radical prostatectomy may experience disruptive side effects, most notably urinary incontinence and erectile dysfunction. The purpose of this study is to compare relevant outcomes between patients awaiting radical prostatectomy for prostate cancer and patients who already underwent the surgery, taking into account type of prostatectomy and use of erectile aids. METHODS We compared self-reports of global quality of life, sexuality, urinary continence, and physical capabilities in 86 nerve-sparing patients, 89 standard-prostatectomy patients, 74 prostatectomy patients who used erectile aids, and a comparison group of 45 patients awaiting radical prostatectomy. RESULTS Regardless of type of surgery, use of erectile aid, or preoperative status, most patients reported good quality of life. The best outcomes in sexuality were reported by patients who used erectile aids, who appeared similar in sexuality to patients awaiting surgery. When differences were detected, standard prostatectomy patients who did not use erectile aids scored worse in most areas of sexuality than nerve-sparing patients who did not use erectile aids. There were no differences in frequency of urinary leakage among the three surgery subgroups. CONCLUSIONS Although most patients reported problems in sexual and urinary function, global quality of life does not appear to be compromised following radical prostatectomy. Findings suggest that postsurgical sexuality differs depending on type of prostatectomy and use of erectile aids, while urinary function is similar across surgery groups. We conclude that erectile aids should be offered routinely to patients who are ineligible for nerve-sparing surgery or experience erectile difficulties following the nerve-sparing procedure.

Social‐cognitive aspects of underserved Latinas preparing to undergo genetic cancer risk assessment for hereditary breast and ovarian cancer

Objectives: As Latinos are a growing ethnic group in the United States, it is important to understand the socio‐cultural factors that may be associated with cancer screening and prevention in this population. The socio‐cultural factors that may affect preparedness to undergo genetic cancer risk assessment (GCRA) deserve particular attention. The pre‐GCRA period can provide insight into variables that may influence how medically underserved Latinas, with limited health resources and access, understand hereditary cancer information and subsequently implement cancer risk management recommendations. This study explores social, cognitive and cultural variables in Latinas prior to undergoing GCRA.

Patient and Partner Quality of Life and Psychosocial Adjustment Following Radical Prostatectomy

We prospectively examined differences in quality of life and psychosocial adjustment in 80 prostate cancer patients and their partners (n = 65) beginning before radical prostatectomy and proceeding across the first year postsurgery. Both members of the couple experienced significant changes associated with the patients cancer, however their experiences differed in some regards. Patients experienced reprieve from emotional distress and negative affect immediately following surgery despite worsened physical functioning. Partner quality of life and psychosocial adjustment scores were generally more constant from presurgery to postsurgery, with improvements noted 1 year later. For both patients and partners, cancer-specific stress symptoms declined progressively over the year. We also obtained partial support for the effectiveness of a single-session communication intervention on patient social/family wellbeing and partner general stress. Findings have implications for patient and partner adjustment following radical prostatectomy, and attest to the importance of incorporating partner evaluations into psychosocial oncology research.

A Prospective Report of Changes in Prostate Cancer Related Quality of Life After Robotic Prostatectomy

In this prospective, longitudinal study the authors examined changes in cognitive, emotional, and interpersonal components of prostate cancer-related quality of life in 71 men who underwent robotic-assisted prostatectomy for prostate cancer. They identified significant changes across several quality-of-life domains from presurgery to 3-months and 1-year postsurgery. Although some components of quality of life returned to baseline by one year postsurgery, decrements in sexual intimacy, sexual confidence, and masculine self-esteem were enduring. These data can be used to guide patients in their expectations for quality of life following robotic prostatectomy and highlight the need for multidisciplinary approaches aimed at improving mens sexual adjustment after this procedure.

Need for cognition and psychosocial adjustment in prostate cancer patients and partners.

Abstract Individual differences in cognitive style, specifically need for cognition (NFC), may play an important role in facilitating communication and psychosocial adjustment to cancer during the presurgical period, a time marked by distress and the need to process diseaserelated information. This study examines the relations between NFC, adjustment, and communication in 106 prostate cancer patients and their partners within 2 weeks prior to radical prostatectomy. High NFC was significantly associated with better psychological adjustment for partners only, whereas for patients, communication with the medical team played a more important role. High NFC patients who were partnered with high NFC partners reported better dyadic communication compared with those who were partnered with low NFC partners. This study indicates that predictors of adjustment may differ for patients and partners, who are likely differentially affected by the disease process.

Abstract A33: Culturally relevant cancer risk counseling for underserved Latinas

Background: Latinas are as likely as the majority to have high cancer risk associated with genetic predisposition to breast cancer and ovarian cancer. Disproportionately underserved, Latinas have a compelling need for access to genetic cancer risk assessment (GCRA) and cancer screening and prevention measures. Objectives: The primary purpose of this project was to evaluate the effects of a culturally relevant GCRA intervention for Latinas. Methods: Four focus groups were conducted consisting of Latinas that have undergone GCRA. Participants completed a demographic questionnaire that included items assessing perceived cancer risk and satisfaction with GCRA. The focus groups entailed a facilitated discussion of the key study variables and other culturally relevant issues that may impact the GCRA intervention. Descriptive statistics and thematic analysis were used. Results: Perceived sense of lack of information and uncertainty about what to expect appeared to play a key role in distress. Most women initially had negative expectations (expecting the worse or bad outcome), but ultimately felt hopeful that they could learn more about the GCRA process and what it meant for them. Information was cited as the primary contributor to positive psychosocial outcomes specifically increased locus of control and self-efficacy. The major cultural themes identified were destiny, religious and spiritual coping, how cultural attitudes and belief influence lack of information, community awareness, and public health issues. Conclusions: Findings indicate that the pre-GCRA window may be most distressing for this population indicating that this may be the most appropriate time for psychological intervention. Citation Information: Cancer Epidemiol Biomarkers Prev 2010;19(10 Suppl):A33.