Tina Broby Mikkelsen

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.

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.

Rehabilitation after cervical cancer: different gains in different settings

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.