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Improving Quality of Life in Men with Prostate Cancer

The results of an NIH-funded, large-scale randomized clinical trial on men's adjustment to prostate cancer found that the effects of educational and supportive group interventions had specific benefits for men.

The results will be published in Health Psychology, which is the leading journal in the field and published by the American Psychological Association.

The study was conducted by Stephen J. Lepore, Professor of Health Education at Teachers College, and by other researchers from Carnegie Mellon University, Northwestern University and the University of Pittsburgh.

This was the first study to examine the effects of education and support group interventions on men's adjustment to prostate cancer. Many prior studies have shown beneficial effects of such groups on women's adjustment to cancer, but none had been conducted exclusively with men.

Prostate cancer is the most common solid tumor malignancy and a leading cause of cancer death in American men. The latest statistics suggest that one in five men will develop prostate cancer in his lifetime. The majority of men afflicted with prostate cancer survive for many years, but they may suffer from a host of adverse effects of the disease or its treatments. From the researcher's point of view, it was critical, then, to develop interventions that can mitigate the adverse effects of this disease and enhance patients' quality of life.

Lepore spoke about the specific findings. "We found that men with cancer can benefit from education and support groups. The biggest concerns that men have when contemplating treatments for prostate cancer are: Will I be able to be as active after treatments as before my cancer? Will I have problems in sexual and urinary functioning? There were two particularly strong and interesting findings from the study: men who received both education and support from peers were the most likely to remain employed in the year after their treatment and were the least likely to be bothered by sexual problems associated with their prostate cancer treatments.

Another interesting finding was that the interventions appeared to reduce social disparities in men's adjustment to prostate cancer treatments. Generally, men with less formal education had poorer health habits and more problems in their physical functioning following prostate cancer treatments than their more educated peers, but when they participated in the group interventions, men with less formal education tended to show the greatest improvements in health behaviors and adjustment. The interventions may have compensated for deficits in access to information or social support in men with less formal education.

This study examined quality of life in 250 men with prostate cancer who were randomly assigned to a control group, a group education intervention (GE), or a group education plus discussion intervention (GED). Both the GE and GED interventions improved men's knowledge about prostate cancer. In the year post-intervention, men in the GED condition reported less bother by sexual problems than controls, and they were more likely to remain steadily employed (93 percent) than men in the GE (75.6 percent) and control (72.5 percent) conditions. Some intervention benefits were evident only in men with less formal education, suggesting the interventions reduced some social disparities in outcomes. Specifically, among non-college graduates, GED and GE resulted in better physical functioning than the control condition, and GED resulted in more positive health behaviors than the control or GE condition.

Group education and support interventions, such as "Man-to-Man" and "US TOO," are becoming increasingly popular among men with prostate cancer. US TOO was founded in 1990 and already has more than 325 chapters in the United States. However, there had been no systematic evaluations of the effects of such groups on quality of life in men with prostate cancer. This study reports results from a randomized, controlled trial of group interventions designed to enhance quality of life in men treated for prostate cancer.

The education-only intervention consisted of six weekly, one-hour lectures that were delivered by an expert on the following topics: overview of prostate cancer biology and epidemiology (oncologist), control of physical side effects (urologist), nutrition and cancer (dietician), stress and coping (oncology nurse), relationships and sexuality (clinical psychologist), follow-up care and future health concerns (urologist). Men also received print materials summarizing the lectures. Lecturers allowed 10 minutes for questions, but participants were not encouraged to talk with one another.

Lepore said that the results of the study imply that the burden of prostate cancer is particularly high among poorer, less-educated and minority men, who also have an elevated probability of contracting, suffering with and dying from prostate cancer. Poorer, less-educated and minority men also have less knowledge about prostate cancer both before and after they get the disease suggesting that educational interventions should be especially fruitful with this population.

"What was exciting about this work is that we showed that those people actually benefit tremendously from this very simple, fairly inexpensive intervention. And so what this suggests to me is that we should be promoting these kinds of educational and support groups for the neediest people-those who have the greatest unmet needs. And we have tools to identify who they are," Lepore said. "We can tailor the materials more specifically to this group, for instance, appropriately modifying the literacy level of the educational materials and building in repetition and multiple ways of delivering messages.

In this way, we can conserve resources; we can say this is where we should be putting our energies-to the folks that are going to need this the most. And so it allows you to have these kinds of targeted and tailored interventions, which will be most efficient and most impactful."

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