Improving*Psychological*Outcomes* for*Men*with*Prostate*Cancer* ! Professor!Suzanne!Chambers! ! ! Griffith!Health!Ins8tute!! Cancer!Council!Queensland! Prostate!Cancer!Founda8on!of!Australia! ARC!Future!Fellow! William!Rudder!Fellow!2013!
Background* ! • Treatment!for!prostate!cancer!has!well! described!nega8ve!effects!! • However ,!outcomes!are!likely!heterogeneous!! • A!Phase!3!trial!of!a!psychoMeduca8onal * interven8on!was!undertaken!aiming!to!reduce! cancerMspecific!and!decisionMrelated!distress! and!improve!quality!of!life!for!men!newly! diagnosed!with!localised!prostate!cancer!and!to! assess!for!effects!of!heterogeneity!!! !
Methods* ! • 740!(81.7%)!men!were!recruited!aWer! diagnosis!and!before!treatment!and! randomised!to!a!teleMbased!nurse!delivered! five!session!psychoMeduca8onal * interven8on! (N=372)!or!usual!care!(N=368).!! • Men!were!assessed!before!treatment;!and!2,! 6,!12,!and!24!months!postMtreatment.!! !
Interven=on* ! • LowMintensity,!telephone!delivered! • 5!sessions!delivered!by!nurse!counsellors! • Elements!included! • Decision!support! • Challenging!unhelpful!cogni8ons! • Stress!reduc8on!techniques! • Coaching!for!problemMsolving!techniques! !
Interven=on* ! • 2!pretreatment!sessions! • Focussed!on!decision!support! • Stress!management! • And!treatment!prepara8on! • 1!session!at!3!weeks!and!1!at!7!weeks! • Focussed!on!adjustment!to!cancer! • Problem!solving!! • Coping!with!treatment! • Final!session!at!5!months! • Addressing!side!effects!and! • Preparing!for!the!future!
Methods* ! Outcome!measures!included:!! • cancerMspecific!and!decisionMrelated!distress! • cogni8ve!judgmental!adjustment! • subjec8ve!wellMbeing! • domainMspecific!and!healthMrelated!quality!of! life!!!
Results* ! No!uncondi8oned!effects!were!found. ** * Classifica8on!analyses!on!preMrandomisa8on!measures!dis8nguished! 3!subgroups:!younger,!higher!educa8on!and!income!men!(N!=!290);! younger,!lower!educa8on!and!income!men!(N!=!106);!and!older!men! (N!=!344).!! ! Younger,!higher!educa8on!and!income!men!showed!posi8ve! interven8on!effects!for!cancerMspecific!distress!( P =.008);!and!mental! health!( P =.042).!! ! By!contrast,!for!younger,!lower!educa8on!men,!par8cipa8on!in!the! interven8on!was!associated!with!decreases!in!cogni8ve!judgmental! adjustment!over!8me!( P =.006).!
Predicted*Cancer*Specific*Distress*by*months,* class*and*treatment*group* 18 16 14 12 Younger/Hi Edu/Control Predicted RIES Younger/Hi Edu/Tx 10 Younger/Lo Edu/Control Younger/Lo Edu/Tx 8 Older control Older Tx 6 4 2 0 0 2 6 12 24 Months
Predicted*SF36*Mental*Subscale*score*by* months,*class*and*treatment*group* 60 50 Predicted SF36 Mental 40 Younger/Hi Edu/Control Younger/Hi Edu/Tx Younger/Lo Edu/Control 30 Younger/Lo Edu/Tx Older Control Older Tx 20 10 0 0 2 6 12 24 Months
Predicted*Cogni=ve*Judgement*Appraisal*total* scores*by*months,*Class*&*Treatment*Group* 24.5 24 23.5 Younger/Hi Edu/Control 23 Predicted CMS Younger/Hi Edu/Tx Younger/Lo Edu/Control 22.5 Younger/Lo Edu/Tx Older Control 22 Older Tx 21.5 21 20.5 0 2 6 12 24 Months
Conclusions* ! • Response!to!interven8on!and!adjustment!over!8me!varied! according!to!previous!sexual!func8oning,!age,!educa8onal! level!and!income!!! • How!to!best!intervene!with!younger,!low!educa8on,!low! income!men!with!prostate!cancer!is!a!cri8cal!future!research! ques8on! • Future!interven8on!research!needs!to!take!into!account! sample!heterogeneity!
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