Intervening to improve psychological outcomes for men with prostate cancer
Intervening to improve psychological outcomes for men with prostate cancer
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DOI：
10.1002/pon.3095
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发表时间：
2013-05-01
期刊：
影响因子：
3.6
通讯作者：
Occhipinti, Stefano
中科院分区：
文献类型：
--
作者：
Chambers, Suzanne K.;Ferguson, Megan;Occhipinti, Stefano
背景前列腺癌是西方世界男性最常见的癌症，治疗的负面影响已被充分描述。然而，结果参差不齐。进行了一项心理教育干预的3期试验，旨在减少癌症特异性和决策相关的痛苦，并改善新诊断为局限性前列腺癌的男性的生活质量。方法740例（81.7%）男性在诊断后和治疗前被招募，并随机接受基于远程护理的五次心理教育干预（N=372）或常规护理（N=368）。在治疗前和治疗后2、6、12和24个月对参与者进行评估。结果测量包括癌症特异性和决策相关的痛苦，认知判断调整，主观幸福感，以及特定领域和健康相关的生活质量。社会支持被认为是一个潜在的调节因素。结果未发现无条件效应。对随机化前测量的分类分析区分了三个亚组：年轻、教育程度较高和收入较高的男性（N=290）;年轻、教育程度较低和收入较低的男性（N=106）;老年男性（N=344）。年轻、受过高等教育和收入较高的男性对癌症特有的痛苦（p=0.008）和心理健康（p=0.042）表现出积极的干预作用。相比之下，对于年轻、受教育程度较低的男性，参与干预与认知判断调整随时间的推移而减少有关（p=0.006）。结论干预和调整的反应随时间的推移而变化，根据以前的性功能，年龄，教育水平和收入。如何最好地干预年轻，低教育，低收入的前列腺癌患者是未来研究的关键问题。版权所有（c）2012约翰威利父子有限公司
Background Prostate cancer is the most common cancer in men in the Western world with well-described negative effects from treatments. However, outcomes are highly heterogeneous. A Phase 3 trial of a psycho-educational intervention was undertaken, aiming to reduce cancer-specific and decision-related distress and improve quality of life for men newly diagnosed with localised prostate cancer. Methods Seven hundred forty (81.7%) men were recruited after diagnosis and before treatment and randomised to a tele-based nurse-delivered five-session psycho-educational intervention (N=372) or usual care (N=368). Participants were assessed before treatment and 2, 6, 12 and 24months post-treatment. Outcome measures included cancer-specific and decision-related distress, cognitive judgmental adjustment, subjective well-being, and domain-specific and health-related quality of life. Social support was assessed as a potential moderator. Results No unconditioned effects were found. Classification analyses on pre-randomisation measures distinguished three subgroups: younger, higher education and income men (N=290); younger, lower education and income men (N=106); and older men (N=344). Younger, higher education and income men showed positive intervention effects for cancer-specific distress (p=0.008) and mental health (p=0.042). By contrast, for younger, lower education men, participation in the intervention was associated with decreases in cognitive judgmental adjustment over time (p=0.006). Conclusions Response to intervention and adjustment over time varied according to previous sexual functioning, age, educational level and income. How to best intervene with younger, low education, low income men with prostate cancer is a critical future research question. Copyright (c) 2012 John Wiley & Sons, Ltd.