'Out of the frying pan into the fire': a qualitative study of the impact on masculinity for men living with advanced prostate cancer

Experiences of cancer-related stigma in Africa: A scoping review

Cancer is a major health issue, particularly in low- and middle-income countries where 70% of cancer deaths occur. Stigma and barriers to screening and treatment lead to poor outcomes. We conducted structured searches of PubMed, Embase, MEDLINE, CINAHL, and CABI Global Health databases according to PRISMA-ScR guidelines. Searches used keywords related to (1) Africa, (2) cancer, and (3) stigma. We then screened to finalize a list of research manuscripts, dissertations, theses, and conference abstracts using quantitative, qualitative, or mixed methods to explore cancer stigma in Africa. This review focused on non-cervical cancers. Breast and cervical cancers have distinct stigma-related experiences due to awareness, screening, and sociocultural perceptions. Including cervical cancer risks dilutes the specificity and depth of findings. The review included 53 studies that linked stigma and cancer in Africa to physical symptoms, appearance changes, misconceptions, and emotional challenges, hindering care and worsening treatment outcomes. Cancer-related stigma negatively impacts screening and treatment engagement in Africa. The lack of intervention studies underscores the need for evidence-based strategies to reduce stigma. Future efforts should reduce barriers to cancer care, enhance public awareness, and implement policy changes to improve outcomes.

What are the lived experiences of patients with cancer and their families in northern Ghana? A qualitative study using narrative interview and creative task approach

OBJECTIVES

Cancer poses a major burden in Ghana that is exacerbated by poor engagement with biomedical treatment. The reasons for this are not well understood for most cancers and in northern Ghana.

DESIGN

This research took combined narrative interviews with a creative task that was analysed through reflexive thematic analysis.

SETTING

A tertiary treatment centre in northern Ghana.

PARTICIPANTS

15 adult (>18 years) patients or their relatives who had been diagnosed and/or treated for cancer within the last 2 years.

RESULTS

The thematic analysis highlighted the psychological burden of cancer and ways participants cope and find meaning, including through religion, trust in biomedical treatment, and occupation and social support. The findings stress the negative impact of the financial burden, shame, worry and the spiralling poverty this causes.The creative task was found to be resonant, emotive and more humanising, which is anticipated to be more effective when communicating with policy-makers and community members. The findings provide rich contextual insights to understand patients' and relatives' perspectives and frame their experiences within what was important to them.

CONCLUSIONS

Together the research has identified a critical need for policy to consider the psychosocial, occupational, spiritual and financial needs of patients with cancer in northern Ghana. It has demonstrated narrative interviews with graphical elicitation as an effective approach to discuss sensitive topics for findings that can engage stakeholders and inform holistic cancer service design.

Quality of Nursing Care: Addressing Sexuality as Part of Prostate Cancer Management, an Umbrella Review

BACKGROUND

Sexuality is a fundamental aspect of health and wellbeing. The management of prostate cancer can result in erectile dysfunction and body feminisation, resulting in loss of masculinity and alterations of body image. Prostate cancer patients identify sexuality as an unmet need and report little or no communication with their healthcare providers on the topic.

AIM

This umbrella review aims to determine the barriers that may preclude nurses from discussing sexuality with prostate cancer patients.

DESIGN

An umbrella review of systematic review studies was undertaken using the PRISMA guidelines.

METHOD

Five databases were comprehensively searched, CINAHL, MEDLINE, PsycINFO, Cochrane and Prospero, from October 1, 2013 to December 1, 2023, using the defined criteria. A total of 11 systematic reviews were included in this review consisting of 10 with quantitative and 1 with quantitative/mixed methods approach.

RESULTS

This study identified common themes, which were categorised into four groups: (a) lack of training and education, (b) age and years of clinical experience of nurses, (c) personal values and attitudes and (d) organisational factors. These factors contribute to why nurses feel unprepared and admit to not having adequate knowledge or expertise to have this discussion.

CONCLUSION

The findings of this study illustrate that nurses require specialised communication skills to manage sensitive discussion with patients. Education is crucial to facilitate and empower nurses to discuss sexuality with their patients. Developing a pathway to specialist referrals will encourage nurses to address this with their patients.

NO PATIENT OR PUBLIC CONTRIBUTION

For the preparation of this paper, no direct involvement of patients or public has been deemed applicable to this work. This is an umbrella review paper.

Theorising masculinity, ageing, and the lived body: the case of prostate cancer

This article conceptualises how masculinity and masculine ideals are played out in relation to prostate cancer treatment and its side-effects, offering a heuristic and theoretical perspective with which to make sense of the complex interrelationship between lived gendered bodies and social structures. With the support of three case studies of older men treated for prostate cancer, the article explores how the concept of hegemonic masculinity can be used to analyse the ill and ageing body. A phenomenologically informed approach to the body, which illustrates how masculinity is lived and experienced through certain body schemas, is used. The three case studies show variation in how masculinity is enacted and embodied, illustrating actions to (1) restore and maintain masculinity through phallic experience; (2) reconstruct masculinity by connecting bodily experience to notions of the ageing and a less potent body; and (3) to counter narrowly defined notions of masculinity by dissociating or decoupling masculinity from ideals of potency and performance. With the help of the case studies, the strategies identified, and the fluidity and dynamism of the concept of hegemonic masculinity, findings reveal how inequalities between men and women are produced and maintained, in and through bodily experience, and diverse body schemas.

Body image in patients with prostate cancer undergoing treatment with hormone therapy: Observational study using both a cross-sectional and longitudinal design

This study aims to examine changes in body image (BI) over time and factors related to BI among patients with prostate cancer who receive hormone therapy (HT). A cross-sectional design and longitudinal design were utilized. Patients with prostate cancer who received HT were recruited from the urology outpatient departments in two hospitals in Taiwan between August 2017 and December 2020. Cross-sectional data were collected from 177 patients who had started HT for prostate cancer. Longitudinal data were collected from 34 newly diagnosed patients before receiving HT and at 1, 3, 6, and 12 months after HT. The variables measured included hormonal symptoms and distress, self-efficacy, and BI. The results showed that BI dissatisfaction ranged from 6.1% to 17.2%. Hormonal symptoms and distress (e.g. lack of vitality) were correlated with BI dissatisfaction. Education on the side effects of HT and coping strategies can be provided to patients to prevent BI dissatisfaction.

Dignity enhanced through faith & family support in palliative care: a qualitative study

BACKGROUND

Dignity is integral to palliative care. Illness can diminish it, causing hopelessness and the wish to hasten death. Yet, dignity is a complex multidimensional phenomenon, influenced by values and context. Understanding its varying interpretations can inform practice and policy. The aim of the study is to explore the understanding of dignity in adult patients with palliative care needs from a Lebanese perspective and how it is preserved during illness and while receiving health services.

DESIGN

Qualitative interview study underpinned with a social constructionist lens. Fourteen patients recruited from home-based hospice and outpatient clinics in Lebanon. Data analysed using reflexive thematic analysis.

RESULTS

Four themes were developed across all the interviews: (a) Dignity anchored through faith in God and religious practices; (b) Family support in maintaining physical, psychological wellbeing, and social connectedness; (c) Physical fitness, mental acuity, and healthy appearance through which patients may escape the stigma of disease, (d) accessible, equitable, and compassionate healthcare.

DISCUSSION

Dignity is elusive and difficult to define but faith and religious beliefs play a significant contribution in this study. For the participants, illness is seen as a natural part of life that does not necessarily diminish dignity, but it is the illness related changes that potentially affect dignity. Findings show the importance of family and children in preserving dignity during illness and how their active presence provide a sense of pride and identity. Participants aspired to restore physical, social, and mental well-being to reclaim their dignity and normalize their lives. Challenges related to physical appearance, memory loss, vitality, and social stigma associated with illness diminished dignity. Accessible, equitable and compassionate healthcare services are also crucial in preserving dignity. Participants valued clear communication, respect, and empathy from healthcare providers and identified affordability of care essential for maintaining dignity.

CONCLUSION

Faith in God, and strong family ties are dominant elements to maintaining dignity in the Lebanese context. Relational connectedness with family, children or God is also a need in maintaining dignity in other communal countries with variations in emphasis. The study indicates that religious and cultural context shapes the needs and perceptions of dignity during illness. These findings are likely to be transferable to many Middle Eastern countries but also countries with strong religious and family ties globally.

Self-perceptions of masculinities and testicular cancer: Qualitative explorations

OBJECTIVE

Masculinities have been explored in men with testicular cancer (TC), though limited contemporary research is available on traditional masculine norms important to masculine self-perception. The purpose of this research was to explore the discourse of TC experience in relation to masculine self-perception.

METHODS

A qualitative descriptive study was conducted consisting of semi-structured interviews with 21 men. Men were aged between 31 and 47 (Mage = 35.7). Most men were diagnosed with Stage 1 cancer (66.6%), all men had finished active treatment and time since diagnosis ranged from 17.3 to 71.8 months (M = 47.2). Independent coding was conducted by two researchers and was refined in coding meetings with authors. Themes were developed in a predominantly deductive manner, and analysis of themes was undertaken using a reflexive analysis approach.

RESULTS

Traditional masculine norms showed differing relationships to masculine self-perception. Two main themes were identified [1] Maintained or enhanced masculine self-perception and [2] threats to masculine self-perception. Subthemes demonstrated that maintaining emotional control, strength and 'winning' was important to men, and reduced physical competencies (i.e., strength, sexual dysfunction, virility) challenged self-perception. Strict adherence to traditional norms in response to threatened self-perception related to psychological distress.

CONCLUSION

Leveraging traditionally masculine norms such as physical strength and control and developing flexible adaptations of masculinities should be encouraged with men with TC to retain self-perception and potentially enable better coping. Masculine self-perception of gay/bisexual men may centre around sexual functioning, though further research is required.

Experiences and perceptions of men following breast cancer diagnosis: a mixed method systematic review

BACKGROUND

Men with breast cancer experience unique physical and emotional challenges. However, a thorough understanding of these experiences including the psychosocial effects and supportive care needs have received less attention. In some settings, men with breast cancer experience stigma within the healthcare system and their care needs are not prioritised. This influences the level of professional support offered, consequently worsening their health and well-being outcomes. This review explored the variabilities in the experiences and treatment modalities of male breast cancer (MBC) across different contexts.

METHODS

All primary study designs including qualitative, quantitative, and mixed methods studies that reported on the experiences, treatment approaches and outcomes of MBC were included in this systematic review. Six databases (Embase, Medline, PsycINFO, Global Health, CINAHL and Web of Science) were searched for articles from January 2000 to September 2023. A results-based convergence synthesis was used for data analysis and reported using PRISMA guidelines.

RESULTS

Of the studies screened (n = 29,687), forty-four fulfilled the predetermined criteria and were included. Our findings relating to the experiences and treatment approaches of MBC are broadly themed into three parts. Theme 1-Navigating through a threat to masculinity: describes how males experienced the illness reflecting on detection, diagnosis, coming to terms with breast cancer, and disclosure. Theme 2- Navigating through treatment: captures the experiences of undergoing breast cancer treatment/ management following their diagnosis. Theme 3-Coping and support systems: describes how MBC patients coped with the disease, treatment process, aftercare/rehabilitative care, and the available support structures.

CONCLUSIONS

Men experience a myriad of issues following a breast cancer diagnosis, especially with their masculinity. Awareness creation efforts of MBC among the public and healthcare practitioners are urgently required, which could change the perception of men in promoting early diagnosis, adherence to treatments, post-treatment monitoring, oncological results and a better quality of life. Considerations for training, education and development of specialised guidelines for healthcare practitioners on MBC would provide the necessary knowledge and skills to enhance their practice through the adoption of person-centred and male-specific care strategies. Professional care intervention and support for MBC should not end after the diagnosis phase but should extend to the entire treatment continuum and aftercare including future research focusing on MBC specific clinical trials.

TRIAL REGISTRATION

PROSPERO Registration No. CRD42021228778.

A critical review and analysis of the context, current burden, and application of policy to improve cancer equity in Ghana

BACKGROUND

Cancer causes a major disease burden worldwide. This is increasingly being realised in low and middle-income countries, which account disproportionately for preventable cancer deaths. Despite the World Health Organization calling for governments to develop policies to address this and alleviate cancer inequality, numerous challenges in executing effective cancer policies remain, which require consideration of the country-specific context. As this has not yet been considered in Ghana, the aim of this review was to bring together and critique the social-environmental, health policy and system factors to identifying opportunities for future health policies to reduce cancer burden in the Ghanian context. A critical policy-focused review was conducted to bring together and critique the current health systems context relating to cancer in Ghana, considering the unmet policy need, health system and social factors contributing to the burden and policy advances related to cancer.

CONCLUSION

The findings highlight the changing burden of cancer in Ghana and the contextual factors within the socio-ecosystem that contribute to this. Policies around expanding access to and coverage of services, as well as the harmonization with medical pluralism have potential to improve outcomes and increase equity but their implementation and robust data to monitor their impact pose significant barriers.