TrueNTH sexual recovery study protocol: a multi-institutional collaborative approach to developing and testing a web-based intervention for couples coping with the side-effects of prostate cancer treatment in a randomized controlled trial

BACKGROUND

Over half of men who receive treatment for prostate suffer from a range of sexual problems that affect negatively their sexual health, sexual intimacy with their partners and their quality of life. In clinical practice, however, care for the sexual side effects of treatment is often suboptimal or unavailable. The goal of the current study is to test a web-based intervention to support the recovery of sexual intimacy of prostate cancer survivors and their partners after treatment.

METHODS

The study team developed an interactive, web-based intervention, tailored to type of treatment received, relationship status (partnered/non-partnered) and sexual orientation. It consists of 10 modules, six follow the trajectory of the illness and four are theme based. They address sexual side effects, rehabilitation, psychological impacts and coaching for self-efficacy. Each includes a video to engage participants, psychoeducation and activities completed by participants on the web. Tailored strategies for identified concerns are sent by email after each module. Six of these modules will be tested in a randomized controlled trial and compared to usual care. Men with localized prostate cancer with partners will be recruited from five academic medical centers. These couples (N = 140) will be assessed prior to treatment, then 3 months and 6 months after treatment. The primary outcome will be the survivors' and partners' Global Satisfaction with Sex Life, assessed by a Patient Reported Outcome Measure Information Systems (PROMIS) measure. Secondary outcomes will include interest in sex, sexual activity, use of sexual aids, dyadic coping, knowledge about sexual recovery, grief about the loss of sexual function, and quality of life. The impact of the intervention on the couple will be assessed using the Actor-Partner Interaction Model, a mixed-effects linear regression model able to estimate both the association of partner characteristics with partner and patient outcomes and the association of patient characteristics with both outcomes.

DISCUSSION

The web-based tool represents a novel approach to addressing the sexual health needs of prostate cancer survivors and their partners that-if found efficacious-will improve access to much needed specialty care in prostate cancer survivorship.

TRIAL REGISTRATION

Clinicaltrials.gov registration # NCT02702453 , registered on March 3, 2016.

Couples' adjustment to breast disease during the first year following diagnosis

The objectives were to determine (a) the extent to which psychosocial, demographic, and medical variables predict women's and husbands' adjustment to breast disease during the first year following diagnosis; (b) the degree of autocorrelation among and intercorrelation between partners' adjustment scores; (c) the extent to which baseline levels of adjustment predict adjustment 1 year later; and (d) the extent to which one partner's adjustment affects the other partner's adjustment. A stress-coping framework guided this study. The sample consisted of 131 couples, 58 couples received a cancer diagnosis and 73 received a benign diagnosis. Couples were interviewed at 1 week, 2 months, and 1 year postdiagnosis. Structural equation modeling was used to analyze the data. The strongest predictors of adjustment for women were severity of the illness and hopelessness and for husbands, their own baseline level of adjustment. Husbands' and wives' levels of adjustment at 1 year had a significant direct effect on each other's adjustment.

Surgical outcomes after breast cancer surgery: measuring acute lymphedema

BACKGROUND

Studies of lymphedema have used inconsistent measures and criteria. The purpose of this pilot study was to measure the onset and incidence of acute lymphedema in breast cancer survivors using strict criteria for limb evaluation.

MATERIALS AND METHODS

Eligible women were those undergoing breast cancer surgery that included axillary staging and/or radiation therapy of the breast. Arm volume, strength, and flexibility were measured preoperatively and quarterly. Lymphedema was defined as a greater than 10% increase in limb volume. Additional strength and flexibility assessments were done at these times.

RESULTS

In 30 evaluable patients, half underwent modified radical mastectomy and half lumpectomy, with half of the lumpectomy patients undergoing axillary node staging. Of the 30 patients 27% were Stage 0; the rest were Stage I (27%), IIA (13%), IIB (23%), and IIIA (7%). One subject was IIIB postoperatively. There were 2 women with a 10% or greater change in limb volume; the change was detected in one woman at 3 months (5% incidence) and in the second woman at 6 months (11% incidence). Both had undergone mastectomy and axillary dissection and one of these two women had symptoms of tingling and numbness in the affected arm that began at 3 months. Overall, 35% of the sample experienced symptoms by 3 months, which included numbness, aching, and tingling of the entire upper extremity, but without volume changes. The relationship between undergoing modified radical mastectomy and experiencing symptoms in the affected limb at 3 months was significant (P = 0.05).

CONCLUSIONS

In this interim report strict methods of measurement and limb volume comparisons detected acute lymphedema at 3 months in 5% of the sample, and at 6 months in 11% of the sample. Furthermore, symptoms were detected in 35% without volume changes at 3 months postoperatively, which may warn of lymphedema occurrence within the next 3 months. This may assist clinical evaluation of symptoms in the postoperative period and support early referral to lymphedema experts.

The relationship between social support, help-seeking behavior, and psychological distress in psychiatric clients

A descriptive exploratory design was used to examine the relationship between the level of social support, the level of psychological distress, and the extent of help-seeking behavior in a nonprobability sample of 53 hospitalized adult psychiatric patients. The subjects completed the Norbeck Social Support Questionnaire, the Brief Symptom Inventory, and a researcher-designed Help-Seeking Behavior Questionnaire. The Pearson Product Moment Correlation coefficients and t test were used to analyze the data. No significant correlation was found between the level of psychological distress and either the level of social support or the extent of help seeking. Social support and help seeking were highly correlated. These results have an implication for nursing practice pertaining to the focus of patient treatment both during hospitalization and in postdischarge planning.

A longitudinal study of the adjustment of patients and husbands to breast cancer

Although adjustment to breast cancer is an ongoing process, few studies have assessed the psychosocial adjustment of patients and husbands over an extended period of time. The purpose of this descriptive study was to compare the psychosocial adjustment of mastectomy patients and their husbands at three points in time: 3 days, 30 days, and 18 months post-surgery. Data were obtained from 41 mastectomy patients and their husbands (n = 82 subjects) at each time point. Three instruments with established reliability and validity were used to measure three components of psychosocial adjustment: the Affects Balance Scale (mood), the Brief Symptom Inventory (symptom distress), and the Psychosocial Adjustment to Illness Scale (role functioning). Repeated measures Analysis of Variance was used to compare changes in subjects' adjustment levels over time. Results indicated that while subjects' levels of mood and levels of role functioning improved over time, subjects' levels of distress did not improve over time. Distress levels reported by patients and husbands at 18 months were similar to levels reported at 3 days and 30 days post-surgery. The findings suggest that difficulties in psychosocial adjustment are not confined to the early phase of illness but persist over time for both patients and husbands. Nursing implications center on the importance of long-term, ongoing assessment.