Elsevier

Applied Nursing Research

Volume 42, August 2018, Pages 51-55
Applied Nursing Research

Original article
Does partnership status affect the quality of life of men having robotic-assisted radical prostatectomy (RARP) for localised prostate cancer?

https://doi.org/10.1016/j.apnr.2018.06.008Get rights and content

Highlights

  • It has been shown that unpartnered men with prostate cancer have worse survival than partnered or married men.

  • Few papers have investigated the effect that partnership status has on prostate-specific quality of life (QoL) measures and none to our knowledge have specifically evaluated outcomes in a sample of patients having robotically-assisted radical prostatectomy (RARP).

  • RARP has rapidly risen in popularity to become the predominant surgical method of treatment for localised prostate cancer.

  • Previous papers investigating outcomes in RARP patients have focused on two questions: 1) ability to achieve an erection firm enough to have intercourse with a partner, and 2) use of urinary pads to control leaking. An analysis of the psychological domains have been neglected.

  • If marital status was found to define a group likely to have worse outcomes at 12-months, then this could be a simple question to direct nursing staff to monitor these patients by, for example, asking them to complete additional, specific questionnaires or to refer for psychological review.

  • We found that unpartnered patients had better sexual function than partnered patients. While this could be surprising in light of expected less opportunity for sexual encounters, we do not know if the unmarried patient performs other sexual activities such as masturbation more often.

  • Our investigation of the more psychological domains found a somewhat surprising result that is under-reported in the literature: all patients having RARP have deficits in sexual confidence, PSA concern, and outlook that persist to the 12-month follow-up. As such, our overall thesis is that while measuring ability to achieve an erection and number of pads used to control urinary leakage is important, the psychological aspects of health following RARP deserve greater attention to improve morbidity and, in all likeliness, satisfaction. Further, such domains could be immediate targets of interventions.

Abstract

Objective

To investigate whether there are any differences in prostate cancer-specific QoL measures at baseline and at 12-months post-surgery between partnered and unpartnered men having robot-assisted radical prostatectomy (RARP) for localised prostate cancer.

Methods

We investigated differences in patient-reported outcomes using the Expanded Prostate cancer Index Composite-26 (EPIC-26) and the Clark et al. Prostate Cancer Quality of Life Scales.

Results

Five hundred and forty patients were eligible for this study, 56 of whom were unpartnered. We found few differences between partnered and unpartnered men in terms of patient-reported quality of life outcomes following RARP. In our sample of patients with a high socio-economic status, partnered men had lower 12-month postoperative EPIC sexual domain scores and clinical T-stage and were more likely to be sexually active preoperatively. Overall, our data show that men having RARP for prostate cancer have low sexual confidence, high PSA concern and a low outlook at 12-months post-RARP, irrespective of partnership status.

Conclusion

The findings of this study suggest that the RARP patient could benefit from a healthcare system that assesses patient sexual outcome following prostatectomy beyond potency and ability to penetrate a partner. By remaining cognisant of other domains such as sexual intimacy, sexual confidence, masculine self-esteem, health worry, PSA concern, outlook and treatment regret, nursing staff may be able to benefit the prostatectomy patient. Where deficits in these domains are observed by the nurse, referral for specialist psychological review could be made. Whether this could work to improve sexual outcomes in men following RARP deserves further investigation.

Introduction

Prostate cancer is one of the most commonly diagnosed cancers in Western men. In Victoria, Australia, prostate cancer accounted for 25% of all newly diagnosed cancer in men in 2014 (Krongrad et al., 1996; Thursfield & Farrugia, 2015). It has been shown that unpartnered men with prostate cancer have worse survival than partnered or married men (Aizer et al., 2013). Further, this finding is maintained when controlling for age, race, stage and treatment type (Krongrad et al., 1996), indicating that this is independent of clinical factors. It is thought that marriage confers a survival benefit for men via the provision of greater social structure, support and promotion of health behaviours from the patients' partner (Baider et al., 2003; Krongrad et al., 1996; Wu et al., 2013). Indeed, higher levels of perceived social support by men with localised prostate cancer has been shown to result in significantly higher health-related quality of life (HRQoL) than for men reporting low levels of social support (Zhou et al., 2010). This relationship may be driven by biological mechanisms relating to neuroendocrine or neuroimmune pathways which are involved in minimising the stress response (Nelles, Joseph, & Konety, 2009; Pinquart & Duberstein, 2010). Patients having surgical treatment for localised prostate cancer may have increased feelings of embarrassment and greater perceived stress as a result of dealing with sequelae of prostatectomy, such as urinary dysfunction and impotence (Clark et al., 2003a). The increased social support that partnered men get from their partner or spouse may lower perceptions of stress, which may improve QoL and, in turn, quantity of life (Krongrad et al., 1996).

Few papers have investigated the effect that partnership status has on prostate-specific quality of life (QoL) measures and none to our knowledge have specifically evaluated outcomes in a sample of patients having robotically-assisted radical prostatectomy (RARP). RARP is a minimally-invasive procedure that has exhibited better perioperative outcomes than the open approach (Huang et al., 2013). However, limitations in the methodology of papers comparing quality of life outcomes means that whether RARP confers better quality of life outcomes is not certain. At the very least, clinical and quality of life outcomes are equivalent between the two surgical groups (Huang et al., 2013). In many centres there has already been a move in urological practice such that RARP is the predominant procedure (Laviana & Hu, 2013).

Previous papers investigating outcomes in RARP patients have focused on two questions: 1) ability to achieve an erection firm enough to have intercourse with a partner, and 2) use of urinary pads to control leaking. An analysis of the psychological domains has been neglected. If marital status was found to define a group likely to have worse outcomes at 12-months, then this could be a simple question to direct nursing staff to monitor these patients by, for example, asking them to complete additional, specific questionnaires or to refer for psychological review. The objective of this study was to investigate whether there are any differences in prostate cancer-specific QoL measures at baseline and at 12-months post-surgery between partnered and unpartnered men having RARP for localised prostate cancer. Such information will be valuable for the subsequent design of interventions to improve the psychosocial outcomes of men having RARP for localised prostate cancer.

Section snippets

Methods

Our study sample included all patients undergoing RARP who were enrolled in a separate longitudinal, observational, cohort study designed to compare outcomes in patients having a prostatectomy using one of the three possible surgical methods: RARP, laparoscopic radical prostatectomy (LRP) or open radical prostatectomy (ORP). Participants enrolled in the longitudinal study were from Victoria, Australia and were men over the age of 18 years who were having a prostatectomy for localised prostate

Results

Five hundred and eighty-three of the men who were enrolled in the observational cohort study had a RARP and were eligible for this study. We selected only those who had completed the question on partnership status (n = 540). The characteristics of these patients are summarised in Table 1. The mean (sd) age was 62.0 (6.8) and the median (range) pre-operative PSA was 6.1 (0.6–81.0). Partnered men had lower clinical T-stage (p = .03) and were more likely to be sexually active preoperatively (p

Discussion

While it has been shown that married patients have significantly longer median survival than patients who were divorced, single, separated or widowed (Krongrad et al., 1996), little investigation has been performed to explore any differences in patient-reported quality of life between partnered and unpartnered men having RARP for localised prostate cancer. Previous studies in partnered versus unpartnered men having a prostatectomy have focused on treatment selection (Chamie et al., 2012; Kazer

Conclusion

While we acknowledge that partnership status is not amenable to direct intervention, our results suggest that studies designed to specifically investigate why unpartnered men present with later clinical stage prostate cancer and why they may have better sexual function at 12-months is warranted. Further, our data show that men with prostate cancer have low sexual confidence, high PSA concern and a low outlook at 12-months post-RARP which could be immediate targets of interventions.

With few

Acknowledgements

Adam Dowrick was supported by a Neil Hamilton Fairley Overseas Clinical Fellowship from the National Health and Medical Research Council (NHMRC) of Australia (581510).

Conflict of interest

The authors declare that they have no conflict of interest.

References (26)

  • K. Chamie

    The impact of social networks and partnership status on treatment choice in men with localized prostate cancer

    BJU International

    (2012)
  • J.A. Clark

    Patients' perceptions of quality of life after treatment for early prostate cancer

    Journal of Clinical Oncology

    (2003)
  • J.A. Clark

    Measuring patients' perceptions of the outcomes of treatment for early prostate cancer

    Medical Care

    (2003)
  • View full text