Campbell, L.C., Keefe, F.J., Scipio, C., McKee, D.C., Edwards, C.L., Herman, S.H., . . . Donatucci, C. (2007). Facilitating research participation and improving quality of life for African American prostate cancer survivors and their intimate partners. A pilot study of telephone-based coping skills training. Cancer, 109(Suppl. 2), 414–424.

To examine the feasibility and effect of a telephonic cognitive behavioral intervention to facilitate research participation and enhance quality of life among African American prostate cancer survivors and their partners

Consenting patients and their partners provided pretreatment measures and then were randomly assigned to either partner-assisted coping skills training (CST) or usual care (control condition). In the control group, individuals received routine care provided through their medical outpatient program. The CST intervention was designed to train survivors and partners in skills for managing symptoms, including provision of information about prostate cancer and possible long-term side effects, teaching problem solving skills and training in cognitive and behavioral coping skills such as communication, relaxation, and activity pacing. CST was provided in six one-hour telephone calls approximately once a week. Sessions were audiotaped and reviewed for protocol adherence. All subjects completed post-treatment study measures at the end of the six-week period.

• The sample included 30 patient participants and 30 spouse participants.
• The mean age was 62.1 ± 8.9 for patients and 58.7 ± 9.8 for partners.
• Females: Partner gender was not stated, so it is assumed that all partners were female (n = 30).
• Males: All patients were male (n = 30).
• All patients had prostate cancer.
• Time since treatment ranged from 1 week to 4 years, with an average of 18 months.
• 86% of patients and 93% of partners had completed at least a high school education, 53% of survivors were working full-time, and 37% were retired.
• Among partners, 46% were working full-time, and 46% were retired.
• Annual income was $30,000 or greater in 67% of the sample.

• Multi-site
• Outpatient setting
• Multiple practices and clinics in North Carolina

A randomized controlled trial design was used.

• Self-Efficacy for Symptom Control Efficacy (SESCI) patient and partner versions
• Expanded Prostate Cancer Index Composite (EPIC)
• Short Form 36 (SF-36) physical function and mental health scales
• Profile of Mood States Short Form (POMS - SF)
• Caregiver Strain Index (CSI)

Seven couples initially randomized to the treatment group withdrew (approximately 30%) primarily because of difficulties in scheduling treatment sessions.

Men who participated in the CST reported significantly higher quality of life related to bowel symptoms (p = 0.042). There were no significant differences between groups in general health, negative mood among partners, caregiver strain, or caregiver self-efficacy. Within the CST group, pre-post treatment measurement demonstrated significant improvement in reported bowel symptoms (p < 0.05), hormonal symptoms (p < 0.05) and self-efficacy (p < 0.05). There were no significant differences between pre and post-treatment measures among the partners (no effect on caregivers).

The telephone intervention was able to be delivered to the majority of participants, suggesting that this approach may be feasible for the delivery of coping skills training. Significant effects to improve caregiver self-efficacy and experience were not seen. This type of intervention appears to be helpful to patients in the area of managing side effects of prostate cancer.

• The sample had less than 30 participants.
• Eligible patients had good performance scores for inclusion, and the majority were working full-time. This suggests that the sample was relatively healthy and caregiving needs may have been low. This may have influenced the lack of significant findings among intimate partners related to the intervention.
• There is no information about what was included in the usual care group in terms of any education, frequency of follow-up, etc.
• There was no attentional control provided in this study. Although the study demonstrated that the telephonic intervention was feasible for the majority of subjects, there was a 30% attrition rate. This points to practical difficulties in provision of such interventions and suggests that those who completed the study may have been those who were biased in terms of their expectations of effect or were most highly motivated to participate.
• This is not generalizable to all patients with prostate cancer because the majority of survivors in this study underwent surgical treatment, and the population included only African Americans.

Telephonic approaches to provide education, counseling, and CST is a promising approach for the provision of patient care, but scheduling sessions, particularly when patients and caregivers are working full-time, is a challenge. This type of intervention appears to be effective in terms of symptom and side-effect management among patients who are receptive to this type of approach, but the impact on caregiver strain and burden is unclear.