Chambers, S.K., Pinnock, C., Lepore, S.J., Hughes, S., & O'Connell, D.L. (2011). A systematic review of psychosocial interventions for men with prostate cancer and their partners. Patient Education and Counseling, 85, e75–e88.

To update a prior systematic review and address the following two clinical questions: (1) Do psychological and cognitive interventions improve psychological adjustment in men with prostate cancer? and (2) Do such interventions alleviate partner distress and improve quality of life in those men?
 

• Databases used were MEDLINE, Embase, CINAHL, and PsycINFO.
• Key words were exp psychosocial support, exp affective symptoms, and words connected to identify prostate cancer–based research.
• Studies that reported randomized clinical trials; described relevant interventions and outcomes; included at least 80% patients with prostate cancer or partners of patients with prostate cancer, or had separate analysis of prostate cancer patient data; and were published between December 31, 1999, and December 1, 2009 were included in the search.
• Studies that were not prostate cancer–specific or did not meet the 80% guideline; had irrelevant outcomes to study; lacked a randomized control trial or clear description of the trial; and were nonresponsive to systematic review questions were excluded.

A total of 195 references were retrieved.

Following a literature search of chosen databases, two reviewers independently reviewed studies identified as relevant to the two study questions. Reviewers used previously published PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria and national (Australian) research criteria to assess studies for inclusion in the systematic review. Study quality was poor, with few studies using double blinding, adequate concealment of treatment allocation, intention-to-treat analysis, and incorporating statements on allocation sequences for study participants. A higher proportion of studies completed after 2005 had sufficient concealment of allocation sequence than those completed before 2005. However, later studies had exclusions that were more likely to cause bias than earlier studies. Some of the 21 studies used in the systematic review did not include useful data to evaluate the intervention, did not collect baseline data, nor provide evidence of significant differences between intervention and usual care groups.   
 

• A total of 21 studies were included in the review.
• Sample range across studies was 32–526 participants (e.g., 263 couples).
• Of the 21 studies, 16 reported patient data only, 4 reported patient and caregiver/spouse data, and 1 reported caregiver/spouse data only. 
• Mean age of participants was 67 years.
• Most patients had localized prostate disease, with 76% undergoing surgery and 48% receiving radiation therapy to treat malignancy.
• Interventions were mostly supportive, with focus on education, cognitive reframing, or coping skills. Major focus for interventions included stress management, uncertainty, cancer/treatment information, symptom management (bowel/urinary function, sexual function), coping skills, and marital/relationship communication. Outcomes assessed included quality of life, mood, anxiety and depression, marital satisfaction, uncertainty, coping skills, symptom distress (fatigue, bowel/urinary function, sexual function), and caregiver strain.

Transition phase after active treatment

Fourteen studies provided relevant information to answer the patient question (1). These studies indicated that group cognitive behavioral programs, with focus on stress management and long-term, nurse-led education and support, positively influenced improved quality of life for patients with prostate cancer. Men with localized disease experienced physical quality-of-life benefits (but not mental quality-of-life, mood, or cancer worry benefits) when exposed to stress management and education at the time of surgery. Four studies provided useful information to answer the caregiver/partner question (2): patient/caregiver dyads exposed to a psychoeducation intervention with a focus on coping skills reported improved quality of life. Nonsignificant or inconsistent results on intervention effects on patient uncertainty, hopelessness, and depression were found across studies. One study improved caregiver physical quality of life, uncertainty, and symptom distress in the short term, but patients did not experience significant benefits from the intervention.

Group cognitive behavioral interventions focused on stress management, led by an expert in psychology, and nurse-led psycho-educational interventions seem to support better psychological adjustment and quality of life of patients with prostate cancer with localized disease. Coping skills interventions appear to help patient/partner adjustment, although evidence remains limited to guide oncology practice. Limitations in studies used for this systematic review include limited samples of diverse individuals, those with advanced disease, and gay men needed to guide effective and equitable interventions and healthcare policy. Although common in North America and Australia, more peer-led interventions, particularly with late-stage survivors of prostate cancer, need to exist based on evidence of their success in decreasing patient isolation and providing information and emotional support. Additional studies must be conducted to validate effective ways, including healthcare structural and process change, to meet the emotional and quality-of-life needs of survivors of prostate cancer at various phases of the disease process and their caregivers.

• The authors did not report results from several studies due to “noninterpretable” data.
• Most studies included North American men with high school or higher education and with localized disease.
• High attrition rates and small sample sizes limited the discovery of significant intervention effects.
• Lack of ethnically diverse samples, limited samples with men with advanced disease, and samples that included only heterosexual men all affect generalizability of findings.
• Key words used for the search may have limited the studies accessed.

Continued nursing research to identify successful and cost-effective programs to improve the quality of life of patients with prostate cancer and their partners must occur. This systematic review found inconsistent findings that advocate for rigorous studies that can offer guidelines for effective family-based and home programs using a variety of formats at various phases of prostate cancer.