Online Exclusive Article

Changes in Sexual Function on Mood and Quality of Life in Patients Undergoing Radiation Therapy for Prostate Cancer

Kristie Howlett

Theresa Koetters

Janet Edrington

Claudia M. West

Steven M. Paul

Kathryn A. Lee

Bradley E. Aouizerat

William Wara

Patrick S. Swift

Christine A. Miaskowski

sexuality, prostate cancer, prostatic neoplasms, health-related quality of life, radiation therapy
ONF 2009, 37(1), E58-E66. DOI: 10.1188/10.ONF.E58-E66

Purpose/Objectives: To describe the percentages of men with and without changes in sexual function from the beginning to end of radiation therapy and evaluate for differences in demographic and clinical characteristics, mood states, and quality of life (QOL) among patients who did and did not experience changes in sexual function.

Design: Descriptive, longitudinal.

Setting: Two radiation therapy departments in northern California.

Sample: 70 men with prostate cancer who underwent primary or adjuvant radiation therapy.

Methods: Self-report questionnaires, medical record reviews, and repeated measures analysis of variance.

Main Research Variables: Changes in sexual function; depression, anxiety, and QOL.

Findings: Patients were categorized into one of four sex groups (No Problem X 2, Problem-No Problem, No Problem-Problem, and Problem X 2) based on their responses to "Is your sexuality impacted by your illness?" at the beginning and end of radiation therapy. About 50% had a problem with sexual function either at the beginning or end of radiation therapy. Overall, men without sexual problems at both the beginning and end of radiation therapy had significantly less anxiety and depression and higher QOL scores than patients who developed a problem at the end and patients who had a problem at both time points.

Conclusions: Changes in sexual function during the course of radiation therapy affect patients' mood and QOL.

Implications for Nursing: Clinicians should evaluate the effects of radiation therapy on sexual function and monitor patients with prostate cancer for depression and anxiety as well as for changes in QOL.

Jump to a section

    References

    Bieling, P.J., Antony, M.M., & Swinson, R.P. (1998). The State-Trait Anxiety Inventory, Trait version: Structure and content re-examined. Behavioral Research and Therapy, 36, 777-788. doi: 10.1016/S0005-7967(98)00023-0
    Bokhour, B.G., Clark, J.A., Inui, T.S., Silliman, R.A., & Talcott, J.A. (2001). Sexuality after treatment for early prostate cancer: Exploring the meanings of "erectile dysfunction." Journal of General Internal Medicine, 16, 649-655. doi: 10.1111/j.1525-1497.2001.00832.x
    Carpenter, J.S., Andrykowski, M.A., Wilson, J., Hall, L.A., Rayens, M.K., Sachs, B., & Cunningham, L.L. (1998). Psychometrics for two short forms of the Center for Epidemiologic Studies-Depression Scale. Issues in Mental Health Nursing, 19, 481-494. doi: 10.1080/016128498248917
    Chen, C.T., Valicenti, R.K., Lu, J., Derose, T., Dicker, A.P., Strup, S.E., … Gomella, L.G. (2001). Does hormonal therapy influence sexual function in men receiving 3D conformal radiation therapy for prostate cancer? International Journal of Radiation Oncology, Biology, Physics, 50, 591-595. doi: 10.1016/S0360-3016(01)01504-8
    Cooperberg, M.R., Koppie, T.M., Lubeck, D.P., Ye, J., Grossfeld, G.D., Mehta, S.S., … CaPSURE. (2003). How potent is potent? Evaluation of sexual function and bother in men who report potency after treatment for prostate cancer: Data from CaPSURE. Urology, 61, 190-196. doi: 10.1016/S0090-4295(02)02118-0
    Dahn, J.R., Penedo, F.J., Gonzalez, J.S., Esquiabro, M., Antoni, M.H., Roos, B.A., & Schneiderman, N. (2004). Sexual functioning and quality of life after prostate cancer treatment: Considering sexual desire. Urology, 63, 273-277. doi: 10.1016/j.urology.2003.09.048
    Darst, E.H. (2007). Sexuality and prostatectomy: Nursing assessment and intervention. Urologic Nursing, 27, 534-541.
    Eller, L.S., Lev, E.L., Gejerman, G., Colella, J., Esposito, M., Lanteri, V., … Sawczuk, I. (2006). Prospective study of quality of life of patients receiving treatment for prostate cancer. Nursing Research, 55(2, Suppl.), S28-S36.
    Ferrell, B.R., Wisdom, C., & Wenzl, C. (1989). Quality of life as an outcome variable in the management of cancer pain. Cancer, 63(11, Suppl.), 2321-2327. doi: 10.1002/1097-0142(19890601)63:11<2321::AID-CNCR2820631142>3.0.CO;2-T
    Galbraith, M.E., Arechiga, A., Ramirez, J., & Pedro, L.W. (2005). Prostate cancer survivors' and partners' self-reports of health-related quality of life, treatment symptoms, and marital satisfaction 2.5-5.5 years after treatment [Online Exclusive]. Oncology Nursing Forum, 32, E30-E41. Retrieved from http://ons.metapress.com/content/t128147q6u1684t8/fulltext.pdf http://ons.metapress.com/content/t128147q6u1684t8/fulltext.pdf
    Green, H.J., Pakenham, K.I., Headley, B.C., Yaxley, J., Nicol, D.L., Mactaggart, P.N., … Gardiner, R.A. (2004). Quality of life compared during pharmacological treatments and clinical monitoring for non-localized prostate cancer: A randomized controlled trial. British Journal of Urology International, 93, 975-979.
    Guyatt, G.H., Osoba, D., Wu, A.W., Wyrwich, K.W., & Norman, G.R. (2002). Methods to explain the clinical significance of health status measures. Mayo Clinic Proceedings, 77, 371-383. doi: 10.4065/77.4.371
    Incrocci, L. (2006). Sexual function after external-beam radiotherapy for prostate cancer. Critical Review of Oncology and Hematology, 57, 165-173. doi: 10.1016/j.critrevonc.2005.06.006
    Incrocci, L., Madalinska, J.B., Essink-Bot, M.L., Van Putten, W.L., Koper, P.C., & Schroder, F.H. (2001). Sexual functioning in patients with localized prostate cancer awaiting treatment. Journal of Sex and Marital Therapy, 27, 353-363. doi: 10.1080/009262301317081106
    Incrocci, L., Slob, A.K., & Levendag, P.C. (2002). Sexual (dys)function after radiotherapy for prostate cancer: A review. International Journal of Radiation Oncology, Biology, Physics, 52, 681-693.
    Karnofsky, D. (1977). Performance scale. In G.T. Kennealy & M.S. Mitchell (Ed.), Factors that influence the therapeutic response in cancer: A comprehensive treatise (pp. 97-101). New York, NY: Plenum Press.
    Kennedy, B.L., Schwab, J.J., Morris, R.L., & Beldia, G. (2001). Assessment of state and trait anxiety in subjects with anxiety and depressive disorders. Psychiatry Quarterly, 72, 263-276. doi: 10.1023/A:1010305200087
    Litwin, M.S., Flanders, S.C., Pasta, D.J., Stoddard, M.L., Lubeck, D.P., & Henning, J.M. (1999). Sexual function and bother after radical prostatectomy or radiation for prostate cancer: Multivariate quality-of-life analysis from CaPSURE. Cancer of the Prostate Strategic Urologic Research Endeavor. Urology, 54, 503-508. doi: 10.1016/S0090-4295(99)00172-7
    Litwin, M.S., Gore, J.L., Kwan, L., Brandeis, J.M., Lee, S.P., Withers, H.R., & Reiter, R.E. (2007). Quality of life after surgery, external beam irradiation, or brachytherapy for early-stage prostate cancer. Cancer, 109, 2239-2247. doi: 10.1002/cncr.22676
    Madsen, L.T., & Ganey-Code, E. (2006). Assessing and addressing erectile function concerns in patients postprostatectomy. Oncology Nursing Forum, 33, 209-211. doi: 10.1188/06.ONF.209-211
    Nelson, C.J., Choi, J.M., Mulhall, J.P., & Roth, A.J. (2007). Determinants of sexual satisfaction in men with prostate cancer. Journal of Sexual Medicine, 4, 1422-1427. doi: 10.1111/j.1743-6109.2007.00547.x
    Norman, G.R., Sloan, J.A., & Wyrwich, K.W. (2003). Interpretation of changes in health-related quality of life: The remarkable universality of half a standard deviation. Medical Care, 41, 582-592. doi: 10.1097/00005650-200305000-00004
    Osoba, D., Rodrigues, G., Myles, J., Zee, B., & Pater, J. (1998). Interpreting the significance of changes in health-related quality-of-life scores. Journal of Clinical Oncology, 16, 139-144.
    Paul, S.M., Zelman, D.C., Smith, M., & Miaskowski, C. (2005). Categorizing the severity of cancer pain: Further exploration of the establishment of cutpoints. Pain, 113, 37-44. doi: 10.1016/j.pain.2004.09.014
    Potosky, A.L., Davis, W.W., Hoffman, R.M., Stanford, J.L., Stephenson, R.A., Penson, D.F., & Harlan, L.C. (2004). Five-year outcomes after prostatectomy or radiotherapy for prostate cancer. Journal of the National Cancer Institute, 96, 1358-1367.
    Potosky, A.L., Reeve, B.B., Clegg, L.X., Hoffman, R.M., Stephenson, R.A., Albertsen, P.C., … Stanford, J.L. (2002). Quality of life following localized prostate cancer treated initially with androgen deprivation therapy or no therapy. Journal of the National Cancer Institute, 94, 430-437.
    Radloff, L.S. (1977). The CES-D scale: A self-report depression scale for research in the general population. Applied Psychological Measurement, 1, 385-401. doi: 10.1177/014662167700100306
    Sanders, S., Pedro, L.W., Bantum, E.O., & Galbraith, M.E. (2006). Couples surviving prostate cancer: Long-term intimacy needs and concerns following treatment. Clinical Journal of Oncology Nursing, 10, 503-508. doi: 10.1188/06.CJON.503-508
    Sheehan, T.J., Fifield, J., Reisine, S., & Tennen, H. (1995). The measurement structure of the Center for Epidemiologic Studies Depression Scale. Journal of Personality Assessment, 64, 507-521. doi: 10.1207/s15327752jpa6403_9
    Soloway, C.T., Soloway, M.S., Kim, S.S., & Kava, B.R. (2005). Sexual, psychological, and dyadic qualities of the prostate cancer ‘couple.’ British Journal of Urology International, 95, 780-785.
    Spielberger, C.G., Gorsuch, R.L., Suchene, R., Vagg, P.R., & Jacobs, G.A. (1983). Manual for the State-Anxiety (form Y): Self-Evaluation Questionnaire. Palo Alto, CA: Consulting Pyschologists Press.
    Stommel, M., Given, B.A., Given, C.W., Kalaian, H.A., Schulz, R., & McCorkle, R. (1993). Gender bias in the measurement properties of the Center for Epidemiologic Studies Depression Scale (CES-D). Psychiatry Research, 49, 239-250. doi: 10.1016/0165-1781(93)90064-N
    Symon, Z., Daignault, S., Symon, R., Dunn, R.L., Sanda, M.G., & Sandler, H.M. (2006). Measuring patients' expectations regarding health-related quality-of-life outcomes associated with prostate cancer surgery or radiotherapy. Urology, 68, 1224-1229. doi: 10.1016/j.urology.2006.08.1092
    Turner, S.L., Adams, K., Bull, C.A., & Berry, M.P. (1999). Sexual dysfunction after radical radiation therapy for prostate cancer: A prospective evaluation. Urology, 54, 124-129. doi: 10.1016/S0090-4295(99)00032-1
    van der Wielen, G.J., van Putten, W.L., & Incrocci, L. (2007). Sexual function after three-dimensional conformal radiotherapy for prostate cancer: Results from a dose-escalation trial. International Journal of Radiation Oncology, Biology, Physics, 68, 479-484. doi: 10.1016/j.ijrobp.2006.12.015
    Ward-Smith, P., & Kapitan, D. (2005). Quality of life among men treated with radiation therapy for prostate cancer. Urologic Nursing, 25, 263-268.
    Zelefsky, M.J., Cowen, D., Fuks, Z., Shike, M., Burman, C., Jackson, A., … Leibel, S.A. (1999). Long term tolerance of high dose three-dimensional conformal radiotherapy in patients with localized prostate carcinoma. Cancer, 85, 2460-2468. doi: 10.1002/(SICI)1097-0142(19990601)85:11<2460::AID-CNCR23>3.0.CO;2-N
    Zelman, D.C., Hoffman, D.L., Seifeldin, R., & Dukes, E.M. (2003). Development of a metric for a day of manageable pain control: Derivation of pain severity cut-points for low back pain and osteoarthritis. Pain, 106, 35-42. doi: 10.1016/S0304-3959(03)00274-4