Stress Management Before Prostatectomy Can Improve Outcome

Allison Gandey

July 13, 2007

July 13, 2007 (Chicago) —  A new study shows that even a brief presurgical stress-management intervention can go a long way in helping men undergoing radical prostatectomy. Reporting at the recent American Society of Clinical Oncology 43rd Annual Meeting, researchers demonstrated that intervention improved quality of life 6 and 12 months after the procedure. "We previously reported on the short-term benefits in reducing mood disturbances before and after surgery," lead author Lorenzo Cohen, PhD, from the University of Texas MD Anderson Cancer Center, in Houston, noted during his presentation.

In this latest randomized trial, the group looked at 158 men scheduled for radical prostatectomy. Patients were randomly assigned to 1 of 3 groups. Men in the stress-management group were asked to discuss their fears and concerns about the upcoming surgery and were taught diaphragmatic breathing, guided imagery, and adaptive coping skills and were given imaginal exposure to the day of surgery.

Men in the supportive-attention group discussed their fears and concerns about the upcoming surgery and underwent a semistructured interview. Men in this group as well as the stress-management group met with a clinical psychologist twice before surgery and were given another brief session just prior to their operation and again before they were discharged from hospital.

Men in the usual-care group had no such interventions or meetings with a psychologist. All patients completed psychosocial and quality-of-life measures, which included additional information on distress and intrusive thoughts. These measures were taken at baseline, 6 months, and 12 months.

Even Basic Supportive Attention Helped Patients

Patients were primarily white (78%), married (85%), and highly educated (about 80% college or higher). The researchers controlled for all of these factors as well as age, baseline prostate-specific antigen, stage of disease, Gleason score, and baseline measures.

Post hoc analyses revealed significantly higher SF-36 Role Physical scores for the stress-management group compared with the usual-care patients (86 vs 63). The comparison between the stress-management patients and the supportive-attention group was less dramatic, but there was benefit for both (86 vs 73). The researchers reported that mixed model analyses revealed a significant group main effect for SF-36 Role Physical ( P = .01).

They also observed a marginally significant group main effect for pain scores ( P = .12), with the stress-management group reporting significantly better pain scores than the usual-care group (80 vs 71). But neither group differed much from the supportive-attention group (77) when it came to pain.

The investigators also reported a group by time effect for general health scores. They showed that by 12 months after surgery the stress-management (74) and the supportive-attention (76) groups both reported higher general health scores than the usual-care group (68). There were no group differences on any of the other outcomes.

"Results suggest that even a brief presurgical stress-management intervention is beneficial in terms of improving aspects of quality of life 6 and 12 months after radical prostatectomy," Dr. Cohen and his team conclude. They suggest that adopting such interventions may well improve outcomes.

American Society of Clinical Oncology 43rd Annual Meeting: Abstract 5148. Presented June 3, 2007.

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