Young Men With Cancer

A Literature Review

Heather J. Campbell-Enns, MSc; Roberta L. Woodgate, PhD, RN

Disclosures

Cancer Nurs. 2013;36(1):E36-47. 

In This Article

Discussion

Young men reveal that they are in a time of life where they identify themselves through their work. They are also building financial resources and creating bonds of relationships within families. Although the lack of original research focused on young men limits the understanding young men's needs, the studies reviewed show that young men with cancer may have needs specific to their cohort. In searching the literature and reviewing these studies, implications for research and clinical practice have been noted.

Implications for Research

In light of current research, methodological and conceptual considerations for future research are explored.

METHODOLOGICAL CONSIDERATIONS. Studies involving young men with cancer are limited in number. Of the studies reviewed, only 6 studies focused on men exclusively. Of these, the youngest man to participate was 16 years, and men older than 80 years were included; thus, no studies could be found that were focused exclusively on men in the young adult age range. All other studies combined men and women within the findings, making it difficult to discern the difference in the experiences of young men in comparison with others. Where cohort and age may be factors in the experience of cancer,[26] young men with cancer need to be the focus of research that situates this cohort in the specific contexts of their lives, disease types, and trajectories.

The sample of articles had other limitations as well. Of the studies in this review, 11 originated in European countries, 2 in the United States, 1 in China, 1 in Brazil, and 1 in Canada. There is a need for further research from these locations as well as studies focusing on men from other countries worldwide. Moreover, the 16 studies spanned a variety of types and stages of cancer as well as points in time after diagnosis. It is unknown as to whether types and stages of their cancers or time since diagnosis are factors in the responses of the men in these studies.

As this field of research interest grows, it is critical that the experiences of young men are explored through a variety of research methods. Of the 16 studies reviewed, 12 were qualitative in nature, most using thematic procedures of data analysis. Longitudinal qualitative studies are needed to explore how young men's perspectives change through the cancer trajectory. As well, using mixed-method approaches[27] would facilitate examining the needs of young men with cancer through a qualitative-quantitative approach. This may begin with indepth interviews to build the knowledge base required for larger quantitative surveys to test prevalence of the findings among young men in various sociocultural contexts.

Consideration is given to the barriers in recruiting men for these studies. It is possible that men will not readily participate in focus groups or in-depth interviews, owing to the masculine characteristics noted in the studies reviewed. In this situation, particular attention needs to be paid to creating an environment of safety for young men disclosing information that may bring about feelings of vulnerability. Nontraditional interview situations may be considered to create an environment where young men feel free to disclose their experiences. For example, interviews involving retrospective accounts of the cancer experience may be possible within planned activity or a comfortable atmosphere suggested by the participant. As well, to increase recruitment of married men or fathers with cancer, it may be beneficial to involve partners or spouses in the study–not only to gain the spousal perspective but also to encourage the man to participate in the study.

CONCEPTUAL CONSIDERATIONS. Conceptual frameworks were not commonly used in the studies reviewed, with the exception of 3 studies described below. The inclusion of theory is fundamental to the conceptualization of research studies because it provides guidance for the investigation.[28] Among the theories used, Hilton et al[16] referred to the theory of gender, which may be of central importance to the concept of young men with cancer, and yet it was not clearly articulated how the theory was applied to this study. Elmberger et al[13] provided a description of the conceptual framework related to transition theory and how it was used to consider transitions in sudden role changes that come with a cancer diagnosis. Finally, Parsons et al[19] described theory relating to returning to work and the complexities intertwined with conceptualizing ''work'' in the context of illness. These authors successfully articulated the historical understanding of work, the place of the study in moving the understanding forward, and followed with a reconceptualization of issue that countered the coping strategy of returning to routine used by Elmberger et al,[13] Helseth and Ulfsaet,[14] and Semple and McCance.[24] It is this articulation of theory that is particularly useful for both practical application and future research.

Other conceptual frameworks may be used to guide research about young men experiencing cancer. In an effort to determine appropriate conceptual frameworks by which to investigate the experience of young men with cancer, existing frameworks or theories are aligned with the major themes presented.

Cancer was shown to impact the masculine identity of young men. The reviewed articles emphasized the male desire to maintain the social norms and values of their cultures. Social capital theorists incorporate a range of perspectives, one being the network perspective, which argues that there are assets in networks.[29] If the relationships found in male networks add value or benefit to the lives of men, the sudden change in masculine identity may alter the perceived benefits; as such, the social capital network perspective is suitable to study the experience of young men with cancer.

Young men with cancer who were parenting minor children experienced a shift in their roles, not only as men but also as fathers. Conceptually, this shift may be understood by perspectives within role theory,[30] as these men identify with their fatherhood roles as constructed by cultural, societal, and gender expectations. In the literature reviewed, men appeared to struggle with the internal expectation to fulfill the fatherhood role while balancing the new role of patient. Closely connected to these struggles are the potential benefits of being accompanied by children when navigating cancer, particularly the comforting affect that the closeness of children can bring in emotionally distressing situations.

The family fulfilled a unique purpose for young men with cancer. Family members were a crucial part of support systems, so much that young men with cancer protected family members from emotional and physical hardship when possible. Family relationships were somewhat reciprocal or interdependent in the literature reviewed. Family systems theory[31–33] may be beneficial when studying role change within the interdependent family context. This theory provides an overview of the complex nature of families, which can be applied to stressful events such as the context of cancer.

Communication in cancer is difficult, especially when life is interrupted suddenly by an unexpected diagnosis, as the situation may be for younger persons with cancer in particular. When a diagnosis shifts the normal life of a young person so drastically, there is little time for the diagnosed individual to incorporate the psychological and emotional aspects of the illness[34] before the experience is shared with family, close friends, and others. Silence may be the resulting method to cope with the distress involved. Although the phenomenon of mutual pretence[35] was developed to describe a communication behavior in the experience of life-limiting illness, mutual presence is used by the young men and their families in the literature reviewed as well. In these situations, the illness is known at some level by all involved but silence remains in an effort to conceal felt distress and protect others. Just like mutual pretence, this silence can be stressful for some members.

Coping with the uncertainty brought about by cancer was a theme present in the reviewed articles. Young men reframed their experiences to form positive outlooks and they created routines in an effort to provide security and regain a sense of control over their lives. Coping and hope have been shown to be interdependent over periods of prolonged psychological stress,[36] and moreover, hope has been identified as an essential resource for those coping with the stress of advanced cancer.[37] As a result, further exploring the conceptualization of hope in this context may be helpful in better understanding how young men with cancer cope with the stress of uncertainty.

Each framework above focuses on 1 theme present in the lives of young men with cancer. However, each of these theories or conceptual frameworks mentioned thus far is limited when the needs of young men with cancer are as numerous and complex as the studies reviewed illustrate. With little research being conducted in this area, using a framework that is larger in scope is appropriate. A developmental theory, such as a life-course perspective,[26] may be beneficial in that it provides a larger field of vision for the investigator to examine a research problem that integrates multiple factors in a study design, such as the cohort's self-perceived roles, the trajectory of disease and the impact of illness.

Implications for Clinical Practice

Keeping in mind that research focusing on the experience of young men in cancer is lacking, findings from this review may be used as a starting point to guide nurses and other health professionals caring for young men with cancer.

This examination of the literature highlights that young men with cancer may need specific support in a range of domains that can be understood using the concept of personcentered care.[3,38] The impact of cancer is far-reaching in that persons with cancer have biological and psychosocial needs in several domains, including physical, practical, informational, emotional, psychological, social, and existential or spiritual and more.[3,38] These needs may be unmet by current cancer care practices[3,39] and impact the individual with cancer as well as those within the individual's social sphere, such as family, friends, and acquaintances, as adaptation to illness is attempted by many.[3] Understanding the unique biological, psychological, and social needs of young men with cancer would enable health professionals to create appropriate supportive care interventions and programs.

Health professions must consider that men of different ages may have different needs through diagnosis, treatment, and survivorship than their older cohort. Young men with cancer have distinct concerns around the issue of masculinity, sexual functioning, fertility, and fatherhood. Where men live in a state of uncertainty, supportive care is needed to aid in coping with common problems among young men with cancer. Furthermore, recalling that some men may be reluctant to communicate their distress, this provision of care needs to be tailored to the communication needs of young men in a nonthreatening environment.

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