Partners' Long-term Appraisal of Their Caregiving Experience, Marital Satisfaction, Sexual Satisfaction, and Quality of Life 2 Years After Prostate Cancer Treatment

Janet K. Harden, PhD; Martin G. Sanda, MD; John T. Wei, MD; Hossein Yarandi, PhD; Larry Hembroff, PhD; Jill Hardy, BS; Laurel L. Northouse, PhD


Cancer Nurs. 2013;36(2):104-113. 

In This Article



This was a companion study within a prospective longitudinal cohort study of men undergoing treatment for localized prostate cancer and their spouses, PROSTQA [9], who were recruited between March 2003 and March 2006 at 9 university-affiliated hospitals. Patients had elected treatment for localized prostate cancer with radical prostatectomy, radiation therapy, or brachytherapy. The primary purpose of the companion study was to determine the long-term effects of prostate cancer treatment on spouses' appraisal of care giving, sexual satisfaction, marital satisfaction, and QOL. Spouses participating in the parent study were recruited for the companion study from all sites of the parent study9 when their partners reached the 24-month follow-up from their primary prostate cancer treatment. All patients and partners provided informed consent.


The sample consisted of 121 spouses of men treated for prostate cancer: 119 were female partners and 2 were male partners. No significant differences were found between the female and male spouses. In the parent study, spouses were eligible to participate if they were identified by the patient as his spouse (included female or male spouses with or without marital ties, but who cohabited in the same household and were involved with the patient for more than a year), were mentally and physically able to participate, and spoke sufficient English to participate. Of the 685 spouses participating in the PROSTQA cohort study, 186 had not reached the 24-month time point at the start of this study in 2006 and were therefore eligible for this study. Spouses participating in the parent study were invited to participate in this companion study between December 2006 and April 2008. Of the eligible 186 spouses, 65 spouses did not complete the 24-month study interview. Nine spouses were not eligible because they were out of the main study (they withdrew or died or the patient withdrew or died), 14 missed the 24-month interview for both studies, 42 spouses declined participation in this additional study, resulting in the final sample of 121.


After providing informed consent for the supplemental questions of the companion study, spouses completed a battery of self-report questionnaires in a computer-assisted telephone interview.

Antecedent Variables

Patient Disease Factors. Information about the patient's type of treatment (prostatectomy, brachytherapy, external beam radiation, and use of neo adjuvant hormonal therapy) and pretreatment cancer severity (Gleason score) was obtained from the patient's medical record. This patient information was collected at baseline in the parent study.

Spouse Person Factors. Demographics were measured with the Risk for Distress (formerly known as Omega Screening Questionnaire as developed by Weisman and Worden[37] and adopted by Mood.[38] The Risk for Distress is composed of 4 parts: (a) demographic and background information, (b) health history, (c) inventory of current concerns, and (d ) symptom scale. Two parts of the Risk for Distress, the demographic information section and the health history, were used to measure spousal person factors. Both parts have shown high reproducibility (995%). The demographic section includes questions about the respondent's age, education, and income at the time of the patient's treatment.

Spouse Expanded Prostate Cancer Index Composite,[1] which consists of 6 questions that measure spouses' perception of bother (how much of a problem to the spouse, ranging from 1 = no problem to 5 = big problem) caused by patient's prostate cancer post treatment symptoms (urinary, sexual, bowel, and hormonal).

Appraisal Appraisal was measured with the Appraisal of Care giving Scale (ACS) as developed by Oberst39 and modified for this study. This scale is grounded in the cognitive-transactional theories of stress and coping. This instrument is most appropriately used after the stressful encounter has occurred and coping has begun, as was the case in this study. The original instrument was modified based on recent research and the need to adapt the instrument for a phone survey. The Brief ACS consists of 9 items and measures 2 types of stressful appraisals, general stressfulness and perceived threat, and 1 type of positive (nonstressful) appraisal, perceived benefit. All items were taken from the original instrument. The original instrument items were content validated by family caregivers, a panel of clinical experts, and a panel of experts familiar with the theory. Construct validity is well established. The intensity of each item is measured on a 5-point Likert-type scale. There are 3 items measuring general stressfulness, 3 items measuring perceived threat, and 3 items measuring perceived benefit. Mean scores were calculated, with higher scores indicating greater general stressfulness, perceived threat, or perceived benefit appraisals. The 3 subscales were used separately in subsequent analysis.

The ACS has been used in a variety of populations including caregivers of cancer patients. Studies that have used the ACS used a summative score for the entire scale.[31,40] In the original work by Oberst,39 the internal consistency ! coefficient for the general stressfulness scale was .73, for the perceived threat scale is .90, and for the perceived benefit scale is .74. The ! coefficient for the general stressfulness scale in this study was .69, for the perceived threat scale is .67, and for the perceived benefit scale is .82.

Marital Satisfaction Satisfaction with the marital relationship was assessed with the Brief Version of the Dyadic Adjustment Scale (DAS),[41,42] a 4-item instrument that measures couple satisfaction with the relationship (the degree to which the couple is satisfied with the present state of the relationship and its commitment to continuance). A total marital satisfaction score was calculated as the sum of the items on the scale. Higher scores represent more distress in the marital relationship. Comparison of the DAS-4 to the DAS-32 indicates that the brief version is a comparable measure of couple satisfaction.[42] This scale has been used to assess marital satisfaction in cancer patients.[43,44]

In the original work by Sabourin et al,[42] the ! coefficient for the DAS-4 was between .84 and .92. The ! coefficient for the DAS-4 in this study was .57. Marital satisfaction may include other factors not measured in this population, limiting the reliability of the DAS.

Sexual Satisfaction Satisfaction with the sexual relationship in the marriage was measured by using the Sexual Satisfaction Scale (SSS), which was investigator developed to supplement the DAS and focuses specifically on sexual satisfaction of spouses of men with prostate cancer. The items were content validated by an expert in sexuality in older adults and an expert in prostate cancer research. The 3-item questionnaire measures satisfaction with relationship intimacy, the affect of prostate cancer treatments on the sexual relationship, and overall sexual satisfaction. The intensity of each item is measured using a 5-point Likert-type scale, with higher scores indicating greater sexual satisfaction. Internal consistency reliability for this study was established at .80.

Quality of life was measured using 2 QOL scales, a generic QOL scale (Medical Outcomes Study Short-Form Health Survey [MOS SF-12])[45] and a cancer-specific QOL scale developed for caregivers of cancer patients (Caregiver Quality of Life Index–Cancer Scale [CQOLC]).[46] The MOS SF-12 consists of 12 items that form a physical component (PCS) and mental health component (MCS) summary scale. Responses are made in different multiple-choice formats. Extensive psychometric testing has been completed on this instrument, including studies with cancer patients, and has shown strong evidence of validity and reliability.

The CQOLC was developed specifically to measure the QOL of caregivers of patients with cancer.[46] The CQOLC consists of 35 items using a 5-point Likert-type scale. The maximum total score is 140. Higher scores reflect better QOL. The instrument was tested in a group of family caregivers of patients with lung, breast, or prostate cancer receiving curative treatment. The ! coefficient reliability for this study was .87. The instrument had good convergent validity with other QOL and emotional distress measures. Divergent validity with measures of physical health, social support, and social desirability also was reported. The instrument was found to be responsive to changes in health state of the patient as well.

Statistical Analysis

Descriptive statistics were generated for all variables in the data set. For the description of spouse's marital relationship, sexual satisfaction, and QOL, summary scores for the DAS-4, SSS, SF-12, and the CQOLC were used.

Spearman correlation coefficients were used to examine relationships among variables. Multiple linear regressions were conducted to determine if patient disease factors (type of treatment and pretreatment cancer severity) and spouse characteristics (age, education, health status, and symptom bother) were associated with the appraisal of caregiving, marital satisfaction, sexual satisfaction, and QOL.