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


Description of the Sample

Table 1 describes demographic characteristics of the sample. The table indicates that 98% of the 121 spouses were female, 20% had a high school education or less, 92% were white, 58% were not currently employed, and 42% reported household incomes greater than $100 000. The average age of the spouses was 60 years (range, 40Y83 years), and the average age of the patients was 64 years (range, 44Y81 years), which was significantly different.

The table also indicates that prostatectomy (primarily ''open'' but including a small number of robotically assisted laparoscopic procedures as well) was the modal treatment of the male patients (58%). For analysis, patients who had radiation and radiation plus neoadjuvant therapy were merged into 1 category and those who had brachytherapy and brachytherapy plus neoadjuvant therapy were merged into another category because of the small numbers of cases in these groups.

At the time of diagnosis and treatment, most patients had a Gleason total score of 6, indicating moderate cancer severity. Because of the small number of cases in Gleason 8 and 9 categories, these 2 categories were merged with the Gleason score of 7 to make 1 category, which indicated more disease severity than in the Gleason 6 category. Analysis of these groups showed no significant differences among the groups.

QOL, Marital Satisfaction, and Sexual Satisfaction at 24 Months

In order to describe the long-term QOL of spouses of men treated for prostate cancer, we used means and SD for indicators of QOL of a cohort of spouses from a previous study immediately following treatment and the present cohort of spouses 2 years following treatment (as listed in Table 2). Scores on the QOL scale (SF-12) PCS varied from 19 to 62 and on the mental component from 28 to 72, with higher scores representing better reported QOL. Table 2 indicates the mean score in the sample at 2 years following treatment was 52.24 for the mental component and 49.12 for the PCS. This is greater than the established healthy female population norm of 48 for the MCS and 49 for the PCS (mean score),[47] indicating the respondent spouses were, on average, generally satisfied with their current QOL. Two-sample t tests were used to compare spouse mean scores at 2 years with a comparative sample of spouses' SF-12 mean scores taken immediately following prostate cancer treatment from an earlier study.[31] Mean scores for the PCS and MCS of the SF-12 of spouses in the current study did not differ significantly from the comparative sample of spouses just following cancer treatment.

The mean scores of the cancer-specific CQOLC scale indicate more variability in the QOL of the spouses. The midpoint of possible scores on this scale was 70, with higher scores indicating poorer QOL. The mean for the CQOLC was 60.04 (SD, 14.28), which is less than midpoint, indicating a slightly higher QOL for many of the spouses in the current study at 2 years' follow-up.

The mean sexual satisfaction score of the SSS was 9.34 (SD, 2.27), which was above the midpoint (7.5) of possible scores, which indicates that spouses on average were generally satisfied with their sexual relationships.

The mean marital satisfaction score of the DAS-4 for the spouses was 12.54 (SD, 1.49), which was very near the distress cut point for this scale of 13 (distressed), indicating some level of distress in the marital relationship within this group of spouses at 2 years.

Factors Associated With Appraisal, Marital Satisfaction, Sexual Satisfaction, and QOL

We next sought to identify factors associated with spouse appraisal of care giving, marital satisfaction, sexual satisfaction, and QOL. We first examined bivariate correlations among study variables. Correlation analysis revealed significant relationships between the subscales of spouses' appraisal of care giving and measures of marital satisfaction, sexual satisfaction, and both general and cancer-specific QOL (Table 3). Spouses with a negative perception of care giving on the threat and stress subscales had lower marital and sexual satisfaction, poorer cancer-specific QOL, and poorer mental QOL at 24 months following treatment. In regard to the benefit subscale, spouses with higher perceptions of benefit had lower marital relationship distress and higher cancer-specific QOL. Physical QOL was not affected by the appraisal variables.

Analysis of spouse's perception of bother about the patient's treatment outcomes and appraisal of the spouse's caregiving experience was performed (Table 4). Spouses who perceived more bother related to the patient's urinary function, bowel function, sexual dysfunction, and problems related to hormone therapy had increased stress and threat on the appraisal subscales. Furthermore, younger spouses expressed more bother related to problems with the patient's sexual dysfunction.

Correlation analyses also showed that spouses' perceptions of bother related to overall urinary incontinence, sexual function, and hormone function and vitality were negatively correlated with sexual satisfaction but had no significant relationship with marital satisfaction (Table 5). Bother related to problems with urinary function, bowel problems, sexual dysfunction, and hormone function and vitality resulted in poorer cancer-specific QOL. Only problems with overall urinary function resulted in spouses' poorer mental QOL. Symptom bother was not related to spouses' physical QOL

Multiple regression was used to examine how much variance patient disease factors, including severity of the disease (Gleason score), the type of treatment men received (prostatectomy, brachytherapy, or external beam radiation therapy), spouse characteristics (age, education, family income, and health status), and spouse symptom bother, account for in appraisal of care giving, marital satisfaction, sexual satisfaction, and QOL.

Predictors of Appraisal

Multiple regression analysis conducted on appraisal of care giving revealed several significant effects. Younger age (F = 9.09, P = .003) and patients treated with radiation therapy (F = 5.36, P = .02) explained 9% of the variance in the appraisal subscale of stress. Younger age also accounted for 4% of the variance in the appraisal subscale of threat. Cancer severity and younger age explained 7% of the variance in the appraisal subscale of benefit. There was no significant effect for other treatment options (radical prostatectomy or brachytherapy), education, income, comorbidities, or spouse symptom bother on the appraisal subscales. Tests for mediation on the appraisal subscales showed that only benefit was a mediator for cancer severity (t = 2.16, P = .03) explaining 3% of the variance.

Predictors of Sexual Satisfaction

We found no significant effect for cancer severity, education, or any of the appraisal subscales on sexual satisfaction. Income (t = 2.31, P = .02) predicted 19% of the variance in sexual satisfaction. Spouse symptom bother related to the patient's sexual function (t = –6.66, P < .0001) and hormone therapy (t = –2.63, P = .01) predicted 39% of the variance in sexual satisfaction.

Predictors of Marital Satisfaction

Appraisal subscales of threat (t = 2.27, P = .03) and benefit (t = 2.44, P = .02) explained 25% of the variance in marital satisfaction but was not significant in sexual satisfaction.

Predictors of QOL

Fifty-five percent of the variance in cancer-specific caregiver QOLwas explained by perceptions of stress (t = 4.00, P = .0001), threat (t = 4.06, P < .0001), and benefit (t = 3.22, P = .002.). Perceptions of threat (t = –2.09, P = .04) and spouse age (t = 2.33, P = .02) also explained 23% of variance in mental QOL (SF-12).

The study found that age had a significant association with spouse QOL. Results indicate that younger spouses (G65 years) had lower cancer-specific QOL (t = ––2.03, P = .04 and lower mental QOL (t = 2.80, P = .01). Older age in spouses (t = –2.11, P = .04) and more comorbidities (t = –4.49, P G .0001) explained 37% of the variance on spouses' physical QOL.

Spouse symptom bother related to the patient's urinary function (t = 2.12, P = .04) and bowel difficulties (t = 2.76, P = .01) predicted 17% of the variance in cancer-specific caregiver QOL. Spouse symptom bother related to the patient's urinary function significantly associated with spouse mental QOL (t = –2.14, P = .04) and physical QOL (t = –2.35 P = .02) on the generic QOL measure (SF-12).