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

Disclosures

Cancer Nurs. 2013;36(2):104-113. 

In This Article

Discussion

This study examined spouses' appraisal of their current care giving experience 2 years following the patients' treatment for localized prostate cancer. The study also examined marital satisfaction, sexual satisfaction, and general and cancer-specific QOL of spouses 2 years following treatment. Results for aim 1, which was to describe the multidimensional QOL, marital satisfaction, and sexual satisfaction of spouses of men treated for prostate cancer at 2 years following treatment, indicate that spouses' QOL was generally good on both the generic and cancer-specific QOL measures.

However, there was a subgroup of spouses who had lower cancer-specific QOL mean scores at 24 months. These were spouses who were younger (<65 years), perceived more threat and stress in their care giving role, and experienced more bother by their husbands' post treatment symptoms. Although spouses at 2 years following treatment were generally satisfied with their sexual relationship, spouses' marital satisfaction scores indicated some marital distress as evidenced by the DAS-4 scores near the distress level. Previous research has found that dyads in relationships that were less satisfying experienced more distress and had been linked to poorer adjustment to the illness.[48,49]

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

Cancer severity at the time of treatment, education, comorbidities, and spouse symptom bother were not associated with spouse appraisal. Higher income was associated with sexual satisfaction in this study. Other research has found higher income was related to frequency of sexual activity in middle-aged and older women.[50] Cost was a factor in the ability to use treatment measures (such as sildenafil) for sexual dysfunction,[51] which may be related to higher sexual satisfaction in this study group among those with higher income. Other findings from this study indicate that spouses who had negative appraisal of their caregiving experience had lower marital and sexual satisfaction and poorer QOL. This was especially evident in younger spouses. Negative appraisal in general was significantly related to lower QOL in younger spouses (69% of the sample were < 65 years of age). Fifty percent of the spouses in this study were working, possibly creating stress between job commitment and a desire to be supportive of their husbands. Since patients had treatment for early-stage prostate cancer, younger spouses and their husbands are more likely to live with the aftermath of treatment for a longer period. Because the spouse's age was significantly different than the age of patient, with many spouses being 4 or more years younger than their husband, spousal negative appraisal could be related to concern about a shortened time together. Interventions to help them manage spousal negative appraisal and improve their QOL would be beneficial. Further analysis revealed significant findings on the subcomponents of the appraisal of caregiving scale (stress, threat, and benefit) for spouses of all ages. Perceptions of threat and general stress associated with caregiving were experienced at 2 years following treatment, creating a negative appraisal of their caregiving experience. Research has also shown that the extent to which spouses perceive their situation as stressful has been associated with less life satisfaction,[13] a factor that negatively affects QOL. Research has shown that the spouses' appraisal of their care giving experience has a strong influence on QOL.[13]

At 2 years following treatment, spouses still expressed bother related to the patients' treatment outcomes. The spouse's version of the Expanded Prostate Cancer Index Composite, which was discussed earlier, is a measure of the spouse's perception of bother that patients' symptoms caused spouses.[9] Spouses who perceived more bother from the patients' urinary function, bowel habits, and hormone problems appraised their care giving situation more negatively and reported a lower QOL. Furthermore, results indicated that younger spouses experienced more bother related to the patient's sexual function at 24 months following his treatment. Solo way and colleagues[24] also found that spouses were distressed by changes in their sexual relationship, and Litwin et al[22] found that erectile dysfunction had a significant negative correlation with marital interaction. Study findings support suggestions that sexual counseling offered following a diagnosis of prostate cancer should be extended to spouses as well as the patient to help facilitate the dyad's successful adjustment to treatment outcomes.

Predictors of Appraisal, Marital Satisfaction, Sexual Satisfaction, and QOL

Younger age was the only significant predictor of negative appraisal (stress and threat) in this study. Cancer severity and younger age predicted a small amount of variance on the benefit subscale. This suggests that younger spouses of men diagnosed with cancer struggle to find some positive aspect to help them cope with their situation. Previous research also found living with prostate cancer influenced younger couples' view of their daily life, changing priorities and family goals.[14] Interventions aimed at positive reframing or finding meaning in difficult situations may help the younger spouse adjust.

Negative appraisal was a significant predictor of marital satisfaction, cancer-specific QOL, and mental QOL but not sexual satisfaction. Living with a cancer diagnosis, even when it has been treated, appears to be a persistent source of distress for spouses. Researchers have found a reciprocal relationship between spouse and patient adjustment.[40,52] This finding implies a need for spousal interventions designed to diminish negative appraisal and support positive coping.

Spouse symptom bother related to the patient's sexual dysfunction and hormone therapy was a significant predictor of sexual satisfaction. Research has shown that partners often report lower level of sexual function than patients,31 but spouses often do not discuss sexual issues with their partner for fear of further increasing the partner's anxiety related to this issue.[24] Spouses may also discount concerns about sexual function in view of the severity of a cancer diagnosis. This suggests the importance of including the spouse in sexual counseling following treatment for prostate cancer. Furthermore, it suggests that interventions designed to facilitate communication within couples managing the aftermath of prostate cancer treatment may be beneficial.

Limitations

While this study provided a closer look at the experiences of spouses of prostate cancer patients at 2 years following treatment, it has some limitations. First, the findings of this study report on one point in time; consequently, causal inferences cannot be made. Second, all variables reported are based on self report and may not reflect objective distress in spouses. Finally, even though the sample was recruited from multiple sites across the country, it was composed primarily of middle- and upper middle- class, well-educated, white spouses and therefore is not reflective of the ethnic/racial diversity of the population of dyads living with prostate cancer as a whole. Future studies are needed with ethnic minorities and individuals of lower educational and incomes levels.

Implications for Practice

Findings in this study (continued negative appraisal of their care giving experience; continued bother from the patients' urinary function, bowel habits, and hormone problems leading to more negative appraisal of their care giving situation and a lower QOL) point to the need to include the spouse in follow-up care offered to the patient. Interventions to help spouses manage their negative appraisal and improve their QOL are needed. Interventions aimed at positive reframing or finding meaning in difficult situations may be especially helpful to younger spouses. Interventions designed to facilitate communication within couples managing the aftermath of prostate cancer treatment could decrease negative appraisal. Study findings support suggestions that sexual counseling offered following a diagnosis of prostate cancer should be extended to spouses as well as the patient to help facilitate the dyad's successful adjustment to treatment outcomes.

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