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.

Conclusions

This study adds to a growing body of research on spouses of men treated for prostate cancer. Findings support the now well established concept that prostate cancer affects not only the person diagnosed with the disease but also his spouse. In this study, spouses' negative appraisal of their care giving experience had a reciprocal affect on QOL: more negative appraisal resulted in more marital distress, less satisfaction with the sexual relationship, and lower QOL scores. Younger spouses of men with prostate cancer are an at-risk group who may benefit from intervention because they have more negative appraisals and lower QOL. There is a need for even longer-term assessment of spouses of prostate cancer patients because men's treatment outcomes (urinary function, bowel habits, and hormone symptoms) continue to affect spouses' QOL for at least 2 years after treatment.

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Acknowledgments
The authors acknowledge PROSTQA Data Coordinating Center Project Management, Michigan State University, East Lansing (Ms Hardy); Dana Farber Cancer Institute, Boston, Massachusetts (Ms Najuch and Mr Chipman); Beth Israel Deaconess Medical Center, Boston, Massachusetts (Ms Crociani), grant administration by Beth Israel Deaconess Medical Center (Ms Doiron), and technical support from coordinators at each clinical site.

This study was funded by theNational Institutes ofHealth (5R03CA119764-2, Dr Harden, principal investigator; and R01-CA95662, Dr Sanda, principal investigator).

Abstract and Introduction
Theoretical Perspective and Review of Literature
Methods
Results
Discussion
Conclusions
References

Table 1. Sample Characteristics
	Spouses (n = 121),
Characteristics	n (%)
Gender
Female	119 (98)
Male	2 (2)
Education
High school or less	24 (20)
Some college/graduate	60 (50)
Postgraduate	37 (30)
Race
White	111 (92)
Black	6 (4)
Asian	2 (2)
Other	2 (2)
Employment status
No employment	71 (58)
Part-time employment	20 (17)
Full time	30 (25)
Couples' income
$10 000Y$30 000	10 (8)
$30 001Y$100 000	58 (48)
9$100 001	51 (42)
Missing data	4 (2)
Treatment
Prostatectomy	72 (58)
Radiation therapy	21 (17)
Brachytherapy	20 (17)
Neoadjuvant + external beam radiation therapy	7 (6)
Neoadjuvant + brachytherapy	2 (2)
Gleason total score (severity)
6	73 (60)
7	41 (34)
8	5 (4)
9	2 (2)

Table 2. Descriptive Data on Marital Satisfaction, Sexual Satisfaction, and Quality of Life
Partners at 24 mo			Comparative Sample^a			2-Sample t
Variable	Mean	SD	Range: Min/Max	Mean	SD	t	P
Quality of Life SF-12
Physical component	49.42	9.22	19–62	48.58	10.25	–0.36	.56
Mental component	51.83	7.36	28–75	51.28	9.86	–0.77	.66
CQOLC	60.04	4.28	29–109	NA
Marital satisfaction
DAS-4	12.54	1.49	8–17	NA
SSS	9.34	.26	2–15	NA

Abbreviations: CQOLC, Caregiver Quality of Life Index–Cancer Scale; DAS, Dyadic Adjustment Scale; NA, not available from comparative study; SSS, Sexual Satisfaction Scale; SF-12, 12-Item Short Form Health Survey.
Higher scores on SSS and SF-12 indicate better sexual satisfaction and quality of life. Higher scores on the DAS-4 and CQOLC indicate less marital satisfaction and lower quality of life.
^aSample of spouses; mean age, 64 years; 38 localized; 11 recurrent; 20 advanced disease (n = 69).

Table 3. Relationship of Appraisal to Marital Satisfaction, Sexual Satisfaction, and Quality of Life (Spearman Correlation Coefficients)
Appraisal	DAS-4	SSS	CQOLC	SF-12 MCS	SF-12 PCS
Threat	0.25^a	–0.26^b	0.573^a	–0.31^a	0.28
Stress	–0.07	–0.30^a	0.57^a	–0.29^b	–0.05
Benefit	–0.19^b	–0.06	0.25^a	0.32	0.22^b

Abbreviations: CQOLC, Caregiver Quality of Life IndexYCancer Scale;
DAS, Dyadic Adjustment Scale; MCS, mental health component;
PCS, physical component; SF-12, 12-Item Short Form Health Survey;
SSS, Sexual Satisfaction Scale.
^a P < .01.
^b P < .05.

Table 4. Relationship of Spouse Expanded Prostate Cancer Index Composite (EPIC) to Appraisal and Age (Spearman Correlation Coefficients)
	Stress	Threat	Benefit	Age
Problem urinary incontinence	0.16	0.11	0.07	–0.12
Irritation or blockage	0.30^a	0.15	–0.05	–0.06
Overall urinary function	0.34^a	0.20^b	0.08	–0.13
Bowel habits	0.29^a	0.19^b	–0.02	–0.11
Sexual function	0.20^b	0.10	–0.06	–0.32^a
Hormone function	0.40^a	0.26^b	0.07	–0.17

Abbreviation: EPIC, Expanded Prostate Cancer Index Composite.
^a P < .05.
^b P < .01.

Table 5. Relationship of Partner Expanded Prostate Cancer Index Composite (EPIC) to Marital Satisfaction, Sexual Satisfaction, and Quality of Life (Pearson Correlation Coefficients)
	DAS-4	SSS	CQOLC	SF-12 MCS	SF-12 PCS
Problem urinary incontinence	–0.13	–0.24^a	0.13	–0.04	–0.04
Irritation or blockage	0.02	–0.23^a	0.18^b	–0.17	–0.03
Overall urinary function	–0.06	–0.14	0.27^a	–0.21^b	–0.12
Bowel habits	–0.01	–0.12	0.23^a	0.03	–0.05
Sexual function	0.02	–0.36^a	0.19^b	–0.12	0.06
Hormone function	–0.16	–0.24^a	0.30^a	–0.08	–0.08

Abbreviations: CQOLC, Caregiver Quality of Life Index––Cancer Scale;
DAS, Dyadic Adjustment Scale; MCS, mental health component;
PCS, physical component; SSS, Sexual Satisfaction Scale.
^a P < .01.
^b P < .05.