Abstract and Introduction
Prostate cancer is perceived as a "couple's disease," where diagnosis and treatment affect not only the patient and his partner, but other members of the family as well. The partner is a key determinant of the patient's quality of life in the treatment process, but the perspective of any emotionally attached individual is under-represented in the current literature. Various aspects of the disease treatment process, such as treatment plans, side effects, and long-term management, affect the quality of life of the person diagnosed with prostate cancer. Thus, identification of quality of life issues can facilitate the development of interventions for both the patient and his family members, and promote communication with healthcare providers. We sought to learn what factors impact the quality of life in partners of men receiving prostate cancer treatment and conducted a systematic review with thematic synthesis of published, peer-reviewed qualitative research. PubMed, MEDLINE, CINAHL, Scopus, PsychINFO, PsychARTICLES and Google Scholar were searched for studies published between January 2006 through October 2017 using search terms related to prostate cancer and the partner's quality of life. Publications were further limited to those written in English and included direct quotes from partners of patients with prostate cancer. Four themes were extracted from 13 isolated articles that explored the importance of sexuality in the partner, the divulgence of appropriate and comprehensive education from healthcare providers, feelings of loneliness and isolation, and togetherness. Quality of life may be impacted by intimacy between the patient and his partner, appropriate and comprehensive education from healthcare providers, feelings of loneliness and isolation, and feelings of togetherness in the dyad. Findings from this review may serve to increase the shared decision-making process between the patient, his partner, and the healthcare provider.
Prostate cancer is one of the most common cancers for men in the western world. According to the American Cancer Society (2017), there were approximately 161,360 new cases of prostate cancer diagnosed in 2017, and an estimated 1 in 7 men will be diagnosed with this disease during their life time. Although it is a common form of cancer, the prognosis of the disease is good, with a 98.2% five-year survival rate (Noone et al., 2017). Prostate cancer can be a slow-growing disease, and because most men diagnosed with prostate cancer do not die from it, research has been focused on the qualitative aspects of the disease. Much is known about the perspectives of men through the prostate cancer treatment process, but knowledge gaps exist in the perspective of the partner.
Minimally invasive surgical techniques have reduced blood loss, length of hospital stay, and time where an indwelling catheter is required when compared to the previous anterior and lithotomy approaches. Yet minimally invasive surgery may not always result in reducing long-term side effects, such as sexual dysfunction and urinary incontinence. External beam radiotherapy and brachytherapy have grown in popularity for treatment of localized disease. Both treatments have markedly reduced hospitals stays, but complications, such as erectile dysfunction and urinary incontinence/bladder issues, are still prevalent and problematic. Adverse effects of treatment, such as incontinence and erectile dysfunction, resolve for some men within the initial one to two years after treatment. For many others, problems with incontinence (20% to 40%) and sexual dysfunction (70% to 80%) will be present for most of their lives (Parker, Wang, Chang, & Wood, 2011). Pre-operative management of post-operative side effects should be disclosed to couples because these side effects can be significant and may cause strain within the relationship. Androgen deprivation therapy is an adjacent treatment that reduces the amount of free testosterone in the body to help reduce localized disease. However, the reduced amount of free testosterone produces side effects (O'Shauggnessy, Ireland, Pelentsov, Thomas, & Esterman, 2012).
Sexual side effects from pro-state cancer treatment have various implications for quality of life (QoL) for both the patient and his partner. Multiple studies have detailed significant functional decline after either prostatectomy or radiation therapy (Letts, Tamyln, & Byers, 2010; Resnick et al, 2013; Street et al., 2009). Sexual dysfunction broadly addresses the experience of reduced sexual desire and difficulty becoming aroused, maintaining erections, ejaculating, and achieving orgasms (Badr & Taylor, 2009). Many men who have undergone prostatectomy and/or radiation therapy experience sexual dysfunction and subsequent distress in their relationships; therefore, it is important to consider the QoL of those in the relationship. Street and associates (2009) state the adverse side effects of treatment can contribute to marital distress in partners. Talking about cancer and sexual problems can be a source of distress for both the patient and his partner (Street et al., 2009. The stress of a life event, such as a cancer diagnosis, can cause more distress in the partner than the patient (Eismann, Waldmann, Rohde, & Katalinic, 2013). Although patients require support from their partner, many do not want to admit they need support. This requires the partner to find new ways to provide support without appearing to do so. They must also balance concern for the patient as well as their own health maintenance. Sometimes, partners will quiet their own struggles to support their partner.
Many couples turn to medical therapy to address side effects with variable levels of success. Side effect management incorporates pharmacologic and non-pharmacologic strategies. Sexual dysfunction has been managed via medications, including sildenafil (Viagra) and tadalafil (Cialis); and mechanical devices, including a vacuum constriction device, penile injections, and surgical intervention with a penile implant. Other treatments are available and encouraged, including sexual therapy and relationship therapy (American Cancer Society, 2017). Healthcare providers applying these options in an individualized treatment plan have provided long-term benefits for patients and their partners.
QoL is a phenomenon that reflects the subjective experience a person has of his or her life (World Health Organization, 1995). Thus, psychosocial and psychosexual factors of prostate cancer diagnosis and treatment can be perceived very differently by individuals. There is a vast array of problems and burdens related to the partner's responsibilities (such as physical, social, and emotional difficulties; information needs; and daily life impact) that can negatively influence the partner's QoL. There is a causal link between the partner's and patient's QoL, suggesting that if a partner's QoL declines, so does the patient's (Williams, Hicks, Chang, Connor, & Maliski, 2014; Wootten, Abbott, Farrell, Austin, & Klein, 2014; Wootten, Abbott, Osborne et al., 2014). Therefore, by addressing the needs of partners and maintaining their QoL, patients could also benefit (Segrin, Badger, & Harrington, 2012).
The existing literature reveals there is a tendency for more communication and transparency between the patient and provider; few studies have explored the view of the decision-making process from the partner's point of view. Only one study uncovered in the literature review discussed how other family members are associated in the decision-making process. In studies that focus on the partner's impact, findings postulate that patients do not make treatment decisions alone; the partner is present for emotional support and fulfills the facilitative roles of the patient's treatment. The variety of terms used to describe the 'patient' and the 'partner' was also revealed in the literature. Terms for the partner include 'spouse,' 'wife,' and 'significant other.' For the purposes of this systematic review, inclusive language will dictate the use of 'partner' to refer to 'spouse' or 'significant other,' and the use of 'patient' will refer to the man with prostate cancer. Original terminology will be used when specifically quoting the partner's perspective. Further, the term 'healthcare provider' will be used to collectively address all medical professionals who directly interact with the patient and his partner.
This systematic review synthesizes the research evidence related to the lived experience of partners of patients diagnosed with prostate cancer and creates a focused set of themes to guide healthcare providers in caring for partners and patients. Understanding the partner's perspective can give insight into preparing patients with prostate cancer for different treatment options and aid in providing emotional support. It can also tailor the application of long-term outcomes into the decision-making process. This article provides evidence supporting that conflict with patients is also an important issue for the partner, and that healthcare providers must provide individualized and holistic care to the partner to address the QoL of the patient. The research question addressed is: 'What factors impact the QoL in partners of men receiving prostate cancer treatment?
Urol Nurs. 2018;38(4):194-206. © 2018 Society of Urologic Nurses and Associates