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BROOKLYN 2 RADIOTHERAPY Catherine BAIRD

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  1. ABSTRACT Prostate cancer was the most commonly registered cancer in 2008. High survival rates following treatment emphasize the importance of enhancing patients' quality of life. Prostate cancer can be treated with surgery, radiation therapy and hormone therapy all of which have side effects that impact on a patient's quality of life. This study reviewed ten recent qualitative primary research studies to determine the impact prostate cancer treatment side effects have on patient sexuality. Key findings suggest that erectile dysfunction and urinary incontinence have a significant impact on sexuality and sexual function by affecting patient self-esteem, masculinity and relationships regardless of age. Some men rationalized their side effects against their survival whereas others questioned if, given the option again, they would have treatment. Current erectile dysfunction treatments are accompanied by more side effects and are often discontinued by patients. The impact these treatments have on spontaneity was found to be significant. Both patients and health professionals are hesitant to discuss sexual issues resulting in poor communication and patient's sexual needs not being addressed. From this review it can be deduced that further training for health professionals is required to enable better communication around management of sexual issues in order to meet patient's needs enhancing the quality of their care. Sat 31stAug 2013 Session 1 / Talk 2 09:46 – 10:01 BROOKLYN 2 RADIOTHERAPY Catherine BAIRD

  2. Sexuality After Prostate Cancer TreatmentBy Catherine Baird A qualitative literature review

  3. Prostate Cancer in NZ • Approx. 3000 registrations each year [1] • In 2009 • 30.2% of male registrations [2] • 12.8% of all male deaths from cancer [2] • Mortality rates reduced by 27.6% [2] [1]

  4. Aim • To assess how side effects from prostate cancer treatments impact on men’s sexuality and whether their sexual concerns are being addressed by health professionals. • Impact of side effects • Treatment of erectile dysfunction • Health professionals approach [2]

  5. Treatments [1] • Surgery • Radical Prostatectomy • TURP • Hormone Therapy • Drugs eg. Zoladex • Orchidectomy • Radiation Therapy • External Beam Radiation Therapy • Brachytherapy

  6. Impact of Side Effects Impotence [3] [4]

  7. Impact of Side Effects Impotence Incontinence

  8. Impact of Side Effects Survival vs Side Effects “At a certain moment you accept your symptoms. And then you carry on living.” [7] “You are stiff all over when you are dead.”[8] “…If I was faced with that again, would I still make the same decision? I am not sure.” [6] “[Incontinence] would be the end of my life. I would rather go.” [9]

  9. Impact of Side Effects Relationships “Sex is 10% of your marriage if it’s fine and 100% of your marriage if it isn’t fine” [11] “There are other ways of showing love” [5] “Now you don’t try to keep her there because why, for what?” [5] “I can see a good looking girl now and it don’t even faze me at all because I can’t”[6] [5]

  10. Impact of Side Effects Masculinity & Self Esteem “You lose that feeling that you are a whole man”[5] “It takes away my confidence” [6] “I didn’t feel very sexually attractive…I didn’t really want to uncover my body” [6] [6]

  11. Treating Erectile Dysfunction [1,11] • Oral drugs • Penile injections • Vacuum pump • Constriction rings • Penile implants • Constriction rings • Penile implant [7]

  12. Treating Erectile Dysfunction Side Effects “[it] is extremely painful…doesn’t seem to work too well” [5] “Unfortunately it’s all volume, no rigidity… and it’s quite painful” [8] [8]

  13. Treating Erectile Dysfunction Spontaneity “There is a sex life, but it’s a rather unnatural one” [5] “By the time you clean yourself up, the urine smell, have a shower put in the injection ra, ra, raa” [6] “It just makes it very premeditated” [6] [9]

  14. Managing Patient Needs Communication “Men don’t talk about things like that… you don’t talk about having sex” [13] “I manage to avoid the topic” [12] “The reaction of my colleagues was a bit horrified that I actually talked to a patient at that level” [12] [10]

  15. Managing Patient Needs Insufficient Information “Either I don’t remember or they didn’t tell me about the nerves being cut” [11] “Not knowing before hand [about penis shortening] is a definite issue”[8] “I am going to sue you boy, before the operation, I could hang and bloody work boot on it, now it’s only a rubber thong on a good day” [6] [11]

  16. Conclusion • Impact of Side Effects • Impotence and Incontinence • Relationships, Masculinity & Self-esteem • Treating Erectile Dysfunction • Side effects • Spontaneity • Managing Patient Needs • Poor Communication • Insufficient Information [12]

  17. References • New Zealand Cancer Society. Prostate cancer: A guide for men with prostate cancer. 2008: Available from: http://www.cancernz.org.nz/assets/files/info/Prostate_Cancer.pdf • Ministry of Health. Cancer: New registrations and deaths 2009. 2012. Available from: http://www.moh.govt.nz/moh.nsf/indexmh/cancer-reg-deaths-2009 • Ministry of Health. Cancer: Selected sites 2008, 2009, and 2010. 2010. Available from: http://www.health.govt.nz/publication/cancer-selected-sites-2008-2009-and-2010 • Ministry of Health. Cancer: New registrations and deaths 2008. 2008. Available from: http://www.moh.govt.nz/moh.nsf/indexmh/cancer-reg-deaths-2008 • Bokhour B, Clark J, Inui T. Sexuality after treatment for early prostate cancer. Journal of General Internal Medicine. 2001;16:649–55. Available from: http://onlinelibrary.wiley.com/doi/10.1111/j.1525-1497.2001.00832.x/full • O’Shaughnessy P “Kevin”, Laws T. Australian men’s long term experiences following prostatectomy: A qualitative descriptive study. Contemporary Nursing. 2010;34(1):98–109. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20230176

  18. References • Korfage IJ, Hak T, de Koning HJ, Essink-Bot M-L. Patients’ perceptions of the side-effects of prostate cancer treatment--a qualitative interview study. Social Science & Medicine (1982). 2006;63(4):911–9. Available from: http://www.ncbi.nlm.nih.gov/pubmed/16798130 • Oliffe J. Constructions of masculinity following prostatectomy-induced impotence. Social Science & Medicine. 2005;60(10):2249–59. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15748673 • Kelly D. Changed men: The embodied impact of prostate cancer. Qualitative Health Research. 2009;19(2):151–63. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19056697 • Petry H, Berry DL, Spichiger E, Kesselring A, Gasser TC, Sulser T, et al. Responses and experiences after radical prostatectomy: Perceptions of married couples in Switzerland. International Journal of Nursing Studies. 2004;41(5):507–13. Available from: http://www.ncbi.nlm.nih.gov/pubmed/15120979 • Schover LR. Sexuality and Fertility after Cancer. Haematology. 2005;(713):523–7. Available from: http://asheducationbook.hematologylibrary.org/content/2005/1/523.full.pdf+html

  19. References • Milne JL, Spiers J a, Moore KN. Men’s experiences following laparoscopic radical prostatectomy: A qualitative descriptive study. International Journal of Nursing Studies. 2008;45(5):765–74. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17482192 • Hordern AJ, Street AF. Communicating about patient sexuality and intimacy after cancer: Mismatched expectations and unmet needs. The Medical Journal of Australia. 2007;186(5):224–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17391082 • O’Brien R, Rose P, Campbell C, Weller D, Neal RD, Wilkinson C, et al. “I wish I’d told them”: A qualitative study examining the unmet psychosexual needs of prostate cancer patients during follow-up after treatment. Patient Education and Counselling. 2011;84(2):200–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20702055

  20. Image References • http://www.trampingnz.com/images/new_zealand.gif • http://coretrainingsolutions.net/wp-content/uploads/2011/11/questionmark-300x300.jpg • http://www.sciencephoto.com/image/431516/large/C0110707-Erectile_dysfunction,_conceptual_artwork-SPL.jpg • http://urinaryincontinencesolutions.com/wp-content/uploads/2011/08/incontenance.jpg • http://www.veria.com/media_publish/548/impotence_full_1333470799.jpg • http://www.freakingnews.com/Quantum-of-Solace-Pictures----2190.asp • http://www.stevestevesteve.com/comics/2011-04-17-Viagra,-Not-Just-For-Impotence.jpg • http://jaysolomon.files.wordpress.com/2009/01/erectile_dysfunction.jpg • http://postmentis.com/comics/2010-03-28-Spontaneity.jpg • http://www.cartoonstock.com/lowres/jlo0168l.jpg • http://www.cartoonstock.com/lowres/jlo0168l.jpg • http://www.mind-control-method.com/comfort.gif