California Cancer Research Program
Completed Projects
The following Principal
Investigators have completed their research as funded by CRP. Where applicable,
publications resulting from CRP funding are also included.
CYCLE I FINAL LAY
ABSTRACTS
[PSYCHOSOCIAL/CULTURAL ASPECTS]
Psychosocial/Cultural Aspects
Marion M. Lee, Ph.D.: Complementary Therapy Use and Quality of Life in Men
with Prostate Cancer
Mark S. Litwin, M.D., M.P.H.: Quality of Life in Men with Early Stage Prostate
Cancer
Georgia R. Sadler, Ph.D., M.B.A.: Problem Solving Therapy for Prostate
Jacqueline O'Connor, Ph.D., M.S.: Benign Prostate Biopsy: Cancer-Relevant Behavioral
Sequelae
ABSTRACTS
Complementary Therapy Use and Quality of Life in Men with Prostate Cancer
University of California,
San Francisco
Investigator-Initiated
Award, $799,952.00 / 36 mos.
(Prostate Cancer)
The goal of our project is to
understand the utilization of complementary and alternative medicine (CAM)
associated with quality of life (QOL) among prostate cancer patients living in
the greater San Francisco Bay Area.
Specific aims are to: 1) determine the types, duration, and frequency of
conventional and CAM therapies used by men with prostate cancer diagnosed in
the Greater Bay Area; 2) determine demographic, lifestyle, psychosocial,
clinical, and other factors associated with types of CAM use; 3) evaluate
ethnic differences in the prevalence of CAM use and factors associated with CAM
use; 4) investigate the influence of CAM use and other demographic, lifestyle,
psychosocial, and clinical factors on QOL.
In the past 12 months, our
tasks included: 1) Conducting analysis on data from the baseline and the
one-year follow-up interviews; and 2) preparing manuscripts for
publication. A total of 543
subjects recruited through Northern California Cancer Registry (NCCC) completed
the baseline interviews by April 27, 2001. By May 7, 2002 we finished all the one-year follow-up
interviews with a one year follow-up rate of 89 % (485/543). In addition, 57 subjects were recruited
from San Francisco Veteran's Affair hospital for the baseline interview, and
subsequently, 47 of them completed the 6-month follow-up interview, and 43 completed
the 12-month follow-up interview.
Analysis of data from the
baseline interview showed that overall, 30% of the subjects had used at least
one CAM. Among all the CAM
therapies included in the study, herbal remedies at 16% were the most popular. Dietary therapies (macrobiotic diet,
megavitamin, and other dietary therapies) accounted for about 10% overall. Factors associated with CAM use
included younger age, having other health problems, regular exercise,
participation in social groups, and influence from relatives or friends with
prostate cancer. Additionally,
some factors were associated with CAM use only in certain ethnic groups. For example, Asian men who had received
hormonal therapies, black men who were not smokers or who had a family history
of prostate cancer, and white men who were single were more likely to use
CAM. These results were published
in the October 2002 issue of the American Journal of Public Health. At the 12 month follow-up, about 25% of
the subjects were using CAM, with herbal remedies still being the most commonly
used.
Overall, CAM users were more
likely to use active coping strategies including seeking social support,
planful problem solving, and self-motivated behavior compared to the subjects
who did not use CAM. CAM use were
not significantly associated with subjects QOL at baseline or at one-year
follow-up. Factors showing
significant correlation with subjects' QOL at one-year follow-up included QOL
at the baseline, coping strategies, demographic factors (race/ethnicity,
employment status, nativity, marital status, and education), lifestyle (regular
exercise and drinking), and clinical factors (comorbidities, having persistent
pain, and having private health insurance).
In summary, our study did not
find signficant association between CAM use and QOL; however, CAM use was
associated with the use of different coping strategies, which are associated
with QOL. In other words, CAM use
may reflect a way for subjects to cope with their diagnosis of prostate cancer
and to improve their QOL.
1. Lee MM, Chang JS, Jacobs B, Wrensch MR. Complementary and Alternative Medicine Use Among Men With Prostate Cancer in 4 Ethnic Populations. Am J Public Health 2002;92:1606-1609.
University of California,
Los Angeles
Investigator-Initiated
Award, $648,042.00 / 36 mos.
(Prostate Cancer)
The research goals of this
project have two specific aims: 1) To compare the three standard treatments for
early stage prostate cancer—radical prostatectomy (RRP), external beam
radiotherapy (XRT), and interstitial seed brachytherapy (Brachy)—with
regard to general health-related quality of life (HRQOL), disease-specific
quality of life, and patient satisfaction with care, and 2) To assess changes
in health-related quality of life over time, beginning at baseline before
treatment and continuing longitudinally for four years.
The RAND SF-36 and University
of California, Los Angeles Prostate Cancer Index (UCLA-PCI) are used in this
study to measure HRQOL in a sample of men with biopsy-proven prostate cancer
before treatment and at intervals of 1, 2, 4, 8, 12, 18, 24, 30, 36, 42, and 48
months post-treatment. The general
HRQOL focus is on such domains as physical and emotional well-being, social
functioning, anxiety over cancer recurrence and cancer interference with family
life and life in general.
Disease-specific HRQOL is also a focus with particular attention to the
known side effects of urinary, sexual, and bowel impairment. Patients serve as their own
controls. Scores between the three
groups are compared.
The collection of data is the
current research task. Patients
are asked to participate in the research study at an average of seven per week. Currently, 452 men have participated
and fall into the following treatment groups: 83 Brachy, 71 XRT, and 298
RRP. Participant ethnicity is
divided as follows: White/Caucasian (84.5%) and Non-White/Caucasian
(15.5%). Patients are interested
in participating when they are told that their responses will help future
prostate cancer patients as they make a treatment choice.
Results of interim analyses
have revealed similar findings to the interim analyses at the end of Year 2, as
the patients in the XRT group exhibit a decline in physical QOL between months
12 and 24, while the Brachy patients experience a decline in energy during
months 12 to 24. In regard to
bowel function, the RRP group experiences a slight decline, suggesting an
overall trend.
In particular, few longitudinal differences among treatment groups have been noted in the general domains of QOL, however substantial differences among treatment groups are becoming evident in the disease-specific domains of QOL. For example, XRT and Brachy patients have greater impairment in bowel function, bowel bother, and irritative urinary symptoms, while RRP patients have greater early impairment in sexual function and bother. Fear of recurrence appears to be more substantial in the XRT and Brachy groups, however this finding needs confirmation.
Jacqueline O'Connor, Ph.D., M.S.
University of California,
Davis
New Investigator Award,
$288,431.00 / 36 mos.
(Prostate Cancer)
The goals of this study are
(1) to identify the psychological factors that motivate menÕs prostate health
practices in general, and (2) to identify psychological factors that predict
stability or change in menÕs cancer prevention and early detection practices
following a threat to prostate health.
To meet these goals we monitored prostate health knowledge, beliefs, and
behaviors in a sample of men of screening age for the duration of the project
period, in four study groups: (1) men who were referred for prostate biopsy
following screening, and whose biopsy results were not positive for cancer; (2)
men who were referred for further examination or tests following screening, but
did not proceed to biopsy; (3) men whose screening results were negative,
requiring no further tests or follow-up; and (4) men who have never undergone
prostate cancer screening.
Screening for prostate cancer includes the digital rectal examination
(DRE) and prostate-specific antigen (PSA) blood test. Of central interest in this project was how the experience
of a benign prostate biopsy affects prostate cancer awareness, beliefs, and
anxiety, and how these psychological factors, in turn, might influence
risk-reducing lifestyle changes and early detection behaviors. We have paid special attention to the
stress associated with cancer screening experiences, and we summarize below
highlights of our findings identifying predictors of self-reported stress
associated with routine prostate screenings, as well as screenings with
false-positive outcomes and subsequent biopsies.
PSA stress: Overall, the men in our sample did not
find PSA screening to be particularly stressful. Only seven percent agreed with the statement that having a
PSA test is a stressful experience.
The following variables were significantly associated with lower levels of PSA stress: knowing someone with prostate
cancer, the belief that one can make choices to reduce oneÕs cancer risk,
familiarity with screening tests and guidelines, higher education and higher
income. Heightened perceptions of
personal risk were significantly associated with higher levels of stress.
DRE stress: In contrast to the relatively low
stress associated with PSA screening, nearly 40% of the men agreed or strongly
agreed that having a DRE is a stressful experience. Younger age, perceptions of personal risk, and worry about
cancer were significantly associated with higher levels of DRE stress, while the belief that one can
make risk-reducing choices was significantly associated with lower levels of stress. Knowing someone with prostate cancer was also associated
with lower levels of DRE stress, though this relationship did not reach
statistical significance.
We note with interest that
knowing someone close with prostate cancer seems to have a stress-buffering
effect rather than a stress-amplifying effect. We also note that having a positive family history for
prostate cancer did not, by itself, predict screening stress. The perception of personal risk, on the
other hand, did significantly influence stress. These findings support those of another recently published
study in which a positive family history predicted psychological distress at
screening only when the perception
of personal susceptibility was also high.
False-Positive Screening and Biopsy Stress: Overall, significant psychological stress is associated with a false-positive screening leading to prostate biopsy. Over one-quarter (27%) of patients reported that their biopsy experience was Òvery stressfulÓ or Òextremely stressful,Ó and another 22% reported that their experience was Òmoderately stressful.Ó Forty-five percent reported experiencing Òa littleÓ stress and only seven percent of patients reported that their experience was Ònot stressful at all.Ó Greater psychological stress was significantly associated with younger age, higher levels of self-reported pain during the biopsy procedure, and greater worry about a possible cancer diagnosis. While biopsy pain and psychological stress were assessed retrospectively in our study, a recently published prospective study reported that pre-biopsy anxiety predicted self-reported pain during the biopsy procedure. The causal role of psychological stress in the experience of physical pain during biopsy certainly deserves further investigation.
Georgia R. Sadler, Ph.D., M.B.A., B.S.N.
University of California,
San Diego
Investigator-Initiated
Award, $734,872.00 / 36 mos.
(Prostate Cancer)
In 2003, an estimated 220,900
men will be diagnosed with prostate cancer, the most common type of cancer
among American men. An estimated
28,900 men will die of this cancer, making it the second leading cause of
cancer death in men. The human and financial costs of prostate cancer are
enormous for the individual patient, his family, and society. Family support is
important in coping with cancer. Studies show that men generally rely much more
heavily, and often exclusively, upon their spouses/partners for support
compared to women, who tend to maintain a more active social support network
with family and friends. Men's reliance on their spouses for support, and the
importance of this socio-emotional support to the men's well-being, and the
equally important goal of not compromising their spouses' health and well
being, make it especially important that the healthcare providers have
effective intervention programs to offer to these women as they assume their
new duties as spousal caregiver.
Focusing attention on maintaining the well being of the spouse is
central to promoting the well being of the couple and their extended family.
Scant attention has been
given to finding effective ways to meet the needs of spousal/caregivers of
patients with prostate cancer. The studies that have been done suggest considerable
benefit could be gained if women's customary problem-solving skills could be
enhanced to help them more effectively manage the stress and demands associated
with a spouse's diagnosis and treatment for prostate cancer, and do so with
less threat to their own health and well-being.
A problem-solving training
intervention for the spouses of men with prostate cancer was developed and
tested in a randomized clinical trial.
One hundred and seventy-one men and their spouses participated and were
asked to report on their mood, dyadic adjustment, quality of life, and levels
of distress. Spouses were randomly
assigned to either the 6-8 week intervention group or the standard supportive
care control group. Data was
collected at three time points: Time 1 (pre-intervention), Time 2 (immediately
following intervention), and Time 3 (6 months after baseline). Average time between diagnosis and
study entry was five and a half months. PatientsÕ ages ranged from 41-89 years
(Mean=65.5, SD=9.96 years) and spousesÕ ages ranged from 32-86 years
(Mean=61.29, SD=10.68 years). In spite of focused efforts to recruit
participants from the regionsÕ minority communities, the majority of the sample
was Caucasian (81% women & 86% men) and over half of the sample had combined
annual incomes over $75,000. The
sample was also fairly relatively well educated, with over 60% of the
participants reporting at least college degrees. Most (77%) of the patients
reported Stage A and B neoplasms.
Preliminary data suggest that
there are discrepancies in perceived problems among health care providers,
patients, and spouses. Data has
also shown that spouse distress is linked to her problem solving, and that
spouse distress mediates the relationship between her problem solving skills
and her husbandÕs distress.
Baseline analyses have also shown that dyadic adjustment moderates the
relationship between patient coping and distress, but that the same
relationship does not hold true for the spouses. Preliminary analyses also
suggest that wives who engaged in religious coping along with their husbands
displayed improved problem-solving skills, potentially allowing them to better
cope with illness.
1.
Banthia R,
Malcarne VL, Varni JW, Ko CM, Sadler GR, and Greenbergs HL. The effects of
dyadic strength and coping styles on psychological distress in couples faced
with prostate cancer. J Behav Med. 2003. 26(1): p. 31-52.
2.
Jacobs JR,
Banthia R, Sadler GR, Varni JW, Malcarne VL, Greenbergs HL, Schmidt J, and
Johnstone PA. Problems associated with prostate cancer: differences of opinion
among health care providers, patients, and spouses. J Cancer Educ. 2002. 17(1):
p. 33-6.
3.
Malcarne VL,
Banthia R, Varni JW, Sadler GR, Greenbergs HL, and Ko CM. Problem-Solving
Skills and Emotional Distress in Spouses of Men with Prostate Cancer. Journal
of Cancer Education. 2002. 17(3): p. 148-152.
California Cancer Research Program
(916) 449-5550