Quality of Life After Radical Prostatectomy
Purpose/Objectives: To examine physical and psychosocial factors that affect the quality of life (QOL) for men 12-24 months after radical prostatectomy treatment for prostate cancer.
Design: Cross-sectional survey.
Setting: An entire population from one tumor registry.
Sample: Of the 132 men meeting inclusion criteria, 97 men responded, with 91 meeting analysis requirements. Analysis was completed on the Caucasian sample (n = 88) with a mean age of 66 years. Most men were married, lived with a spouse or partner, and had a high level of education.
Methods: A survey was developed to assess men 12-24 months prostatectomy. The tumor registry mailed the survey, which was completed at home, and participants returned it in a prestamped, addressed envelope.
Main Research Variables: Major hypotheses in the causal model were that age, sexual function, urinary function, and sexual appraisal would only have indirect effects on QOL, whereas urinary function appraisal, self-esteem, anger suppression, perceived social support, depression, and health locus of control would directly affect QOL.
Findings: As analyzed by path analytic techniques, the hypothesized causal model explained 72% variance in the QOL variable. Perceived social support, self-esteem, and health locus of control were significant predictors of QOL. Urinary function appraisal contributed indirectly through health locus of control. Contrary to the hypotheses, anger suppression and depression were not significant predictors of QOL.
Conclusions: After radical prostatectomy for prostate cancer, perceived social support, self-esteem, and health locus of control may influence men's QOL. Future research is needed to increase understanding about the adaptation trajectory of men's response to the impact of prostate cancer.
Implications for Nursing: Nurses can help patients by providing a thorough assessment of each patient's values that may affect QOL before any intervention begins, using research-based evidence regarding potential side effects of interventions, clear and concise information from a variety of sources that addresses the possible concerns of men and their spouses, and focused counseling that addresses patient-specific problems.
American Cancer Society. (2002). What are the key statistics for prostate cancer? Retrieved December 21, 2002, from <a target="_blank" href='http://www.cancer.org/docroot/CRI/content/CRI_2_4_1X_What_are_the_key_st...
Anderson, K.L. (1995). The effect of chronic obstructive pulmonary disease on quality of life. <i>Research in Nursing and Health, 18</i>, 547-556.
Andresen, E.M., Carter, W.B., Malmgren, J.A., & Patrick, D.L. (1994). Screening for depression in well older adults: Evaluation of a short form of the CES-D (Center for Epidemiologic Studies Depression Scale). <i>American Journal of Preventive Medicine, 10</i>, 77-84.
Bacon, C.G., Giovannucci, E., Testa, M., & Kawachi, I. (2001). The impact of cancer treatment on quality of life outcomes for patients with localized prostate cancer. <i>Journal of Urology, 166</i>, 1804-1810.
Braslis, K.G., Santa-Cruz, C., Brickman, A.L., & Solloway, M.S. (1994). Quality of life 12 months after radical prostatectomy. <i>British Journal of Urology, 75</i>, 48-53.
Burckhardt, C.S. (1985). The impact of arthritis on quality of life. <i>Nursing Research, 34</i>, 11-16.
Burckhardt, C.S., Woods, S.L., Schultz, A.A., & Ziebarth, D.M. (1989). Quality of life of adults with chronic illness: A psychometric study. <i>Research in Nursing and Health, 12</i>, 347-354.
Campbell, A., Converse, P.E., & Rodgers, W.L. (1976). <i>The quality of American life.</i> New York: Russell Sage Foundation.
Catalona, W.J., & Bigg, S.W. (1990). Nerve-sparing radical prostatectomy: Evaluation of results after 250 patients. <i>Journal of Urology, 143</i>, 538-544.
Conn, V.S., Taylor, S.G., & Abele, P.B. (1991). Myocardial infarction survivors: Age and gender differences in physical health, psychosocial state and regimen adherence. <i>Journal of Advanced Nursing, 16</i>, 1026-1034.
Davis, J.W., Kuban, D.A., Lynch, D.F., & Schellhammer, P.F. (2001). Quality of life after treatment for localized prostate cancer: Differences based on treatment modality. <i>Journal of Urology, 166</i>, 947-952.
Diener, E. (1984). Subjective well-being. <i>Psychological Bulletin, 95</i>, 542-575.
Diener, E., & Diener, M. (1995). Cross-cultural correlates of life satisfaction and self-esteem. <i>Journal of Personality and Social Psychology, 68</i>, 653-663.
Engberg, S. (1998, January). <i>The prevalence and characteristics of urinary incontinence following radical prostatectomy.</i> Paper presented at the meeting of the Fourth Multi-Specialty Nursing Conference on Urinary Continence, Orlando, FL.
Flanagan, J.C. (1978). A research approach to improving our quality of life. <i>American Psychologist, 33</i>, 138-147.
Fowler, F.J., Jr., Barry, M.J., Lu-Yao, G., Wasson, J., Roman, A., Wennberg, J., et al. (1995). Effect of radical prostatectomy for prostate cancer on patient quality of life: Results from a Medicare survey. <i>Urology, 45</i>, 1007-1014.
Gburek, B., Harmon, B., & Chodak, G.W. (1992). Quality of life assessment in patients with prostate cancer treated by radical prostatectomy, radiation therapy, or a combination [Abstract]. <i>Journal of Urology, 147</i>, 466A.
Godding, P.R., McAnulty, R.D., Wittrock, D.A., Britt, D.M., & Khansur, T. (1995). Predictors of depression among male cancer patients. <i>Journal of Nervous and Mental Disease, 183</i>, 95-98.
Goodwin, J.S., Hunt, W.C., & Samet, J.M. (1991). A population-based study of functional status and social support networks of elderly patients newly diagnosed with cancer. <i>Archives of Internal Medicine, 151</i>, 366-370.
Gregoire, I., Kalogeropoulos, D., & Corcos, J. (1997). The effectiveness of a professionally led support group for men with prostate cancer. <i>Urologic Nursing, 17</i>(2), 58-66.
Guidry, J.J., Aday, L.A., Zhang, D., & Winn, R.J. (1997). The role of informal and formal social support networks for patients with cancer. <i>Cancer Practice, 5</i>, 241-246.
Guillory, J.A. (1996). <i>Relationships of selected physiological, psychosocial and spiritual variables associated with survivorship in socioeconomically disadvantaged African American women with breast cancer.</i> Unpublished doctoral dissertation, Medical College of Georgia, Augusta.
Herr, H.W. (1994). Quality of life of incontinent men after radical prostatectomy. <i>Journal of Urology, 151</i>, 652-654.
Heyman, E.N., & Rosner, T.T. (1996). Prostate cancer: An intimate view from patients and wives. <i>Urologic Nursing, 16</i>(2), 37-44.
Hickson, J., Housley, W.F., & Boyle, C. (1988). The relationship of locus of control, age, and sex to life satisfaction and death anxiety in older persons. <i>International Journal of Aging and Human Development, 26</i>, 191-199.
Hong, S.M., & Giannakopoulos, E. (1994). The relationship of satisfaction with life to personality characteristics. <i>Journal of Psychology, 128</i>, 547-558.
Howe, R.J. (1994). Prostate cancer: A patient's perspective. <i>Journal of Urology, 152</i>, 1700-1703.
Kinney, W.B., & Coyle, C.P. (1992). Predicting life satisfaction among adults with physical disabilities. <i>Archives of Physical Medicine and Rehabilitation, 73</i>, 863-869.
Kornblith, A.B., Herr, H.W., Ofman, U.S., Scher, H.I., & Holland, J.C. (1994). Quality of life of patients with prostate cancer and their spouses. <i>Cancer, 73</i>, 2791-2801.
Krause, N. (1990). Perceived health problems, formal/informal support, and life satisfaction among older adults. <i>Journals of Gerontology, 45</i>(5), S193-S205.
Krongrad, A., Granville, L.J., Burke, M.A., Golden, R.M., Lai, S., Cho, L., et al. (1997). Predictors of general quality of life in patients with benign prostate hyperplasia or prostate cancer. <i>Journal of Urology, 157</i>, 534-538.
Krupski, T., Petroni, G.R., Bissonette, E.A., & Theodorescu, D. (2000). Quality of life comparison of radical prostatectomy and interstitial brachytherapy in the treatment of clinically localized prostate cancer. <i>Urology, 55</i>, 736-742.
Laborde, J.M., & Powers, M.J. (1985). Life satisfaction, health control orientation, and illness-related factors in persons with osteoarthritis. <i>Research in Nursing and Health, 8</i>, 183-190.
Lane, C.D. (1991). <i>Anger, social support, and illness symptoms: Their interrelationships among persons with chronic obstructive pulmonary disease.</i> Unpublished doctoral dissertation, Kent State University, Kent, OH.
Leandri, P., Rossignol, G., Gautier, J.R., & Ramon, J. (1992). Radical retropubic prostatectomy: Morbidity and quality of life. Experience with 620 consecutive cases. <i>Journal of Urology, 147</i>, 883-887.
Levitt, M.J., Clark, M.C., Rotton, J., & Finley, G.E. (1987). Social support, perceived control, and well-being: A study of an environmentally stressed population. <i>International Journal of Aging and Human Development, 25</i>, 247-258.
Lewis, F.M. (1982). Experienced personal control and quality of life in late-stage cancer patients. <i>Nursing Research, 31</i>, 113-119.
Lim, A.J., Brandon, A.H., Fiedler, J., Brickman, A.L., Boyer, C.I., Raub, W.A., Jr., et al. (1995). Quality of life: Radical prostatectomy versus radiation therapy for prostate cancer. <i>Journal of Urology, 154</i>, 1420-1425.
Litwin, M.S., Hays, R.D., Fink, A., Ganz, P.A., Leake, B., Leach, G.E., et al. (1995). Quality-of-life outcomes in men treated for localized prostate cancer. <i>JAMA, 273</i>, 129-135.
Nunnally, J.C. (1978). <i>Psychometric theory</i> (2nd ed.). New York: McGraw-Hill.
Patrick, D.L., & Erickson, P. (1993). <i>Health status and health policy.</i> New York: Oxford University Press.
Pedersen, K.V., Carlsson, P., Rahmquist, M., & Varenhorst, E. (1993). Quality of life after radical retropubic prostatectomy for carcinoma of the prostate. <i>European Urology, 24</i>, 7-11.
Pedhazur, E.J. (1982). <i>Multiple regression in behavioral research: Explanation and prediction</i> (2nd ed.). New York: Holt, Rinehart, and Winston.
Perez, M.A., Skinner, E.C., & Meyerowitz, B.E. (2002). Sexuality and intimacy following radical prostatectomy: Patient and partner perspectives. <i>Health Psychology, 21</i>, 288-293.
Polit, D., & Hungler, B. (1995). <i>Nursing research: Principles and methods</i> (5th ed.). Philadelphia: Lippincott.
Polit, D.F. (1996). <i>Data analysis and statistics for nursing research.</i> Stamford, CT: Appleton and Lange.
Quinlan, D.M., Epstein, J.I., Carter, B.S., & Walsh, P.C. (1991). Sexual function following radical prostatectomy: Influence of preservation of neurovascular bundles. <i>Journal of Urology, 145</i>, 998-1002.
Rieker, P., Clark, J., Kalish, L., Coleman, N., Talcott, J., Weeks, J., et al. (1993). Health-related quality of life following treatment for early stage prostate cancer [Abstract]. <i>Proceedings of the American Society of Clinical Oncology, 12</i>, 452a.
Rieker, P.P. (1996). How should a man with testicular cancer be counseled and what information is available to him? <i>Seminars in Urologic Oncology, 14</i>, 17-22.
Rosenberg, M. (1965). <i>Society and the adolescent self-image.</i> Princeton, NJ: Princeton University Press.
Rossetti, S.R., & Terrone, C. (1996). Quality of life in prostate cancer patients. <i>European Urology, 30</i>(Suppl. 1), 44-48.
Rossignol, G., Leandri, P., Gautier, J.R., Quintens, H., Gabay-Torbiero, L., & Tap, G. (1991). Radical retropubic prostatectomy: Complications and quality of life (429 cases, 1983-1989). <i>European Urology, 19</i>, 186-191.
Rotter, J.B. (1966). Generalized expectancies for internal versus external control of reinforcement. <i>Psychological Monographs, 80</i>(1), 1-28.
Seligman, M.E. (1973). Fall into helplessness. <i>Psychology Today, 15</i>(1), 43-48.
Shrader-Bogen, C.L., Kjellberg, J.L., McPherson, C.P., & Murray, C.L. (1997). Quality of life and treatment outcomes: Prostate carcinoma patients' perspectives after prostatectomy or radiation therapy. <i>Cancer, 79</i>, 1977-1986.
Smith, A.D. (1981). Causes and classification of impotence. <i>Urologic Clinics of North America, 15</i>, 79-89.
Spielberger, C.D. (1996). <i>State-trait anger expression inventory professional manual.</i> Tampa, FL: Psychological Assessment Resources.
Steineck, G., Helgesen, F., Adolfsson, J., Dickman, P.W., Johansson, J., Norlen, B.J., et al. (2002). Quality of life after radical prostatectomy or watchful waiting. <i>New England Journal of Medicine, 347</i>, 790-796.
Steiner, M.S., Morton, R.A., & Walsh, P.C. (1991). Impact of anatomical radical prostatectomy on urinary continence. <i>Journal of Urology, 151</i>, 512-515.
Strauss, B., Paulsen, G., Strenge, G., Graetz, S., Regensburger, D., & Speidel, H. (1992). Preoperative and late postoperative psychosocial state following coronary artery bypass surgery. <i>Thoracic and Cardiovascular Surgeon, 40</i>(2), 59-64.
U.S. Census Bureau. (2000). Demographic profiles: 100-percent and sample data. Retrieved December 18, 2002, from <a target="_blank" href='http://www.census.gov/Press-Release/www/2002/demoprofiles.html'>http://w...
Wagner, G., & Green, R. (1981). <i>Impotence.</i> New York: Plenum Press.
Walfisch, S., Maoz, B., & Antonovsky, H. (1984). Sexual satisfaction among middle-aged couples: Correlation with frequency of intercourse and health status. <i>Maturitas, 6</i>, 285-296.
Wallston, K.A., Wallston, B.S., & DeVillis, R. (1978). Development of the Multidimensional Health Locus of Control (MHLC) Scales. <i>Health Education Monographs, 6</i>, 160-170.
Walsh, P.C., & Donker, P.J. (1982). Impotence following radical prostatectomy: Insight into etiology and prevention. <i>Journal of Urology, 128</i>, 492-497.
Walsh, P.C., & Partin, A.W. (1994). Treatment of early stage prostate cancer: Radical prostatectomy. In V.T. DeVita, S. Hellman, & S.A. Rosenberg, (Eds.) <i>Important advances in oncology</i> (pp. 211-223). Philadelphia: Lippincott.
Walsh, P.C., Partin, A.W., & Epstein, J.I. (1994). Cancer control and quality of life following anatomical radical retropubic prostatectomy: Results at 10 years. <i>Journal of Urology, 152</i>, 1831-1836.
Wei, J.T., Dunn, R.L., Sandler, H.M., McLaughlin, P.W., Montie, J.E., Litwin, M.S., et al. (2002). Comprehensive comparison of health-related quality of life after contemporary therapies for localized prostate cancer. <i>Journal of Clinical Oncology, 20</i>, 557-566.
Weinert, C. (1987). A social support measure: PRQ85. <i>Nursing Research, 36</i>, 273-277.
Weinert, C., & Brandt, P.A. (1987). Measuring social support with the Personal Resource Questionnaire. <i>Western Journal of Nursing Research, 9</i>, 589-602.
Wingate, S. (1995). Quality of life for women after a myocardial infarction. <i>Heart and Lung, 24</i>, 467-473.
Young, K.J., & Longman, A.J. (1983). Quality of life and persons with melanoma: A pilot study. <i>Cancer Nursing, 6</i>, 219-225.