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Keywords:

  • prostatic neoplasms;
  • quality of life;
  • psychology;
  • psychologic adaptation;
  • coping behavior;
  • affect;
  • personality;
  • well-being

Abstract

  1. Top of page
  2. Abstract
  3. Purpose of the Current Study
  4. MATERIALS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. Acknowledgements
  8. REFERENCES

BACKGROUND

Despite growing numbers of prostate cancer (PCa) survivors, to the authors' knowledge there is little research regarding how personality, coping, and treatment influence men's psychologic well-being, as distinct from the often-studied functional, health-related quality of life. The purpose of this study was to examine how hope, optimism, use of coping strategies, and primary treatment predict well-being, positive and negative affect, impact, depression, and adaptive changes among PCa survivors.

METHODS

A questionnaire tapping personality, primary treatment, and coping strategy predictor variables and outcome variables of both positive and negative aspects of well-being was sent to 1–8-year PCa survivors. The final sample included 490 men.

RESULTS

Basic univariate analyses demonstrated that the men reported being happy, hopeful, and positive, with low levels of negative outcomes. Regression analyses demonstrated that positive outcomes were influenced primarily by personality. Negative outcomes were found to be affected by both personality and coping strategies. Adaptive changes were the only ones found to be significantly affected by primary treatment.

CONCLUSIONS

Although longer-term survivorship of PCa does not appear to be a highly traumatic experience, personality factors and the use of coping strategies years after treatment were found to introduce variability to well-being in complex ways, differing in relation to positive and negative outcomes. Clinical attention should be given to how the experience of cancer fits within the larger context of an individual's attitudes, choices, and coping strategy orientation. Cancer 2006. © 2006 American Cancer Society.

More than 230,000 men in the U.S. were expected to be diagnosed with prostate cancer (PCa) in 2005, joining approximately 1.4 million men already diagnosed.1 Due to advancements in detection and treatment and the slow-growing nature of PCa, most men live for decades after diagnosis. Consequently, understanding and addressing PCa survivors' “long-term” quality of life (QOL) has increasing importance to survivors, their families, and the U.S. healthcare system.

Considerable research exists on both functional and general health-related quality of life (HRQOL) after diagnosis and treatment for PCa.2–9 Several of these studies have examined treatment group differences in prostate-specific HRQOL.2, 3, 8 In general, men who go through radical prostatectomy report more urinary and sexual dysfunction compared with men who undergo radiation therapy, whereas men who undergo external beam radiation experience more bowel dysfunction. Compared with non-PCa controls, the PCa group is either equal to or better than the controls on more general aspects of QOL, such as depression and overall happiness. With few exceptions, most studies focus on the first year or possibly the first 2 years after diagnosis and treatment, and therefore reflect treatment effects more than the experience of having cancer.

How men do in these functional HRQOL outcomes is critical, because the treatment side effects represent a major source of distress and concern for PCa survivors, and therefore those studies are extremely important and useful. However, to our knowledge, much less is known regarding men's longer-term issues or regarding more psychologically based QOL having to do with the experience of being a cancer survivor. One study that examined this issue explored the predictive value of sexual, urinary, and bowel dysfunction on QOL after the diagnosis and treatment of prostate cancer.2 Not surprisingly, this study found that men who reported dysfunction in any of these areas reported lower levels of mental and social functioning. Other studies that address the mental and psychologic QOL of survivors exist, but the majority use the higher-order mental health component of the Medical Outcomes Study 36 Item Short Form (SF-36), which is comprised of measures of vitality, social functioning, role limitations, and mental health, and/or levels of depression (often the Center for Epidemiological Studies Depression [CES-D] scale) as the measure of psychologic QOL.10, 11 These scales capture an important part of mental health QOL and depressive reactions are sources of concern for men dealing with PCa, but we suggest a complementary perspective that evaluates the “work” of personality processes or the subjective global evaluation. In other words, in this study, psychologic well-being is viewed as the aggregation of the ways men view their lives in relation to having had PCa. Several important QOL domains, such as men's current affective states and adaptive lifestyle changes, as well as depressive symptoms, were examined. Considering such outcome variables can be an important complement to the functionally oriented HRQOL research.

In addition, most previous studies have been limited to nonpsychological factors such as treatment modalities and disease characteristics as predictor variables, with too little attention paid to personality factors and coping styles. In a broader sense, recognition of the importance of personality and behavioral factors in relation to QOL, including with cancer, has grown in recent years.12–16 There is some evidence that positive psychologic adjustment and personality factors may be related to better immune functioning.16 It is theoretically and conceptually plausible that the above benefits also apply to men with PCa, but to our knowledge, to date they have not been examined in this population.

Treatment modality can have profound physical consequences for men, including erectile dysfunction, urinary incontinence, and bowel incontinence.4, 17–19 Although the extent of side effects varies both by characteristics of the men and treatment modality, every modality contains a significant risk of problems in 1 or more of those areas. Whereas the longer-term impact of the side effects resulting from decisions are often not as deleterious as may be expected,4, 5 it is not clear how men successfully compartmentalize the negative aspects of those side effects and report high QOL within a relatively short time after diagnosis. Therefore, more research is needed concerning the role of preexisting personality factors as interacting with disease characteristics in influencing outcomes. Finally, it is important to consider both positive and negative psychologic outcomes beyond functional HRQOL.

Purpose of the Current Study

  1. Top of page
  2. Abstract
  3. Purpose of the Current Study
  4. MATERIALS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. Acknowledgements
  8. REFERENCES

The current study examined men's psychologic well-being and adaptive lifestyle changes after a diagnosis of PCa, specifically the influence of personality factors, coping strategies, and primary treatment on happiness/subjective well-being, positive and negative affect, depression, impact of events, and adaptive life changes. We expected personality and coping strategies to influence men's self-reported scores on the outcome variables, although the direction of patterns are dependent on individual factors. We also investigated whether primary treatment (radical prostatectomy or external beam radiation therapy) would have an impact on outcomes.

MATERIALS AND METHODS

  1. Top of page
  2. Abstract
  3. Purpose of the Current Study
  4. MATERIALS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. Acknowledgements
  8. REFERENCES

Participants

Participants were 490 men diagnosed with PCa between 1-8 years previously. The mean time since diagnosis was 46.7 months (median, 42.0 months). This time period was chosen to represent a time after the initial adjustment and stabilization of physical effects and to provide a complement to both the vast majority of studies that focus on 1 or 2 years after treatment and the few studies concerning long-term survivorship, which by definition of the Office of Cancer Survivorship is 5 years or more after treatment.20 Approximately 51% of the study participants underwent radical prostatectomy as their primary treatment, 42% received radiation, and 3% were treated with hormones. All but 16% of the men had initial prostate-specific antigen (PSA) scores between 4 and 20, in a moderate range slightly above the customary unit of 4 between normal and elevated whereas approximately 75% who reported an initial Gleason score (many participants did not know their Gleason score) had Gleason scores of 5, 6, or 7. Both of those characteristics indicate for the most part relatively nonaggressive disease in the sample. Nearly 25% of participants reported either rising PSA after treatment or secondary treatment.

The mean age of the patients at time of study participation was 69.7 years (standard deviation [SD] of 7.85; range, 49-88 years). Approximately 94% of the sample was white, 3% were African American, and 1% were Hispanic.

Measures

Mastery

Mastery, or sense of control, is an important variable in how people respond to life events and life circumstances. The MIDI Control Scale21 has 2 subscales, Mastery and Constraints. For this study, only the Mastery subscale was used. Typical questions in this 7-item subscale include: “To a great extent my life is controlled by accidental happenings,” and “I can pretty much accomplish anything I want to.” The Mastery subscale has exhibited good reliability. To our knowledge it has not been used previously with cancer samples.

Optimism and hope

Scheier et al.22, 23 developed the Life Orientation Test as a measure of optimism and found it to be a major contributor to variation in coping and adaptation. The LOT-R is a 6-item scale including items such as: “In uncertain times, I usually expect the best.” The scale has exhibited good reliability and validity in use with chronically ill populations, including cancer.24, 25 Similarly, Snyder et al.26 developed the Hope Scale, a 12-item measure. An example of items is: “I can think of ways to get out of jams.” The Hope scale is divided into Hope-agency and Hope-pathways, the former related more to one's own sense of power and the latter to the sense of presence of obstacles or facilitators. They and other researchers have shown both validity and reliability for this measure. Because both these measures are brief and appear to tap into somewhat different factors, both were used.24, 26

Coping strategies

This study measured coping strategies using the Brief COPE scale of Carver et al.27 Participants rate how they are currently coping with the stress in their life associated with cancer. Examples of questions are: “I've been concentrating my efforts on doing something about the situation I am in,” or “I have been using alcohol or drugs to make myself feel better.” Response choices range from “I haven't been doing this at all,” to “I have been doing this a lot.” The Brief COPE consists of 28 items grouped into 14 conceptually distinct subscales. The subscales include active coping, planning, suppression of competing activities, restraint coping, seeking instrumental social support, seeking emotional social support, positive reinterpretation, acceptance, turning to religion, focus on venting of emotions, denial, behavioral disengagement, mental disengagement, and alcohol and drug use. These subscales have acceptable α reliabilities, with 11 of the 14 subscales exceeding .60, whereas the remaining 3 subscales (venting, denial, and acceptance) exceed .50.27 The Brief COPE subscales were based on functional and potentially less useful properties of coping strategies. Therefore, as recommended by Carver, factor analysis was used to create higher-order factors from the subscales of the Brief COPE empirically within our data in an effort to capture adaptive versus maladaptive styles of coping as they relate to psychologic well-being.28

The adaptive category includes such subscales as active coping, seeking emotional and instrumental support, planning, and the maladaptive or escapist coping one includes subscales such as denial and use of drugs and alcohol. Factor loadings for the active adaptive strategies ranged from .494 to .707 and from .420 to .564 for maladaptive or escapist coping. These 2 factors will be used in all analyses discussed below, referred to as “adaptive coping” and “escapist coping.”

Primary treatment

Primary treatment and different physical and emotional consequences of different treatments are hypothesized to play a role in men's psychologic health. Therefore, respondents were asked to indicate the type of primary treatment they received. Because 95% of cases used either surgery or radiation (primarily external beam radiation and some brachytherapy), the analysis was limited to surgery versus radiation. Although originally the analysis was to include PSA at diagnosis and Gleason grade as indicators of severity, the PSA variable had insufficient variation, and many men did not know what their Gleason grade had been; therefore, those were not included. In addition, recurrence was originally included. It only demonstrated scattered relations with outcome variables, and because of that and the ambiguity with regard to the best definition of recurrence, it was not included as a variable in the analyses.29

Subjective well-being/happiness

Well-being or happiness is often measured objectively or conceptualized as HRQOL.11, 30 The current study focused on subjective well-being. Although existing multiitem scales provide more precise measurement, a single-item happiness measure is relatively highly correlated with more extensive measures and appropriate for indicating a global sense of well-being for the purposes of group comparisons.31, 32 Therefore, the current study used a single item. Respondents were asked to rate their current overall happiness on a Likert scale, ranging from “1,” indicating “very happy” to “5,” indicating “very unhappy.”

Negative and positive affect

The Positive and Negative Affect Schedule (PANAS) was created to measure affect, both positive and negative.33 Participants rate the degree they currently experience the moods using a 5-point Likert scale with “1” being “not at all” and “5” “very much.” This scale contains 20 descriptive mood adjectives such as scared, proud, hostile, and inspired. High positive affect includes high energy, full concentration, and pleasurable engagement, whereas negative affect includes subjective distress, unpleasurable engagement, and aversive mood states such as anger and fear. Potential maxima are 75 for positive affect and 63 for negative affect. This scale has been used and validated with cancer populations.34

Depression

The CES-D scale is a 20-item scale used regularly in research on cancer adjustment.35 Respondents choose from 4 possible responses in a Likert format, in which “0” is “rarely or none of the time” and “3” is “almost or all of the time.” Scores range from 0 to 60, with higher scores reflecting greater levels of depressive symptoms. The CES-D has very good internal consistency, with α values of .85 for cancer populations.36

Impact of events

The Impact of Events Scale (IES) is a 15-item questionnaire designed to identify the degree to which persons who have experienced a negative life event continue to experience intrusive thoughts and/or avoidance after the event.37–39 Respondents indicate frequency of response identified in the question; such as “I had strong feelings about it.” Each item is scored as “0” = “not at all”; “1” = “rarely”; “3” = “sometimes”; and “5” = “often”. Scores can range from 0 to 75. It exhibits high reliability and validity and has been used in numerous studies related to illness, including cancer.38, 40

Adaptive changes

This scale was developed for this research and measures adaptive changes by asking a set of 9 closed-ended questions that examined changes in diet, exercise, vitamins, potency-related aids, pace of life, etc. Respondents were asked to indicate whether they had made changes in the above areas, after their diagnosis, and to what degree. Possible response choices ranged from “3” being “changed dramatically” to “0” being “didn't change at all.” For this study, scores are reported in aggregate form to represent a global adaptive change measure (potential range from 0-27). The Cronbach α for this scale was .81. Higher scores represent more change.

Procedures

Power analyses were conducted to determine necessary sample size for both descriptive and regression analysis aspects of the study. Using conservative estimation of effect sizes and 80% power, those indicated a size between 351 and 396 as sufficient. To ensure at least those numbers based on a relatively low response rate estimation, questionnaires were mailed to 1500 PCa survivors from a Connecticut metropolitan tertiary care hospital cancer registry. The registry worked back from the most recent entries until 1500 were obtained. A total of 490 responses represent a 34% reply rate of a potential 1430 (70 were returned as undeliverable). Participants represent a fairly wide range of PCa survivors. In keeping with current characteristics, most were diagnosed relatively early in PCa progression. The goal of having men in a survivorship phase after stabilization and the sampling procedures and database characteristics resulted in time since diagnosis ranging from 1 year to 8 years.

The study was approved by the Institutional Review Boards at both the University of Connecticut and Hartford Hospital. Potential participants were sent a packet containing introductory letters from the director of the hospital's cancer center and the principal investigator explaining the purpose of the study and the safeguards for confidentiality. The questionnaire including both demographic questions and the battery of scales, a consent form, and 2 stamped return envelopes. To maximize anonymity, the Cancer Registry mailed out the questionnaires directly and participants were asked to send the consent form in a separate envelope and not to provide names or any other identifiable information on the questionnaire itself, which was mailed directly to the researchers. Therefore, researchers had no access to participant names and Cancer Registry staff had no access to returned questionnaires.

Analytic Methods

Univariate statistics were used to summarize the demographic and clinical characteristics of the sample. To examine overall well-being, we looked at group means, SDs, and distribution (percentages) of predictor and well-being outcome scores. Multivariate linear models were used to examine the association between treatment, personality, and coping on the 6 outcome measures of well-being. Partial correlations and P-values derived from Student t-tests were then examined and used as an indicator of the strength of relation between each individual predictor and the outcomes. A Bonferroni correction was used (0.05/6 = 0.008) to determine which associations were unlikely to be the result of chance alone. Multicollinearity in multivariate regression analysis was tested using variance inflation factors; all were less than 2.0.

RESULTS

  1. Top of page
  2. Abstract
  3. Purpose of the Current Study
  4. MATERIALS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. Acknowledgements
  8. REFERENCES

Overall Well-Being

In general, 1 to 8 years after diagnosis, the men in the current study self-reported doing well in terms of psychologic well-being. In fact, 90.7% reported being either somewhat or very happy (57.9% very), and only 2.7% somewhat or very unhappy. In addition, they were found to be generally hopeful and positive, and reported low levels of depression (mean [X] = 7.38 [SD of 7.03]), negative impact of the event (X = 10.31 [SD of 10.30]), and negative affect (X = 22.78 [SD of 6.76]), and high levels of happiness (X = 1.55 [SD of 0.76]) and positive affect (X = 52.58 [SD of 10.10]). In fact, scores on depression were found to be lower in this group than national norms for this age group,41 and nearly 20% of participants reported no impact on any of the IES items. On average, they had made some adaptive changes, but not to a high degree (X = 8.04 [SD of 5.38]).

Predicting Function

A series of multiple regression analyses were conducted to examine whether primary treatment (surgery or radiation), personality factors (mastery, hope agency and pathways, optimism), and use of coping strategies (adaptive and escapist) influence men's self-reported scores on happiness, positive affect, negative affect, impact of events, depression, and adaptive changes. For these analyses, the highest number of cases was 454 rather than the total of 490 because we limited our analyses of treatment to surgery or radiation. Although predictors could be grouped into several major categories (e.g., personality factors, coping strategies, and treatment), because we were not testing specific hypothesized relations we entered all predictor variables simultaneously and then inspected partial correlations and P-values derived from Student t-tests to determine the strengths of relations.

In Table 1 we present partial correlations between the relative predictors and the 6 mental health outcomes. The set of factors explained a moderate amount of the variance in happiness (adjusted correlation [R]2 = 0.274, F(7,431) = 24.62 [P <.001]), a high amount of variance in positive affect (adjusted R2 = 0.449; F(7,425) = 51.21 [P <.001]), a moderate amount of variance in negative affect (adjusted R2 = 0.233, F(7,424) = 19.68 [P <.001]), a high degree of variance in depression (adjusted R2 = 0.360, F(7,431) = 36.15 [P <.001]), a moderate amount of variance with regard to the impact of events measure (adjusted R2 = 0.264, F(7,385) = 23.46 [P <.001]), and a modest amount of variance in adaptive changes (adjusted R2 = 0.194, F(7,426) = 15.90 [P <.001]). Happiness and positive affect were both predicted by hope-agency and optimism, with mastery also found to be a significant predictor of positive affect and escapist coping of happiness. Negative measures of negative affect, depression, and impact of events were most clearly predicted by the 2 types of coping measures, with some less consistent impact of optimism and hope-agency. The behavior-oriented measure of adaptive changes was the only one predicted by the treatment characteristic of surgery versus radiation.

Table 1. Partial Correlations of the Predictors with Health Outcomes
 HappinessPositive AffectNegative AffectImpact of EventsDepressionAdaptive Change
  • All P values were derived from Student t tests.

  • *

    P < .05.

  • P < .01.

  • P < .001.

Surgery−.035−.011−.004−.013−.013.151
Mastery−.038.193−.072−.025−.063.077
Hope agency.166.316−.119*−.017−.195.036
Hope pathways.040.059.061.028−.010.025
Optimism.337.267−.188−.098*−.255−.052
Adaptive coping.054−.039.233.421.207.403
Escapist coping−.157−.110*.223.222.276−.036

These analyses show that positive mental health outcomes are primarily influenced by personality, whereas negative mental health outcomes are affected by both personality and coping strategies, especially the latter. The likelihood of making adaptive changes was not found to be related to either, except for the closely related aspect of adaptive coping.

DISCUSSION

  1. Top of page
  2. Abstract
  3. Purpose of the Current Study
  4. MATERIALS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. Acknowledgements
  8. REFERENCES

The current study offers insight into the longer-term psychological effects of PCa survivorship. At least among a set of men at 1 year to 8 years after diagnosis and treatment, this has not been a highly traumatic event. Scores on depression and, especially, the trauma-related impact of events measure indicated a group of men who were not traumatized for the long term by having had and been treated for PCa. This finding is similar to other studies of long-term cancer survivors, including those with PCa.3–7, 10, 11 We can offer several speculative explanations for this finding. First, it is plausible that men who are diagnosed and treated early take comfort in knowing that there is a relatively low likelihood of recurrence and a very low likelihood of dying from PCa as long as 15 years to 20 years after diagnosis, if ever. Therefore, once treated, many men consider the disease taken care of and do not spend much time thinking about it. It should be noted that the sample does not have a large number of patients with either very low or very high PSAs or Gleason scores. Men with more extreme prognostic factors may exhibit significantly greater distress years after diagnosis. Conversely, this distribution of severity of disease at diagnosis is very similar to that of recently diagnosed and treated men, and therefore the results are likely to be indicative of the longer-term experiences of most men diagnosed with PCa.

Another plausible explanation for the generally high well-being is that having PCa with the disease characteristics noted earlier may not be as powerful an influence on mental health as other normative or nonnormative life events that late middle-age and older men may be facing. For example, Bellizzi42 found that some cancer survivors who reported little positive or negative impact by the disease were dealing with vision losses associated with aging, recent loss of a loved one, and other more traumatic life events. There are also indications in the data from the current that this group of men felt other life experiences to have had more impact on their senses of well-being (unpublished data).43

One striking aspect of the results of the current study is the lack of strong correlations between treatment and these outcomes. Surgery was correlated with making more adaptive changes than radiation, but treatment type was not found to be a significant factor in any positive or negative psychologic outcome. These results are distinct from the greater significance of treatment modality in many studies of HRQOL. Because both treatments have more or less equivalent, high likelihoods of success, the differences in treatments in relation to QOL are likely to be limited to the functional outcomes usually examined, but not these more psychologic outcomes. In addition, the time since treatment beginning a year after diagnosis may of course be a factor in mitigating any treatment-specific impacts.

The major findings in the current regression analyses indicate that the relation of predictor variables to outcome variables is complex; different outcomes are affected by different individual factors and different overall influences. At first glance, these different relations may appear to be simply indicative of wide variability in influence, in which optimism and hope-agency have quite a few significant effects, mastery a few, hope-pathways none, and adaptive and escapist coping a range of effects, occasionally in tandem and other times not. However, on further investigation, several patterns begin to emerge. Both predictor and outcome variables can be grouped, and patterns of those groups of variables to each other investigated. In particular, 4 predictor variables—mastery, optimism, hope-agency, and hope-pathways—are personality variables, whereas adaptive and escapist coping are behavioral strategies, and treatment is a nonpsychologic disease characteristic. On the outcome side, happiness/subjective well-being and positive affect are positive QOL outcomes; depression, impact of events, and negative affect are negative QOL outcomes; and adaptive change is a behavioral response.

It then becomes clear that the different categories of predictors have different effects in relation to different kinds of outcomes. For example, positive outcomes, including positive affect and happiness, are primarily influenced by personality variables, especially optimism. Only escapist coping use is related, with relatively modest negative relations, to both of these variables. Conversely, negative outcomes, including depression, negative affect, and impact of events, are more dominated by strong positive relations to both types of coping, and then negative relations to optimism and little or none with other personality factors.

With respect to the former constellation (personality and positive outcomes), it appears that a personality disposition of being optimistic and, to a lesser degree, hopeful and having a sense of mastery enables men to see the positive side of what is at least initially a highly negative experience. Alternatively, men who report more negative outcomes, such as depression or negative affect, are likely to be those who continue to be affected by the disease years after treatment, and thereby continue to engage in a range of coping strategies to try to attenuate the negative psychological sequelae. Therefore, this use may result in greater attention to the disease, psychologic sequelae, and intensity of effects. These findings suggest that both styles of coping may have positive and negative components. Finally, the outcome of adaptive changes exhibits a considerably different, unique relation, in that it is related positively with adaptive coping but unrelated to escapist and, as noted earlier, is the only outcome related to treatment.

These findings relate to appropriate ways for clinicians to deal with PCa survivors, most of whom are doing very well and therefore are not engaging actively in a great deal of coping. Although active coping years later may support positive behavioral changes, it and escapist coping are both positively related to negative QOL. Other factors, such as personality, prognosis, and other contextual factors, will likely influence the extent and effect of engaging in coping of any form. If the goal is to maximize positive psychologic adaptation, it may be more appropriate to focus on increasing mastery, perceived hopefulness and, especially, optimistic orientation, given their positive relation to positive outcomes and negative relation to negative outcomes.

The current study has certain limitations. Foremost, it was limited by a general homogeneity of background and specifically a lack of racial diversity. Despite efforts to obtain a diverse and representative sample, we were restricted by the actual numbers of African Americans and Hispanics in the Cancer Registry and a low response rate from those populations. The response rate from these 2 groups was 10%, which is low, but somewhat common for these 2 racial groups.44 Likewise, most respondents had relatively high educational and socioeconomic status characteristics. Future research is needed to determine whether these findings are representative of a more diverse group of PCa survivors. In addition, the sample is dominated by men who were diagnosed early and have good prognoses. Although men diagnosed with advanced disease are a relatively small percentage of the population, certainly a study of similar predictors and outcomes is likely to demonstrate more serious disruptions of lives and QOL than portrayed herein. Likewise, the time since diagnosis disallowed very recently diagnosed, and the study was cross-sectional. Again, the purpose of this research was to examine intermediate to longer-term survivorship, so in that sense it fulfilled its purpose. Nevertheless, greater investigation is needed that begins shortly after diagnosis and follows men longitudinally to examine the temporal patterning of influences of PCa treatments, personality factors, and coping strategy use.

Perhaps the most important finding from the current study is that the overall tone of these men's psychologic QOL was skewed distinctly toward the positive. The relatively low level of impact of cancer expressed by the men in this study (and those in the studies by Bellizzi42 and Ganz et al.45) does not mean that PCa does not have any long-term effects. Rather, it indicates that it is particularly important to examine much more directly how the experience of cancer fits into the larger sense of their lives. We believe it is truly heartening in a broader social and QOL sense that, in fact, men who have experienced the trauma and difficulties of PCa and treatment (and the often significant permanent negative effects of that treatment) live lives that are satisfying and that they perceive to be of high quality.

Acknowledgements

  1. Top of page
  2. Abstract
  3. Purpose of the Current Study
  4. MATERIALS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. Acknowledgements
  8. REFERENCES

The authors thank Andrew Salner, MD, Director of the Hartford Hospital Cancer Program, for collaborating during all stages of this study; Deborah Jacques and the staff of the Hartford Hospital Cancer Registry, who assisted in sample selection and mailing; and Ilene Staff, PhD, and anonymous reviewers for comments on an earlier version. We also thank the men who kindly volunteered to participate in this study.

REFERENCES

  1. Top of page
  2. Abstract
  3. Purpose of the Current Study
  4. MATERIALS AND METHODS
  5. RESULTS
  6. DISCUSSION
  7. Acknowledgements
  8. REFERENCES