Comparison of Symptoms, Depression, Intimacy, and Quality of Life According to Treatment Duration in Men with Prostate Cancer Undergoing Androgen Deprivation Therapy

Yoonhee Seok; Eunyoung E. Suh

doi:10.5388/aon.2019.19.3.169

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Seok and Suh: Comparison of Symptoms, Depression, Intimacy, and Quality of Life According to Treatment Duration in Men with Prostate Cancer Undergoing Androgen Deprivation Therapy

Original Article

Asian Oncol Nurs 2019;19(3):169-178.

Published online: 12 September 2019

DOI: https://doi.org/10.5388/aon.2019.19.3.169

Comparison of Symptoms, Depression, Intimacy, and Quality of Life According to Treatment Duration in Men with Prostate Cancer Undergoing Androgen Deprivation Therapy

Yoonhee Seok¹, Eunyoung E. Suh²

^¹College of Nursing, Seoul National University, Seoul

^²College of Nursing, Research Institute of Nursing Science, Seoul National University, Seoul, Korea

Address reprint requests to: Suh, Eunyoung E College of Nursing, Seoul National University, Room No.508, 103, Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: +82-2-740-8484 Fax: +82-2-742-7324 E-mail: esuh@snu.ac.kr

Received 9 August 2019 Revised 16 September 2019 Accepted 18 September 2019

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

This study was conducted to identify the differences in symptoms, depression, intimacy and quality of life (QOL), and the factors influencing QOL in men with prostate cancer undergoing androgen deprivation therapy (ADT).

Methods

This study used a cross-sectional, descriptive research design. Data were collected using a self-report questionnaire from 122 men with prostate cancer undergoing ADT. The data collection period was from November 19, 2018 to February 25, 2019. Data were analyzed using t-tests, χ² tests, Fisher's exact tests, 4-way ANOVA and multiple regression.

Results

The mean age of the men was 70.3±7.3. There were statistically significant differences in urinary, bowel, sexual and hormonal symptoms according to treatment duration (F=23.74, p<.001). Factors influencing QOL explained 55% of the variance (adjusted R²=.55, p<.001). These factors were depression (β=-.52, p<.001), intimacy (β=.23, p=.001), ADT duration (β=-.17, p=.011), economic status middle (β=.23, p=.006), high (β=.29, p=.001) and sleep (β=.15, p=.023).

Conclusion

The study found an association between ADT duration and symptoms, and the factors influencing QOL of participants. It provides a base for future research direction on ADT and patient QOL.

Keywords: Prostatic Neoplasm, Hormone replacement therapy, Depression, Relationship, Quality of life

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Figure 1.

Comparisons of symptoms according to duration of androgen deprivation therapy.

Table 1.

Homogeneity Tests on Participant's Characteristics (N= 122)

Variables	Categories	Total	pre ADT	1∼6M	7∼12M	＞13M	x²/t/F	p
Variables	Categories	n (%) or M ± SD	n (%) or M ± SD	n (%) or M ± SD	n (%) or M ± SD	n (%) or M ± SD	x²/t/F	p
General characteristics	Age* (70.3 ± 7.3)						5.32	.829
	45∼59	7 (5.7)	3 (10.0)	2 (6.7)	1 (3.3)	1 (3.1)
	60∼6970∼79	49 (40.2) 54 (44.3)	13 (43.3)11 (36.7)	11 (36.7)14 (46.7)	14 (46.7)14 (46.7)	11 (34.4)15 (46.9)
	70∼7980	54 (44.3)	11 (36.7)	14 (46.7)	14 (46.7)	15 (46.9)
	≥80	12 (9.8)	3 (10.0)	3 (10.0)	1 (3.3)	5 (15.6)
	Type of living together Alone	1 (0.8)	1 (3.3)	0 (0.0)	0 (0.0)	0 (0.0)	8.22	.143
	Wife	91 (74.6)	21 (70.0)	20 (66.7)	27 (90.0)	23 (71.9)
	Wife and children	30 (24.6)	8 (26.7)	10 (33.3)	3 (10.0)	9 (28.1)
	Perceived economic state						13.72	.028
	High	20 (16.4)	5 (16.7)	9 (30.0)	4 (13.3)	1 (3.1)
	Middle	83 (68.0)	21 (70.0)	20 (66.7)	20 (66.7)	22 (68.8)
	Low	19 (15.6)	4 (13.3)	1 (3.3)	6 (20.0)	9 (28.1)
	Level of education						1.99	.995
	Below elementary school	27 (22.1)	5 (16.7)	7 (23.3)	7 (23.3)	8 (25.0)
	Middle school	19 (15.6)	5 (16.7)	5 (16.7)	4 (13.3)	5 (15.6)
	High school	37 (30.3)	8 (26.7)	9 (30.0)	10 (33.3)	10 (31.3)
	Above college	39 (32.0)	12 (40.0)	9 (30.0)	9 (30.0)	9 (28.1)
	Religion						8.98	.438
	Christian	23 (18.9)	4 (13.3)	6 (20.0)	6 (20.0)	7 (21.9)
	Catholic	16 (13.1)	6 (20.0)	2 (6.7)	1 (3.3)	7 (21.9)
	Buddhism	25 (20.5)	7 (23.3)	5 (16.7)	8 (26.7)	5 (15.6)
	None	58 (47.5)	13 (43.3)	17 (56.7)	15 (50.0)	13 (40.6)
	Employment Yes	47 (38.5)	11 (36.7)	14 (46.7)	10 (33.3)	12 (37.5)	1.25	.782
	No	75 (61.5)	19 (63.3)	16 (53.3)	20 (66.7)	20 (62.5)
	Exercise						2.74	.460
	Yes	80 (65.6)	21 (70.0)	16 (53.3)	20 (66.7)	23 (71.9)
	No	42 (34.4)	9 (30.0)	14 (46.7)	10 (33.3)	9 (28.1)
	Sleeping	122 (100.0)	6.43 ± 1.17	6.57 ± 1.28	6.77 ± 1.28	7.00 ± 1.19	1.25	.293
Health related characteristics	Prostate cancer stage						18.14	.005
	II	48 (39.3)	14 (46.7)	14 (46.7)	13 (43.3)	7 (21.9)
	III	47 (38.5)	15 (50.0)	6 (20.0)	12 (40.0)	14 (43.8)
	IV	27 (22.1)	1 (3.3)	10 (33.3)	5 (16.7)	11 (34.4)
	Gleason score						3.85	.284
	5∼7	47 (38.5)	11 (36.7)	9 (30.0)	16 (53.3)	11 (34.4)
	≥⁸	75 (61.5)	19 (63.3)	21 (70.0)	14 (46.7)	21 (65.6)
	Treatment						24.83	.001
	OP RT	67 (54.9) 6 (4.9)	23 (76.7) 0 (0.0)	18 (60.0) 1 (3.3)	10 (33.3) 4 (13.3)	16 (50.0) 1 (3.1)
	RT	6 (4.9)	0 (0.0)	1 (3.3)	4 (13.3)	1 (3.1)
	OP+RT None	13 (10.7) 36 (29.5)	0 (0.0) 7 (23.3)	0 (0.0)11 (36.7)	8 (26.7) 8 (26.7)	5 (15.6)10 (31.3)
	None Past history (multiple answer) Hypertension	36 (29.5) 45 (36.9)	7 (23.3)11 (36.7)	11 (36.7)11 (36.7)	8 (26.7)11 (36.7)	10 (31.3)12 (37.5)	0.07	1.000
	Hypertension Diabetes	45 (36.9) 13 (10.7)	11 (36.7) 3 (10.0)	11 (36.7) 4 (13.3)	11 (36.7) 2 (6.7)	12 (37.5) 4 (12.5)	0.070.97	1.000.917
	Diabetes	13 (10.7)	3 (10.0)	4 (13.3)	2 (6.7)	4 (12.5)	0.97	.917
	Hyperlipidemia Osteoporosis	10 (8.2) 3 (2.5)	2 (6.7) 0 (0.0)	3 (10.0) 2 (6.7)	2 (6.7) 0 (0.0)	3 (9.4) 1 (3.1)	0.562.92	1.000.465
	Osteoporosis Others	3 (2.5) 32 (26.2)	0 (0.0) 4 (13.3)	2 (6.7) 9 (30.0)	0 (0.0)10 (33.3)	1 (3.1) 9 (28.1)	2.923.83	.465.298
	Others	32 (26.2)	4 (13.3)	9 (30.0)	10 (33.3)	9 (28.1)	3.83	.298
	None	45 (36.9)	16 (53.3)	9 (30.0)	11 (36.7)	9 (28.1)	5.15	.161
	Treatment duration (month)	12.7 ± 16.4	0.0 ± 0.0	4.4 ± 1.7	10.8 ± 1.6	34.3 ±18.4	81.1 ＜.001	<.001

ADT= Androgen de eprivation therapy; M= Month, OP= Operation; RT= Rad diotherapy.

Table 2.

Descriptive Statistics of Symptoms, Depression, Intimacy, and Quality of Life (N= 122)

Categories	Possible range	Min∼Max	M ± SD	n (%)	Range of scale
Symptoms	0∼100	55.00∼92.50	72.31 ± 8.52		0∼100
Urinary domain		37.50∼100.00	85.10 ± 14.27
Function		13.40∼100.00	90.06 ± 18.11
Bother		32.14∼100.00	81.56 ± 14.74
Incontinence		0∼100	85.17 ± 25.05
Irritation/obstruction		42.86∼100.00	88.06 ± 12.61
Bowel domain		73.21∼100.00	97.95 ± 4.50
Function		71.43∼100.00	97.80 ± 5.14
Bother		75.00∼100.00	98.10 ± 4.41
Sexual domain		0∼75	25.23 ± 16.66
Function		0∼65.78	9.26 ± 16.32
Bother		0∼100	61.17 ± 36.73
Hormonal domain Function		31.82∼100.00 10∼100	81.35 ± 18.63 76.11 ± 23.81
Function		10∼100	76.11 ± 23.81
Bother		50∼100	85.72 ± 15.33
Depression	0∼60	0∼32	11.89 ± 6.75		0∼3
＜1616	0∼1516∼60	0∼1516∼32	8.79 ± 4.1120.97 4.33	91 (74.6)31 (25.4)
≥16	16∼60	16∼32	20.97 ± 4.33	31 (25.4)
Intimacy	15∼75	20∼70	43.19 ± 9.03		1∼5
QOL	0∼156	69∼148	111.32 ± 16.32		0∼4
Physical well-being	0∼28	13∼28	24.60 ± 3.29
Social/family well-being	0∼28	0∼26	14.77 ± 4.87
Emotional well-being	0∼24	10∼24	18.70 ± 3.72
Functional well-being	0∼28	2∼28	17.60 ± 5.75
Additional concerns	0∼48	18∼45	35.65 ± 4.71

QOL= Quality of life.

Table 3.

Comparisons of Physical Symptoms, Depression, Intimacy, and Quality of Life^* (N= 122)

Variables	pre ADT ^a	1∼6M ^b	7∼12M ^c	＞13M ^d	x ² or F	p	Post hoc
Variables	M ± SD	M ± SD	M ± SD	M ± SD	x ² or F	p	Post hoc
Symptoms	82.99 ± 9.60	69.14 ± 8.81	70.63 ± 7.61	70.62 ± 8.69	23.74	＜.001	b, c, d＜ a
Urinary domain	97.07 ± 18.45	83.39 ± 16.92	87.65 ± 14.62	82.15 ± 16.69	7.22	＜.001	b, d＜ a
Function	102.18 ± 23.98	91.92 ± 21.99	95.50 ± 19.00	88.52 ± 21.69	3.21	.026	d＜ a
Bother	93.43 ± 19.14	77.29 ± 17.55	82.04 ± 15.17	77.60 ± 17.31	8.31	＜.001	b, c, d＜ a
Incontinence	104.84 ± 32.44	86.13 ± 29.76	93.21 ± 25.72	87.28 ± 29.35	3.76	.013	b, d＜ a
Irritation/obstruction	94.20 ± 16.78	84.86 ± 15.39	88.71 ± 13.30	81.52 ± 15.18	5.73	.001	b. d＜ a
Bowel domain	100.23 ± 6.21	99.32 ± 5.70	98.05 ± 4.93	96.23 ± 5.62	3.92	.011	d＜ a
Function	100.23 ± 7.06	98.72 ± 6.47	98.14 ± 5.60	95.55 ± 6.39	3.95	.010	d＜ a
Bother	100.22 ± 6.15	99.92 ± 5.64	97.95 ± 4.87	96.90 ± 5.56	3.26	.024	d＜ a
Sexual domain	40.47 ± 21.43	19.23 ± 19.66	23.25 ± 16.99	26.10 ± 19.39	9.82	＜.001	b, c, d＜ a
Function	26.57 ± 19.59	2.57 ± 17.96	6.33 ± 15.53	5.91 ± 17.72	16.43	＜.001	b, c, d＜ a
Bother	71.75 ± 52.62	56.72 ± 48.26	61.32 ± 41.71	71.55 ± 47.60	1.09	.357
Hormonal domain	95.95 ± 23.16	74.19 ± 21.25	73.15 ± 18.36	78.05 ± 20.95	10.83	＜.001	b, c, d＜ a
Function	94.95 ± 29.64	67.75 ± 27.19	64.31 ± 23.50	72.61 ± 26.82	11.07	＜.001	b, c, d＜ a
Bother	96.78 ± 19.44	79.55 ± 17.83	80.52 ± 15.41	82.58 ± 17.59	8.92	＜.001	b, c, d＜ a
Depression	9.03 ± 9.59	11.26 ± 8.80	11.46 ± 7.60	12.78 ± 8.68	1.36	.260
Intimacy	45.15 ± 12.98	42.35 ± 11.90	44.04 ± 10.29	42.46 ± 11.74	0.59	.623
QOL	114.08 ± 22.42	112.22 ± 20.56	110.00 ± 17.77	106.15 ± 20.28	1.17	.325
Physical well-being	24.81 ± 4.56	24.70 ± 4.18	23.86 ± 3.61	23.21 ± 4.12	1.34	.266
Social/family well-being	14.26 ± 6.87	14.71 ± 6.30	13.71 ± 5.45	14.93 ± 6.22	0.34	.797
Emotional well-being	19.36 ± 5.14	20.04 ± 4.72	18.48 ± 4.08	17.98 ± 4.65	1.54	.208
Functional well-being	18.41 ± 7.95	17.88 ± 7.29	17.69 ± 6.30	15.99 ± 7.19	0.91	.439
Additional concerns	37.24 ± 6.39	34.89 ± 5.86	36.26 ± 5.06	34.03 ± 5.78	2.74	.047	a= b= c= d

^* Adjusted for economic state, prostate cancer stage, and treatment; ADT= Androgen deprivation therapy; M= Month; QOL= Quality of life.

Table 4.

The Influencing Factors on Quality of Life (N=122)

Variables	B	SE	^β	t	p	VIF
(Constant)	97.99	6.51		15.05	＜.001
Depression	–1.27	0.16	–.52	–8.00	＜.001	1.15
Intimacy	0.41	0.12	.23	3.48	.001	1.16
Duration of ADT	–165	0.06	–.17	–2.57	.011	1.10
Economic status
Middle	8.04	2.86	.23	2.80	.006	1.80
High	12.74	3.69	.29	3.45	.001	1.89
Sleep*	6.16	2.67	.15	2.30	.023	1.07
		R=.755 5, R²=.569, Adj. R R²=.55, F=25.33, p ＜.001

ADT₌ Androgen deprivation therapy; Adj. R²= Adjusted R²; SE₌ Standard error; B₌ Unstandardized estimates; β= Standardized estimates; VIF₌ Variance inflation factor; Durbin-Watson= 1.82; Dummy Variable: *Sleep ≥6 hr group (1),＜6 hr group (0).

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