Journal List > Asian Oncol Nurs > v.19(3) > 1134879

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

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.

References

1. National Cancer Information Center. https://www.cancer.go.kr. [Assessed June 2, 2019].
2. Grunfeld EA, Halliday A, Martin P, Drudge-Coates L. Andropause syndrome in men treated for metastatic prostate cancer: a qualitative study of the impact of symptoms. Cancer Nurs. 2012; 35:63–9.
3. Benedict C, Traeger L, Dahn JR, Antoni M, Zhou ES, Bustillo N, et al. Sexual bother in men with advanced prostate cancer undergoing androgen deprivation therapy. J Sex Med. 2014; 11:2571–80.
crossref
4. Lee M, Jim HS, Fishman M, Zachariah B, Heysek R, Biagioli M, et al. Depressive symptomatology in men receiving androgen deprivation therapy for prostate cancer: a controlled comparison. Psychooncology. 2015; 24:472–7.
crossref
5. Sevilla C, Maliski SL, Kwan L, Connor SE, Litwin MS. Long-term quality of life in disadvantaged men with prostate cancer on androgen-deprivation therapy. Prostate Cancer Prostatic Dis. 2012; 15:237–43.
crossref
6. Baker H, Wellman S, Lavender V. Functional quality-of-life outcomes reported by men treated for localized prostate cancer: a systematic literature review. Oncol Nurs Forum. 2016; 43:199–218.
crossref
7. Donovan KA, Gonzalez BD, Nelson AM, Fishman MN, Zachariah B, Jacobsen PB. Effect of androgen deprivation therapy on sexual function and bother in men with prostate cancer: a controlled comparison. Psychooncology. 2018; 27:316–24.
crossref
8. Baguley BJ, Skinner TL, Leveritt MD, Wright OR. Nutrition therapy with high intensity interval training to improve prostate cancer-related fatigue in men on androgen deprivation therapy: a study protocol. BMC Cancer. 2017; 17:1.
crossref
9. Ahmadi H, Daneshmand S. Androgen deprivation therapy: evidence-based management of side effects. BJU Int. 2013; 111:543–8.
crossref
10. Yang GJ, Kang JH, Suh IS, Kim HY. Health-related quality of life and depression after radical prostatectomy or hormonal therapy. Asian Oncol Nurs. 2013; 134:248–55.
crossref
11. Watts S, Leydon G, Birch B, Prescott P, Lai L, Eardley S, et al. Depression and anxiety in prostate cancer: a systematic review and metaanalysis of prevalence rates. BMJ Open. 2014; 4:e003901.
crossref
12. Cho HM, Yoo EK. Effects of depression, family support on resilience in patients with gynecological cancer. J Korea Soc Wellness. 2015; 10:183–95.
13. Colloca G, Colloca P. The effects of social support on health-related quality of life of patients with metastatic prostate cancer. J Cancer Educ. 2016; 31:244–52.
crossref
14. Kim SC. Characteristics of prostate cancer that underwent prostatectomy at young age [dissertation]. Ulsan: Ulsan Univ.;2010.
15. Wei JT, Dunn RL, Litwin MS, Sandler HM, Sanda MG. Development and validation of the expanded prostate cancer index composite (EPIC) for comprehensive assessment of health-related quality of life in men with prostate cancer. Urology. 2000; 56:899–905.
crossref
16. Chung KJ, Kim JJ, Lim SH, Kim TH, Han DH, Lee SW. Development and validation of the Korean version of expanded prostate cancer index composite: questionnaire assessing health-related quality of life after prostate cancer treatment. Korean J Urol. 2010; 51:601–12.
crossref
17. Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Appl Psychol Meas. 1977; 1:385–401.
18. Chon KK, Choi SC, Yang BC. Integrated adaptation of CES-D in Korea. Korean J Health Psychol. 2001; 6:59–76.
19. Lee KH. A measure of marital intimacy. J Korean Home Econ Assoc. 1995; 33:235–49.
20. Alibhai SM, Breunis H, Timilshina N, Naglie G, Tannock I, Krahn M, et al. Long-term impact of androgen-deprivation therapy on physical function and quality of life. Cancer. 2015; 121:2350–7.
crossref
21. Punnen S, Cowan JE, Chan JM, Carroll PR, Cooperberg MR. Long-term health-related quality of life after primary treatment for localized prostate cancer: results from the CaPSURE registry. Eur Urol. 2015; 68:600–8.
crossref
22. Lee SJ, Lee YS, Kim YE. The degree of elderly sexual desire and their attitudes towards sex. Korean J Clin Soc Work. 2013; 10:1–21.
23. Tripp DA, Verreault P, Tong S, Izard J, Black A, Siemens DR. Biopsychosocial impact of prostate cancer and androgen-deprivation therapy. Can Urol Assoc J. 2017; 11:338–43.
crossref
24. Oh SY, Ryu EJ. Educational needs for sexual health and its effect on depression and the quality of life in patients with prostate cancer. Asian Oncol Nurs. 2015; 15:163–70.
crossref
25. Nead KT, Sinha S, Yang DD, Nguyen PL. Association of androgen deprivation therapy and depression in the treatment of prostate cancer: a systematic review and metaanalysis. Urol Oncol. 2017; 35:664. .e1–9.
crossref
26. Beck AM, Robinson JW, Carlson LE. Sexual values as the key to maintaining satisfying sex after prostate cancer treatment: the physical plea-sure-relational intimacy model of sexual motivation. Arch Sex Behav. 2013; 42:1637–47.
crossref
27. Lee I. The effect of communication on marital adjustment of cancer patients and their spouses-focusing on the actor effect and partner effect. Korean J Soc Welf. 2011; 63:179–205.
28. Nam K, Tae Y, Kim C, Lee S. Influence of uncertainty and uncertainty appraisal on quality of life in prostate cancer patients after prostatectomy. Asian Oncol Nurs. 2017; 17:45–55.
crossref
29. Jun SS, Kim DH, Kim MY. Sleep disturbance in prostate cancer patients. J Korean Acad Fundam Nurs. 2010; 17:169–76.
30. Gagliano-Jucá T, Travison TG, Nguyen PL, Kantoff PW, Taplin ME, Ki-bel AS, et al. Effects of androgen deprivation therapy on pain perception, quality of life, and depression in men with prostate cancer. J Pain Symptom Manage. 2018; 55:307–317.e1.
crossref

Figure 1.
Comparisons of symptoms according to duration of androgen deprivation therapy.
aon-19-169f1.tif
Table 1.
Homogeneity Tests on Participant's Characteristics (N= 122)
Variables Categories Total pre ADT 1∼6M 7∼12M >13M x2/t/F p
n (%) or M ± SD n (%) or M ± SD n (%) or M ± SD n (%) or M ± SD n (%) or M ± SD
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
M ± SD M ± SD M ± SD M ± SD
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).

TOOLS
Similar articles