Skip to main content

Advertisement

Log in

Technology-Based Psychosocial Intervention to Improve Quality of Life and Reduce Symptom Burden in Men with Advanced Prostate Cancer: Results from a Randomized Controlled Trial

  • Full length manuscript
  • Published:
International Journal of Behavioral Medicine Aims and scope Submit manuscript

Abstract

Background

Men with advanced prostate cancer (APC) face multiple challenges including poor prognosis, poor health-related quality of life (HRQOL), and elevated symptom burden. This study sought to establish the efficacy of a tablet-delivered, group-based psychosocial intervention for improving HRQOL and reducing symptom burden in men with APC. We hypothesized that men randomized to cognitive-behavioral stress management (CBSM) would report improved HRQOL and reduced symptom burden relative to men randomized to an active control health promotion (HP) condition. Condition effects on intervention targets and moderators of these effects were explored.

Methods

Men with APC (N = 192) were randomized (1:1) to 10-week tablet-delivered CBSM or HP, and followed for 1 year. Multilevel modeling was used to evaluate condition effects over time.

Results

Changes in HRQOL and symptom burden did not differ between groups. Men in both groups improved across several intervention targets; men in the CBSM condition reported greater increases in self-reported ability to relax, and both conditions showed improvements in cancer-related anxiety, cancer-related distress, and feelings of cohesiveness with other patients over time. Moderating factors included baseline interpersonal disruption, fatigue, and sexual functioning.

Conclusions

Tablet-delivered CBSM and HP were well received by men with APC. The hypothesized effects of CBSM on HRQOL and symptom burden were not supported, though improvements in intervention targets were observed across conditions. Participants reported high-baseline HRQOL relative to cancer and general population norms, possibly limiting intervention effects. The identified moderating factors should be considered in the development and implementation of interventions targeting HRQOL and symptom burden.

Trial Registration

ClinicalTrials.gov Identifier: NCT03149185

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

References

  1. American Cancer Society. Cancer Facts & Figures 2018. Atlanta: American Cancer Society; 2018.

  2. Chen RC, Chang P, Vetter RJ, et al. Recommended patient-reported core set of symptoms to measure in prostate cancer treatment trials. J Natl Cancer Inst. 2014;106:dju132.

    PubMed  PubMed Central  Google Scholar 

  3. Sonn GA, Sadetsky N, Presti JC, Litwin MS. Differing perceptions of quality of life in patients with prostate cancer and their doctors. J Urol. 2013;189:S59–65.

    PubMed  Google Scholar 

  4. Warde P, Mason M, Ding K, et al. Combined androgen deprivation therapy and radiation therapy for locally advanced prostate cancer: a randomised, phase 3 trial. Lancet. 2011;378:2104–11.

    PubMed  PubMed Central  Google Scholar 

  5. Zajdlewicz L, Hyde MK, Lepore SJ, Gardiner RA, Chambers SK. Health-related quality of life after the diagnosis of locally advanced or advanced prostate cancer: a longitudinal study. Cancer Nurs. 2017;40:412–9.

    PubMed  Google Scholar 

  6. Perlmutter MA, Lepor H. Androgen deprivation therapy in the treatment of advanced prostate cancer. Rev Urol. 2007;9(Suppl 1):S3–8.

    PubMed  PubMed Central  Google Scholar 

  7. Potosky AL, Reeve BB, Clegg LX, Hoffman RM, Stephenson RA, Albertsen PC, et al. Quality of life following localized prostate cancer treated initially with androgen deprivation therapy or no therapy. J Natl Cancer Inst. 2002;94(6):430–7.

    PubMed  Google Scholar 

  8. Sheinfeld Gorin S, Krebs P, Gadr H. Meta-analysis of psychosocial interventions to reduce pain in patients with cancer. J Clin Oncol. 2012;30:539–47.

    PubMed  PubMed Central  Google Scholar 

  9. de la Torre-Luque A, Gambara H, López E, Cruzado JA. Psychological treatments to improve quality of life in cancer contexts: a meta-analysis. Int J Clin Health Psychol. 2016;16:211–9.

    PubMed  Google Scholar 

  10. Penedo FJ, Dahn JR, Molton I, Gonzalez JS, Kinsinger D, Roos BA, et al. Cognitive-behavioral stress management improves stress-management skills and quality of life in men recovering from treatment of prostate carcinoma. Cancer. 2004;100:192–200.

    PubMed  Google Scholar 

  11. Traeger L, Penedo FJ, Gonzalez JS, Dahn JR, Lechner SC, Schneiderman N, et al. Illness perceptions and emotional well-being in men treated for localized prostate cancer. J Psychosom Res. 2009;67:389–97.

    PubMed  Google Scholar 

  12. Parahoo K, McDonough S, McCaughan E. Psychosocial interventions for men with prostate cancer: a Cochrane systematic review. BJU Int. 2015;116:174–83.

    PubMed  Google Scholar 

  13. Folstein MF, Folstein SE, McHugh PR. “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res. 1975;12:189–98.

    CAS  PubMed  Google Scholar 

  14. Penedo FJ, Antoni MH, Schneiderman N. Cognitive-behavioral stress management for prostate cancer recovery facilitator guide. New York: Oxford University Press; 2008.

    Google Scholar 

  15. Fox RS, Moreno PI, Yanez B, et al. Integrating PROMIS® computerized adaptive tests into a web-based intervention for prostate cancer. Health Psychol. 2019;38:403–9.

    PubMed  PubMed Central  Google Scholar 

  16. Schueller SM, Begale M, Penedo FJ, Mohr DC. Purple: a modular system for developing and deploying behavioral intervention technologies. J Med Internet Res. 2014;16:e181.

    PubMed  PubMed Central  Google Scholar 

  17. Cella DF, Tulsky DS, Gray G, Sarafian B, Linn E, Bonomi A, et al. The functional assessment of cancer therapy scale: development and validation of the general measure. J Clin Oncol. 1993;11:570–9.

    CAS  PubMed  Google Scholar 

  18. Brucker PS, Yost K, Cashy J, Webster K, Cella D. General population and cancer patient norms for the functional assessment of cancer therapy-general (FACT-G). Eval Health Prof. 2005;28:192–211.

    PubMed  Google Scholar 

  19. Wei JR, 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.

    CAS  PubMed  Google Scholar 

  20. Ader DN. Developing the Patient-Reported Outcomes Measurement Information System (PROMIS). Med Care. 2007;45:S1–2.

    Google Scholar 

  21. Schalet BD, Pilkonis PA, Yu L, et al. Clinical validity of PROMIS depression, anxiety, and anger across diverse clinical samples. J Clin Epidemiol. 2016;73:119–27.

    PubMed  PubMed Central  Google Scholar 

  22. Clover K, Lambert SD, Oldmeadow C, et al. PROMIS depression measures perform similarly to legacy measures relative to a structured diagnostic interview for depression in cancer patients. Qual Life Res. 2018;27:1357–67.

    PubMed  Google Scholar 

  23. Hann DM, Jacobsen PB, Azzarello LM, Martin SC, Curran SL, Fields KK, et al. Measurement of fatigue in cancer patients: development and validation of the Fatigue Symptom Inventory. Qual Life Res. 1998;7:301–10.

    CAS  PubMed  Google Scholar 

  24. Donovan KA, Jacobsen PB. The fatigue symptom inventory: a systematic review of its psychometric properties. Support Care Cancer. 2011;19:169–85.

    Google Scholar 

  25. Melzack R. The short-form McGill Pain Questionnaire. Pain. 1987;30:191–7.

    CAS  PubMed  Google Scholar 

  26. Kahl C, Cleland JA. Visual analogue scale, numeric pain rating scale and the McGill Pain Questionnaire: an overview of psychometric properties. Phys Ther Rev. 2005;10:123–8.

    Google Scholar 

  27. Antoni MH, Lechner SC, Kazi A, Wimberly SR, Sifre T, Urcuyo KR, et al. How stress management improves quality of life after treatment for breast cancer. J Consult Clin Psychol. 2006;74:1143–52.

  28. Roth AJ, Rosenfield B, Kornblith AB, et al. The Memorial Anxiety Scale for Prostate Cancer: validation of a new scale to measure anxiety in men with with prostate cancer. Cancer. 2003;97:2910–8.

    PubMed  Google Scholar 

  29. Bradburn N. The structure of psychological well-being. Chicago: Aldine; 1969.

    Google Scholar 

  30. Bergner M, Bobbitt RA, Carter WB, Gilson BS. The sickness impact profile: development and final revision of a health status measure. Med Care. 1981;19:787–805.

    CAS  Google Scholar 

  31. Cohen S, Kamarck T, Mermelstein R. A global measure of perceived stress. J Health Soc Behav. 1983;24:385–96.

    CAS  Google Scholar 

  32. Weiss DS, Marmar CR. The impact of event scale – revised. In: Wilson JP, Tang CS, editors. Psychological trauma and PTSD. New York: Guilford Press; 1997. p. 399–411.

    Google Scholar 

  33. Stanton AL, Ganz PA, Kwan L, Meyerowitz BE, Bower JE, Krupnick JL, et al. Outcomes from the moving beyond cancer psychoeducational, randomized, controlled trial with breast cancer patients. J Clin Oncol. 2005;23:6009–18.

    PubMed  Google Scholar 

  34. Derogatis LR. The psychosocial adjustment to illness scale (PAIS). J Psychosom Res. 1986;30:77–91.

    CAS  PubMed  Google Scholar 

  35. Charlson M, Szatrowski TP, Peterson J, Gold J. Validation of a combined comorbidity index. J Clin Epidemiol. 1994;47:1245–51.

    CAS  Google Scholar 

  36. Preacher KJ, Curran PJ, Bauer DJ. Computational tools for probing interactions in multiple linear regression, multilevel modeling, and latent curve analysis. J Educ Behav Stat. 2006;31:437–48.

    Google Scholar 

  37. Pearman T, Yanez B, Peipert J, Wortman K, Beaumont J, Cella D. Ambulatory cancer and US general population reference values and cutoff scores for the functional assessment of cancer therapy. Cancer. 2014;120:2902–9.

    PubMed  Google Scholar 

  38. Penedo FJ, Molton I, Dahn JR, Shen BJ, Kinsinger D, Traeger L, et al. A randomized clinical trial of group-based cognitive-behavioral stress management in localized prostate cancer: development of stress management skills improves quality of life and benefit finding. Ann Behav Med. 2006;31:261–70.

    PubMed  Google Scholar 

  39. Greer JA, Jacobs J, Pensak N, MacDonald J, Fuh CX, Perez GK, et al. Randomzied trial of a tailored cognitive-behavioral therapy mobile application for anxiety in patients with incurable cancer. Oncologist. 2019;24:1111–20.

    PubMed  PubMed Central  Google Scholar 

  40. Huang GJ, Sadetsky N, Penson DF. Health related quality of life for men treated for localized prostate cancer with long-term follow-up. J Urol. 2010;183:2206–12.

    PubMed  PubMed Central  Google Scholar 

  41. Antoni MH. Stress management effects on psychological, endocrinological, and immune functioning in men with HIV infection: empirical support for a psychoneuroimmunological model. Stress. 2003;6:173–88.

    CAS  PubMed  Google Scholar 

  42. Antoni MH, Lechner S, Diaz A, et al. Cognitive behavioral stress management effects on psychosocial and physiological adaptation in women undergoing treatment for breast cancer. Brain Behav Immun. 2009;23:580–91.

    CAS  PubMed  Google Scholar 

  43. Walker LM, Tran S, Wassersug RJ, Thomas B, Robinson JW. Patients and partners lack knowledge of androgen deprivation therapy side effects. Urol Oncol. 2013;31:1098–105.

    PubMed  Google Scholar 

  44. Wu PH, Chen SW, Huang WT, Chang SC, Hsu MC. Effects of a psychoeducational intervention in patients with breast cancer undergoing chemotherapy. J Nurs Res. 2018;26:266–79.

    PubMed  Google Scholar 

  45. Karnell LH, Christensen AJ, Rosenthal EL, Magnuson JS, Funk GF. Influence of social support on health-related quality of life outcomes in head and neck cancer. Head Neck. 2007;29:143–6.

    PubMed  Google Scholar 

  46. Filazoglu G, Griva K. Coping and social support and health related quality of life in women with breast cancer in Turkey. Psychol Health Med. 2008;13:559–73.

    PubMed  Google Scholar 

  47. Leung J, Pachana NA, McLaughlin D. Social support and health-related quality of life in women with breast cancer: a longitudinal study. Psychooncology. 2014;23:1014–20.

    PubMed  Google Scholar 

  48. Bouchard LC, Yanez B, Dahn JR, et al. Brief report of a tablet-delivered psychosocial intervention for men with advanced prostate cancer: acceptability and efficacy by race. Transl Behav Med. 2019;9:629–37.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Frank J. Penedo.

Ethics declarations

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Penedo, F.J., Fox, R.S., Oswald, L.B. et al. Technology-Based Psychosocial Intervention to Improve Quality of Life and Reduce Symptom Burden in Men with Advanced Prostate Cancer: Results from a Randomized Controlled Trial. Int.J. Behav. Med. 27, 490–505 (2020). https://doi.org/10.1007/s12529-019-09839-7

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s12529-019-09839-7

Keywords

Navigation