THE "NEW" PROSTATE CANCER INFOLINK

An upcoming article in the Journal of Clinical Oncology apparently indicates that stress management prior to radical prostatectomy (RP) can significantly impact patients’ responses to treatment in both the short and the long term. Specifically, the study showed that men who participated in brief stress management sessions experienced less short-term mood disturbance and better long-term quality of life, compared to patients who had the procedure but did not have any behavioral intervention.

Parker et al. randomly assigned 159 men who were scheduled for RP to one of three patient groups, who then received:

• Two sessions of pre-surgical stress management (plus two boosters) (the SM group) or
• Two sessions of supportive attention (plus two boosters) (the SA group) or
• Standard care (the SC group)

Patients were evaluated 1 month before surgery; 1 week before surgery; the morning of surgery; 6 weeks after surgery, and 6 and 12 months after surgery.

The results of the study indicated the following:

• Prior to surgery, men in the SM group had significantly less mood disturbance than men in the SC group, but there were no significant differences between the SM and SA or SA and SC groups.
• In the year after surgery, there were significant differences in responses based on the Medical Outcomes Study 36-item short form survey (SF-36) physical component summary (PCS) scores. The men in the SM group had significantly higher PCS scores than men in the SC group (P = .0009), but there were no significant differences between the SM and SA or SA and SC groups.
• Also following surgery, there were no group effects on prostate-specific quality of life or SF-36 mental health scores.

The authors conclude that, “These findings demonstrate the efficacy of a brief pre-surgical stress management intervention in improving some short-term and long-term outcomes.” They go on to suggest that, if these results can be replicated by others, such brief stress management may be a useful adjunct to standard care for men with prostate cancer undergoing surgery.

In a media release from the M. D. Anderson Cancer Center, Dr. Lorenzo Cohen, the study’s senior author, who is a professor in M. D. Anderson’s Departments of Behavioral Science and General Oncology, and director of the center’s Integrative Medicine Program is quoted as saying, “We know that for men with early-stage prostate cancer, the time when they are making treatment decisions is very stressful. A radical prostatectomy is not without possible, very personal, consequences, including urinary incontinence and erectile dysfunction. Patients may also be worried about the uncertainty that the surgery will cure their cancer.

“From other areas of research, we know that going into a surgical setting overly stressed may increase a patient’s recovery time. With this study, we wanted to intervene in the pre- and post-surgical setting and try to help relieve stress and minimize mood disturbance, such as depression, anxiety and distress, both in the short- and long-term.”

The stress management was apparently based on aspects of cognitive behavioral therapy. Men in the stress management group met with a clinical psychologist and were taught simple behavioral techniques, including diaphragmatic breathing and relaxing guided imagery and cognitive therapy. Those in the supportive attention groups met with the same psychologist, but sessions were more general, and centered around open discussions. Patients in the standard care group did not receive any behavioral therapy.

According to the media release, “Cohen and his team were surprised to see this level of difference in physical functioning during the long-term follow-up because the interventions in the pre- and peri-operative settings were so brief and mainly focused on aspects of stress management.”

Cohen is again quoted as follows: “We’re trying to understand what is potentially associated with a patient’s long-term quality of life and what was it that happened in the stress management group that resulted in a much better quality of life in the year post-surgery.”

“Before we can suggest that stress management is useful prior to surgery for all men undergoing a radical prostatectomy, we need to better understand the mechanism behind our findings, as well as understand for whom this type of intervention will be the most useful.

Cohen goes on to suggest that all patients who are diagnosed with cancer and need to undergo treatment should be encouraged to participate in some form of stress management program. “We know that they are safe and may improve patients’ well-being and help them adjust to a cancer diagnosis,” he says.

Filed under: Management, Treatment Tagged: | pre-surgical stress management