Prostate CancerPreliminary Results of a Randomised Controlled Trial of an Online Psychological Intervention to Reduce Distress in Men Treated for Localised Prostate Cancer
Introduction
Prostate cancer (PCa) is one of the most commonly diagnosed cancers in men worldwide [3], with Australia amongst the countries that have the highest incidence [3]. Five-year survival rates are high in part because of advances in treatment but also as a result of early diagnosis. Registry data demonstrate that 93% of men have localised disease at diagnosis in contemporary practice in Australia [4]. Unfortunately all treatment options may result in significant decrements in quality of life (QoL), including erectile dysfunction, urinary incontinence, and bowel urgency [5]. These residual symptoms can have a significant impact on patient QoL and mental health [6], [7]. The prevalence of mood, anxiety, and adjustment disorders amongst men who have PCa ranges from 9% to 24% [8], [9], [10], [11], and there is some evidence that physical side effects of PCa treatment (eg, incontinence and sexual dysfunction) are directly associated with anxiety and depressive symptoms [12].
The support needs of men who have PCa are well documented. Many men report high levels of unmet supportive care needs [13], particularly in the area of psychological support (54%) and sexual support (47%) [13]. Unfortunately, access to evidence-based and timely psychosocial support is often limited, particularly in rural and remote regions. Two recent systematic reviews evaluating psychosocial interventions for PCa patients have indicated that only a limited evidence base exists for psychosocial and psychosexual interventions in PCa and that further research is required [14], [15].
The online environment holds appeal for many in accessing information and support anonymously, at a convenient time and location, and in a format that is easily tailored and personalised [16], [17]. Internet-based interventions to support the mental health of people affected by cancer have shown promise in augmenting the limited face-to-face mental health services available in cancer care [16], [17]. In addition, we found only one intervention that specifically focused on supporting men who had PCa and that evaluated the efficacy of an online therapist-assisted psychological intervention compared with a traditional face-to-face psychological intervention [18]. This study found that the Internet-delivered intervention was as effective as the traditional face-to-face intervention in producing enduring improvements in sexual outcomes for men who had PCa and their partner or spouse [18]. Although this study highlighted the potential utility of online interventions for this population, to date, no self-guided online interventions that had no to minimal therapist support focusing on a range of identified PCa-specific problem areas have been developed and evaluated for localised PCa patients.
This article reports on the psychological outcomes of a randomised controlled trial (RCT) of a self-guided online psychological intervention called My Road Ahead (MRA). The overall aim of the RCT was to examine the efficacy of the online intervention in reducing participants’ psychological distress from baseline to postintervention. The three conditions for the RCT were MRA alone (MRA Only), MRA plus the use of a moderated online forum (MRA + Forum), and the forum alone (Forum). We hypothesised that participants randomised to receive MRA, with or without access to the forum, compared with those who received access to the forum-only condition would demonstrate significantly greater reductions in psychological distress from pre- to postintervention. Furthermore, we hypothesised that participants randomised to receive access to the moderated forum in addition to MRA compared with those who received access only to MRA would demonstrate significantly greater reduction in psychological distress from pre- to postintervention. We also planned an examination of the factors that predicted reductions in psychological distress.
Section snippets
Materials and methods
We obtained ethical approval to conduct the study from the Melbourne Health, Swinburne University of Technology, Deakin University, and Peter MacCallum Cancer Centre human research ethics committees.
Participants
Of the 152 participants recruited, 10 were excluded because they reported that they had received treatment for advanced or locally advanced PCa following their treatment for localised disease. The remaining 142 participants had received treatment only for localised disease and were randomly allocated to the three intervention conditions. The mean age was 61 yr of age (standard deviation [SD]: 7; range: 42–82), and the mean time since diagnosis was 3.5 yr (SD: 1.8; range: 6–60 mo). Sixty-five
Discussion
The combination of the intervention, My Road Ahead, with access to the forum showed significantly superior improvements in participant psychological distress from pre- to postintervention compared with the other two intervention conditions (MRA Only or Forum). A statistically and clinically significant improvement in psychological distress was seen for participants who had access to both the online intervention and moderated forum, while no significant change in psychological distress was seen
Conclusions
The current study indicates that there may be more benefit for those participants who were experiencing higher levels of distress at baseline, suggesting that delivery of this intervention only to those who were experiencing high levels of distress at baseline could improve the effect size of this intervention. Follow-up of participant outcomes is also important, and this data will be collected and reported. Future examination of the optimal timing of the provision of this intervention
References (33)
- et al.
The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the Beck Depression and Anxiety Inventories
Behav Res Ther
(1995) - et al.
Psychological functioning associated with prostate cancer: cross-sectional comparison of patients treated with radiotherapy, brachytherapy, or surgery
J Pain Symptom Manage
(2005) - et al.
A systematic review of psychosocial interventions for men with prostate cancer and their partners
Patient Educ Couns
(2011) - et al.
Review: psychosocial interventions addressing sexual or relationship functioning in men with prostate cancer
J Sex Med
(2012) - et al.
A systematic review of Internet-based self-help therapeutic interventions to improve distress and disease-control among adults with chronic health conditions
Clin Psychol Rev
(2013) - et al.
Patients’ perceptions of quality of life after treatment for early prostate cancer
J Clin Oncol
(2003) - Prostate cancer estimated incidence, mortality, and prevalence worldwide in 2012. GLOBOCAN 2012 Web site....
- et al.
Patterns of care for men diagnosed with prostate cancer in Victoria from 2008 to 2011
Med J Aust
(2013) - et al.
Long-term functional outcomes after treatment for localized prostate cancer
N Engl J Med
(2013) - et al.
Presurgery experiences of prostate cancer patients and their spouses
Cancer Pract
(1999)
Sexuality after treatment for early prostate cancer: exploring the meanings of “erectile dysfunction”
J Gen Intern Med
The psychosocial impact of prostate cancer on patients and their partners
Med J Aust
Anxiety, depression and quality of life of cancer patients undergoing radiation therapy: a cross-sectional study in a community hospital outpatient centre
Eur J Cancer Care (Engl)
Depression in men receiving androgen deprivation therapy for prostate cancer: a pilot study
Psychooncology
Prospective study of quality of life of patients receiving treatment for prostate cancer
Nurs Res
Age, health, and education determine supportive care needs of men younger than 70 years with prostate cancer
J Clin Oncol
Cited by (59)
Distress and Quality of Life Among Patients with Advanced Genitourinary Cancers
2020, European Urology FocusSupportive care interventions for men with urological cancers: a scoping review
2023, Supportive Care in CancerSocial media for psychological support of patients with chronic non-infectious diseases: A systematic review
2023, Health Promotion International