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Prostate counselling support

February 7th, 2008

ALMOST 3000 men die of prostate cancer each year in Australia and an estimated 18,700 are diagnosed with the disease. With baby boomers now reaching their 50s and 60s, those figures are set to increase.

So, is enough being done to reduce the emotional toll that surgery can take on men?

Not surprisingly, sexual dysfunction tops the list of the most common post-operative side effects that men complain about in a study published in a recent issue of Urologic Nursing.

Significantly, it is urinary dysfunction issues that are troubling men most and many are not emotionally prepared for these complications, says lead author Bryan Weber, assistant professor in the University of Florida College of Nursing.

Professor Weber said, given the various treatment options for prostate cancer, men who undergo radical prostatectomy might initially decide the risk of physical dysfunction was worth the benefit of improved survival. However, many did not know what to expect in the months after surgery.

“The effects of this treatment are quite immediate and can lead to depression and frustration,” she said.

The authors evaluated 72 men six weeks after they underwent prostatectomy, measuring their physical function and assessing whether they had urinary, bowel and sexual dysfunction. Measurement of self-confidence, social support and uncertainty about their disease and treatment were also recorded.

“Almost immediately after treatment, men may experience depression, awkwardness and emasculation, which will have a great effect on their quality of life.”

Over half the men reported low to moderate social support, indicating that many of the topics proved embarrassing for them to discuss with others. The level of social support was significantly related to urinary problems, revealing those with incontinence may need additional support compared to those with greater bladder control.

Asked by Consult if greater access to formal counselling services was needed for this group of patients, Professor Weber agreed.

“Yes – men have indicated that little information is provided pre and post surgery that highlights available options in dealing with treatment side effects.

“After an initial diagnosis of prostate cancer, men may be so focused on eradicating the disease that they don’t realise the effects the treatment will have on their quality of life, both for them and their families.”

Physical side effects of prostate cancer treatment limit daily activities and may interfere with a man’s sense of masculinity and self-confidence. Urinary incontinence requires the use of pads which can create concern about leakage and odour, Professor Weber said.

“Sexual dysfunction interferes with a man’s sense of self and may limit the relationship he has with his significant other.”

Professor Weber suggests clinicians assess men and their support systems, identify changes in physical function that may occur as a result of treatment and direct them to products and services designed to help them cope with the immediate effects of sexual dysfunction and urinary and bowel incontinence.

Men also need to be made aware of the numerous medications to ease sexual dysfunction, their cost and potential side effects.

“Education and counselling should be provided to these men to better inform and prepare patients for the physical side effects they are likely to experience postoperatively.

“Since we know that men are less likely to rely on support groups or be more embarrassed to discuss these items with family and friends, it’s even more vital for health-care professionals to stress these issues and include options for patients.

“Men need to be introduced to different options, make choices and regain control over their lives.”

Source
Urologic Nursing

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