1. SEXUAL DYSFUNCTION AND ADAPTATION IN COUPLES
AFFECTED BY PROSTATE CANCER SURGERY:
STEPS TOWARDS A BIOPSYCHOSOCIAL MODEL OF TREATMENT
Andrew Matthew1,5, Ph.D., Leah Jamnicky1, R.N., Sidney Radomski1, MD., John Trachtenberg1,5, MD., Shabbir M.H. Alibhai2,5, MD., Neil Fleshner1,5, MD., Anthony Finelli, MD1., Michael Jewett1, MD., Alex Zlotta1, MD., Kristen Currie1 MA.,
Wei Xu1 Ph.D, Daniel Santa Mina1,4, Ph.D (cand)., and Paul Ritvo1,3,4, Ph.D.
1..Princess Margaret Hospital; 2.Toronto General Hospital; 3.Cancer Care Ontario, 4York University; 5University of Toronto
BACKGROUND Patient Distress Patient Retreat from Partner Partner Distress SUMMARY
- Physical - Patient retreat
- Masculinity
Prostate cancer (PCa) is the most common cancer in Canadian - Cognitive/Emotional - Inadequacy in pleasing
- Inadequacy in partner Given the prevalence of ED post-RP
men1. The primary choice for early stage, localized PCa is the pleasing partner
radical prostatectomy (RP). Unfortunately, 75% of patients Given the severity of distress
- Treatment regret
experience sexual dysfunction (SD) for at least 2 years Given the gap between efficacy and ongoing use
following RP2, and 40-75% of patients experience long-term Given the influence of psychological factors on ED and use of
Patient & Partner Pro-erectile Agents
SD 3-5. 60% of patients report moderate to severe distress with Distress
Given the knowledge of Shielding Factors
SD6. Psychosocial distress associated with SD is especially Loss of Usual Social
elevated in younger men and partners of RP patients7-9. Support
Change in Sexual Response
Pattern -More research and new more comprehensive
Although pro-erectile aids are effective at improving post-RP - Partner - Patient
clinical approaches are needed-
SD, the benefits are offset by low rates of ongoing use10-11. - Individual friend Ineffective - Partner
- Couple friends Communication - Couple
- Even in “good” communicators
OBJECTIVES Figure 1. Patient and Partner Distress
1) To map the field of couples’ responses to sexual
CONCLUSION
dysfunction (DISTRESS)
The unique relevance of this research is its focus on
Unrealistic Expectations Confusion regarding Course of Confusion re: use of ED
2) To map the field of couples’ responses to pro-erectile Recovery Therapy
intimate, sensitive responses of patients and partners
agents and devices (ADHERENCE) - Lack of systematic approach
to cancer treatment-related disability and the
coordination of activities of physicians and psychosocial
professionals in deriving appropriate and sensitive
treatment that provides assistance in resolving sexual
dysfunction and sustaining healthy sexual and non-
METHODS Obstacles to Effective Use
sexual intimacy. The data obtained in this study can be
used to inform the development of appropriate and
of ED Therapy
This is a longitudinal multi-centre study, using a qualitative - Side-effects
sensitive bio-psychosocial couples’ interventions that
methodology design. Twenty-five (n=25) post-radical - Invasiveness
addresses, cognitive, emotional, and communicative
prostatectomy patients experiencing sexual dysfunction and - Cost/Accessibility
problems associated with sexual dysfunction and sexual
their partners were interviewed (simultaneously and
Lack of Naturalness & dysfunction treatment post-radical prostatectomy.
Performance Anxiety Spontaneity
independently) at 3 time points: 3 to 6 months, 12 to 15 -Trial and Failure
months, and 21 to 24 months post surgery. All
Figure 2. Avoidance/Rejection of Pro-Erectile Therapy
patient/partner/couple interviews were tape-recorded,
transcribed and imported into NVIVOsoftware (REF1), a
computerized qualitative analysis program. Categories and
associated sub-categories were developed using the
REFERENCES
Grounded Theory Paradigm Model (REF2) method for Creativity/Resourcefulness to Changes in Broad Perspective of Masculinity 1) Will add references
Sexual Response
qualitative analysis. Importance of Orgasms 2) REF1: NVIVO (2006). QSR International Pty Limited.
3) REF2: Strauss, A. & Corbin, J. (1990). Basics of
qualitative research: Grounded theory procedures
and techniques. London: Sage.
RESULTS Realistic Optimism
Shielding Factors
Humour
- hope
The figures below depict three organizing domains
(Patient/Partner Distress, Avoidance/Rejection of ED
Therapy, and Shielding Factors) used to meaningfully Acceptance Effective Communication
-Patience
group emergent categories and subcategories.
-Global Oncology Perspective
Figure 3. Distress and Non-Adherence: Shielding Factors