Transcript B2-Sat-1-2-Baird - New Zealand Institute of Medical Radiation

Sat 31st Aug 2013
Session 1 / Talk 2
09:46 – 10:01
BROOKLYN 2
RADIOTHERAPY
Catherine BAIRD
ABSTRACT
Prostate cancer was the most commonly registered cancer in 2008. High survival rates following treatment
emphasize the importance of enhancing patients' quality of life. Prostate cancer can be treated with surgery,
radiation therapy and hormone therapy all of which have side effects that impact on a patient's quality of life.
This study reviewed ten recent qualitative primary research studies to determine the impact prostate cancer
treatment side effects have on patient sexuality. Key findings suggest that erectile dysfunction and urinary
incontinence have a significant impact on sexuality and sexual function by affecting patient self-esteem,
masculinity and relationships regardless of age. Some men rationalized their side effects against their survival
whereas others questioned if, given the option again, they would have treatment. Current erectile dysfunction
treatments are accompanied by more side effects and are often discontinued by patients. The impact these
treatments have on spontaneity was found to be significant. Both patients and health professionals are hesitant
to discuss sexual issues resulting in poor communication and patient's sexual needs not being addressed. From
this review it can be deduced that further training for health professionals is required to enable better
communication around management of sexual issues in order to meet patient's needs enhancing the quality of
their care.
SEXUALITY AFTER PROSTATE
CANCER TREATMENT
By Catherine Baird
A qualitative literature review
Prostate Cancer in NZ

Approx. 3000 registrations each year [1]

In 2009
of male registrations [2]
 12.8% of all male deaths from cancer [2]
 30.2%

Mortality rates reduced by 27.6% [2]
[1]
Aim

To assess how side effects from prostate cancer
treatments impact on men’s sexuality and whether their
sexual concerns are being addressed by health
professionals.
 Impact
of side effects
 Treatment of erectile dysfunction
 Health professionals approach
[2]
Treatments [1]

Surgery
 Radical
Prostatectomy
 TURP

Hormone Therapy
 Drugs
eg. Zoladex
 Orchidectomy

Radiation Therapy
 External
Beam Radiation Therapy
 Brachytherapy
Impact of Side Effects
Impotence
Impotence
[3]
Incontinence
[4]
Impact of Side Effects
“It never goes out of your
[5]
mind”
Impotence
“You don’t forget about it” [5]
“I don’t dwell on the
cancer issue, but I dwell Incontinence
on the continence” [6]
Impact of Side Effects
Survival vs Side Effects
“At a certain moment you
accept your symptoms.
And then you carry on
living.” [7]
“…If I was faced with that
again, would I still make
the same decision? I am not
sure.” [6]
“You are stiff all over when
you are dead.”[8]
“[Incontinence] would be
the end of my life. I would
rather go.” [9]
Impact of Side Effects
Relationships
“There are other ways of
showing love” [5]
“Now you don’t try to keep
her there because why, for
what?” [5]
“I can see a good looking
girl now and it don’t even
faze me at all because I
can’t” [6]
[5]
“Sex is 10% of your
marriage if it’s fine and
100% of your marriage if
it isn’t fine” [11]
Impact of Side Effects
Masculinity & Self Esteem
“You lose that feeling that
you are a whole man” [5]
“It takes away my
confidence” [6]
“I didn’t feel very sexually
attractive…I didn’t really
want to uncover my body”
[6]
[6]
Treating Erectile Dysfunction [1,11]





Oral drugs
Penile injections
Vacuum pump
Constriction rings
Penile implants


Constriction rings
Penile implant
[7]
Treating Erectile Dysfunction
Side Effects
“[it] is extremely
painful…doesn’t seem to
work too well” [5]
“Unfortunately it’s all
volume, no rigidity… and
it’s quite painful” [8]
[8]
Treating Erectile Dysfunction
Spontaneity
“There is a sex life, but it’s
a rather unnatural one” [5]
“By the time you clean
yourself up, the urine
smell, have a shower put in
the injection ra, ra, raa” [6]
“It just makes it very
premeditated” [6]
[9]
Managing Patient Needs
Communication
“Men don’t talk about
things like that… you don’t
talk about having sex” [13]
“I manage to avoid the
topic” [12]
[10]
“The reaction of my
colleagues was a bit
horrified that I actually
talked to a patient at that
level” [12]
Managing Patient Needs
Insufficient
Information
[11]
“Either I don’t remember or
they didn’t tell me about the
nerves being cut” [11]
“Not knowing before hand
[about penis shortening] is a
definite issue” [8]
“I am going to sue you boy,
before the operation, I could
hang and bloody work boot
on it, now it’s only a rubber
thong on a good day” [6]
Conclusion

Impact of Side Effects
 Impotence
and
Incontinence
 Relationships,
Masculinity & Selfesteem


Managing Patient Needs
 Poor
Communication
 Insufficient Information
Treating Erectile
Dysfunction
 Side
effects
 Spontaneity
[12]
References
1.
2.
3.
4.
5.
6.
New Zealand Cancer Society. Prostate cancer: A guide for men with prostate cancer.
2008: Available from:
http://www.cancernz.org.nz/assets/files/info/Prostate_Cancer.pdf
Ministry of Health. Cancer: New registrations and deaths 2009. 2012. Available from:
http://www.moh.govt.nz/moh.nsf/indexmh/cancer-reg-deaths-2009
Ministry of Health. Cancer: Selected sites 2008, 2009, and 2010. 2010. Available from:
http://www.health.govt.nz/publication/cancer-selected-sites-2008-2009-and-2010
Ministry of Health. Cancer: New registrations and deaths 2008. 2008. Available from:
http://www.moh.govt.nz/moh.nsf/indexmh/cancer-reg-deaths-2008
Bokhour B, Clark J, Inui T. Sexuality after treatment for early prostate cancer. Journal of
General Internal Medicine. 2001;16:649–55. Available from:
http://onlinelibrary.wiley.com/doi/10.1111/j.1525-1497.2001.00832.x/full
O’Shaughnessy P “Kevin”, Laws T. Australian men’s long term experiences following
prostatectomy: A qualitative descriptive study. Contemporary Nursing. 2010;34(1):98–
109. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20230176
References
7.
8.
9.
10.
11.
Korfage IJ, Hak T, de Koning HJ, Essink-Bot M-L. Patients’ perceptions of the sideeffects of prostate cancer treatment--a qualitative interview study. Social Science &
Medicine (1982). 2006;63(4):911–9. Available from:
http://www.ncbi.nlm.nih.gov/pubmed/16798130
Oliffe J. Constructions of masculinity following prostatectomy-induced impotence.
Social Science & Medicine. 2005;60(10):2249–59. Available from:
http://www.ncbi.nlm.nih.gov/pubmed/15748673
Kelly D. Changed men: The embodied impact of prostate cancer. Qualitative Health
Research. 2009;19(2):151–63. Available from:
http://www.ncbi.nlm.nih.gov/pubmed/19056697
Petry H, Berry DL, Spichiger E, Kesselring A, Gasser TC, Sulser T, et al. Responses and
experiences after radical prostatectomy: Perceptions of married couples in Switzerland.
International Journal of Nursing Studies. 2004;41(5):507–13. Available from:
http://www.ncbi.nlm.nih.gov/pubmed/15120979
Schover LR. Sexuality and Fertility after Cancer. Haematology. 2005;(713):523–7.
Available from:
http://asheducationbook.hematologylibrary.org/content/2005/1/523.full.pdf+html
References
11.
12.
13.
Milne JL, Spiers J a, Moore KN. Men’s experiences following laparoscopic radical
prostatectomy: A qualitative descriptive study. International Journal of Nursing Studies.
2008;45(5):765–74. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17482192
Hordern AJ, Street AF. Communicating about patient sexuality and intimacy after cancer:
Mismatched expectations and unmet needs. The Medical Journal of Australia.
2007;186(5):224–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/17391082
O’Brien R, Rose P, Campbell C, Weller D, Neal RD, Wilkinson C, et al. “I wish I’d told
them”: A qualitative study examining the unmet psychosexual needs of prostate cancer
patients during follow-up after treatment. Patient Education and Counselling.
2011;84(2):200–7. Available from: http://www.ncbi.nlm.nih.gov/pubmed/20702055
Image References
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5.
6.
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8.
http://www.trampingnz.com/images/new_zealand.gif
http://coretrainingsolutions.net/wp-content/uploads/2011/11/questionmark300x300.jpg
http://www.sciencephoto.com/image/431516/large/C0110707Erectile_dysfunction,_conceptual_artwork-SPL.jpg
http://urinaryincontinencesolutions.com/wpcontent/uploads/2011/08/incontenance.jpg
http://www.veria.com/media_publish/548/impotence_full_1333470799.jpg
http://www.freakingnews.com/Quantum-of-Solace-Pictures----2190.asp
http://www.stevestevesteve.com/comics/2011-04-17-Viagra,-Not-Just-ForImpotence.jpg
http://jaysolomon.files.wordpress.com/2009/01/erectile_dysfunction.jpg
10.
http://postmentis.com/comics/2010-03-28-Spontaneity.jpg
http://www.cartoonstock.com/lowres/jlo0168l.jpg
11.
http://www.cartoonstock.com/lowres/jlo0168l.jpg
12.
http://www.mind-control-method.com/comfort.gif
9.