Table 7 Comparing different cancer treatments and psychological adjustment

Lee et al. (2001)

• Prospective 12 months assessment of QOL (Functional Assessment of cancer therapy – Prostate) after surgery, radiotherapy or brachytherapy

• Patients with localized disease: 23 treated with surgery, 23 with radiotherapy and 44 with brachytherapy

• After one month, virtually no change in emotional well being in all 3 groups

• After 12 months, emotional well being similar to baseline in all 3 groups

Fossa et al. (2001)

• Prospective assessment of QOL (EORTC) at 6 weekly intervals until death

• 101 men treated with steroids, 100 with hormone therapy – all showing hormone-resistant metastatic PCA

• Men on steroids have better role functioning and less fatigue, especially between weeks 3 and 12.

• Because of attrition thereafter, comparisons between the two groups not possible

da Silva (1993)

• QOL (EORTC – Prostate) assessed at 6 months by urologists and patients

• 76 men with metastatic PCA – treated with orchidectomy or hormone therapy

• Because of feasibility problems, comparative analysis not possible

• Ratings by urologists correlate poorly with those of patients

Eton et al. (2001)

• Cross-sectional assessment of QOL (UCLA Prostate Cancer Index) within 7 weeks of launch of treatment.

• Men with localised PCA; 156 treated surgically, 49 with radiotherapy, and 51 with brachytherapy

• 3 treatment groups similar in psychological aspects

• Support, self-efficacy and self-esteem predict better QOL

Litwin et al.

• Observational study of PCA (Cancer Rehabilitation Evaluation System and Functional Assessment of Cancer Therapy – General) patients and age and ZIP-code matched controls

• 214 localized PCA patients

• 273 controls

• No differences in general QOL, including emotional well being, between surgery, radiotherapy and observation only sub-groups, or between PCA patients and controls

Fossa et al. (1997)

• Cross-sectional, retrospective assessment of QOL (EORTC)

• 379 men with PCA of various stages: 57 observed only, 112 received hormonal therapy, 96 surgery

• Sexual impairment and fatigue common in 3 treated groups but this does not have much effect on ratings of QOL

Lilleby et al. (1999)

• Controlled, cross-sectional assessment of QOL (EORTC) one year after treatment

• 154 men with PCA of various stages received radiotherapy, 108 surgery; 38 control

• Emotional function similar in 3 groups

• Emotional function good or only slightly impaired in most patients

Cassileth et al. (1992)

• Prospective assessment of QOL (Functional Living Index-Cancer) and mood at 3 and 6 months follow-up

• 159 men with advanced PCA; 115 chose hormone therapy, 32 orchidectomy

• Mood improved at 3 months in both groups

• Improvement greater in hormone therapy than orchidectomy patients at 6 months

Bokhour et al. (2001)

• Participation in focus group (7 groups); qualitative approach to QOL concerns

• Men treated 12–24 months previously

• 48 men with early PCA treated with surgery, radiotherapy or brachytherapy

• Most men had sexual difficulties in terms of sexual relationships, intimacy and sense of masculinity

• QOL – sexual effects – treatment type associations not mentioned

Van Andel et al. (2003)

• QOL (EORTC) assessed pre-treatment only

• 65 patients with localized disease treated surgically, 73 with radiotherapy

• Cognitive, but not emotional, function better in patients about to be treated surgically. Also especially in terms of sexual functioning and fatigue

Steginga et al. (2004)

• Prospective study before one of three treatments and two and 12 months after treatment

• A range of psychological distress scales eg. Impact of Events Scale and Satisfaction with Life Scale

• 111 patients with localised disease – 56% treated surgically, 19% with RT and 25% with watchful waiting

• No differences found by medical treatment group in psychological adjustment at baseline or at follow-up.

• Overall QOL similar to community norms