Technology-Based Psychosocial Intervention to Improve Quality of Life and Reduce Symptom Burden in Men with Advanced Prostate Cancer: Results from a Randomized Controlled Trial.

BACKGROUND: Men with advanced prostate cancer (APC) face multiple challenges including poor prognosis, poor health-related quality of life (HRQOL), and elevated symptom burden. This study sought to establish the efficacy of a tablet-delivered, group-based psychosocial intervention for improving HRQOL and reducing symptom burden in men with APC. We hypothesized that men randomized to cognitive-behavioral stress management (CBSM) would report improved HRQOL and reduced symptom burden relative to men randomized to an active control health promotion (HP) condition. Condition effects on intervention targets and moderators of these effects were explored. METHODS: Men with APC (N = 192) were randomized (1:1) to 10-week tablet-delivered CBSM or HP, and followed for 1 year. Multilevel modeling was used to evaluate condition effects over time. RESULTS: Changes in HRQOL and symptom burden did not differ between groups. Men in both groups improved across several intervention targets; men in the CBSM condition reported greater increases in self-reported ability to relax, and both conditions showed improvements in cancer-related anxiety, cancer-related distress, and feelings of cohesiveness with other patients over time. Moderating factors included baseline interpersonal disruption, fatigue, and sexual functioning. CONCLUSIONS: Tablet-delivered CBSM and HP were well received by men with APC. The hypothesized effects of CBSM on HRQOL and symptom burden were not supported, though improvements in intervention targets were observed across conditions. Participants reported high-baseline HRQOL relative to cancer and general population norms, possibly limiting intervention effects. The identified moderating factors should be considered in the development and implementation of interventions targeting HRQOL and symptom burden. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03149185.

Brief report of a tablet-delivered psychosocial intervention for men with advanced prostate cancer: Acceptability and efficacy by race.

Relative to non-Hispanic whites (NHW), black men are disproportionately affected by prostate cancer (PC) incidence, have poorer PC outcomes, and report greater compromises in health-related quality of life. Despite these challenges, black men are underrepresented in psychosocial cancer research, possibly due to limited access to supportive oncology programs. The purpose of this article is to examine the acceptability and efficacy for reducing disease-specific distress of a tablet-delivered psychosocial intervention for older men with advanced PC (APC) and explore differences by race. Men with APC (N = 192, 37.5% black, age M = 68.84 years) were randomized to 10-week Cognitive Behavioral Stress Management (CBSM) or attention-control Health Promotion (HP), both delivered via tablets. Assessments occurred at baseline in person, weekly during the 10-week program via tablets, and at 6 and 12 months in person. Weekly session evaluations and postprogram exit surveys assessed acceptability. Efficacy was assessed with a measure of PC-anxiety validated with racially diverse PC patients using linear mixed effects modeling. Study retention and group attendance did not differ by race. CBSM and HP were both acceptable among older APC patients. Black men rated both conditions more favorably than NHW men. Men in CBSM (vs. HP) reported greater reductions in PC-anxiety at 6 months (not sustained at 12 months). Black men in CBSM reported greater decreases in PC-anxiety over time compared with all other groups. Tablet-delivered CBSM and HP were acceptable for black and NHW APC patients, although black men rated both conditions more favorably. Black men reported a unique intervention benefit related to reduced disease-specific distress.

Fatalism, medical mistrust, and pretreatment health-related quality of life in ethnically diverse prostate cancer patients.

OBJECTIVE: Few studies have examined the impact of cultural processes prevalent in minority ethnic groups such as cancer fatalism and medical mistrust on health-related quality of life (HRQoL) following a cancer diagnosis. The present study examined relationships among ethnicity, HRQoL, and two possible cultural vulnerability factors-fatalistic attitudes and medical mistrust-among an ethnically diverse sample of men with prostate cancer (PC) prior to undergoing active treatment. METHODS: A total of 268 men with localized PC (30% African American, 29% Hispanic, and 41% non-Hispanic White) were assessed cross-sectionally prior to active treatment. Path analyses examined relationships among ethnicity, vulnerability factors, and HRQoL. RESULTS: Ethnicity was not related to HRQoL after controlling for relevant covariates. Hispanic men reported greater cancer fatalism compared with non-Hispanic White men (ß = 0.15, p = 0.03), and both Hispanics (ß = 0.19, p < 0.01) and African Americans (ß = 0.20, p < 0.01) reported greater medical mistrust than non-Hispanic Whites. Fatalism demonstrated a trend toward negatively impacting physical well-being (ß = -0.12, p = 0.06), but was not significantly related to emotional well-being (ß = -0.10, p = 0.11). Greater medical mistrust was associated with poorer physical (ß = -0.14, p = 0.03) and emotional well-being (ß = -0.13, p = 0.04). CONCLUSIONS: Results indicate that fatalistic attitudes and medical system mistrust were more prevalent among minority men. Less trust in the medical system was associated with poorer physical and emotional well-being. Attention to perceptions of the healthcare system and its relation to HRQoL may have implications for targeting culturally driven attitudes that may compromise adjustment to a PC diagnosis.Copyright © 2015 John Wiley & Sons, Ltd.

Feasibility, acceptability, and preliminary efficacy of a technology-assisted psychosocial intervention for racially diverse men with advanced prostate cancer.

BACKGROUND: The utility of psychosocial interventions in reducing symptom burden and improving health-related quality of life (HRQOL) for men with localized prostate cancer has been demonstrated. However, studies have yet to demonstrate the efficacy of interventions in advanced prostate cancer (APC). This study examined the feasibility, acceptability, and preliminary efficacy of a technology-assisted, 10-week, group-based psychosocial intervention for diverse men with APC. METHODS: The participants were 74 men (mean age, 68.84 years; non-Hispanic white, 57%; black, 40.5%) who were randomized to a cognitive-behavioral stress management (CBSM) treatment or health promotion (HP) attention-control condition. The participants were assessed at the baseline, weekly throughout the 10-week program, and 6 months after the baseline. Outcomes were assessed with the Patient-Reported Outcomes Measurement Information System along with established measures of HRQOL, CBSM intervention targets (eg, relaxation skills), and patient-reported acceptability. RESULTS: Feasibility was demonstrated through good retention rates (>85%) and acceptable average attendance rates (>70%), and acceptability was demonstrated through very favorable weekly session evaluations (mean score, 4/5) and exit surveys (mean score, 3.6/4). Men randomized to the CBSM condition reported significant reductions (P < .05) in depressive symptoms and improvements in relaxation self-efficacy (P < .05) at the 6-month follow-up. CBSM participants reported trends for improvement in distress and functional well-being (P < .08) in comparison with those in the HP condition. Effect sizes ranged from medium (0.54) to large (1.87) and, in some instances, were clinically meaningful. CONCLUSIONS: Technology-based CBSM interventions among diverse men with APC may be feasible, acceptable, and efficacious.

Positive and negative mood in men with advanced prostate cancer undergoing androgen deprivation therapy: considering the role of social support and stress.

UNLABELLED: Advanced prostate cancer patients often undergo androgen deprivation therapy (ADT). Advanced disease and adverse ADT side effects are often debilitating and negatively impact mood. Social support has been shown to mitigate detrimental effects of stress on mood. OBJECTIVE: This study sought to characterize positive and negative mood in this select patient population and determine whether social support moderated relations between stress and mood. METHODS: Participants (N = 80) completed the Interpersonal Support Evaluation List, Perceived Stress Scale, and Derogatis Affect Balance Scale at a single time point. Hierarchical regression models evaluated relations among social support, stress, and mood controlling for relevant covariates. Standard moderation analyses were performed. RESULTS: Participants reported higher levels of negative and positive mood compared with published means of localized prostate cancer patients. Overall, mood was more positive than negative. Stress levels were comparable to cancer populations with recurrent disease. Moderated regression analyses showed that social support partially buffered the effects of stress on positive mood; men with high stress and low support reported the lowest levels of positive mood. The model with negative mood as the dependent measure did not support moderation; that is, the relationship between stress and negative mood did not differ by level of social support. CONCLUSION: Among individuals living with advanced prostate cancer, social support may be an important factor that sustains positive mood in the presence of stress. Future work should examine the extent to which social support prospectively impacts health-related quality of life by promoting positive mood. Limitations include cross-sectional design, which precludes causal inferences.

Sexual bother in men with advanced prostate cancer undergoing androgen deprivation therapy.

INTRODUCTION: Men with advanced prostate cancer (APC) undergoing androgen deprivation therapy (ADT) often experience distressing sexual side effects. Sexual bother is an important component of adjustment. Factors associated with increased bother are not well understood. AIMS: This study sought to describe sexual dysfunction and bother in APC patients undergoing ADT, identify socio-demographic and health/disease-related characteristics related to sexual bother, and evaluate associations between sexual bother and psychosocial well-being and quality of life (QOL). METHODS: Baseline data of a larger psychosocial intervention study was used. Pearson's correlation and independent samples t-test tested bivariate relations. Multivariate regression analysis evaluated relations between sexual bother and psychosocial and QOL outcomes. MAIN OUTCOME MEASURES: The Expanded Prostate Cancer Index Composite sexual function and bother subscales, Center for Epidemiologic Studies Depression Scale, Functional Assessment of Cancer Therapy--General, and Dyadic Adjustment Scale were the main outcome measures. RESULTS: Participants (N = 80) were 70 years old (standard deviation [SD] = 9.6) and reported 18.7 months (SD = 17.3) of ADT. Sexual dysfunction (mean = 10.1; SD = 18.0) was highly prevalent. Greater sexual bother (lower scores) was related to younger age (ß = 0.25, P = 0.03) and fewer months of ADT (ß = 0.22, P = 0.05). Controlling for age, months of ADT, current and precancer sexual function, sexual bother correlated with more depressive symptoms (ß = -0.24, P = 0.06) and lower QOL (ß = 0.25, P = 0.05). Contrary to hypotheses, greater sexual bother was related to greater dyadic satisfaction (ß = -0.35, P = 0.03) and cohesion (ß = -0.42, P = 0.01). CONCLUSIONS: The majority of APC patients undergoing ADT will experience sexual dysfunction, but there is variability in their degree of sexual bother. Psychosocial aspects of sexual functioning should be considered when evaluating men's adjustment to ADT effects. Assessment of sexual bother may help identify men at risk for more general distress and lowered QOL. Psychosocial interventions targeting sexual bother may complement medical treatments for sexual dysfunction and be clinically relevant, particularly for younger men and those first starting ADT.

Identifying how and for whom cognitive-behavioral stress management improves emotional well-being among recent prostate cancer survivors.

OBJECTIVE: The outcomes of a 10-week cognitive-behavioral stress management (CBSM) group intervention were evaluated in prostate cancer survivors. A model was tested in which CBSM-related improvements in emotional well-being were attained through changes in men's perceptions of their condition, as conceptualized by information processing explanations of self-regulation theory. The model also tested whether life stress and treatment-related side effects moderated intervention effects. METHODS: Men treated for localized prostate cancer (n = 257) within the past 18 months were randomized to CBSM or a half-day psycho-educational seminar. At pre-intervention and 12-week follow-up, emotional well-being, illness perceptions, life stress, and sexual and urinary function were assessed using validated questionnaires. RESULTS: After controlling for covariates, CBSM participants showed greater improvements in emotional well-being relative to control participants (ß = 0.13, p < 0.05). For men reporting higher stress upon study entry, CBSM-related improvements were partially explained by changes in some, but not all, illness perceptions. Sexual and urinary dysfunction did not influence CBSM-related gains. CONCLUSIONS: Prostate cancer perceptions may be an important target for enhancing emotional well-being, particularly for men experiencing general life stress. However, interventions that explicitly target mental representations of cancer may be needed to modify perceptions of the disease.

Perceived social support as a predictor of disease-specific quality of life in head-and-neck cancer patients.

BACKGROUND: Treatment for head-and-neck cancer (HNC) can lead to severe decrements in disease-specific quality of life (DSQOL) due to disfigurement and disability in speech, eating, and/or breathing. Psychosocial factors such as social support may explain individual variance in DSQOL outcomes. OBJECTIVE: The researchers sought to evaluate changes in perceived availability of social support from pretreatment to posttreatment and to determine whether decreases in perceived social support predicted poorer posttreatment DSQOL among HNC patients, controlling for disease- and treatment-related factors. METHODS: Participants (n = 32) were newly diagnosed with HNC and were awaiting surgery and/or radiation treatment. Measures included the ENRICHD Social Support instrument (ESSI) to assess perceived social support and the Functional Assessment of Cancer Therapy-Head & Neck (FACT-H&N) to assess DSQOL. Paired-samples t-tests and hierarchical regression analyses were conducted to determine relationships between pretreatment and posttreatment perceived social support and DSQOL. RESULTS: Perceived social support decreased significantly from pre- to posttreatment (F[31] = -2.71, P < .01). After adjusting for relevant covariates and pretreatment DSQOL, change in perceived social support remained a significant predictor of posttreatment DSQOL (ß = .47, P < .01). LIMITATIONS: This study included a relatively small sample of HNC patients, which limited power to evaluate mechanisms of observed relationships. CONCLUSIONS: Increased social isolation may be a risk factor for poorer physical recovery from, or adjustment to, treatment-related side effects. Social support may be an important target for psychosocial interventions for patients who face challenging treatment side effects.

Weight management for veterans: examining change in weight before and after MOVE!

In the year 2000, 31% of women and 40% of men receiving outpatient care at Veteran Affairs (VA) medical facilities were overweight (BMI ≥25 and <30 kg/m(2)); 37.4% of women and 32.9% of men were obese (BMI ≥30 kg/m(2)). The purpose of the present study was to assess treatment effects of MOVE! Weight Management Program for Veterans by comparing the trajectory of change in weight postintervention (3, 6, and 12 months postenrollment) to a preintervention period (1, 3, and 5 years before enrollment). The sample consisted of 862 veterans participating in MOVE! at the Miami VA. All veterans participated in a 2-h Self-Management Support (SMS) session, which involved completion of a self-assessment questionnaire and a nutrition education group session. After completing SMS, veterans had the option of continuing with Supportive Group Sessions (SGS), which included 10-weekly group sessions led by a multidisciplinary team. Veterans served as their own controls in the analyses. Veterans gained 2 kg/year before enrolling in MOVE!. There were similar increases in weight across sex, racial/ethnic groups, and treatment condition. Weight for participants in SMS stabilized after enrollment whereas participants in SGS had an average weight loss of 1.6 kg/year. The preintervention slope for weight was significantly different from the postintervention slope, suggesting treatment effect. Findings from this study support the need for a lifestyle modification program such as MOVE! in primary care settings to assist overweight and obese patients in managing their weight.

Illness perceptions and emotional well-being in men treated for localized prostate cancer.

OBJECTIVE: Emotional adjustment to cancer survivorship may be influenced by how patients interpret treatment side effects and other cancer-related experiences. The current study examined cognitive representations of illness, as conceptualized by the Self-Regulatory Model (SRM), in men treated for localized prostate cancer (PC). More severe PC perceptions were hypothesized to predict poorer emotional well being, particularly among men experiencing greater post-treatment sexual dysfunction or general life stress. METHODS: The Perceived Stress Scale, Expanded Prostate Cancer Index Composite, Illness Perception Questionnaire-Revised, and Functional Assessment of Cancer Therapy were administered to 214 men within 18 months of completing treatment for early stage PC. RESULTS: Perceptions that PC was less comprehensible, was less likely to be controlled by treatment, and was more likely caused by one's own personality and behaviors remained associated with poorer emotional well being after adjusting for relevant medical and demographic factors. Life stress moderated the relationship between perceived consequences of PC and emotional well-being, such that more severe perceptions of negative consequences predicted poorer emotional well-being only for men experiencing higher life stress. Degree of sexual dysfunction did not moderate any relationships between cancer perceptions and emotional well-being. CONCLUSION: Within 18 months of completing treatment for localized PC, more severe perceived consequences of PC were associated with poorer emotional well-being, particularly among men experiencing greater life stress. Interventions that target distortions in illness perceptions may enhance emotional adjustment among the most distressed PC survivors.

Promoting recovery of sexual functioning after radical prostatectomy with group-based stress management: the role of interpersonal sensitivity.

OBJECTIVE: Treatment for localized prostate carcinoma (PCa) is frequently associated with decrements in sexual functioning and satisfaction. Given the highly interpersonal nature of these decrements, interpersonal problems (such as interpersonal sensitivity) may affect recovery of sexual functioning after PCa treatment through interference with physician and partner communication and through distorted cognitions surrounding sexual dysfunction. The objective of the present study was to determine the effect of interpersonal sensitivity on several treatment indicators, including response to a group-based psychosocial intervention. METHODS: Participants were 101 older men recovering from radical prostatectomy who were enrolled in a randomized controlled trial of a 10-week group-based cognitive-behavioral stress management (CBSM) intervention. Measures included the Inventory of Interpersonal Problems and the sexual functioning subscale of the University of California-Los Angeles quality-of-life measure. RESULTS: At baseline, interpersonal sensitivity was related to a belief linking sexual dysfunction to core male identity (r=.29, P<.05). Using hierarchical regression, we found that (a) the CBSM intervention was effective in promoting sexual recovery in all participants, and (b) this effect was moderated by interpersonal sensitivity, such that individuals with higher levels of interpersonal sensitivity made larger improvements in sexual functioning in response to CBSM. CONCLUSIONS: CBSM was effective in improving sexual function after radical prostatectomy. Individuals with higher levels of interpersonal sensitivity were more likely to perceive sexual dysfunction as a threat to masculine identity and made larger gains in the CBSM intervention. Results and relevance to the older male cancer patients are discussed from the perspective of interpersonal theory.

Ethnicity and determinants of quality of life after prostate cancer treatment.

OBJECTIVES: To examine the quality of life (QOL) in a sample of men recently treated for localized prostate cancer to determine whether minority men are at greater risk of decrements in QOL and to identify factors that might explain disparities in QOL outcomes. METHODS: The relationship between ethnicity and QOL was evaluated in a diverse sample of 204 men (85 non-Hispanic white, 37 African-American, and 82 Hispanic men). We also assessed associations with other factors known to be related to QOL (ie, sociodemographic, medical, and health behavior factors). Hierarchical regression analysis was used to assess the relationship between ethnicity and QOL. Factors that were anticipated to explain the ethnic differences in QOL were then added in stepwise analyses. RESULTS: Ethnic group membership was related to QOL such that minority men had lower QOL than non-Hispanic white men. In subsequent steps, the association between ethnic group membership and QOL was partially mediated by sociodemographic, medical, and health behavior factors, with each factor adding significant incremental variance (5%, 5%, and 17%, respectively). Three variables remained significant in the final model, which explained 37% of the variance in QOL scores: medical comorbidity, physical activity, and sleep functioning. CONCLUSIONS: Health behaviors appear to be strongly related to men's QOL after prostate cancer treatment. Intervention studies aimed at improving QOL should include a brief assessment of health behaviors and may want to incorporate intervention components designed to address physical activity and sleep functioning.

A randomized clinical trial of group-based cognitive-behavioral stress management in localized prostate cancer: development of stress management skills improves quality of life and benefit finding.

BACKGROUND: Recent literature has indicated that a significant percentage of oncology patients describe finding some benefit (e.g., improved personal growth, sense of meaning, and enhanced interpersonal relationships) in the cancer experience. However, few studies have investigated the role of group-based psychosocial interventions in improving benefit finding (BF), and virtually none have investigated these constructs in men. PURPOSE: This study examined whether a cognitive-behavioral stress management (CBSM) intervention improves BF and quality of life (QoL) in men recovering from treatment for localized prostate cancer. METHODS: Participants in this study were 191 men (M age = 65.1) treated with radiation or radical prostatectomy for clinically localized (i.e., Stage I or II) prostate cancer. Participants were primarily non-Hispanic White (40%) or Hispanic (41%), followed by Black (18%) and other ethnicity (1%), were an average of 65.1 years old (SD = 7.7), and earned an average of 47,800 US dollars annually (SD = 41,000 US dollars). Participants were randomized to either a 10-week group-based cognitive-behavioral stress management intervention or a half-day educational seminar as a control condition. All participants provided demographic information and completed the Positive Contributions Scale-Cancer to assess BF, the Functional Assessment of Cancer Therapy to measure quality of life, and a measure of perceived stress management skills. Structural equation modeling was utilized for all analyses. RESULTS: Results indicated that the CBSM condition led to increases in BF and QoL and that these changes were mediated by the development of stress management skills. CONCLUSIONS: Results support the use of group-based cognitive-behavioral interventions in promoting QoL and BF in this population.

Anger suppression mediates the relationship between optimism and natural killer cell cytotoxicity in men treated for localized prostate cancer.

OBJECTIVE: This study evaluated relations among optimism, depression, anger suppression and natural killer cell cytotoxicity (NKCC) in 61 men treated for localized prostate cancer (PC). METHOD: All participants were assessed at a single time point where demographics, optimism, depression and anger suppression were measured. We also collected peripheral venous blood to assess NKCC. RESULTS: Results showed that greater optimism was associated with greater NKCC (beta=.27, P<.05), less depression (beta=-.63, P<.001) and less anger suppression (beta=-.29, P<.05). Furthermore, less anger suppression (beta=-.35, P<.01) was associated with greater NKCC. In a hierarchical regression model controlling for depression and then anger suppression, the relationship between optimism and NKCC became nonsignificant [beta=.18, t(56)=1.51, P=.14], while anger suppression remained significantly correlated with NKCC [beta=-.29, t(56)=-2.40, P<.05]. CONCLUSIONS: Results suggest that optimism is associated with NKCC and a greater ability to adaptively express anger. Furthermore, it appears that less anger suppression partially mediates the relationship between optimism and NKCC.

Psychosocial and sociodemographic correlates of benefit-finding in men treated for localized prostate cancer.

BACKGROUND: Prostate cancer (PCa) treatment involves decrements in quality of life such as decreased sexual functioning and urinary/bowel incontinence. Prior work in other cancers has identified positive consequences (e.g. personal growth) following diagnosis and treatment, a phenomenon that has been referred to as benefit-finding (BF) and positively related to quality of life. METHOD: The present study evaluated demographic and psychosocial correlates of BF in men treated for localized PCa. Participants were 250 men who were 6-18 months post treatment, who completed measures of coping strategies, perceived social support, and BF. RESULTS: In regression models both coping and social support were positively related to BF scores, even after controlling for income, education and ethnic identification. CONCLUSION: Active coping strategies and greater perceived social support are important correlates of greater BF following localized PCa treatment.

Physical activity and sexual functioning after radiotherapy for prostate cancer: beneficial effects for patients undergoing external beam radiotherapy.

OBJECTIVES: To evaluate, in a cross-sectional study, the relationships among physical activity, sexual functioning, and treatment type for 111 men who had undergone radiotherapy for localized prostate cancer within the past 18 months. Physical activity preserves the sexual functioning capacity of older men. However, little information exists regarding the association of physical activity with sexual functioning after treatment for localized prostate cancer. METHODS: We tested the main effects of physical activity and treatment procedure, as well as their interaction, using hierarchical regression analysis. We hypothesized that greater physical activity would relate to better reported sexual functioning and that this relationship would be moderated by the type of medical treatment. RESULTS: After controlling for age, medical comorbidity, fatigue, and urinary and bowel functioning, more physical activity was significantly associated with better sexual functioning, and the interaction of physical activity and treatment procedure added a significant amount of explained variance. Overall, 35% of the variance in sexual functioning was accounted for by the model. Post hoc tests of moderation revealed that men who underwent external beam radiotherapy had significantly greater sexual functioning scores as physical activity increased but the effect of physical activity on sexual function after brachytherapy and combination therapy was nonsignificant. CONCLUSIONS: Physical activity was positively correlated with sexual functioning for those who underwent external beam radiotherapy. These relationships should be replicated and explored in a larger, longitudinal sample to ascertain whether the effects of physical activity in this at-risk population extend over time and protect men from treatment-related decrements in sexual functioning.

Exercise and well-being: a review of mental and physical health benefits associated with physical activity.

PURPOSE OF REVIEW: This review highlights recent work evaluating the relationship between exercise, physical activity and physical and mental health. Both cross-sectional and longitudinal studies, as well as randomized clinical trials, are included. Special attention is given to physical conditions, including obesity, cancer, cardiovascular disease and sexual dysfunction. Furthermore, studies relating physical activity to depression and other mood states are reviewed. The studies include diverse ethnic populations, including men and women, as well as several age groups (e.g. adolescents, middle-aged and older adults). RECENT FINDINGS: Results of the studies continue to support a growing literature suggesting that exercise, physical activity and physical-activity interventions have beneficial effects across several physical and mental-health outcomes. Generally, participants engaging in regular physical activity display more desirable health outcomes across a variety of physical conditions. Similarly, participants in randomized clinical trials of physical-activity interventions show better health outcomes, including better general and health-related quality of life, better functional capacity and better mood states. SUMMARY: The studies have several implications for clinical practice and research. Most work suggests that exercise and physical activity are associated with better quality of life and health outcomes. Therefore, assessment and promotion of exercise and physical activity may be beneficial in achieving desired benefits across several populations. Several limitations were noted, particularly in research involving randomized clinical trials. These trials tend to involve limited sample sizes with short follow-up periods, thus limiting the clinical implications of the benefits associated with physical activity.

Physical activity interventions in the elderly: cancer and comorbidity.

The relationship among age, comorbidity, and physical activity have been relatively understudied among breast, colorectal, and prostate cancer populations despite their known impact on morbidity and mortality. In this article, we review evidence supporting the efficacy of physical activity interventions in improving cardiovascular risk groups, the elderly and cancer patients. Preliminary studies conducted with older patients suggest that physical activity interventions can reduce fatigue, elevate mood, improve physical functioning, reduce physical, role limitations, decrease falls, attenuate losses in bone density, promote weight loss, and modify CHD risk factors. Although relatively few randomized clinical trials have assessed the efficacy of physical activity interventions in cancer patients, the research suggests that these interventions can have both physical and mental health benefits. The implications and limitations of these findings are discussed. Further studies that use larger sample sizes and examine possible moderating variables, such as age, on the efficacy of such interventions are needed.

Sexual functioning and quality of life after prostate cancer treatment: considering sexual desire.

OBJECTIVES: To evaluate whether the relationship between sexual desire and quality of life (QOL) is moderated by sexual functioning in 91 men who had received treatment for localized prostate cancer within the past 18 months. METHODS: Items from the University of California, Los Angeles, Prostate Cancer Index and Expanded Prostate Cancer Index Composite were used to assess sexual factors, and the Functional Assessment of Cancer Therapy--General Module was administered to evaluate QOL. Education, income, and the Charlson comorbidity index were significantly related to QOL and controlled in all analyses. We tested a moderated regression model to predict QOL. RESULTS: Although a main effect was detected for sexual functioning, the interaction of sexual desire and sexual functioning added a significant amount to the explained variance in QOL. Post hoc tests of moderation revealed that men with lower sexual functioning had significantly lower QOL scores as the level of sexual desire increased, suggesting that desire in the absence of adequate functioning may result in poorer QOL. Additionally, a tendency was found for men with better sexual functioning to have higher QOL scores as the level of sexual desire increased. CONCLUSIONS: The results of our study suggest that both sexual desire and sexual functioning are necessary for optimal QOL and highlight the utility of considering these two facets of sexuality independently to maximize the prediction of variance in QOL scores.

Prostate cancer and QOL: impact of treatment, disease burden and psychosocial interventions.

Prostate cancer is highly prevalent and the second leading cause of cancer-related deaths in American men. Treatment of localized prostate cancer is highly effective but can result in urinary, bowel and sexual dysfunction, undermining quality of life. Within 5 years of treatment, approximately a third of men will have a rising prostate-specific antigen level necessitating hormonal therapy which has a broad range of detrimental side effects. Moreover, the impact of hormonal therapy may overlay existing issues (e.g., comorbid illness) common to older men. Men with advanced disease experience significant disease- (e.g., metastasis) and treatment-related impairments, which may further compromise quality of life. A substantial amount of literature indicates that cancer patients benefit significantly from psychosocial interventions, and psychosocial factors may serve to buffer prostate cancer patients from some disease- and treatment-related decrements in quality of life. While very few randomized clinical trials have been conducted with prostate cancer patients, recent results suggest that such interventions improve coping skills, increase prostate cancer knowledge, reduce treatment-related disruption of daily activities, diminish bother associated with sexual problems and enhance global quality of life. In order to better understand who benefits most from psychosocial interventions, additional studies are needed to more fully assess the potential mediators and moderators of these intervention findings.