Helping people cope with advanced prostate cancer : identifying and meeting their unmet coping needs

Most of what is known about psychosocial adjustment to cancer comes from studies of women with early stage cancer, mainly breast cancer. The findings suggest that for women in an intimate relationship, support from their partner is an important predictor of their adjustment. Randomised Control Trials (RCTs) of couple-based interventions show they are efficacious for improving couples' adjustment to breast and gynaecological cancers, particularly for reduction of sexual problems. The most common cancer in men worldwide is prostate cancer. It is unclear whether results from intervention research targeting female cancers generalises to men with prostate cancers, and their partners, or to people with advanced stage disease. There has been no published RCT of a couple-based intervention for men with cancer, few interventions involving patients with advanced disease, and none specifically designed for men with advanced stage prostate cancer. While men and women find the same types of partner support behaviours helpful generally, they do show disparity in their coping and preferences for support in some situations, particularly health related challenges. It is also difficult to engage men in coping interventions, perhaps because the programs do not address their needs. Further, while people facing advanced or terminal cancer may derive benefit from some aspects of interventions for early stage disease, they are also likely to have additional needs, such as managing unfinished business, changes in roles, and increases in carer burden that these programs do not address. This literature review describes the nature of advanced stage prostate cancer and the psychosocial challenges that diagnosis and treatments pose for men and their partners. The efficacy of interventions involving men with advanced stage disease is reviewed, and the implications of these findings for assessment and intervention of couples coping with advanced stage prostate cancer is discussed