OBJECTIVES: Metastatic prostate cancer is a serious disease that affects both men and their intimate partners. We explored the perceptions of men who have been treated for metastatic prostate cancer and the views of their wives regarding the changes that were caused by prostate cancer and its treatment.
STUDY DESIGN: We conducted retrospective focus group interviews with married men and separate focus groups with their wives
POPULATION: Twenty married men (11 white and 9 African American) with an average age of 69 years (range=60-82 years) and 7 of the wives (5 white and 2 African American) participated in our study. Thirteen of the men were treated with orchiectomy, and 7 received monthly hormone ablation therapy.
OUTCOMES MEASURED: We compared the accounts of husbands and wives concerning the diagnosis and treatment of prostate cancer.
RESULTS: The participants’ accounts indicate little spousal communication about the implications of prostate cancer on their lives. In particular, couples appear to talk little about their emotions, worries, and fears.
CONCLUSIONS: Although wives have a profound interest in their husbands’ prostate cancer, actual communication about the disease, its treatment, and the feelings it evokes may be less than we believe. Noncommunication in marriages might indicate that these couples are at increased risk for poor adjustment to prostrate cancer.
Prostate cancer (the most common cancer in men) has a considerable impact on the quality of patients’ lives. After a frightening diagnosis, the treatments cause a variety of unpleasant side effects. In the case of metastatic disease, hormonal treatment through either orchiectomy or a permanent regimen of medications to suppress testosterone causes nausea, hot flashes, loss of muscle tone, and erectile dysfunction.1 The complex psychosocial effects of diagnosis and treatment, such as changes in body and self-image, masculinity, sexuality, and uncertainty, are gradually recognized.2 However, most investigations of quality of life have focused on the patients, increasing our understanding of how men respond to prostate cancer, but telling us little about how this disease affects the shared lives of men and their significant others. Prostate cancer threatens men’s survival and families’ futures. Sexual dysfunction following treatment has implications for both men and their intimate partners. Therefore, we explored the perceptions of men who have been treated for prostate cancer, and those of their wives, regarding the changes that were caused by prostate cancer and its treatment.
The effect of illness on marital quality is largely an unresolved area.3 Some researchers argue that there is no change—or if there is a change, it is a positive association between illness and the spousal relationship, because it brings spouses closer together.4 Others point to negative impacts on the marital relationship.5 It has been suggested that a worsening of marital quality can be explained by the financial implications of illness, the problematic behavior of the sick person, and the changed division of labor in the couple, including the loss of shared activities.5 A decline in marital quality is often perceived by spouses who suffer from increased stress and depression because of their spouses’ disease.5,6 Research on couples coping with illness has highlighted the importance of open communication for positive adjustment by patients and their spouses.7,8 But couples’ ability to communicate varies,8 and many avoid truthful and open communication with each other9 and with other friends and family members.10
Only a few prostate cancer studies have considered the patient’s social context. Studies that include spouses point to the interrelationship of their reactions to prostate cancer.3,11-17 We focussed on couples’ communication about prostate cancer and its treatment effects.
Methods
Our study is part of a larger investigation of the psychosocial effects of metastatic prostate cancer, that had the development of quality-of-life scales as its goal.2 We recruited a convenience sample of men who had undergone treatment and some of their wives. After we obtained informed consent, 15 focus groups were conducted with patients and 2 were conducted with the wives. The wives participated in focus groups immediately after their husbands, which minimized the opportunities for them to discuss the content of their respective focus groups. A medical sociologist and a urologist (both men) conducted the sessions, which were videotaped and transcribed for analysis.
We examined what the 20 married participants said about their experiences with prostate cancer. The husbands had an average age of 69 years; 11 were white, 9 were African American; 13 had undergone orchiectomy, and 7 were receiving monthly injections to suppress testosterone. Of the 7 wives, 5 were white and 2 African American.
We analyzed these data according to grounded theory methods of qualitative analysis.18 Thus, we developed codes to interpret the content of focus group participants’ accounts and then inductively developed summary themes characterizing their expressed experiences of prostate cancer. This method involves constant comparison of analytic codes. Within the set of 20 husbands, we compared how they described their communication with their wives in the context of discussions with other men. Then we compared within the set of 7 husband-wife pairs how each party described their communication with their spouse. The first author analyzed all data, and the second author independently analyzed a random selection of the data for validation. Disagreements in interpretation were resolved by continued comparative usage of the data, revising the codes and themes.