PHILADELPHIA (July 23, 2021) – Although it improved certain aspects of adaptive coping among prostate cancer survivors, a small randomized, controlled trial found use of PROGRESS, a web-based intervention developed at Fox Chase Cancer Center, did not fully address coping and psychosocial demands.
Prostate cancer is one of the most prevalent cancers in men. Poor physical functioning and negative psychological outcomes are often reported by survivors after treatment.
Suzanne M. Miller, PhD, a professor in the Cancer Prevention and Control Program, was the study’s lead author, and Erin K. Tagai, PhD, MPH, a postdoctoral fellow in Miller’s lab, was first author. Alexander Kutikov, MD, chief of the Division of Urology and Urologic Oncology, and biostatistician Elizabeth Handorf, PhD, an associate professor, were also authors.
Given the size of the population diagnosed with prostate cancer, it’s important to assess symptoms and the long-term effects of treatment, Miller said. “We want to provide the best, most patient-centered care while minimizing patients’ regret about their treatment decisions,” she added.
Another reason for the study was to find ways to enhance patient care without overloading healthcare professionals who have to help patient address various psychosocial issues, Tagai said.
“We are always concerned about all of the aspects of a patient,” including the physical and psychological, Miller said. “Sexual and urinary dysfunction are not pleasant or easy to deal with. That’s why we are always asking, ‘How can we use our skills to further enhance patient care?’”
Miller said that when patients weigh treatment options, they also want to know what is involved in the process of transitioning to survivorship. During and after treatment for prostate cancer, “dynamics change, especially with a partner. At Fox Chase, we are sensitive to the psychosocial aspects of decision making.”
Anyone enrolled in the study was personally introduced to PROGRESS by staff and received support while participating. Slightly older participants, who may have more time, used PROGRESS more than younger men, Miller said. PROGRESS stands for Prostate Cancer Online Guide & Resources for Electronic Survivorship Service.
In intent-to-treat analyses, patients in the randomized intervention group had improved diversion coping such as the healthy redirection of worrying thoughts about their cancer. This same group had more difficulty with marital communication.
As-treated analyses found patients “reported fewer practical concerns but had worse positive coping” compared to patients who opted not to use PROGRESS at all.
PROGRESS usage among those randomized to the intervention group was just 38.7%. “We expected more men to engage,” Miller said.
This points to the need, she added, for additional research to better understand the gaps in intervention delivery and poor improvement across all domains of functional quality of life and adaptive coping.
“It’s not just the cure we care about,” Miller said. “It’s the quality of life for the patient and his partner.” Miller said future studies would likely engage spouses and partners in addition to patients. Gender does figure in to usage and responses, she added.
“Once you have a program like PROGRESS the challenge is getting it into the health delivery system so that it can truly help patients,” Tagai said. “Prostate cancer patients report a lot of anxiety while coping with uncertainty. We want to minimize unnecessary psychological side effects.”
Miller described the design of PROGRESS as very careful, very deliberate, very collaborative and “very novel.” Clinicians, researchers, and former patients were all part of the development team. Still, it was “a best guess” based on the science available, said Miller.
The study, “Improved Cancer Coping From a Web-Based Intervention for Prostate Cancer Survivors: A Randomized Controlled Trial,” was published in Psychooncology.