MEDIATION EFFECT OF FRIENDS’ SUPPORT ON THE RELATIONSHIP BETWEEN SEX-RELATED SYMPTOMS AND QUALITY OF LIFE IN PATIENTS AFTER RADICAL PROSTATECTOMY

Background and objective

With the increase in the survival rate of patients undergoing prostate cancer surgery, management of the quality of life has become important. Particularly, since sex-related disabilities of patients immensely affect their quality of life, management of the same is of utmost necessity. This study aimed to investigate whether support from friends could play a mediating role in patients with prostate cancer, after radical prostatec-tomy, for the management of sex-related symptoms and improvement of the quality of life.

Material and methods 

This descriptive survey was conducted on 212 patients, aged 20 years or older, diagnosed with prostate can-cer, and subjected to radical prostatectomy, in two South Korean University Hospitals. Data were collected from June 20 to August 10, 2017, using self-report questionnaires. Data were analyzed using the t-test, Pearson’s correlation coefficient, and multiple regression analysis. A mediation analysis was performed according to Baron and Kenny, along with bootstrapping methods.

Results

Patients’ quality of life was significantly correlated with the experience of sex-related symptoms (r = –0.65, P< 0.001) and support from friends (r = 0.47, P< 0.001); the latter had a significant negative correlation with the experience of sex-related symptoms (r = –0.35, P < 0.001). Support from friends showed a partial mediating effect in the correlation between the experience of sex-related symptoms and quality of life (95% CI, –0.65 to –0.06).

Conclusions

Our findings indicated the necessity of psychosocial nursing programs that could utilize the support from friends to improve the quality of life of patients with prostate cancer following radical prostatectomy.

friend; prostatic neoplasm; quality of life; sexuality; symptom

1. Bray F, Ferlay J, Soerjomataram I, et al. Global can-cer statistics 2018: GLOBOCAN estimates of inci-dence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68:394–424. https://doi.org/10.3322/caac.21492

2. National Cancer Information Center, 2017;[Accessed 2019 Dec 2019]. Available from: https://www.cancer.go.kr/lay1/S1T639C641/contents.do

3. Resnick MJ, Guzzo, TJ, Cowan JE, et al. Factors associated with satisfaction with prostate cancer care: Results from cancer of the prostate strate-gic urologic research endeavor (CaPSURE). BJU Int. 2012;111(2):213–20. https://doi.org/10.1111/j.1464-410X.2012.11423.

4. Chambers SK, Chung E, Wittert G, et al. Erectile dysfunction, masculinity, and psychosocial out-comes: A review of the experiences of men after prostate cancer treatment. Transl Androl Urol. 2017;6(1):60–8. https://doi.org/10.21037/tau

5. Punnen S, Cowan JE, Dunn LB, et al. A longitu-dinal study of anxiety, depression and distress as predictors of sexual and urinary quality of life in men with prostate cancer. BJU Int. 2013;112:E67–

75. https://doi.org/10.1111/bju.12209

6. Michael C, Barnett F, Gray M. The experiences of prostate cancer survivors: Changes to physical function and its impact on quality of life. Int J Ther Rehabil. 2016;23:323–30. https://doi.org/10.12968/ijtr.2016.23.7.323

7. Neris RR, Leite ACAB, Nascimento LC, et al. “What I was and what I am”: A qualitative study of survivors’ experience of urological cancer. Eur J Oncol Nurs. 2020;44:101692. https://doi. org/10.1016/j.ejon.2019.101692

8. Burns SM, Mahalik JR. Sexual functioning as a moderator of the relationship between masculinity and men’s adjustment following treatment for pros-tate cancer. Am J Mens Health. 2008;2:6–16. https://doi.org/10.1177/1557988307304325

9. Zaider T, Manne S, Nelson C, et al. Loss of masculine identity, marital affection, and sex-ual bother in men with localized prostate can-cer. J Sex Med. 2012;9(10):2724–32. https://doi. org/10.1111/j.1743-6109.2012.02897.x

10. Gallant MP. The influence of social support on chronic illness self-management: A review and direc-tions for research. Health Educ Behav. 2003;30:170–

95. https://doi.org/10.1177/1090198102251030

11. Steginga SK, Pinnock C, Gardner M, et al. Evaluating peer support for prostate cancer: The Prostate Cancer Peer Support Inventory. BJU Int. 2005;95(1):46–50. https://doi.org/10.1111/j.1464-410X.2005.05247.x

12. Lafaye A, Petit S, Richaud P, et al. Dyadic effects of coping strategies on emotional state and quality of life in prostate cancer patients and their spouses. Psychooncology. 2014;23(7):797–803. https://doi. org/10.1002/pon.3483

13. Imm KR, Williams F, Housten AJ, et al. African American prostate cancer survivorship: Exploring the role of social support in quality of life after radi-cal prostatectomy. J Psychosoc Oncol. 2017;35:409–

23. https://doi.org/10.1080/07347332.2017.1294641

14. Christie KM, Meyerowitz BE, Giedzinska-Simons A, et al. Predictors of affect following treatment decision-making for prostate cancer: Conversations, cognitive processing, and coping. Psychooncology. 2009;18(5):508–14. https://doi.org/10.1002/pon.1420

15. Walsh E, Hegarty J. Men’s experiences of radi-cal prostatectomy as treatment for prostate can-cer. Eur J Oncol Nurs. 2010;14:125–33. https://doi. org/10.1016/j.ejon.2009.10.003

16. Rumsey N, Clarke A, White P, et al. Altered body image: Appearance-related concerns of people with visible disfigurement. J Adv Nurs. 2004;48(5):443–53. https://doi.org/10.1111/j.1365-2648.2004.03227.x

17. van Andel G, Bottomley A, Fossa SD, et al. An international field study of the EORTC QLQ-PR25: A questionnaire for assessing the health-related quality of life of patients with prostate cancer. Eur J Cancer. 2008;44(16):2418–24. https://doi. org/10.1016/j.ejca.2008.07.030

18. Zimet GD, Dahlem NW, Zimet SG, et al. The multi-dimensional scale of perceived social support. J Pers Assess. 1988;52(1):30–41. https://doi.org/10.1207/s15327752jpa5201_2

19. Lee EH. Development and psychometric evaluation of a quality of life scale for Korean patients with cancer (C-QOL). JKAN. 2007;37(3):324–33. https://doi.org/10.4040/jkan.2007.37.3.324

20. Hayes AF. Introduction to mediation, modera-tion, and conditional process analysis: A regres-sion-based approach. 2nd ed. New York (NY): Guilford Publications; 2013.

21. Baron RM, Kenny DA. The moderator-media-tor variable distinction in social psychological research: Conceptual, strategic, and statistical con-siderations. J Pers Soc Psychol. 1986;51(6):1173–82. https://doi.org/10.1037/0022-3514.51.6.1173

22. Shrout PE, Bolger N. Mediation in experimental and nonexperimental studies: New procedures and recommendations. Psychol Meth. 2002;7(4):422–45. https://doi.org/10.1037/1082-989X.7.4.422

23. Nam KH, Tae YS, Kim CS, et al. Influence of uncertainty and uncertainty appraisal on quality of life in prostate cancer patients after prostatectomy. Asian Oncol Nurs. 2017;17(1):45–54. https://doi. org/10.5388/aon.2017.17.1.45

24. Sanda MG, Dunn RL, Michalski J, et al. Quality of life and satisfaction with outcome among prostate- cancer survivors. New Engl J Med. 2008;358(12): 1250–61. https://doi.org/10.1056/NEJMoa074311

25. Tsikis ST, Nottingham CU, Faris SF. The relation-ship between incontinence and erectile dysfunc-tion after robotic prostatectomy: Are they mutually exclusive? J Sex Med. 2017;14:1241–7. https://doi. org/10.1016/j.jsxm.2017.08.002

26. Wilson B, Morris BA, Chambers S. A structural equation model of posttraumatic growth after pros-tate cancer. Psychooncology. 2014;23(11):1212–19. https://doi.org/10.1002/pon.3546

27. Khalil AA, Abed MA. Perceived social support is a partial mediator of the relationship between depressive symptoms and quality of life in patients receiving hemodialysis. Arch Psychiatr Nurs. 2014;28(2):114–18. https://doi.org/10.1016/j. apnu.2013.11.007

28. Boehmer U, Clark JA. Communication about pros-tate cancer between men and their wives. J Fam Pract. 2001;50(3):226–31.

29. Nelson K, Bennett P, Rance J. The experiences of giving and receiving social support for men with localised prostate cancer and their partners. Ecancermedicalscience. 2019;13:989. https://doi. org/10.3332/ecancer.2019.989

30. Nam KH, Kim HY, Kim JH, et al. Effects of social support and self-efficacy on the psychosocial adjustment of Korean ostomy patients. Int Wound J. 2019;16 Suppl 1:13–20. https://doi.org./10.1111/iwj.13038