Table 7.

Comparing different cancer treatments and psychological adjustment

Study	Design	Characteristics of the sample	Major findings
Lee et al. (2001)	• Prospective 12 months assessment of QOL (Functional Assessment of cancer therapy – Prostate) after surgery, radiotherapy or brachytherapy	• Patients with localized disease: 23 treated with surgery, 23 with radiotherapy and 44 with brachytherapy	• After one month, virtually no change in emotional well being in all 3 groups • After 12 months, emotional well being similar to baseline in all 3 groups
Fossa et al. (2001)	• Prospective assessment of QOL (EORTC) at 6 weekly intervals until death	• 101 men treated with steroids, 100 with hormone therapy – all showing hormone-resistant metastatic PCA	• Men on steroids have better role functioning and less fatigue, especially between weeks 3 and 12. • Because of attrition thereafter, comparisons between the two groups not possible
da Silva (1993)	• QOL (EORTC – Prostate) assessed at 6 months by urologists and patients	• 76 men with metastatic PCA – treated with orchidectomy or hormone therapy	• Because of feasibility problems, comparative analysis not possible • Ratings by urologists correlate poorly with those of patients
Eton et al. (2001)	• Cross-sectional assessment of QOL (UCLA Prostate Cancer Index) within 7 weeks of launch of treatment.	• Men with localised PCA; 156 treated surgically, 49 with radiotherapy, and 51 with brachytherapy	• 3 treatment groups similar in psychological aspects • Support, self-efficacy and self-esteem predict better QOL
Litwin et al.	• Observational study of PCA (Cancer Rehabilitation Evaluation System and Functional Assessment of Cancer Therapy – General) patients and age and ZIP-code matched controls	• 214 localized PCA patients • 273 controls	• No differences in general QOL, including emotional well being, between surgery, radiotherapy and observation only sub-groups, or between PCA patients and controls
Fossa et al. (1997)	• Cross-sectional, retrospective assessment of QOL (EORTC)	• 379 men with PCA of various stages: 57 observed only, 112 received hormonal therapy, 96 surgery	• Sexual impairment and fatigue common in 3 treated groups but this does not have much effect on ratings of QOL
Lilleby et al. (1999)	• Controlled, cross-sectional assessment of QOL (EORTC) one year after treatment	• 154 men with PCA of various stages received radiotherapy, 108 surgery; 38 control	• Emotional function similar in 3 groups • Emotional function good or only slightly impaired in most patients
Cassileth et al. (1992)	• Prospective assessment of QOL (Functional Living Index-Cancer) and mood at 3 and 6 months follow-up	• 159 men with advanced PCA; 115 chose hormone therapy, 32 orchidectomy	• Mood improved at 3 months in both groups • Improvement greater in hormone therapy than orchidectomy patients at 6 months
Bokhour et al. (2001)	• Participation in focus group (7 groups); qualitative approach to QOL concerns • Men treated 12–24 months previously	• 48 men with early PCA treated with surgery, radiotherapy or brachytherapy	• Most men had sexual difficulties in terms of sexual relationships, intimacy and sense of masculinity • QOL – sexual effects – treatment type associations not mentioned
Van Andel et al. (2003)	• QOL (EORTC) assessed pre-treatment only	• 65 patients with localized disease treated surgically, 73 with radiotherapy	• Cognitive, but not emotional, function better in patients about to be treated surgically. Also especially in terms of sexual functioning and fatigue
Steginga et al. (2004)	• Prospective study before one of three treatments and two and 12 months after treatment • A range of psychological distress scales eg. Impact of Events Scale and Satisfaction with Life Scale	• 111 patients with localised disease – 56% treated surgically, 19% with RT and 25% with watchful waiting	• No differences found by medical treatment group in psychological adjustment at baseline or at follow-up. • Overall QOL similar to community norms