Pre-surgery sessions boost prostate patients' mood

Men with prostate cancer who take part in a brief stress management program before undergoing surgery to remove their prostate feel better mentally before and after the operation, and report better physical functioning a full year after the surgery, a new study shows.

The result "is intriguing and suggests the possibility that skills taught before surgery might have a lasting effect on patients' recovery and quality of life," Dr. Lorenzo Cohen of The University of Texas M.D. Anderson Cancer Center in Houston and his team write in the Journal of Clinical Oncology.

Radical prostatectomy, as the operation is called, often has distressing side effects, including incontinence and erectile dysfunction, Cohen and his team note in their report.

While a number of psychosocial approaches to helping prostate cancer patients cope have been shown to help, they add, most of these interventions are delivered after the patient has completed treatment. Given that the time before surgery may be particularly stressful for prostate cancer patients, Cohen and his colleagues tested whether intervening at that point might be helpful, too.

They randomly assigned 159 men awaiting prostate surgery to a stress management group, a "supportive attention" group, or standard care.

Stress management focused chiefly on helping men learn relaxation skills and coping strategies for their recovery period. Supportive attention involved simply taking patients' history and listening to them talk about their concerns.

The men in the stress management and supportive attention groups had two 60- to 90-minute sessions with a clinical psychologist one or two weeks before surgery, along with a five-minute booster directly before they went in for surgery and a second 10- to 15-minute booster session 48 hours afterwards.

One week before the surgery and on the day of the surgery, the researchers found that the men who underwent stress management sessions had less mood disturbance, such as anxiety or worry, than the men in the standard care group. There was no difference in quality of life or mood disturbance between the supportive attention group and the standard care group.

A year after the surgery, the men in the stress management group had better urinary, sexual and bowel function than the men who received standard care.

The men in the current study were in relatively good mental health, the researchers note, while most were white, married and well-educated. Future studies should look at more diverse groups of patients, Cohen and his team say, and should also examine whether the intervention might be even more effective in men at greater risk of distress.

SOURCE: Journal of Clinical Oncology, April 6, 2009.