title: Intervening to improve psychological outcomes for men with prostate cancer.
abstract: BACKGROUND
  Prostate cancer is the most common cancer in men in the Western world with well-described negative effects from treatments. However, outcomes are highly heterogeneous. A Phase 3 trial of a psycho-educational intervention was undertaken, aiming to reduce cancer-specific and decision-related distress and improve quality of life for men newly diagnosed with localised prostate cancer.
  
  
  METHODS
  Seven hundred forty (81.7%) men were recruited after diagnosis and before treatment and randomised to a tele-based nurse-delivered five-session psycho-educational intervention (N = 372) or usual care (N = 368). Participants were assessed before treatment and 2, 6, 12 and 24 months post-treatment. Outcome measures included cancer-specific and decision-related distress, cognitive judgmental adjustment, subjective well-being, and domain-specific and health-related quality of life. Social support was assessed as a potential moderator.
  
  
  RESULTS
  No unconditioned effects were found. Classification analyses on pre-randomisation measures distinguished three subgroups: younger, higher education and income men (N =  90); younger, lower education and income men (N = 106); and older men (N = 344). Younger, higher education and income men showed positive intervention effects for cancer-specific distress (p = 0.008) and mental health (p = 0.042). By contrast, for younger, lower education men, participation in the intervention was associated with decreases in cognitive judgmental adjustment over time (p = 0.006).
  
  
  CONCLUSIONS
  Response to intervention and adjustment over time varied according to previous sexual functioning, age, educational level and income. How to best intervene with younger, low education, low income men with prostate cancer is a critical future research question.
authors.affiliation: Griffith Health Institute, Griffith University, Gold Coast, Australia. suzanne.chambers@griffith.edu.au
authors.forename: Suzanne K
authors.initials: SK
authors.lastname: Chambers
authors.forename: Megan
authors.initials: M
authors.lastname: Ferguson
authors.forename: R A
authors.initials: RA
authors.lastname: Gardiner
authors.forename: Joanne
authors.initials: J
authors.lastname: Aitken
authors.forename: Stefano
authors.initials: S
authors.lastname: Occhipinti
mesh_terms: D000223:Adaptation, Psychological; D000367:Age Factors; D004522:Educational Status; D006801:Humans; D007182:Income / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D011471:Prostatic Neoplasms / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology; D012944:Social Support; D013315:Stress, Psychological / Q000209:etiology / Q000517:prevention & control