An educational intervention for patients on androgen deprivation therapy and their partners, "Beyond the Abstract," by Lauren M. Walker, et al

BERKELEY, CA ( - In North America alone, at any one time, approximately a half million men with prostate cancer (PCa) are on androgen deprivation therapy (ADT). Many patients remain on this treatment for more than a decade when they are otherwise free of cancer symptoms. ADT profoundly affects not only a patient’s quality of life, but also that of his intimate partner. This is hardly surprising given that ADT, which results in castrate levels of testosterone, causes: 1) body feminization; 2) diminished sexual interest and function; 3) cognitive and affective changes; and 4) fatigue and variable amounts of depression. ADT also increases the risk of osteoporosis, cardiovascular disease, obesity, and insulin resistance.

Although the side effects of ADT have been empirically established, patients and their partners frequently report being inadequately prepared for the adverse effects of this treatment. Consequently, we hypothesized that if couples were better prepared, they would be better able to adapt. Couples were randomly assigned to either usual care or to receive a comprehensive self-help workbook: Androgen Deprivation Therapy: An Essential Guide for Prostate Cancer Patients and Their Partners. The workbook, written by the Androgen Deprivation Therapy Working Group, details how ADT can slow the growth of prostate cancer, but negatively affects various bodily functions. The workbook also provides suggestions on how men and their partners can use evidence-based management strategies to keep their bodies, minds, and relationships strong while on this treatment. A one-time educational session was paired with the workbook where couples were encouraged to anticipate and plan pre-emptively for ADT-related changes.

Perhaps the most important finding in our study was the gains in relational intimacy and adjustment reported by couples who received the workbook compared to controls.

  • Partners who received the workbook reported less strain in their relationship.
  • Couples receiving the workbook were more likely to remain sexually active.

These results suggest that, despite the severe impact that ADT has on both erectile function and libido, an educational intervention is effective in helping couples adapt to treatment side effects and maintain sexual activity and relational intimacy.

Adjusting to ADT is challenging for many prostate cancer patients and their partners. In particular, the side effects can place a strain on intimate relationships and the psychological wellbeing for both patients and their partners. Our study shows that educating couples about the side effects of ADT, and how to effectively manage them, may reduce the burden that ADT places on so many patients and their partners.

Although the results are promising, questions remain about the best method for including patient education as part of routine clinical practice when ADT is prescribed. This is a problem in knowledge translation, where an educational intervention is shown to help patients, but is not normally offered to them. All authors on the Walker, et al. paper are members of the ADT Working Group, which was established to develop ways to improve the quality of life for men on ADT. The ADT Working Group’s primary focus is addressing this problem in knowledge translation. Indeed, the Working Group is now organizing, in Canada, a multi-province study to determine the most effective strategies for changing clinical practice around prescribing ADT. The ultimate goal of that project is to make sure that patients starting on ADT (and their partners) receive an effective and timely educational program about managing ADT side effects. The ADT Workbook will be a key element in that educational program.

Written by:
Lauren M. Walker,a, b Amy J. Hampton,a, c Richard J. Wassersug,d, e Bejoy C. Thomas,b, f and John W. Robinsona, b, f as part of Beyond the Abstract on This initiative offers a method of publishing for the professional urology community. Authors are given an opportunity to expand on the circumstances, limitations etc... of their research by referencing the published abstract.

a Department of Psychology, University of Calgary, Alberta, Canada
b Department of Psychosocial Resources, Tom Baker Cancer Centre, Alberta, Canada
c Department of Urological Sciences, University of British Columbia, Canada
d Department of Urologic Sciences, University of British Columbia, Canada
e Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia
f Department of Oncology, University of Calgary, Alberta, Canada

Androgen Deprivation Therapy and maintenance of intimacy: A randomized controlled pilot study of an educational intervention for patients and their partners - Abstract

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