Non-High School Graduates Especially At Risk For Lower Quality Of Life After Prostate Cancer Treatment
- From: Matti Narkia <mna@xxxxxxxx>
- Date: Wed, 18 Apr 2007 21:11:55 +0300
Non-High School Graduates Especially At Risk For Lower Quality Of Life
After Prostate Cancer Treatment
Article Date: 17 Apr 2007 - 19:00 PDT
Among men who have received similar treatments for prostate cancer,
those with less education - particularly those who did not graduate
from high school - experience a significant drop in their quality of
life after treatment compared with men who have more education,
according to a study led by researchers at the San Francisco VA
Medical Center (SFVAMC).
"These men did not start out with a lower quality of life before
cancer," says lead author Sara J. Knight, PhD, a staff psychologist at
SFVAMC. "What's surprising is that after treatment, they have
clinically significant problems across the board - mental and
emotional as well as physical - in managing their lives."
The authors acknowledge that low educational level is often associated
with lower income, which can lead to lower quality of life, but stress
that for the men in their study, low education alone was associated
with lower quality of life, irrespective of income. "In our analysis,
it's their lower educational level that has made them more vulnerable
to the effects of prostate cancer and its treatment," says Knight, who
is also an assistant professor of psychiatry and urology at the
University of California, San Francisco (UCSF).
The paper is available in the on-line Early View section of the
journal Cancer.
The researchers analyzed the results of a self-reported
quality-of-life survey completed by 248 patients who were diagnosed
with prostate cancer between 1989 and 2002 and treated at three
Veterans Affairs medical centers. Treatments included surgery,
radiation therapy, hormone therapy, and observation or "watchful
waiting."
After adjusting for a host of factors including severity and stage of
cancer, treatment, age, education, income, marital status, and other
diseases, the researchers found that men without high school diplomas
"experienced greater decline and less recovery" during the first year
after prostate cancer treatment across a wide variety of domains,
including physical, emotional, and social functioning, vitality,
mental health, general health, urinary function, and sexual function.
"More generally, the lower your educational level, the greater the
likelihood that you would have a lower quality of life after diagnosis
and treatment," says Knight.
She points out a key aspect of the study: The subjects, as VA
patients, all had equal access to the same quality of health care.
"Since health care access is a key factor in predicting health
outcomes, it's significant that we were able to control for this
variable," she says.
The good news, she says, is that clinicians across the country can
immediately begin to identify and help prostate cancer patients who
are at greater risk for poor quality of life. "We can identify these
men by their educational levels, ask them what difficulties they're
having in managing their day-to-day lives, and try to provide them
with the appropriate resources." She notes that VA medical centers
offer a broad range of counseling and referral services to help
veterans with mental, emotional, career, and other problems.
Knight says that the study is "as far as we know, the first to
emphasize the impact of educational level on quality of life after
prostate cancer treatment, as opposed to health literacy, a much more
narrow measure which we've known for some time has an effect on health
outcomes."
The study authors indicate they do not know why education plays such a
large role in determining quality of life after prostate cancer
treatment. One reason, they say, might be that "even in an
equal-access health care system" such as the VA, men with less
education have more trouble understanding educational materials about
prostate cancer, its treatment, and post-treatment management, which
in turn may lead to poorer disease management, greater worry, and
greater difficulty adjusting to life as a cancer survivor.
"If that's the case, then we can begin to address the problem by
creating educational materials that are better targeted to men with
less education," says Knight.
She says another possible explanation is economic: "Men with less
education might, indeed, have fewer financial resources, so prostate
cancer is going to have a greater negative impact on their lives. For
example, if you're driving a cab or working on a delivery truck,
urinary dysfunction can become extremely disabling. It's hard to
manage your symptoms, take breaks, and get enough rest when you're
worried about keeping your job."
Knight stresses that, thanks to today's effective treatments, "men
with prostate cancer can live a long time. If these problems go
unaddressed, these men will have a much worse time over the course of
their lives."
The researchers caution that because their study is based on results
from only three VA medical centers, additional research will be needed
to determine if the results can be generalized to all VA patients or
to men in general.
Excerpted from
Non-High School Graduates Especially At Risk For Lower Quality Of Life
After Prostate Cancer Treatment
<http://www.medicalnewstoday.com/medicalnews.php?newsid=67718&nfid=crss>
--
Matti Narkia
.
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