Journal article extract: Psycho-Oncology, 29, 2020
Belinda C. Goodwin, Nicholas Ralph, Michael J. Ireland, Melissa K. Hyde, John L. Oliffe, Jeff Dunn, Suzanne Chambers
Prostate cancer is a significant global health concern with approximately 1.4 million men diagnosed with the disease worldwide each year. With advancements in prostate cancer treatment, the likelihood of living 10 years after diagnosis has improved and survival rates are now at 90.6% in Australia, 98% in the United States, and 84% in the United Kingdom. Nevertheless, increased survival does not necessarily translate to improved quality of life. Men can experience significant physical and psychological symptoms and declining health-related quality of life over time. In addition, men with prostate cancer report distress and uncertainty regarding their disease progression and prognosis leading to further psychological burden over time.
Almost one in two men diagnosed with prostate cancer report unmet psychological and psychosocial care needs and although many studies report the prevalence of psychological need in prostate cancer patients, few have identified the triggers or the frequency at which men seek support. In an Australian study (n = 76) of rural males living with cancer, younger men were found to be more likely to seek support from health professionals. The presence of anxiety, depression, and stress did not correspond with help-seeking behaviour. Actual levels of psychological and emotional distress may therefore be poor predictors of seeking support among men with cancer.
Gendered dimensions of men’s prostate cancer illness experiences such as masculinities may provide some insight into their help-seeking behaviours. Masculinities represent a framework of socially constructed gendered ideals to which men diversely align.
The current study investigated psychological and emotional help-seeking behaviour in men with prostate cancer several years posttreatment and found that only a minority of respondents who reported a need for such support actively sought it. Those who did seek support tended to be younger and sourced it largely from their GP or through prostate cancer support groups. Those with the highest degree of need for psychological support were less likely to seek this support if they were high in optimistic action, an alignment to masculine norms that reflects an orientation toward taking positive action in the face of challenges.
The importance of psychological and emotional well-being is increasingly being emphasized as part of survivorship care; yet at least 70% of respondents in the current study who required support failed to seek it within 12 months since baseline. This means a large proportion of prostate cancer survivors who are experiencing treatment do not seek help for emotional and psychological issues, and therefore, their needs remain unmet over time. The current study demonstrated that intention to seek support was only moderately associated with subsequently accessing care. With high unmet psychological and emotional needs persisting in men with prostate cancer over the last two decades different mechanisms may need to be introduced to target psychological help seeking in those men who espouse intent but tend to avoid it. Clinicians should be aware that men with chronic illness who appear to approach challenges with optimistic action may in fact be in need of psychological care but less likely to seek help and must therefore continue to prompt, facilitate, and follow-up with them regarding their efforts to seek appropriate support. To promote psychological help seeking in this at-risk subgroup, actively engaging help might be reframed and affirmed as strength-based positive actions to solving significant problems. Moreover, the benefits of improved well-being for men might be formally linked to aiding family and friends to appeal to men’s ideals about protecting others.