Cancer Control Research5R21CA149536-02
Nelson, Christian J.
ACCEPTANCE AND COMMITMENT THERAPY FOR ERECTILE DYSFUNCTION FOLLOWING RADICAL PROS
DESCRIPTION (provided by applicant): The Institute of Medicine's recent report highlights the distinct need to address sexual dysfunction in cancer survivors. Prostate cancer is the most common cancer in men in the US; 90 percent of all prostate cancers are diagnosed in the early stage, and the relative 5 and 10 year survival rates are over 90 percent. A primary side-effect of prostate cancer treatment is erectile dysfunction (ED), with as many as 85 percent of men reporting problems with erections more than 4 years after early stage treatment. ED can have negative quality of life implications. Men who have ED report significant frustration, increased depressive symptoms, and reduced general happiness with life. ED can also have deleterious effects on men's intimate relationships, often times causing relationship stress, a reduction in intimacy, and sexual dysfunctions in female partners. Radical prostatectomy (RP) is one of the gold standard treatments for early stage prostate cancer, and the medical field has made important advances in understanding ED after RP. The current best practices treatment for ED after RP is the concept of "erectile rehabilitation." Despite these medical advances, frustration, shame, and disappointment often lead men to avoid seeking and sustaining treatment for ED. This delay in pursuing and difficulty sustaining treatment can be especially damaging in men following RP since it is imperative for erectile rehabilitation that treatment start immediately after RP and continue for 2 years post RP. We propose an innovative psychological intervention that will be integrated with an erectile rehabilitation program. This treatment will consist of 7 sessions (4 sessions in person, 3 over the phone) that will help men accept the need for ED treatment, identify and overcome the barriers to this treatment, and then commit to an erectile rehabilitation program. This novel intervention will utilize therapeutic concepts from the cognitive-behavioral treatment Acceptance and Commitment Therapy (ACT), and apply these concepts to ED after RP (i.e., intervention name, ACT-ED). The innovativeness of this intervention lies in 1) the shift to a proactive focus on erectile rehabilitation, increasing the chance of erectile recovery and avoiding the psychosocial issues related to chronic ED, and 2) the novel approach of applying ACT concepts to sexual medicine. Our research group is uniquely situated and qualified to run this type of intervention. This proposal is relevant to the PA-09-130 R21 mechanism as it will assess the feasibility and initial efficacy of applying this innovative intervention to a novel setting, with high significance for hundreds of thousands of prostate cancer survivors. The primary aim of the study is to investigate the feasibility, tolerability, and acceptability of a psychotherapy treatment integrated into an erectile rehabilitation program (i.e., ACT-ED). The secondary aim is to investigate the impact of ACT-ED on penile injection compliance, ED treatment satisfaction, sexual functioning, sexual self-esteem, ED bother, depression symptoms, acceptance and self-awareness. PUBLIC HEALTH RELEVANCE: Although life saving, prostate cancer treatment can have a high cost to survivors in regard to their sexual health. Prostate cancer is the most common type of cancer in men in the US; over 90 percent of men are diagnosed in the early stage, and the 5 and 10 year survivor rates are over 90 percent. Since 85 percent of men treated for early stage cancer report difficulties with erections, sexual functioning after early stage treatment for prostate cancer impacts hundreds of thousands of prostate cancer survivors. ACT-ED is designed to address this significant survivorship issues by providing a brief intervention to promote acceptance of ED and a commitment to an erectile rehabilitation program after radical prostatectomy to improve sexual functioning.