Assessment of selected quality of life domains in patients who have undergone conservative or radical surgical treatment for penile cancer: an observational study
Roman Sosnowski A C , Jan Karol Wolski A , Urszula Ziętalewicz B , Michał Szymański A , Robert Bakuła A and Tomasz Demkow A
+ Author Affiliations
- Author Affiliations
A Department of Uro-oncology, M. Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Roentgena 5 Street, 02-781 Warsaw, Poland.
B Faculty of Psychology, Department of Health Psychology and Rehabilitation, University of Warsaw, Stawki 5/7 Street, 00-183 Warsaw, Poland.
C Corresponding author. Email: roman.sosnowski@gmail.com
Sexual Health 16(1) 32-38 https://doi.org/10.1071/SH17119
Submitted: 7 July 2017 Accepted: 6 August 2018 Published: 12 December 2018
Abstract
Background: Surgery is the standard treatment for organ-restricted penile cancer, but it is also a disfiguring procedure that can profoundly affect quality of life. Using a survey, in this study we assessed the effect of different surgical invasiveness on satisfaction in selected life domains of patients who underwent penile-sparing surgery and partial penectomy. Methods: Forty patients who underwent penile-sparing surgery (n = 13) or partial penectomy (n = 27) were enrolled in the study. The response rate was 71%. Information was obtained after surgery on sexuality, self-esteem, masculinity and partner relationships using the International Index of Erectile Function, the Self-Esteem Scale and the Conformity to Masculinity Norms Inventory questionnaires. We evaluated the effect of primary surgery type on selected domains of quality of life and correlations between study variables after surgery. Results: High self-esteem, satisfactory erectile function and masculinity results in both groups were comparable to those in the published literature. Men who underwent less disfiguring treatment had a significantly higher sense of masculinity than those who underwent partial penectomy (P = 0.05). No significant differences were observed in erectile dysfunction and self-esteem. The level of aggressiveness of a surgical procedure was a predictor of sense of masculinity (P = 0.01), but was not associated with self-esteem and sexual dysfunction (P = 0.28 and P = 0.55 respectively); 83% of patients were able to satisfactorily maintain partner relationships. Conclusions: Disfiguring treatments for penile cancer significantly interfere with the sense of masculinity, but sexual functioning and self-esteem do not differ according to the type of surgical procedure. Most men maintained stable partner relationships after surgery, regardless of surgery type.
Additional keywords: Conformity to Masculinity Norms Inventory, health-related quality of life (HRQoL), International Index of Erectile Function, partial penectomy, penile-sparing surgery, self-esteem.
References
[1] Chaux A, Netto GJ, Rodriguez IM, Barreto JE, Oertell J, Ocampos S, Boggino H, Codas R, Xavier Bosch F, de Sanjose S, Muñoz N, Hildesheim A, Cubilla AL. Epidemiologic profile, sexual history, pathologic features, and human papillomavirus status of 103 patients with penile carcinoma. World J Urol 2013; 31 861–7.| Epidemiologic profile, sexual history, pathologic features, and human papillomavirus status of 103 patients with penile carcinoma.Crossref | GoogleScholarGoogle Scholar |
[2] Favorito LA, Nardi AC, Ronalsa M, Zequi SC, Sampaio FJ, Glina S. Epidemiologic study on penile cancer in Brazil. Int Braz J Urol 2008; 34 587–93.
| Epidemiologic study on penile cancer in Brazil.Crossref | GoogleScholarGoogle Scholar |
[3] Barnholtz-Sloan JS, Maldonado JL, Pow-sang J, Giuliano AR. Incidence trends in primary malignant penile cancer [published erratum appears in Urol Oncol 2008; 26: 112]. Urol Oncol 2007; 25 361–7.
| Incidence trends in primary malignant penile cancer [published erratum appears in Urol Oncol 2008; 26: 112].Crossref | GoogleScholarGoogle Scholar |
[4] Forman D, Bray F, Brewster DH, Gombe Mbalawa C, Kohler B, Piñeros M, Steliarova-Foucher E, Swaminathan R, Ferlay J, eds. Cancer incidence in five continents: volume X – IARC Scientific Publications No. 164. Lyon, France: International Agency for Research on Cancer; 2014. Available online at: http://ci5.iarc.fr/CI5I-X/old/vol10/CI5vol10.pdf [verified 1 October 2018].
[5] Sewell J, Ranasinghe W, De Silva D, Ayres B, Ranasinghe T, Hounsome L, Verne J, Persad R. Trends in penile cancer: a comparative study between Australia, England and Wales, and the US. Springerplus 2015; 4 420
| Trends in penile cancer: a comparative study between Australia, England and Wales, and the US.Crossref | GoogleScholarGoogle Scholar |
[6] Arya M, Li R, Pegler K, Sangar V, Kelly JD, Minhas S, Muneer A, Coleman MP. Long-term trends in incidence, survival and mortality of primary penile cancer in England. Cancer Causes Control 2013; 24 2169–76.
| Long-term trends in incidence, survival and mortality of primary penile cancer in England.Crossref | GoogleScholarGoogle Scholar |
[7] Didkowska J, Wojciechowska U, Olasek P. Nowotwory złośliwe w Polsce w 2015 roku – Cancer in Poland in 2015. Warsaw, Poland: Krajowy Rejestr Nowotworów and Centrum Onkologii – Instytut im. Marii Skłodowskiej-Curie; 2017. Available online at: http://onkologia.org.pl/wp-content/uploads/Nowotwory_2015.pdf [verified 1 October 2018].
[8] Hakenberg OW, Compérat E, Minhas S, Necchi A, Protzel C, Watkin N. Penile cancer. Arnhem, The Netherlands: European Association of Urology; 2014. Available online at: http://uroweb.org/guideline/penile-cancer/ [verified 1 October 2018].
[9] Sosnowski R, Kuligowski M, Kuczkiewicz O, Moskal K, Wolski JK, Bjurlin MA, Wysock JS, Pęczkowski P, Protzel C, Demkow T. Primary penile cancer organ sparing treatment. Cent European J Urol 2016; 69 377–83.
| Primary penile cancer organ sparing treatment.Crossref | GoogleScholarGoogle Scholar |
[10] Maddineni SB, Lau MM, Sangar VK. Identifying the needs of penile cancer sufferers: a systematic review of the quality of life, psychosexual and psychosocial literature in penile cancer. BMC Urol 2009; 9 8
| Identifying the needs of penile cancer sufferers: a systematic review of the quality of life, psychosexual and psychosocial literature in penile cancer.Crossref | GoogleScholarGoogle Scholar |
[11] Kieffer JM, Djajadiningrat RS, van Muilekom EA, Graafland NM, Horenblas S, Aaronson NK. Quality of life for patients treated for penile cancer. J Urol 2014; 192 1105–10.
| Quality of life for patients treated for penile cancer.Crossref | GoogleScholarGoogle Scholar |
[12] Bullen K, Edwards S, Marke V, Matthews S. Looking past the obvious: experiences of altered masculinity in penile cancer. Psychooncology 2010; 19 933–40.
| Looking past the obvious: experiences of altered masculinity in penile cancer.Crossref | GoogleScholarGoogle Scholar |
[13] MacLennan S, Imamura M, Lapitan MC, Omar MI, Lam TB, Hilvano-Cabungcal AM, Royle P, Stewart F, MacLennan G, MacLennan SJ, Dahm P, Canfield SE, McClinton S, Griffiths TR, Ljungberg B, N’Dow J, UCAN Systematic Review Reference Group and EAU Renal Cancer Guideline Panel. Systematic review of perioperative and quality-of-life outcomes following surgical management of localised renal cancer. Eur Urol 2012; 62 1097–117.
| Systematic review of perioperative and quality-of-life outcomes following surgical management of localised renal cancer.Crossref | GoogleScholarGoogle Scholar |
[14] Somani BK, Gimlin D, Fayers P, N’Dow J. Quality of life and body image for bladder cancer patients undergoing radical cystectomy and urinary diversion – a prospective cohort study with a systematic review of literature. Urology 2009; 74 1138–43.
| Quality of life and body image for bladder cancer patients undergoing radical cystectomy and urinary diversion – a prospective cohort study with a systematic review of literature.Crossref | GoogleScholarGoogle Scholar |
[15] Gerharz EW, Månsson A, Hunt S, Skinner EC, Månsson W. Quality of life after cystectomy and urinary diversion: an evidence based analysis. J Urol 2005; 174 1729–36.
| Quality of life after cystectomy and urinary diversion: an evidence based analysis.Crossref | GoogleScholarGoogle Scholar |
[16] Rosen RC, Riley A, Wagner G, Osterloh IH, Kirkpatrick J, Mishra A. The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction. Urology 1997; 49 822–30.
| The International Index of Erectile Function (IIEF): a multidimensional scale for assessment of erectile dysfunction.Crossref | GoogleScholarGoogle Scholar |
[17] Rosenberg M. Society and adolescent self-image. New York: Princeton University Press; 1965.
[18] Burns SM, Mahalik JR. Sexual functioning as a moderator of the relationship between masculinity and men’s adjustment following treatment for prostate cancer. Am J Mens Health 2008; 2 6–16.
| Sexual functioning as a moderator of the relationship between masculinity and men’s adjustment following treatment for prostate cancer.Crossref | GoogleScholarGoogle Scholar |
[19] Mahalik JR, Locke BD, Ludlow LH, Diemer M, Scott RPJ, Gottfried M. Development of the Conformity to Masculine Norms Inventory. Psychol Men Masc 2003; 4 3–25.
| Development of the Conformity to Masculine Norms Inventory.Crossref | GoogleScholarGoogle Scholar |
[20] Opjordsmoen S, Fossa SD. Quality of life in patients treated for penile cancer. A follow-up study. Br J Urol 1994; 74 652–7.
| Quality of life in patients treated for penile cancer. A follow-up study.Crossref | GoogleScholarGoogle Scholar |
[21] Romero FR, Romero KR, Mattos MA, Garcia CR, Fernandes Rde C, Perez MD. Sexual function after partial penectomy for penile cancer. Urology 2005; 66 1292–5.
| Sexual function after partial penectomy for penile cancer.Crossref | GoogleScholarGoogle Scholar |
[22] Sansalone S, Silvani M, Leonardi R, Vespasiani G, Iacovelli V. Sexual outcomes after partial penectomy for penile cancer: results from a multi-institutional study. Asian J Androl 2017; 19 57–61.
[23] D’ancona CAL, Botega NJ, De Moraes C, Da Silva Lavoura N, Santos JK, Rodrigues Netto N. Quality of life after partial penectomy for penile carcinoma. Urology 1997; 50 593–6.
| Quality of life after partial penectomy for penile carcinoma.Crossref | GoogleScholarGoogle Scholar |
[24] Ficarra V, Righetti R, D’Amico A, Pilloni S, Balzarro M, Schiavone D, Malossini G, Mobilio G. General state of health and psychological well-being in patients after surgery for urological malignant neoplasms. Urol Int 2000; 65 130–4.
| General state of health and psychological well-being in patients after surgery for urological malignant neoplasms.Crossref | GoogleScholarGoogle Scholar |
[25] Alei G, Letizia P, Sorvillo V, Alei L, Ricottilli F, Scuderi N. Lichen sclerosus in patients with squamous cell carcinoma. Our experience with partial penectomy and reconstruction with ventral fenestrated flap. Ann Ital Chir 2012; 83 363–7.
[26] Greenfield DM, Walters SJ, Coleman RE, Hancock BW, Snowden JA, Shalet SM, DeRogatis LR, Ross RJ. Quality of life, self-esteem, fatigue, and sexual function in young men after cancer: a controlled cross-sectional study. Cancer 2010; 116 1592–601.
| Quality of life, self-esteem, fatigue, and sexual function in young men after cancer: a controlled cross-sectional study.Crossref | GoogleScholarGoogle Scholar |
[27] Manne S, Badr H. Intimacy and relationship processes in couples’ psychosocial adaptation to cancer. Cancer 2008; 112 2541–55.
| Intimacy and relationship processes in couples’ psychosocial adaptation to cancer.Crossref | GoogleScholarGoogle Scholar |
[28] Dorval M, Guay S, Mondor M, Masse B, Falardeau M, Robidoux A, Deschênes L, Maunsell E. Couples who get closer after breast cancer: frequency and predictors in a prospective investigation. J Clin Oncol 2005; 23 3588–96.
| Couples who get closer after breast cancer: frequency and predictors in a prospective investigation.Crossref | GoogleScholarGoogle Scholar |
[29] Traa MJ, De Vries J, Bodenmann G, Den Oudsten BL. Dyadic coping and relationship functioning in couples coping with cancer: a systematic review. Br J Health Psychol 2015; 20 85–114.
| Dyadic coping and relationship functioning in couples coping with cancer: a systematic review.Crossref | GoogleScholarGoogle Scholar |
[30] Branney P, Witty K, Eardley I. Patients’ experiences of penile cancer. Eur Urol 2011; 59 959–61.
| Patients’ experiences of penile cancer.Crossref | GoogleScholarGoogle Scholar |
[31] Witty K, Branney P, Evans J, Bullen K, White A, Eardley I. The impact of surgical treatment for penile cancer – patients’ perspectives. Eur J Oncol Nurs 2013; 17 661–7.
| The impact of surgical treatment for penile cancer – patients’ perspectives.Crossref | GoogleScholarGoogle Scholar |
[32] Reilly ED, Rochlen AB, Awad GH. Men’s self-compassion and self-esteem: the moderating roles of shame and masculine norm adherence. Psychol Men Masc 2014; 15 22–8.
| Men’s self-compassion and self-esteem: the moderating roles of shame and masculine norm adherence.Crossref | GoogleScholarGoogle Scholar |
[33] Oliffe J. Constructions of masculinity following prostatectomy-induced impotence. Soc Sci Med 2005; 60 2249–59.
| Constructions of masculinity following prostatectomy-induced impotence.Crossref | GoogleScholarGoogle Scholar |
[34] Forrester DA. Myths of masculinity. Impact upon men’s health. Nurs Clin North Am 1986; 21 15–23.
[35] Courtenay WH. Constructions of masculinity and their influence on men’s well-being: a theory of gender and health. Soc Sci Med 2000; 50 1385–401.
| Constructions of masculinity and their influence on men’s well-being: a theory of gender and health.Crossref | GoogleScholarGoogle Scholar |
[36] Lee PA. Survey report: concept of penis size. J Sex Marital Ther 1996; 22 131–5.
| Survey report: concept of penis size.Crossref | GoogleScholarGoogle Scholar |
[37] Fergus KD, Gray RE, Fitch MI, Labrecque M, Phillips C. Active consideration: conceptualizing patient-provided support for spouse caregivers in the context of prostate cancer. Qual Health Res 2002; 12 492–514.
| Active consideration: conceptualizing patient-provided support for spouse caregivers in the context of prostate cancer.Crossref | GoogleScholarGoogle Scholar |
