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Evid Based Nurs 12:126 doi:10.1136/ebn.12.4.126
  • Qualitative

Men experienced and responded to the embodied and emotional effects of prostate cancer in different ways

Question

How does the experience of prostate cancer affect masculine embodiment?

Design

Qualitative study using an ethnographic approach.

Setting

Clinics in the UK.

Participants

14 men with prostate cancer and 5 healthcare professionals (1 surgeon, 1 radiotherapist, and 3 specialist nurses).

Methods

Data were collected through individual interviews, observation of consultations and treatment and waiting areas over 18 months, and from media reports. Interview transcripts and field notes were analysed thematically.

Main findings

(1) Physical change: living with a new body. After prostate cancer, men found that their bodies no longer conformed to conventional ideas of masculinity. Some men accepted changes stoically, while others sought help in managing their losses. Some men were particularly concerned about loss of sexual function, whereas others were more concerned about incontinence: “I did not want my testicles operated on and become incontinent. That would be the end of my life…” Men who received sufficient advance information on their cancer and treatment options appeared to adapt more successfully. Those who lacked control expressed anger and frustration and focused on the damage done to their body. (2) Diagnosis. Most men described the experience of rectal biopsy as unpleasant and embarrassing rather than painful. (3) Restoring the masculine self. Men perceived cancer as alien to the body yet linked with the self. They dealt with the physical, social, and emotional costs of the disease in different ways. Some resented disease-related limitations, some were accepting and fatalistic, and some emphasised former masculine identities. Some men tried to regain control of their bodies by focusing on physical fitness or changing their diet, although their experiences shaped how they presented themselves to the world: “I started getting cramp, my body was letting me down again and I started crying, I was running along crying…” (4) Working with changed men. Healthcare professionals were aware of the relation between bodily and social aspects of masculinity in men with prostate cancer, and 1 emphasised the need for a coordinated approach to men’s health. (5) Survival of the fittest. Men made sense of cancer by focusing on changes to the physical body and on the fates of others. Some men felt emotionally isolated, although healthcare professionals provided emotional care for cancer-related embodied threats. (6) A new male identity. Most men acknowledged limitations and changes in the functioning of their “new body”; most were particularly concerned about impotence. Some men focused on the broader consequences of cancer and started to question fundamental assumptions about masculinity and life. (7) Seeing other men in the world. Some men started to question traditional masculine roles and became aware of their vulnerability. Many had been unable to talk about their cancer in depth before the study interviews, and some questioned why they hadn’t shared their feelings with more people. One patient who was involved in a men’s group commented, “You see the real essence of the men and not the shell that we put on because we’re all stripped naked, we’re all there with tubes sticking out of us. It just seems unnecessary for them to have to go through all that to learn and understand themselves and [be] able to be honest with themselves about what is really important to them.”

Conclusion

Mens’ responses to the embodied and emotional effects of prostate cancer were unique but often implied a positive impact on their sense of self, other men, and ideas of manhood.

Abstracted from

Kelly D. Changed men: the embodied impact of prostate cancer. Qual Health Res 2009;19:151–63.

Footnotes

  • Source of funding King's Fund and University College Hospital Special Trustees.

Commentary

Ideas of gender influence how men think, feel, and behave; thus, they affect mens’ experiences of health and illness. Kelly explored the masculine embodiment of men with prostate cancer. The study highlights the complexity of gender in the lives of men with prostate cancer and provides insight into individual responses to that complexity. Previous studies have highlighted similarities of gender responses to cancer, notably breast and prostate cancer,1 on the basis that physical and psychosocial effects on men’s and women’s lives are similar. This study is different: it highlights gender-specific differences. Knowing that men and women have different responses and coping mechanisms is a key starting point for planning the provision of health care.

The study findings are unique, profound, insightful, and moving. The conclusions are similar to other prostate cancer research where positive outcomes have been reported over time in relation to self, others, and the experience of having cancer.2 These results imply that a collaborative team approach that emphasises being “present” for patients may provide opportunities for open and meaningful communication and sharing of information.

Ideas of gender challenge those who research patterns of psychosocial responses to prostate cancer diagnoses. Gender and its embodiment may limit our ability to get to the heart of patients’ true feelings. Longitudinal research can shed light on a patient’s cancer journey and help identify those with risk factors related to stress and coping.

My uncle’s experiences of being a prostate cancer survivor highlight some of the positive aspects. Information related to treatment options and a good relationship with the clinical team (specialists, nurses, radiologists, etc) contributed to his sense of informed decision making and positivity. In his own words: ”I believe I made the correct decision for radiation vs other procedures. I was never depressed during or after the procedure…[I’m] doing fine, especially when the stock market goes up!”

References

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