Body image, self-esteem, and sense of masculinity in patients with prostate cancer: a qualitative meta-synthesis

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Abstract

Purpose

Body image, self-esteem, and masculinity are three interconnected constructs in men with prostate cancer, with profound effects on quality of life. This meta-synthesis aimed to evaluate all known qualitative studies published studying the effect of prostate cancer on these constructs.

Methods

A systematic review utilising PubMed, Embase, MEDLINE, and PsycINFO databases up to May 2020 was conducted in line with PRISMA and ENTREQ guidelines. All qualitative studies of men’s experiences with body image, self-esteem, and masculinity whilst living with prostate cancer were included. A thematic meta-synthesis was conducted to identify emergent descriptive and analytical themes under the main study constructs.

Results

Of 2188 articles identified, 68 were included. Eight descriptive themes were identified under two analytical themes: ‘Becoming a Prostate Cancer Patient’ and ‘Becoming a Prostate Cancer Survivor’. These described the distress caused by changes to body image, sexual functioning, sense of masculinity, and self-esteem, and the subsequent discourses men engaged with to cope with and manage their disease. A key element was increased flexibility in masculinity definitions, and finding other ways to re-affirm masculinity.

Conclusions

Prostate cancer has an important effect on men’s health post-diagnosis, and we identified strong relationships between each construct evaluated. The role of hegemonic masculinity is important when considering men’s coping mechanisms and is also a key factor when addressing these constructs in counselling post-treatment.

Implications for Cancer Survivors

This meta-synthesis provides key topics that uniquely affect prostate cancer survivors, enabling these patients to be effectively counselled, and have their concerns recognised by clinicians.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11764-021-01007-9.

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Most cited references 125

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Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

David Moher, Alessandro Liberati, Jennifer Tetzlaff … (2011)

David Moher and colleagues introduce PRISMA, an update of the QUOROM guidelines for reporting systematic reviews and meta-analyses

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Methods for the thematic synthesis of qualitative research in systematic reviews

James Thomas, Angela Harden (2008)

Background There is a growing recognition of the value of synthesising qualitative research in the evidence base in order to facilitate effective and appropriate health care. In response to this, methods for undertaking these syntheses are currently being developed. Thematic analysis is a method that is often used to analyse data in primary qualitative research. This paper reports on the use of this type of analysis in systematic reviews to bring together and integrate the findings of multiple qualitative studies. Methods We describe thematic synthesis, outline several steps for its conduct and illustrate the process and outcome of this approach using a completed review of health promotion research. Thematic synthesis has three stages: the coding of text 'line-by-line'; the development of 'descriptive themes'; and the generation of 'analytical themes'. While the development of descriptive themes remains 'close' to the primary studies, the analytical themes represent a stage of interpretation whereby the reviewers 'go beyond' the primary studies and generate new interpretive constructs, explanations or hypotheses. The use of computer software can facilitate this method of synthesis; detailed guidance is given on how this can be achieved. Results We used thematic synthesis to combine the studies of children's views and identified key themes to explore in the intervention studies. Most interventions were based in school and often combined learning about health benefits with 'hands-on' experience. The studies of children's views suggested that fruit and vegetables should be treated in different ways, and that messages should not focus on health warnings. Interventions that were in line with these suggestions tended to be more effective. Thematic synthesis enabled us to stay 'close' to the results of the primary studies, synthesising them in a transparent way, and facilitating the explicit production of new concepts and hypotheses. Conclusion We compare thematic synthesis to other methods for the synthesis of qualitative research, discussing issues of context and rigour. Thematic synthesis is presented as a tried and tested method that preserves an explicit and transparent link between conclusions and the text of primary studies; as such it preserves principles that have traditionally been important to systematic reviewing.

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Epidemiology of Prostate Cancer

Prashanth Rawla (2019)

Prostate cancer is the second most frequent cancer diagnosis made in men and the fifth leading cause of death worldwide. Prostate cancer may be asymptomatic at the early stage and often has an indolent course that may require only active surveillance. Based on GLOBOCAN 2018 estimates, 1,276,106 new cases of prostate cancer were reported worldwide in 2018, with higher prevalence in the developed countries. Differences in the incidence rates worldwide reflect differences in the use of diagnostic testing. Prostate cancer incidence and mortality rates are strongly related to the age with the highest incidence being seen in elderly men (> 65 years of age). African-American men have the highest incidence rates and more aggressive type of prostate cancer compared to White men. There is no evidence yet on how to prevent prostate cancer; however, it is possible to lower the risk by limiting high-fat foods, increasing the intake of vegetables and fruits and performing more exercise. Screening is highly recommended at age 45 for men with familial history and African-American men. Up-to-date statistics on prostate cancer occurrence and outcomes along with a better understanding of the etiology and causative risk factors are essential for the primary prevention of this disease.

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Author and article information

Contributors

Kamran Ahmed:

ORCID: http://orcid.org/0000-0002-5135-9211

kamran.ahmed@kcl.ac.uk

Journal

Journal ID (nlm-ta): J Cancer Surviv

Journal ID (iso-abbrev): J Cancer Surviv

Title: Journal of Cancer Survivorship

Publisher: Springer US (New York )

ISSN (Print): 1932-2259

ISSN (Electronic): 1932-2267

Publication date (Electronic): 8 May 2021

Publication date PMC-release: 8 May 2021

Publication date (Print): 2022

Volume: 16

Issue: 1

Pages: 95-110

Affiliations

[1 ]GRID grid.467480.9, ISNI 0000 0004 0449 5311, MRC Centre for Transplantation, Guy’s Hospital Campus, , King’s College London, King’s Health Partners, ; London, UK

[2 ]GRID grid.13097.3c, ISNI 0000 0001 2322 6764, King’s College London Institute of Psychiatry, Psychology and Neuroscience, ; London, UK

[3 ]GRID grid.37640.36, ISNI 0000 0000 9439 0839, South London and Maudsley NHS Foundation Trust, ; London, UK

[4 ]GRID grid.46699.34, ISNI 0000 0004 0391 9020, Department of Urology, , King’s College Hospital, ; London, UK

Author information

Jessica Bowie http://orcid.org/0000-0003-4216-5316

Kamran Ahmed http://orcid.org/0000-0002-5135-9211

Article

Publisher ID: 1007

DOI: 10.1007/s11764-021-01007-9

PMC ID: 8881246

PubMed ID: 33963973

SO-VID: bd744678-1e6c-4324-97a5-3f8a84ec7f06

License:

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/.

History

Date received : 24 August 2020

Date accepted : 17 February 2021

Funding

Funded by: Medical Research Council Centre for Transplantation

Funded by: King's Medical Research Trust

Funded by: National institute for Health Research Biomedical Research Centre

Funded by: King’s College London-Vattikuti Institute of Robotic Surgery

Funded by: GSTT Charity

Funded by: FundRef http://dx.doi.org/10.13039/501100000297, Royal College of Surgeons of England;

Funded by: The Urology Foundation

Funded by: The Coptcoat Charity

Funded by: FundRef http://dx.doi.org/10.13039/501100000872, Pelican Cancer Foundation;

Funded by: National Institute for Health Research Biomedical Research Centre at the South London and Maudsley NHS Foundation Trust

Funded by: MRC Mental Health Data Pathfinder Award to KCL

Funded by: National Institute for Health Research Senior Investigator Award

Funded by: National Institute for Health Research Applied Research Collaboration South London at King’s College Hospital NHS Foundation Trust

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ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: body image,cancer,masculinity,mental health,oncology,prostate cancer

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ScienceOpen disciplines: Oncology & Radiotherapy

Keywords: body image, cancer, masculinity, mental health, oncology, prostate cancer

Body image, self-esteem, and sense of masculinity in patients with prostate cancer: a qualitative meta-synthesis

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Implications for Cancer Survivors

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Karger: Oncology

Most cited references 125

Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

Methods for the thematic synthesis of qualitative research in systematic reviews

Epidemiology of Prostate Cancer

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