'Men struggle with low mood more significantly than women after cancer treatment’
Our series on how cancer affects different patient demographics looks at men who are living with cancer
When Errol McKellar was told he had prostate cancer, which if left unchecked could kill him in six months, he walked out of the consultation, sat in his car and ‘cried like a baby’.
As with many men in their 50s, the London-based garage mechanic was unaware of the warning signs and attributed his symptoms to ageing rather than disease.
Diagnosis came by chance. At his wife’s insistence, he went to his GP because of his snoring. While waiting to be seen he happened to pick up a leaflet about prostate cancer. The blood test he had that day probably saved his life – and the lives of many other men, too.
A common perception is that men with symptoms suggestive of cancer tend to ignore or dismiss them as being insignificant. As a result, they seek help late and treatment is consequently less successful.
But is that truly the case? What more can nurses do to help men cope with the challenge of living with cancer?
Men are most at risk from lung, colorectal and prostate cancer, according to Dr Karen Roberts, chief of nursing and allied health professionals for Macmillan Cancer Support.
Challenges facing men who have been diagnosed with cancer
- Lack of awareness among men of the significance of symptoms
- Late presentation as a result
- Variable access to specialist nursing care
- Psychological effect of diagnosis
- Perceived reluctance to discuss feelings
Research quoted by the Men’s Health Forum suggests:
- Men are less likely than women to recall warning signs about cancer
- Men consult GPs less than women
- Men appear to legitimise health-service use only when a threshold of ill health has been exceeded
(Source: Men’s Health Forum)
‘And the data tell us that prostate cancer is probably going to become the most common cancer affecting men by 2030,’ she adds.
Indeed, figures published in February by the charity Prostate Cancer UK showed that the disease already kills nearly 12,000 men in the UK each year, slightly more than the number of women who die from breast cancer.
Dr Roberts says men are 70% more likely than women to die from cancer, primarily because of delayed presentation. ‘They are less likely to engage in information around cancer signs and symptoms, so are less likely to recognise and have an awareness that things are not right.’
She is wary of generalisations, but believes men tend to ascribe their symptoms to simply getting older, as was the case with Mr McKellar. ‘Aches and pains are more accepted, whereas women would be more likely to go to the GP and seek help,’ she says.
That said, she believes many younger men are much more aware of the importance of keeping fit and looking after their health. She cites former footballer David Beckham as a ‘phenomenal’ role model.
While it is easy to make assumptions about the behaviour of men pre-diagnosis, evidence about the effect cancer has on them is clearer.
‘The data tell us that after cancer treatment, men struggle with low mood more significantly than women,’ says Dr Roberts.
Access to expert care
Also, a factor in men’s interaction with cancer services is their access to expert care. In a census of specialist cancer nurses and support workers, published in April, Macmillan Cancer Support revealed wide variation in caseloads of specialist nurses working in urology and prostate cancer.
Nearly 12,000 men
in the UK die each year due to prostate cancer
(Source: Prostate Cancer UK)
‘We haven’t got a huge handle on the level of unmet need,’ says Dr Roberts. ‘But I think we can clearly say that we need to work much harder on engaging men in health and well-being events and in what happens after a cancer diagnosis.’
Victor Abu, a senior lecturer in adult nursing at London South Bank University, who has extensive clinical experience in prostate and uro-oncological care, agrees that any reluctance among men to present with symptoms is often attributable to lack of awareness rather than unwillingness.
What men need, he suggests, is information – which is where nurses can make a real difference.
‘You, as a nurse, must have knowledge of what you are dealing with. With that knowledge, you can engage men in conversation so that they have a clearer understanding of what they should be looking for.
‘Knowledge and information support are really crucial for nurses on the frontline.’
Differences in survival rates
Cancer treatment is, on the whole, becoming more successful, but with cancers that typically affect men there are, for various reasons, huge differences in survival rates.
In England and Wales, for example, 98% of men with testicular cancer survive for five or more years after diagnosis, according to the Royal College of General Practitioners. But the Royal College of Physicians says the outlook for patients with mesothelioma, predominantly linked to asbestos and found mainly in older men who worked in industries like shipbuilding, is far worse. Just 7% are alive three years after being diagnosed.
‘One of the things I hear is that men don’t talk about their feelings. But if I walk into an encounter with a man and I presume he’s not going to talk about his feelings, then I won’t hear him when he does. In my experience, all men talk about their feelings’
Factor in the inequitable access to specialist cancer services, which Victor Abu says leads to some ‘appalling’ experiences of care, and it is clear that for some men cancer remains a lottery.
98% of men
of men with testicular cancer in England and Wales survive for five years or more after diagnosis
(Source: Royal College of General Practitioners)
But for nurses engaged in offering care and support, is the patient’s gender a factor in how they should respond?
Not at all, says Barry Quinn, Macmillan director of nursing for cancer and palliative care at Barts Health NHS Trust.
‘This might sound a bit clichéd and obvious, but what’s more important than the gender, ethnicity, sexuality or religion of the person is for nurses to listen.’
Appraise own lives
He adds: ‘One of the things I hear is that men don’t talk about their feelings, and there may be some literature to support these generalisations. But I don’t find them helpful because if I walk into an encounter with a man and I presume he’s not going to talk about his feelings, then I won’t hear him when he does. In my experience, all men talk about their feelings.’
Research he conducted into what it was like to live with cancer demonstrated that for men and women there was little difference. Those he interviewed said contracting the disease made them appraise their own lives, their own mortality.
‘They also talked about the importance of relationships and what sort of relationships helped, whether it was with a doctor, a nurse or a family member.
‘And of all the things they talked about, the most important was somebody taking the time to listen and to understand.’
In short, he says, what works for both men and women is person-centred care.
‘Nurses can engage men in conversation so that they have a clearer understanding of what they should be looking for’
But there are nuances in that care that can make a difference, suggests Owen Sharp, global CEO of the Movember Foundation, the international movement that aims to stop men ‘dying too young’.
Men respond well to benchmarking, he argues – knowing where their symptoms rank in comparison with other men being treated for the same condition.
‘They like to understand where they are on a journey of recovery,’ says Mr Sharp, a former nurse. ‘Their sense of well-being and propensity to move forward is much increased by understanding they’re not an anomaly.’
He urges nurses to find the tools that enable them to have meaningful discussions with men about the effect of cancer on all aspects of their lives.
‘Allowing men to be involved in decision-making and engaged with their treatment has a significant impact’
‘Just because a man sits there and says nothing when you’re having an outpatient or clinic appointment with him, don’t assume there aren’t any issues. Can you find a way to get them to open up and have those conversations?
‘Allowing men to be involved in decision-making and engaged with their treatment has a significant impact.’
Honesty about the effect of treatment is also valued, he says.
‘With prostate cancer in particular there’s a fairly high level of decision-regret, so men later in life may wonder whether they did the right thing in having the treatment they chose.’
And men commonly report that if they had understood the impact of treatment on, for example, sexual functioning or continence they might have made different choices.
‘They say, “I might have made the right decision, but I don’t feel I was making an entirely informed decision”.’
Mr Sharp adds: ‘The clinicians who make the biggest difference are the ones who take the time and find the right routes and mechanisms to have those difficult conversations.’
Male customers at Errol McKellar’s garage are routinely offered a discount when they bring in their cars for repairs – providing they go to be tested for prostate cancer.
After being treated for the disease himself, Mr McKellar eventually returned to work. ‘The first day I went back to my garage in Hackney, east London, a guy walked in. We were having a conversation and he said: “I hear you’ve not been too well. Good to see you back”. Without even thinking about it, I said: “When did you last have your prostate checked?”.’
Mr McKellar offered the man 20% off his bill if he went to be tested.
‘Took your advice’
‘He came back two weeks later waving this bit of paper and said: “I took your advice”.’
The man was the first of 48 customers to date who – encouraged by Mr McKellar to be tested – have been diagnosed with prostate cancer. Two have since died. They were aged 36 and 42.
Mr McKellar has now won national awards for efforts to raise awareness of prostate cancer, especially among men from black African and Caribbean backgrounds, who are twice as likely as white men to be affected by the disease.
‘I’m the lucky one,’ Mr McKellar says. ‘I’m still here to tell my story.’
- How cancer affects different patient demographics – other articles in this Cancer Nursing Practice series
- Cancer Research UK
- Prostate Cancer UK
- Macmillan Cancer Support