Abstract
Although men’s cancer experiences have received limited attention within the field of psychosocial oncology, increasing attention is being devoted to the development and evaluation of men-centered programs. This scoping review describes this emergent body of literature, detailing the focus, participation, and impact of interventions designed to help men with cancer build illness-specific knowledge, adapt to illness, manage side effects, distress, and uncertainty, sustain relationships, and more. Striving to build on existing knowledge, research gaps and opportunities are discussed, including a need for stronger methodologies, more tailored and targeted supports, attention to the experiences of men with nonprostate cancers, and the explicit integration of gender analyses in the research process.
Amid evidence of the influence and impacts of gender in health and illness, scholars are encouraged to consider gender dynamics in all studies of human health (Bottorff, Oliffe, & Kelly, 2012). At a global level, the value of gender-aware health research is accepted by leading medical and public health journals, and gender mainstreaming policies directing an assessment of the implications of planned action on men and women (Hankivsky, 2005) have been adopted by international organizations, including the World Health Organization and the United Nations (Kuhlmann & Annandale, 2012). As Kuhlmann and Annandale (2012) explained, gender analyses are recognized as important to “increasing the quality and efficiency of health systems and services” (p. 351). Despite these trends, gender dynamics have traditionally received limited attention in psychosocial oncology research, with a particular deficit in research attention to men’s cancer experiences (Moynihan, 2002). This pattern may be shifting (Hoyt & Rubin, 2012), as researchers and practitioners are increasingly developing a range of psychosocial oncology interventions to advance the health and well-being of men with cancer (Alfano & Rowland, 2006; Holland & Weiss, 2010; Stanton, 2006). However, less is known about how gender analyses are being integrated into this important scholarship.
To provide an overview of the research in this area and propose an agenda for future research, a scoping review of the empirical, peer-reviewed literature on men-centered psychosocial oncology interventions was conducted with special attention to gender analyses. Aligned with Arksey and O’Malley’s (2005) scoping review framework, work oriented toward mapping out this field of study (including the extent, range, and nature of related research), drawing conclusions about patterns in the extant literature, and highlighting current gaps and opportunities for driving research forward. Attentive to a range of relevant dynamics, two research questions were identified as important to elucidating current discussions and advancing knowledge, research, and practice related to men-centered cancer support: (a) What does the literature on men-centered psychosocial oncology interventions tell us about how interventions for men are designed/delivered, who is participating in programs, and what are the desired impacts of interventions, and (b) What are the limitations in the current literature, including challenges related to study design, methods, integration of gender analyses, and more? Psycho-oncology includes the “psychological reactions” of cancer patients and families, clinician-related stresses, and social, behavioral, and psychological factors linked to cancer risk and survival (Holland & Weiss, 2010). This review, however, focuses on programs designed to foster shifts in thoughts, feelings, attitudes, and behaviors among men with cancer at any stage of the illness trajectory.
Method
Scoping reviews are distinguished from systematic reviews in their focus on providing an overview of the research landscape to propose an agenda for future research, rather than evaluating research quality or providing a synthesis or meta-analysis of findings (Gough, Thomas, & Oliver, 2012). A scoping review can not only serve as a critical first step in planning a systematic review (Armstrong, Hall, Doyle, & Waters, 2011), but it also offers a unique and immediate contribution via a narrative description of research within a particular area and valuably integrates important scholarship often excluded from systematic reviews, including qualitative research and other studies that do not follow a randomized control trial study design (Arksey & O’Malley, 2005).
Subsequent to the identification of research questions, Arksey and O’Malley’s (2005) scoping review framework organizes methods around four key stages, including identifying and selecting relevant studies, charting the data, and collating/summarizing/reporting. Thus, as a starting point, the current study included a search of the scientific literature using PubMed/Medline and CINHAL databases. Aligned with the research questions, search terms were broad, including (men AND cancer AND psychosocial AND [intervention OR support OR program]) and searches filtered for articles published in peer-reviewed journals between 2000 to early 2014 and written in English. Through this process, 723 articles were identified. After importing the abstracts into RefWorks, 68 duplicates were identified, reducing the total to 689.
As per Arksey and O’Malley’s (2005) framework, articles were screened for relevance. Inclusion criteria selected for articles featuring discussions of psychosocial oncology programs or interventions specifically designed for men with a cancer diagnosis (individually or including a partner) and integrating reports of empirical findings (i.e., not protocols/plans). Scoping reviews require critical boundary setting in terms of focus. Although these criteria eliminated studies designed for men and women, research focused on men’s cancer experiences and needs more generally, and interventions related to men and cancer screening or men as caregivers, the criteria set were important in conducting a focused and manageable search congruent with the goals of this article. After applying these criteria, 35 articles were retained for the current review. To identify any missed articles, including those in nonmedical databases, a secondary Google Scholar search was initiated and yielded 12 additional articles that fit the criteria, bringing the total to 47.
Among the articles fitting the inclusion criteria after the first screening, seven were reviews completed within the past decade, including detailed reviews of interventions for men with cancer and their partners (Chambers, Pinnock, Lepore, Hughes, & O’Connell, 2011), posttreatment interventions for men with cancer (Dale, Adair, & Humphris, 2010), research on the effectiveness of psychosocial interventions for men with cancer (Parahoo et al., 2013), and self-management interventions for men with cancer (Cockle-Hearne & Faithfull, 2010) as well as reviews of literature on prostate cancer support groups (Manne, 2002; Thaxton, Emshoff, & Guessous, 2005) and a discussion of three decades of research focused on supporting men with cancer (Weber & Sherwill-Navarro, 2005). In reviewing the bibliographies of each of these review articles, 13 additional references met the inclusion criteria, bringing the total articles included in this scoping review to 60. Notably, the majority of the research discussed in these previous review articles was specific to men with prostate cancer, a trend permeating scholarship on men and cancer and related interventions (Wenger & Oliffe, 2012). Less common in these existing reviews were more recent studies, interventions for men with nonprostate cancers, research specific to prostate cancer support groups, and other relevant studies often omitted from systematic reviews, including non–randomized controlled trial (non-RCT) studies, qualitative, and mixed methods studies (please see Table 1 for a full listing of articles included). Although not included here, Germino (2001) offers an overview of related scholarship prior to 2000.
Articles Included in the Scoping Review.
Note. RCT = randomized controlled trial; PCSG = prostate cancer support groups.
Following the identification of relevant studies, the first author reviewed the full text of each article, ensuring relevance and reviewing overall themes. Aligned with the research questions guiding this scoping review, focus was on clarifying broad patterns in the design and delivery of psychosocial oncology supports for men. Through a process of consultation with the coauthors, agreement was achieved on overall patterns and gaps and each of the 60 articles were charted according to author (year), methodology/methods, population of focus, intervention type, intervention focus, and whether the scholarship attended to gender. Specifically, this latter analysis considered whether authors moved beyond gender as a categorical variable or reference to gender disparities related to men’s use of cancer support, to address/consider social patterning in how men experienced cancer and/or perceived, engaged with, or responded to cancer support interventions (e.g., as indicated through explicit attention to gendered patterns, masculinity/masculinities, identity threats, related social constraints/ barriers/ pressures, etc.). Because the focus of this review is on general trends and does not seek to evaluate quality, charting emphasized the basic characteristics of articles (see Table 1).
Results
Researchers have contributed to two broad domains of literature with respect to men-centered psychosocial oncology interventions. The first is the experimental literature focused on determining the acceptability, effectiveness, or impact of a specific individual, dyadic, or group-based psychosocial intervention among men with cancer. This research is often based on experimental designs with an RCT or comparison group methodology, although studies using qualitative or mixed methodologies are also included. The second domain includes studies examining group dynamics, participant experiences, and perceived benefits of existing men-centered cancer support groups, primarily prostate cancer support groups (PCSGs). Attentive to online and face-to-face groups, this research is often guided by qualitative methodologies (e.g., ethnography, grounded theory, thematic, narrative, or discourse analysis). Considering patterns across these approaches, trends were identified that related to intervention focus/style, participants, and impacts, and highlighted limitations in the current literature.
Intervention Focus/Style
Researchers have examined an array of psychosocial interventions, including supports integrating informational or psychoeducational strategies, cognitive behavior techniques, and/or other independent and interactive activities. These interventions have focused on reducing men’s distress or enhancing quality of life following a cancer diagnosis through individualized instruction or support from specialists or peers (Badger et al., 2011; Chambers et al., 2008; Chambers et al., 2012; Chambers et al., 2013; Giesler et al., 2005; Livingston et al., 2010; Weber et al., 2004), group education/ discussion (Boonzaier et al., 2009; Lepore et al., 2003; Traeger et al., 2013), expressive writing (Pauley et al., 2011; Rosenberg et al., 2002), and via multidisciplinary approaches integrating dietary, mood management, physical activity, and/or social support activities (Adamsen et al., 2001; Ames et al., 2011; Berglund et al., 2007; Carmack Taylor et al., 2006; Daubenmier et al., 2006; Kronenwetter et al., 2005).
Beyond broad efforts to enhance quality of life, interventions have been designed to bolster men’s knowledge about their diagnosis and disease, treatment, and/or side-effects (Flynn et al., 2004; Hack et al., 2007; Kim et al., 2002; Templeton & Coates, 2004), improve their adaption to cancer (Walsh Scura et al., 2004), facilitate treatment-related decision making (Davison et al., 2007), reduce decision-related distress (Berry et al., 2012; Steginga, Ferguson, Clutton, Gardiner, & Nicol, 2008), and enhance self-management skills and general capacities to support psychological health (Martin et al., 2013).
Programs have been organized to diminish treatment-related side-effects (Culos-Reed et al., 2010; Zhang et al., 2006, 2007; Zhang, Galanek, Strauss, & Siminoff, 2008), promote sexual recovery (Molton et al., 2008), and enhance relationship satisfaction and/or sexual intimacy between partners (Canada et al., 2005; Manne et al., 2011; McCorkle et al., 2007). Finally, supports have sought to reduce distress or strengthen coping and/or stress-management skills among men (Campbell et al., 2007; Parker et al., 2009; Penedo et al., 2006; Penedo et al., 2007) or within a couple (Collins et al., 2013; Northouse et al., 2007), to help men manage cancer-related uncertainty (Kazer et al., 2011; Mishel et al., 2002) and to integrate unknowns into their life views (Bailey et al., 2004).
Designed for individual men, men and partners/family members, and dyads or groups of men sharing a cancer diagnosis, interventions have been delivered in person, online (including multimedia and interactive sites), and by mail or telephone. Most have involved professional facilitators, including nurses, psychologists, and physiotherapists. Although not all are theory-driven, a range of frameworks have informed programs, including cognitive behavior theory (CBT), self-efficacy, social cognitive, stress and coping, and self-regulation theories as well as illness uncertainty, interpersonal theory, and stages of motivational readiness.
As this scholarship has relied on data drawn from studies of interventions for which men have been recruited, it offers limited guidance on what motivates men to participate in programs (and few articles report why men refused). However, some have argued that men might not participate due to time commitments, work conflicts, inconvenience, discomfort in being reminded of their cancer, health restrictions, a lack of interest or desire to receive help, or a perception that the intervention will not bring benefit (Parker et al., 2009; Steginga et al., 2008; Weber et al., 2004; Zhang et al., 2008). Specific to the experiences of African American men, Campbell et al. (2007) noted systematic barriers to study recruitment, including concerns related to a lack of trust in clinical researchers, travel costs and constraints, and stigmas related to psychological services.
In contrast to the diversity of programs considered in the clinical intervention research, PCSGs are more uniform in their provision of psychosocial support, with both virtual and face-to-face groups organized around (a) educational presentations from medical experts, (b) group discussions about treatment options, disease management, and/or health promotion, or (c) a mix of elements (Oliffe et al., 2010; Seale et al., 2006; Thaxton et al., 2005). Consistent with these patterns, research indicates that men often join PCSGs to learn about their disease and side-effect management, sort through treatment options, obtain lifestyle supports, meet others sharing their diagnosis (Arrington et al., 2005; Gray, Fitch, Davis, & Phillips, 1997; Klemm, Hurst, Dearholt, & Trone, 1999; Manne, 2002; Oliffe et al., 2010; Seale et al., 2006; Smith et al., 2002), and/or participate in advocacy (Thaxton et al., 2005). Amid differing views on whether the presence of women facilitates or inhibits discussions, wives and other family members might be included in the main group and/or offered parallel opportunities (Bottorff et al., 2008; Thaxton et al., 2005). Group leaders comprise health care professionals and men with prostate cancer experience, and sessions can operate with an open- or closed-format, with the former structure allowing for greater “latitude” for participants to attend as needed (Thaxton et al., 2005).
Notably, in this focus on information provision, some have argued that PCSGs can be less equipped to support men’s emotional experiences (Arrington et al., 2005; Coreil & Behal, 1999; Weber & Sherwill-Navarro, 2005). Although experiencing significant psychosocial concerns in relation to a cancer diagnosis (Manne, 2002), men have been reported to more often adopt an “instrumental” style oriented to action and focus on “functionality” rather than “feelings” in the context of in-person and online PCSGs (Oliffe et al., 2010; Seale et al., 2006). While many men do share ordinarily private elements of their illness experience in these groups (Oliffe et al., 2010), research indicates that social or emotional supports are often secondary motivations for attendance (Thaxton et al., 2005), with some exceptions (Trapp et al., 2012). In addition, Arrington et al. (2005) observed three processes within PCSGs that can actively inhibit discussion of emotions, including “topic turning” or moving conversation from emotional elements to focus on actions or medical aspects, use of comparisons to match the occurrence of experiences rather than explore the content of these, and group facilitators who guide discussion toward medical or physical aspects of illness.
Intervention Participants
As detailed, much of the empirical literature on men-centered cancer interventions has focused on prostate cancer, with more limited attention to supports for men with other cancer types (Adamsen et al., 2001; Livingston et al., 2010; Martin et al., 2013; Pauley et al., 2011). Within the broad domain of prostate cancer-specific interventions, PCSGs are typically open to men with this diagnosis, regardless of disease stage, length of illness, or treatment modality (Thaxton et al., 2005). In contrast, clinical trial research tends to focus on men at specific points in the illness trajectory, including men newly diagnosed (Berglund et al., 2007; Berry et al., 2012; Chambers et al., 2008; Collins et al., 2013; Flynn et al., 2004; Manne et al., 2011; Walsh Scura et al., 2004) and living posttreatment (Campbell et al., 2007; Giesler et al., 2005; Rosenberg et al., 2002; Traeger et al., 2013).
Programs have also been designed for men with different stages of prostate cancer, including men in watchful waiting and active surveillance (Bailey et al., 2004; Daubenmier et al., 2006; Kazer et al., 2011), with localized or early stage disease (Canada et al., 2005; Chambers et al., 2008; Chambers et al., 2013; Collins et al., 2013; Davison et al., 2007; Kronenwetter et al., 2005; Mishel et al., 2002; Penedo et al., 2006; Penedo et al., 2007; Steginga et al., 2008; Traeger et al., 2013), men experiencing a biochemical recurrence (Ames et al., 2011), those with advanced diagnoses (Chambers et al., 2012), and groups of men at various disease stages (Badger et al., 2011; Hack et al., 2007; Northouse et al., 2007). Finally, interventions have been delivered according to treatment modality, including programs specific to men with prostate cancer who receive radiation (Kim et al., 2002), hormone therapies (Carmack Taylor et al., 2006; Culos-Reed et al., 2010; Templeton & Coates, 2004), or surgery (McCorkle et al., 2007; Molton et al., 2008; Parker et al., 2009; Weber et al., 2004; Zhang et al., 2006, 2007).
Across diverse illness and disease patterns, there has been less variability in the social locations of men participating in the psychosocial oncology interventions described in the research literature. In fact, with few exceptions (e.g., Campbell et al., 2007; Mishel et al., 2002; Penedo et al., 2007), researchers have relied heavily on samples of educated, White, heterosexual, married, middle- to older-age adult males (Chambers et al., 2011). These patterns align with those observed in research on men in PCSGs (Thaxton et al., 2005). Notably, although few men, in general, participate in online and in-person cancer support groups (Lieberman, 2008; Seale et al., 2006; Thaxton et al., 2005), rates are even lower among men marginalized by sexual identity, race, and/or limited economic resources (Blank, 2005; Jones et al., 2011; Matsunaga & Cook Gotay, 2005; Ramsey, Zeliadt, Hall, Ekwueme, & Penson, 2007).
Intervention Impacts
Findings on impacts are mixed. This limitation emerges, at least in part, from significant diversities in intervention design, foci, target population, and outcome measures, concerns related to sustainability, methodological rigor, and ambiguity around program details and core concepts (Dale et al., 2010; Cockle-Hearne & Faithfull, 2010; Parahoo et al., 2013). Similarly, the impacts of PCSGs are difficult to glean due to a limited volume of evaluative research (Manne, 2002; Thaxton et al., 2005) and sustainability issues (Oliffe et al., 2008). As Dale et al. (2010) argued in their review, “it is difficult to draw conclusions on what makes an effective intervention for men with cancer” (p. 235).
Amid a lack of consensus and empirical weight to guide best practice, at least short-term benefits have been reported in reviews of the research evaluating men’s participation in clinical psychoeducational interventions. Included are enhanced knowledge, healthy behaviors, and quality of life, while programs integrating CBT (especially as combined with psychoeducation) reveal positive outcomes, including improved adjustment, quality of life, self-efficacy, and reduced distress and depression (Chambers et al., 2011; Dale et al., 2010; Giesler et al., 2005; Parahoo et al., 2013). Notably, research demonstrating no impact is less likely to be published, a trend complicating an overall assessment of intervention efficacy.
Research specific to PCSGs indicates that men in professionally facilitated groups can experience increased health literacy, knowledge, and involvement in treatment, improved coping and adjustment, and enhanced self-esteem (Gregoire, Kalogeropoulos, & Corcos, 1997; Manne, 2002; Oliffe et al., 2008; Oliffe et al., 2011; Thaxton et al., 2005). Furtherore, although men might not solicit emotional support, PCSGs can help normalize prostate cancer and its treatment side-effects, relieve isolation and distress, and enable mutual support and camaraderie (Matsunaga & Cook Gotay, 2005; Oliffe et al., 2010; Steginga, Pinnock, Gardner, & Dunn, 2004), although these are often detailed as “secondary benefits” of participation (Krizek, Roberts, Ragan, Ferrara, & Lord, 1999; Zhang et al., 2008). As Oliffe et al. (2010) noted, PCSG attendees are provided opportunities to observe “living examples” of survivorship (and serve as one for others), discuss lifestyle shifts, and obtain treatment-related details and guidance specific to their illness stage.
Limitations in the Current Literature
Previous reviews of the literature on men-centered psychosocial oncology supports have consistently emphasized a need for more empirical evidence to guide the development and delivery of effective interventions (Chambers et al., 2011; Parahoo et al., 2013; Thaxton et al., 2005). As Chambers et al. (2011) noted, those who develop and deliver cancer supports “have a responsibility” to ensure that these interventions are capable of making a measurable impact in the lives of those with cancer and their caregivers (p. e87). To this end, authors have called for research integrating more detailed program information, rigorous evaluative methods, measures of long-term impact (Dale et al., 2010), transparent reporting (Parahoo et al., 2013), and attention to the experiences of racialized, low-income, single, and/or gay men and to variability among men at different disease stages (Chambers et al., 2011; Cockle-Hearne & Faithfull, 2010; Dale et al., 2010; Parahoo et al., 2013; Thaxton et al., 2005). In addition to examining diversities and similarities among subgroups of men, this call is emphasized by a need to understand and address inequities in current practice. Although less often highlighted in previous reviews or discussions of interventions, this demand for greater diversity extends to a need for more research on young men (Campbell-Enns & Woodgate, 2013) and men with nonprostate cancers. To the latter point, a broad approach to developing supports relevant to men with cancer includes efforts considerate of whether prostate cancer-specific understandings resonate (or not) with other cancers, allowing researchers to distil patterns across cancer sites (Wenger & Oliffe, 2012).
Beyond methodological concerns, reviews of the literature on men-centered psychosocial oncology interventions have highlighted gaps related to program structures and content, with emphasis on a need for more tailored and/or targeted interventions. Although programs have been designed to address a variety of cancer-related challenges (e.g., treatment choices, management of side effects), they have been less customized to the realities of the men they seek to serve. This lack of customization can be a critical limitation in efforts to achieve desired impacts. As Badger et al. (2013) explained, a “one size fits all approach” is less likely to be effective than “tailored” programs (p. 14).
Linked with efforts to understand the needs and preferences of specific groups of men, reviews have called for more research on the relative efficacy of psychoeducational, counseling and/or CBT approaches, study into whether one-to-one strategies, group sessions, or combined efforts are most effective, and examinations of open- versus closed-format groups, professional versus peer support versus self-help strategies, and variation related to the intervention timing and setting (Chambers et al., 2011; Cockle-Hearne & Faithfull, 2010; Parahoo et al., 2013; Thaxton et al., 2005). Some have considered elements of difference (Badger et al., 2011; Traeger et al., 2013), but a need for additional research into “who benefits most and from what” intervention aspects (Penedo & Dahn, 2004, p. 532) remains relevant (Badger et al., 2013).
Associated with limitations in methodology and focus is the sparse integration of gender analyses in the extant literature. Gender is often implicit in discussions of men-centered cancer supports. Research specifically organized to develop, pilot, or evaluate men-centered cancer support interventions at some level acknowledges this broad population as distinct. Additionally, calls to engage a broader diversity of men and consider the merits of interventions among subgroups recognizes that men’s cancer experiences can vary not only by cancer site (including sex-specific cancers emphasized in this literature), but also according to their age, culture, class, and more (Chambers et al., 2011; Pedersen, Armes, &Ream, 2011; Zanchetta, Cognet, Xenocostas, Aoki, &Talbot, 2007). This tacit attention to the intersections of gender and other social identities (Griffith, 2012) aligns with an appreciation of multiple male realities or masculinities (Connell, 1995).
Despite these patterns, studies of men-centered psychosocial oncology programs have seldom explicitly considered and/or significantly engaged with gender dynamics, with the exception of some PCSG research (e.g., Bottorff et al., 2008; Oliffe et al., 2009). In carefully reviewing how gender was included within the extant research, it is evident that while scholars might integrate the language of gender to categorize their sample or observe that disease and/or treatment impacts on sexual function can influence men’s sense of masculinity, few have included details on their conceptualization of gender, integrated a theory-based foundation in gender and health (or referenced related literature), examined the reality of masculinities, and/or systematically distilled within the analysis or related discussion how men’s needs, preferences, or experiences of cancer supports were informed by societal expectations of men. With this focus, research tends to be sex-specific, but gender-blind.
Indeed, the paucity of gender analyses is a concern in the broader field of psychosocial oncology (Moynihan, 2002). As Moynihan (2002) argued, limited attention has been devoted to “why” men or women with cancer might respond to a particular program or “why” interactions of gender, age, or ethnicity matter. In this omission, she noted, it is “impossible to understand the ways in which being male or female may affect behavior and attitude, both from the point of view of users and providers” (p. 170). Although this challenge is rarely acknowledged as a limitation in the literature on men-centered cancer interventions, recognition of gender-related influences as a key dynamic in men’s cancer experiences is pivotal to advancing knowledge about effective men-centered psychosocial interventions.
Discussion
The findings of this review highlight patterns in the current research and important directions to advance the field. Beyond efforts to fine-tune research questions and enhance methodologies, researchers have an opportunity to move services toward underresearched and underserved populations of men. Engaging wider sampling efforts and integrating learning from literature on psychosocial needs among subpopulations of men (Blank, 2005; Pierce, Chadiha, Vargas, & Mosley, 2003) and men with a variety of cancers (Cecil, McCaughan, & Parahoo, 2010; Wenger, 2013a), scholars can pursue meaningful programs for a diversity of men. This research will need to find creative approaches to the challenge of delivering tailored and targeted interventions within a resource-constrained environment.
More profoundly, current gaps in the scholarship on men-centered interventions beg thoughtful efforts for advancing this field and practice through more explicit integration of gender analyses in the study and reporting of how men perceive cancer-related needs and respond to psychosocial supports. Gender analyses enable researchers to consider how men experience and respond to psychosocial interventions not simply because they have cancer in a particular part of their body, but also because they have particular expectations for how their bodies should appear and function. A gender lens accepts that the interlocking subjectivities informing a man’s experience of cancer are, at least in part, patterned by gender-related influences. It recognizes that individuals learn to locate themselves as a male or female through social expectations communicated by family, peers, teachers, and others (Stewart, 2003).
Although exposed to a variety of gender norms (i.e., sociohistorical and culturally specific expectations of how men and women should look, think, feel, and behave) according to intersections of race, class, age and more, individuals develop gender identities, or a sense of self as a man or woman, in a social world where taught differences are often treated as biological facts (West & Zimmerman, 1987). As men and women are defined in relation to one another, particular ways of being a man or a woman are idealized (Connell, 1995; Schippers, 2007) within a broader gender order (Connell, 2009) and practices and policies in the home, workplace, and community infused with these expectations “differentially shape the health-related choices of men and women” (Bird & Rieker, 2008, p. 54).
Clinical Implications
This scoping review is necessarily limited by the selected search terms and insights are restricted to the analysis of studies that fit the inclusion criteria. Future scoping reviews might valuably build on what has been identified here by adjusting the boundaries of the review process to consider emergent research on cancer programming designed for men and women, interventions for men as caregivers or in regard to cancer screening, and/or program forms less represented in the literature gathered here (e.g., peer support programs, particularly those initiated and developed by men living with cancer). These future efforts might help extend, nuance, and deepen understandings of the research landscape on men and cancer support.
While recognizing these limitations, this review provides valuable guidance relevant to clinical research and practice. Fundamentally, as researchers seek to produce more inclusive understandings of men’s experiences and more relevant interventions, the integration of gender considerations into the theoretical base, research questions, methodological choices, analyses, and reporting can contribute to more robust and meaningful findings. Researchers who recognize and report gender-related influences as informing illness experiences (Johnson, Greaves, & Repta, 2009) are in a better position to explain why men are responding in particular ways. Moving beyond research focused on testing an intervention with a group of men and reporting the outcomes, the integration of gender analyses can contribute insights into why a particular intervention designed for women might not work for men or why different populations of men might be responding to a program in particular ways.
This focus can facilitate broader understandings about how to develop and deliver men-centered psychosocial interventions, an effort that might foster coherence across individual studies and amplify the impact of a single effort. Even more, when integrating a “gender relations” approach, this gender-aware research can avoid a “competing victims discourse” that would position men’s and women’s health as separate or vying. Instead, it can examine how dynamic gender relations might constrain and/or facilitate health opportunities and illness responses between and among groups of men and women (Schofield, Connell, Walker, Wood, & Butland, 2000) and pursue understandings and responses benefitting both women and men (Broom, 2009; Oliffe, Kelly, Bottorff, Johnson, & Wong, 2011), thus avoiding efforts that address the health needs of one group in a way that perpetuates inequalities or brings harm to another (e.g., privileging men’s needs over women’s or groups of men over other men).
There is a rich body of literature to support these efforts, including research by social scientists on gendered patterns in how men experience health and illness at a broad level (Charmaz, 1994; Robertson, 2007; Watson, 2000) and perceive, discuss, and respond to cancer, specifically (Cecil et al., 2010; Chapple & Ziebland, 2002; Gray, Fitch, Fergus, Mykhalovskiy, & Church, 2002; Hilton, Emslie, Hunt, Chapple, & Ziebland, 2009; Kelly, 2009; Oliffe, 2006; Wenger, 2013a, 2013b; Wenger & Oliffe, 2014). This work attends to how cancer can challenge a man’s alignment with and purchase on various masculine ideals as illness and treatments compromise physical strength, familiar roles, relationships, and more. Additionally, much of this research accepts that these patterns can vary by the qualities of a man’s disease, the context of his life, and diversities related to how messages about how to be a man intersect with other identity scripts (e.g., age, ethnicity, sexual identity). As researchers integrate this awareness into their work, there are opportunities to develop inventions considerate of patterns in how men experience cancer and the particular needs men might prioritize during illness.
Also relevant is research examining gendered patterns in clinical service use, including scholarship that describes how masculine ideals prioritizing self-reliance, independence, and control can stigmatize support use (Addis & Mahalik, 2003; Galdas, 2009), particularly as related to the emotional needs men with cancer can experience (Goldzweig et al., 2010; Pudrovska, 2010). Directly, findings suggesting that men can be particularly resistant to discussing the emotional elements of their cancer experience (Moynihan, 1998; O’Brien et al., 2011; Ridge, Emslie, & White, 2011) align with research describing men’s resistance to psychosocial programs as, in part, linked to concerns with appearing vulnerable and anticipated discomfort in discussing their illness experience within a group setting (Voerman et al., 2007; Weber, Roberts, & McDougall, 2000).
Engaging with these dynamics, research on men’s help-seeking has lent insight into how men can enact a range of independent and interactive strategies to address a variety of illness-related needs over time (Wenger, 2011) and how men can step around restrictive gender expectations as they emphasize other identities (Galdas, Cheater, & Marshall, 2007; O’Brien, Hunt, & Hart, 2005; Robertson, 2003). Researchers have also explored how men might reconstruct help-seeking as a responsible, “masculine” response to illness (Farrimond, 2011; Johnson, Oliffe, Kelly, Galdas, & Ogrodniczuk, 2012; Noone & Stephens, 2008; Oliffe, Ogrodniczuk, Bottorff, Johnson, & Hoyak, 2012; Robertson, 2007; Wenger & Oliffe, 2014) and/or rely on family or clinicians to help them legitimize service use (Robertson, 2003).
Research attuned to both the stigmas men can experience related to help-seeking and the strategies men might use to manage these can be critical to developing tailored marketing or delivery strategies that build on men’s strengths in managing illness and facilitate comfortable clinical engagement. Existing research provides some practical insight here, including evidence that men who are reluctant to attend support groups might be open to dyadic interventions (Thaxton et al., 2005; Weber et al., 2007) and that anonymity and access to information through Internet supports can mitigate some challenges men experience in face-to-face programs (A. Broom, 2005; Klemm et al., 2003). Similarly, research attuned to the challenges men can experience in discussing cancer-related emotions (Arrington, 2010; Roesch et al., 2005) has highlighted the importance of carefully considering the language used to promote supports and the possibility of staged approaches to engagement (Krizek et al., 1999) as well as the power of humor as a lever enabling men to engage the potential discomfort of acknowledging vulnerability and working through cancer-related distress (Oliffe, Ogrodniczuk, et al., 2009).
In addition to enhancing research design and informing analytic insights, a gender lens and the integration of parallel literatures can prompt or emphasize new paths of inquiry. In particular, as researchers seek to understand gender dynamics in how groups of men experience, perceive, and respond to cancer and its myriad challenges within the context of their lives, there is an opportunity to move beyond familiar support structures and strategies and interrogate basic elements of program development and delivery. In this effort, a productive point of focus might be on how men with cancer are taking action to manage the challenges of their diagnosis, both within and outside of the traditional cancer support system. Research on self-led support initiatives is an important complement to studies of how men experience and are affected by professionally conceived and organized psychosocial programs and resources. Aligned with calls to move beyond clinical conceptualizations of help-seeking (Wenger, 2011), attention to how men are developing strategies to address their self-identified needs can enable productive insights about supportive care programming that are grounded in men’s lived experience.
Building on scholarship attentive to men’s independent or informal help-seeking or management strategies (e.g., Gray, Fitch, Phillips, Labrecque, & Fergus, 2000; Oliffe, Davison, Pickles & Mróz, 2009; Wenger, 2013b), there is value in focusing on men’s collaborative efforts, including peer-support networks. Although relatively underresearched, there is evidence that connections with those sharing one’s diagnosis can be important to accessing critical information, reducing feelings of isolation, and promoting health (Arrington et al., 2005; Chambers et al., 2011; Oliffe, Ogrodniczuk, et al., 2010). As peer-led groups proliferate internationally, scholarship on how men are working together to identify and manage their cancer-related needs is well positioned to interrogate gender dynamics in the structure, content, and functioning of these grass roots networks, including opportunities to consider similarities and differences with groups established by women (and/or mixed groups) and patterns across populations of men and by cancer types. Along with increased attention to gender dynamics within psychosocial oncology research more broadly, scholarship on men’s self-led efforts can help disrupt assumptions about men’s cancer needs and support preferences, expose gaps in the formal cancer support system, and inspire innovative strategies.
Conclusion
Often focused on the lives of men with prostate cancer, scholars and practitioners have developed and examined programs designed to enhance men’s illness-related knowledge and adaptation, coping skills, and problem solving, increase men’s relationship satisfaction and engagement in healthy lifestyles, enable mutual support opportunities, facilitate efforts to manage side effects, distress, and uncertainty, and improve quality of life, more generally. Despite important advances in understanding, clarity around how best to engage specific subgroups of men and improve psychological and physical outcomes remains limited.
As researchers work across disciplines to address these gaps, the integration of gender analyses can deepen, extend, and cohere understandings of how to develop and deliver psychosocial oncology supports for a diversity of men. This shift will require engagement with parallel bodies of literature on the relationship between gender and health and studies specific to intersections of masculinities, cancer, and help-seeking. Even more, it will challenge researchers to integrate an appreciation of gender-related influences as relevant in men’s cancer experiences at both a theoretical and methodological level, a requirement calling for methods and analyses better able to capture the dynamic and contextual nature of gender. These are no small matters. However, the opportunities are significant as researchers can forge deeper understandings of men’s needs and preferences and propel the development of relevant, appealing, and effective supports for men living with cancer.
Footnotes
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Lisa M. Wenger was supported by a fellowship from the Psychosocial Oncology Research Training program (PORT) during the completion of this article.