November 14, 2011

The phrase “What Women Want” is almost its own punch line: it's the title theme of a romantic comedy, the crux of advice columns, and the focus of puzzled articles in Men’s Health magazine. But in the world of psychological cancer support, “What Men Want” is a far more elusive question.

Quite simply, we don’t know.

A survey recently published as a letter to the editor in the journal Psycho-Oncology (20:444-446, 2011), only serves to further muddy the water, already rutted with 4 x 4 tire tracks of manly power and go-it-alone self-sufficiency.

Among 35 prostate cancer patients, 55% agreed with the statement, “I should be able to take care of my problems by myself.” And yet, 56% said, “I would be less depressed, if I talked about my problems.”

So where might these self-aware stoics turn for such help?

More than half (52%) said, “I don’t want to become dependent on a therapist.”

But 55% said, “It is almost as important for my doctors to listen to me talk about my emotional problems as to cure my cancer.”

The findings arose from a secondary analysis of a needs survey exploring barriers to mental health care at Memorial Sloan-Kettering Cancer Center. The sample size was small and the data are more than a decade old, but they intrigued principal investigator Mark I. Weinberger in light of new attention to unmet mental health care needs among underserved groups, including men.

“Having men enter mental health treatment is a difficult task,” said Dr. Weinberger, a psychologist who teaches in the department of psychiatry at Weill Cornell Medical College in White Plains, N.Y., in an interview. “Stigma, among other things, impedes their starting treatment.”

Having completed much of my doctoral training at a cancer center, I view this as an understatement.

While some men avail themselves of psychological support in the form of counseling or support groups, I saw many actively turn away from well-meaning efforts to provide forums for addressing the emotional distress that accompanies a cancer diagnosis.

Research bears out my observations.

Studies show that men are less likely than women to seek support outside of a significant other. They are less likely than women to participate in support when it is offered. In qualitative studies, they consistently ask for “information” rather than “support.”

And yet, when psychosocial support somehow leaps over the barriers, men benefit far more than women (Δ = 0.45 compared to Δ = 0.25), according to a meta-analysis of 37 studies (Patient Educ & Couns 2003:50:179-186).

So how do we reach men, who themselves appear confused about what kind of help they want, and from whom?

One clue may lie in the results of Dr. Weinberger’s secondary analysis. More than half of men believe it is vitally important for doctors to listen to their emotional concerns, so doctors need to make the most of their time in the room, using such communication tools as those highlighted in my blog of Nov. 1. 

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