Facing life-prolonging treatment: The perspectives of men with advanced metastatic prostate cancer - An interview study.

PURPOSE: Several life-prolonging treatment options have recently become available for metastatic castration-resistant prostate cancer. However, research regarding patient experiences while undergoing these treatments is scarce. The aim was to explore the perspectives of men when facing life-prolonging treatment of metastatic castration-resistant prostate cancer. METHOD: Qualitative interviews were conducted with 16 men as they were starting, undergoing or had completed their first life-prolonging treatment. Interpretive description was used for analysis. RESULTS: The results illuminate the complexity of facing life-prolonging treatment, with interlaced dimensions beyond just the outcome, and where the men described other dimensions of their lives in relation to the treatment. The results are presented as 4 themes; Considering treatment when the remainder of life is at stake, Preparing for the life-prolonging treatment after deciding to go through with it, Considering the prospect of the life-prolonging treatment not being successful and Reflecting on death and dying in the light of a life-limiting illness. CONCLUSIONS: The quality and content of the remainder of life are central for men when facing life-prolonging treatment of metastatic castration-resistant prostate cancer. This is important when weighing desired treatment outcomes against side effects, and when reflecting upon whether going through with treatment would be worth it or not. The results illuminate the importance of encouraging men at this stage to express expectations, hopes and fears regarding the treatment and the future when considering life-prolonging treatments. Nurses working with these patients are important in the decision-making process and in evaluating treatments, to detect needs for interventions.

Castrate-resistant prostate cancer: lessons learnt from a pilot study in the palliative care research population.

BACKGROUND: Palliative care patients are inherently difficult to recruit to and retain on studies. Even when patients are recruited, it is hard to complete studies with sufficient data. There is a dearth of literature specific to men with castrate resistant prostate cancer (CRPC) and the clinical trials coordinator/research nurse's perspective in improving trial outcomes in palliative care. Objectives To describe the lessons learnt (by the nursing research team) from a prospective cohort study of men with CRPC and the practical implications for future research in this area. METHODS: A pilot feasibility cohort study that followed patients with CRPC from referral until death. The participants completed questionnaires while the researcher documented treatments, disease status and symptom burden. The recruitment methods, data quality and results were analysed. RESULTS AND DISCUSSION: Several lessons have been learnt with regard to facilitating trial recruitment and design. These lessons are: the importance of building relationships with local urology teams, including all men with the diagnosis of CRPC as documented by a medical oncologist or urologist, reducing questionnaire burden, capturing symptom scores in clinic, actively following up patients by phone, and recording all reasons for drop-out or lost to follow-up. These lessons can now be implemented to improve future studies involving this demographic.

Continuous, comprehensive and crucial care: The role of the CNS in the metastatic castration-resistant prostate cancer patient pathway.

Several treatment options are now available to men with metastatic castration-resistant prostate cancer (mCRPC). While survival rates for mCRPC continue to improve, patients are faced with increasingly complex treatment pathways and decisions. The clinical nurse specialist (CNS) plays a crucial role in navigating patients with mCRPC through their treatment pathway and fulfils a number of key responsibilities, including providing holistic care and support to patients and their families, educating and communicating with them in a timely and effective manner, and liaising with other healthcare professionals to seamlessly coordinate patient treatment. However, increasing patient caseloads and administrative duties are leaving CNSs with little time to fulfil their supportive role. Additional resources are needed in order to both promote and preserve this supportive role, thus ensuring that mCRPC patients receive the best possible care.

Navigating Treatment of Metastatic Castration- Resistant Prostate Cancer: Nursing Perspectives.

BACKGROUND: Treatment of metastatic castration-resistant prostate cancer (mCRPC) has evolved rapidly. In particular, five new treatments that extend survival in mCRPC have been approved since 2010, including the chemotherapy cabazitaxel (Jevtana®), hormonal agents abiraterone (Zytiga®) and enzalutamide (Xtandi®), vaccine sipuleucel-T (Provenge®), and radiopharmaceutical radium-223 (Xofigo®); all have different indications and toxicity profiles. OBJECTIVES: This review discusses treatment advances in mCRPC, including considerations for side-effect management and treatment sequencing. Studies relating to quality of care in prostate cancer are also discussed. METHODS: Nonsystematic searches were performed on published manuscripts and abstracts from major oncology or urology congresses, focusing on practical characteristics of the previously mentioned new treatments that extend survival in mCRPC, as well as studies relating to quality of care and the role of nurses in prostate cancer management. FINDINGS: To ensure that patients derive optimal clinical benefit, assessing overall health and proactively managing expected side effects are essential. Treatment sequencing in mCRPC is an important consideration, but clinical data in this area are limited. Despite medical advances in mCRPC, studies have identified other aspects of care in which improvement is needed. Nurses can make major contributions to addressing supportive care needs, which has been shown to improve patient care and outcomes in prostate cancer. Although patient navigation programs have improved coordination of care, inconsistent implementation among centers has been identified for prostate cancer. Greater use of outcome measures can help to identify unmet patient needs.

Nursing management of patients with castration-resistant prostate cancer undergoing radium-223 dichloride treatment.

BACKGROUND: Radium-223 dichloride, or radium-223, is a first-in-class alpha emitter that selectively targets bone metastases with high-energy, short-range alpha particles and is approved for the treatment of patients with castration-resistant prostate cancer (CRPC), symptomatic bone metastases, and no known visceral metastatic disease. Nurses are essential in educating patients about radium-223. OBJECTIVES: This article provides oncology nurses with information from the randomized phase III Alpharadin in Symptomatic Prostate Cancer (ALSYMPCA) trial, as well as important handling, administration, and safety details unique to radium-223. METHODS: Data from the ALSYMPCA trial and related published information on radium-223 were reviewed. FINDINGS: Radium-223 is the only alpha-emitting radiopharmaceutical that has been shown to improve overall survival in patients with CRPC, as demonstrated in the ALSYMPCA trial. In addition, radium-223 delays time to first symptomatic skeletal event, and it is well tolerated with a low incidence of myelosuppression and gastrointestinal adverse events. Delivered on an outpatient basis, radium-223 requires universal precautions for handling and administration. Because of the potential for additive myelosuppression, the concomitant use of radium-223 with chemotherapy, other systemic radioisotopes, or hemibody external radiation therapy is not recommended.

Metastatic castration-resistant prostate cancer. Part 2: helping patients make informed choices and managing treatment side effects.

Nursing patients with mCRPC presents considerable challenges to nurses. They need to draw upon a variety of skills to support and care for patients throughout the disease journey. As the majority of patients with mCRPC are elderly, they tend to have co-morbidities and possibly side effects from previous treatment that need consideration. Some patients will present at around 50 years of age and will also have specific, different needs. The majority of patients with mCRPC will have bone metastases that may cause disability and pain. The International Society of Geriatric Oncology (SIOG) has recommended that older men are treated according to health status and not chronological age. So nurses need to understand how to assess patients' status effectively, regardless of their age. This will enable nurses to provide appropriate and effective intervention and to support their patients during treatment for advancing disease. This article reviews the main methods of assessment and the nursing interventions for the common side effects associated with treatment for mCRPC.