Improving the pathway for men with suspected prostate cancer.

Kelly Kusinski, Urology Advanced Nurse Practitioner, The Royal Wolverhampton NHS Trust (kelly.kusinski@nhs.net), runner-up in the Urology Nurse of the Year category in the BJN Awards 2021.

Prostate cancer survivorship priorities for men and their partners: Delphi consensus from a nurse specialist cohort.

AIMS & OBJECTIVES: To describe the prostate cancer survivorship experience and priorities from the perspective of prostate cancer specialist nurses. BACKGROUND: Specialist nurses are providing long-term survivorship care to men and their partners however, few prostate cancer survivorship interventions are effective and priorities for nurse-led survivorship care are poorly understood. DESIGN: A three-round modified Delphi approach. METHODS: The study was conducted between 1 December 2018 and 28 February 2019 to develop a consensus view from an expert nurse cohort (43 prostate cancer specialist nurses: 90% response). First, participants described men's prostate cancer survivorship experience and priorities for improving care for men and partners. In subsequent rounds, participants identified key descriptors of the survivorship experience; rated priorities for importance and feasibility; and identified a top priority action for men and for partners. Thematic analysis and descriptive statistics were applied. Guidelines for Reporting Reliability and Agreement Studies informed the conduct of the study. RESULTS: Prostate cancer specialist nurses characterised the prostate cancer survivorship experience of men as under-resourced, disjointed and distressing. In all, 11 survivorship priorities for men and three for partners were identified within five broad areas: capacity building; care coordination; physical and psychosocial care; community awareness and early detection; and palliative care. However, feasibility for individual items was frequently described as low. CONCLUSION: Internationally, prostate cancer survivorship care for men and their partners requires urgent action to meet future need and address gaps in capacity and care coordination. Low feasibility of survivorship priorities may reflect translational challenges related to capacity. Prostate cancer survivorship care guidelines connected to practice priorities are urgently needed. RELEVANCE TO CLINICAL PRACTICE: These findings address key gaps in the evidence for developing national nurse-led prostate cancer survivorship priorities. These priorities can be used to inform survivorship guidelines including nursing care for men with prostate cancer and their partners.

[Management of hormone deprivation therapies in prostate cancer: Role of the nurse]. / Hormonothérapie dans le cancer de la prostate : quel rôle pour l'IDE en 2020 ?

Hormone deprivation therapies play a key role in the treatment of prostate cancer. These treatments require standardized care and regular monitoring. The objective of this work was to review the different hormonal therapies available, their side effects and the role of a coordinating nurse in the management of these therapies. First generation hormone therapy is the standard treatment for metastatic prostate cancer. In the past years, second generation hormone therapies have been indicated in combination with first-generation hormone therapies at different stages of the disease. These molecules are responsible for several side effects that should be monitored and prevented. Thus, after an initial assessment, clinical and paraclinical follow-up are essential. Our center has set up monitoring by a coordinating nurse (IDEC) to optimize the education and follow-up of the patient, but also to provide psychosocial support adapted throughout the patient's care path under hormone therapy. This monitoring and information function by IDEC can be facilitated by new digital solutions.

Trial of personalised care after treatment-Prostate cancer: A randomised feasibility trial of a nurse-led psycho-educational intervention.

OBJECTIVE: The present parallel randomised control trial evaluated the feasibility of a nurse-led psycho-educational intervention aimed at improving the self-management of prostate cancer survivors. METHODS: We identified 305 eligible patients from a district general hospital, diagnosed 9-48 months previously, who completed radical treatment, or were monitored clinically (ineligible for treatment). Ninety-five patients were recruited by blinded selection and randomised to Intervention (N = 48) and Control (N = 47) groups. Participant allocation was revealed to patients and researchers after recruitment was completed. For 36 weeks, participants received augmented usual care (Control) or augmented usual care and additional nurse support (Intervention) provided in two community hospitals and a university clinic, or by telephone. RESULTS: Data from 91 participants (Intervention, N = 45; Control, N = 46) were analysed. All feasibility metrics met predefined targets: recruitment rate (31.15%; 95% CI: 25.95%-36.35%), attrition rate (9.47%; 95% CI: 3.58%-15.36%) and outcome measures completion rates (77%-92%). Forty-five patients received the intervention, with no adverse events. The Extended Prostate Cancer Index Composite can inform the minimum sample size for a future effectiveness trial. The net intervention cost was £317 per patient. CONCLUSIONS: The results supported the feasibility and acceptability of the intervention, suggesting that it should be evaluated in a fully powered trial to assess its effectiveness and cost-effectiveness.

Investigating the effect of a symposium on sexual health care in prostate cancer among Dutch healthcare professionals.

AIMS AND OBJECTIVES: To investigate whether a symposium aimed at healthcare professionals in the uro-oncological field changes knowledge, competence and general practice regarding sexual dysfunction after prostate cancer treatment. BACKGROUND: Sexual dysfunction is not frequently discussed by healthcare professionals; lack of knowledge and training are two of the most often reported barriers. Provision of additional training could improve knowledge, competence and general practice of healthcare professionals. DESIGN: Two questionnaires were used in this pre-post study to determine knowledge, competence and general practice at the time of the symposium and six months afterwards. METHODS: In order to perform repeated measures to analyse alterations among participating healthcare professionals (n = 55), the McNemar's test was used. A STROBE checklist was completed. RESULTS: Seventy-three per cent (n = 40) stated that not enough attention was paid to prostate cancer-related sexual dysfunction during their education. Nurses felt significantly less competent in discussing sexual function, advising on sexual dysfunction and actively inquiring sexual complaints compared to other healthcare professionals. After the symposium, sexual dysfunction was significantly more often discussed. No significant effects were found on knowledge on sexual dysfunction, knowledge on treatment of sexual dysfunction, competence in discussing sexual function, advising on sexual dysfunction, actively inquiring sexual complaints and rate of referral. Tools needed to address sexual dysfunction concerned written information materials (75.5%) and a website containing adequate information (56.6%). CONCLUSIONS: The symposium had no significant influence on knowledge, competence and rate of referral in men with sexual dysfunction after prostate cancer treatment. However, sexual dysfunction was more frequently discussed after the symposium, so increase of awareness of consequences of prostate cancer treatment was achieved. RELEVANCE TO CLINICAL PRACTICE: Consequences of prostate cancer treatment to sexual function should be taken in consideration in daily practice; written information materials and a website containing adequate information were indicated as valuable resources to address sexual dysfunction in routine consultations.

The Scottish prostate cryotherapy service-the role of the clinical nurse specialist.

This article outlines the role of the clinical nurse specialist in establishing a Scotland-wide national designated service for prostate cryotherapy for patients with radiation-recurrent prostate cancer. The service was established in 2009 and provides prostate cryotherapy across Scotland. This article reviews and discusses the challenges involved in setting up a new service for tertiary treatment as well as highlighting the key achievements of the service. The challenges have included introducing the cryotherapy procedure in a safe and quality assured manner, developing and refining the referral process, educating both primary and secondary care teams on salvage prostate cryotherapy as a treatment modality and surgical procedure, as well as managing of complications following salvage prostate cryotherapy. The article also outlines the achievements of both the service and the treatment as well as how the service has developed since 2009.

[Comprehensive nursing intervention helps improve medication compliance of prostate cancer patients undergoing endocrine therapy].

OBJECTIVE: To explore the role of comprehensive nursing intervention in improving medication compliance of prostate cancer patients undergoing endocrine therapy. METHODS: We practiced comprehensive nursing intervention in 43 prostate cancer patients undergoing endocrine therapy in our hospital from January 2016 to December 2018. Using the 8-item Morisky Medication Adherence Scale (MMAS-8), we investigated the medication compliance of the patients at 1, 3 and 6 months after treatment. RESULTS: The MMAS-8 score of the patients was 7.8 ± 1.1 at 1 month after medication, decreased to 6.2 ± 1.9 at 3 months (P < 0.05), and increased to 7.9 ± 1.2 at 6 months (P < 0.05). CONCLUSIONS: Comprehensive nursing intervention can improve the medication compliance of prostate cancer patients undergoing endocrine therapy and the outcomes of treatment as well.

Methodological exemplar of integrating quantitative and qualitative evidence - supportive care for men with prostate cancer: what are the most important components?

AIMS: To present a methodological exemplar of integrating findings from a quantitative and qualitative review on the same topic to provide insight into components of care that contribute to supportive care that is acceptable to men with prostate cancer. BACKGROUND: Men with prostate cancer are likely to live a long time with the disease, experience side effects from treatment and therefore have ongoing supportive care needs. Quantitative and qualitative reviews have been published but the findings have yet to be integrated. DESIGN: Integration of quantitative and qualitative synthesized evidence. DATA SOURCE: Two previously published systematic reviews. REVIEW METHODS: Synthesized evidence on supportive care for men with prostate cancer was integrated from two previously published systematic reviews: a narrative quantitative review and a qualitative review with thematic synthesis. These two streams of synthesized evidence were synthesized using concurrent narrative summary. Data from both reviews were used to develop a set of propositions from which a summary of components of care that likely to contribute to supportive care acceptable to men with prostate cancer were identified. RESULTS: Nine propositions were developed which covered men's supportive care focusing on the role of health professionals. These propositions were used to compose nine components of care likely to lead to supportive care that is acceptable to men with prostate cancer. Some of these components are no/low cost such as developing a more empathic personalized approach, but more specific approaches need further investigation in randomized controlled trials, for example, online support. CONCLUSION: This methodological exemplar demonstrates the integration of quantitative and qualitative synthesized data to determine components of care likely to lead to provision of supportive care acceptable to men with prostate cancer.

Wife Caregiver Experiences in the Patient with Prostate Cancer at Home.

This study explored the caregiving experiences of wives of patients with prostate cancer. Twenty wives revealed those older, educated, or married longer were less burdened by caregiving, but needed more information. Findings contribute new dimensions in caregiving for patients with prostate cancer and their wives.

Which coping strategies can predict beneficial feelings associated with prostate cancer?

AIMS AND OBJECTIVES: This study aimed to identify the extent to which different coping strategies can predict benefit finding in prostate cancer experiences. BACKGROUND: Although beginning evidence suggests that the capacity to find positives in adversity and find some benefit from cancer-associated experiences may be influenced by coping, little is known about which coping strategies can predict benefit finding in prostate cancer. DESIGN: Cross-sectional. METHOD: Data from men (n = 209) diagnosed with prostate cancer receiving hormone suppression therapy were analysed using descriptive statistics, bivariate correlations and backward stepwise multiple linear regression. Sociodemographic and clinical data, and self-report scales (17-item Benefit Finding Scale and Brief COPE) were used. RESULTS: Bivariate analyses showed significant correlations between 14 coping strategies and benefit finding in prostate cancer. Multiple linear regression modelling showed that the predictor variables 'acceptance', 'positive reframing' and 'turning to religion' explained 35% of the variance in dependant variable benefit finding when the other variables were controlled for. Of the three predictor variables, acceptance and positive reinterpretation were most strongly related to benefit finding. CONCLUSION: The self-reported coping strategies 'acceptance' and 'positive reframing' emerged as being most significantly predictive of benefit finding in this sample. 'Turning to religion' was also significant, but to a somewhat lesser extent in predicting benefit finding in the disruptive experience of prostate cancer. RELEVANCE TO CLINICAL PRACTICE: The use of positively oriented emotional coping strategies of 'acceptance', 'positive reframing' and 'turning to religion' are influential to benefit finding in prostate cancer. An understanding of the coping strategies that are predictive to benefit finding can assist clinicians to discern and target men who are more or less likely to find benefit, and to develop person-centred support strategies and interventions with an aim to optimising positive emotional states throughout the cancer journey.

Accuracy of PSA Self-Reports among Low-Income Men with Prostate Cancer after a Public Health Nursing Intervention.

OBJECTIVES: To examine accuracy of patient-reported prostate-specific antigen (PSA) levels among indigent, uninsured men in a state-funded prostate cancer treatment program that provides case management, care coordination, and health education. DESIGN AND SAMPLE: Program evaluation. About 114 men with matched self- and lab-reported PSA levels at program enrollment and another time point within 18 months. MEASURES: Abstraction of self- and lab-reported PSA levels to determine self-report as "accurate" or "inaccurate," and evaluate accuracy change over time, before and after nursing interventions. Chi-square tests compared patients with accurate versus inaccurate PSA values. Nonlinear multivariate analyses explored trends in self-reported accuracy over time. INTERVENTION: Program enrollees receive prostate cancer education from a Nurse Case Manager (NCM), including significance of PSA levels. Men self-report PSA results to their NCM following lab draws and appointments. The NCM provides ongoing education about PSA levels. RESULTS: Of the sample, 46% (n = 53) accurately reported PSA levels. Accuracy of PSA self-reports improved with increasing time since program enrollment. Compared with men at public facilities, those treated at private facilities showed increasing accuracy in self-reported PSA (p = .038). CONCLUSION: A targeted nursing intervention may increase specific knowledge of PSA levels. Additionally, the provider/treatment setting significantly impacts a patient's disease education and knowledge.

Identifying Unmet Care Needs of Patients with Prostate Cancer To Assist with Their Success in Coping.

In the United Kingdom, our Health Needs Assessment survey return rate of 42% identified unmet needs in subjects with prostate cancer. Subjects reported the greatest unmet need was related to erectile dysfunction. Other unmet needs were related to incontinence, tiredness, hot flashes, lower urinary tract symptoms, rectal bleeding, and relationship issues.

Urology-oncology Macmillan/Prostate Cancer UK specialist nursing team.

Sian Fletcher, Viv Zinyemba and Samantha Richards, Great Western Hospital, Swindon, discuss their roles within a urology-oncology service and how they pull together as team to do their best for their patients.

Lower urinary tract symptoms of prostate cancer patients undergoing treatments over eight-month follow-up.

AIMS AND OBJECTIVES: To examine the changes in lower urinary tract symptoms after open radical prostatectomy, laparoscopic radical prostatectomy and brachytherapy and to determine which treatment resulted in improved lower urinary tract symptoms at 8 months follow-up. BACKGROUND: Lower urinary tract symptoms are a primary side effect after prostate cancer treatment. DESIGN: A time-series survey design with descriptive and comparative elements. METHODS: A sample of 51 prostate cancer patients was recruited: open radical prostatectomy = 20, laparoscopic radical prostatectomy = 23 and brachytherapy = 8. Data were collected at six time points: before treatment/baseline, 1 week post-treatment, 1 month post-treatment, 2 month post-treatment, 3 month post-treatment and 8 months post-treatment. The lower urinary tract symptoms were assessed using the International Prostate Symptom Score, with a higher score indicating a worse condition. One-way anova was used to predict the progress of urinary symptoms after treatments. Bootstrap re-sampling was conducted to assess the stability of the outcomes. RESULTS: Although there were no significant differences in the lower urinary tract symptoms among the three groups after treatments, the laparoscopic radical prostatectomy group had the lowest International Prostate Symptom Score score at baseline. Compared with the baseline symptoms for patients undergoing each treatment, there were significant improvements after 2 months in the open radical prostatectomy and brachytherapy groups, and after 3 months in the laparoscopic radical prostatectomy group. CONCLUSIONS: The prostate cancer patients undergoing the three treatments have similar lower urinary tract symptoms over 8-month follow-up although different lower urinary tract symptoms were presented before treatments. RELEVANCE TO CLINICAL PRACTICE: Results could be applied to educating and counselling prostate cancer patients regarding symptoms during recovery after surgery. It could also help patients better understand the outcomes related to the differing treatment methods.

[Transference in the Nurse-Patient Relationship: A Case Report on a Prostate Cancer Patient].

This article explores the dilemma posed with regard to a prostate cancer patient suffering from transference syndrome. Transference is generally recognized as an unconscious and inevitable part of relationships. Both nurse and patient "transfer" their past emotional and psychological needs into present situations and react accordingly. Consequently, the emotions and behaviors of nurses influence the reactions of their patients. Nurses must better understand their contributions to the nurse-patient relationship in order to better detect patient thoughts and feelings. Furthermore, nurses must recognize the needs of their patients and maintain a neutral and uncritical attitude. We developed a case management model to provide a consultation corner for cancer patients. Additionally, in an attempt to improve the quality of life of cancer patients, the developed model encouraged medical personnel to discuss sexual, belonging, and love problems with patients and to hold attitudes of professionalism, composure, caring, and solemnity. Belonging and love are basic human needs. However, for patients with prostate cancer, this basic need cannot be satisfied. Even professionally trained medical personnel have difficulty directly addressing this problem. This paper describes the meaning of transference and the importance of this concept in the therapeutic nurse-patient relationship. Finally, developing better insights into the nurse-patient relationship will help nurses use these insights to improve the quality of patient interactions and of care.

Prostate cancer survivorship: a nurse-led service model.

A significant proportion of men suffer side effects and are acknowledged to have unmet physical, functional and psychological needs after prostate cancer treatment. A nurse-led survivorship programme was implemented at Newcastle upon Tyne Hospitals NHS Foundation Trust for men with prostate cancer. This article describes implementation of the model and presents the results of an early evaluation to assess its impact. In the first 6 months 169 men (90% of those invited) engaged in the survivorship programme. Holistic needs assessments in particular were found to be invaluable for addressing individual men's needs and signposting them to relevant services. Collaboration between existing organisations and initiatives across primary and secondary care resulted in the establishment of a comprehensive network of services available to men on the programme. The nurse-led Newcastle survivorship model has been able to deliver individualised survivorship care with a high satisfaction rating within routine NHS practice.

Love, faith and hope - a secondary analysis of prostate cancer survivors and their partners.

BACKGROUND: Men's experience of recovery from treatment for prostate cancer has been extensively researched with reports highlighting the physical side effects of treatments such as erectile dysfunction and incontinence. The psychological, emotional and spiritual burden of prostate cancer on men and their partners has received far less attention. DESIGN: In this study, a secondary thematic analysis of data from a series of separate but related qualitative studies with prostate cancer survivors and their partners was conducted to further explore themes of love, hope and faith within this population. RESULTS: This study identified unresolved needs related to the emotive concepts of love, hope and faith. The findings from this study can be employed to refine psychosocial assessments of men with prostate cancer, and provide a more comprehensive understanding of prostate cancer survivors supportive care needs.

Quality of life and satisfaction with information after radical prostatectomy, radical external beam radiotherapy and postoperative radiotherapy: a long-term follow-up study.

AIMS AND OBJECTIVES: To assess patients' symptoms, quality of life and satisfaction with information three to four years after radical prostatectomy, radical external beam radiotherapy and postoperative radiotherapy and to analyse differences between treatment groups and the relationship between disease-specific, health-related and overall quality of life and satisfaction with information. BACKGROUND: Radical prostate cancer treatments are associated with changes in quality of life. Differences between patients undergoing different treatments in symptoms and quality of life have been reported, but there are limited long-term data comparing radical prostatectomy with radical external beam radiotherapy and postoperative radiotherapy. DESIGN: A cross-sectional survey design was used. METHODS: The study sample included 143 men treated with radical prostatectomy and/or radical external beam radiotherapy. Quality of life was measured using the 12-item Short Form Health Survey and the 50-item Expanded Prostate Cancer Index Composite Instrument. Questions assessing overall Quality of life and satisfaction with information were included. Descriptive statistics and interference statistical methods were applied to analyse the data. RESULTS: Radical external beam radiotherapy was associated with less urinary incontinence and better urinary function. There were no differences between the groups for disease-specific quality of life sum scores. Sexual quality of life was reported very low in all groups. Disease-specific quality of life and health-related quality of life were associated with overall quality of life. Patients having undergone surgery were more satisfied with information, and there was a positive correlation between quality of life and patient satisfaction. CONCLUSION: Pretreatment information and patient education lead to better quality of life and satisfaction. This study indicates a need for structured, pretreatment information and follow-up for all men going through radical prostate cancer treatment. RELEVANCE TO CLINICAL PRACTICE: Long-term quality of life effects should be considered when planning follow-up and information for men after radical prostate cancer treatment. Structured and organised information/education may increase preparedness for symptoms and bother after the treatment, improve symptom management strategies and result in improved quality of life.

Purposeful normalization when caring for husbands recovering from prostate cancer.

Despite a growing awareness that prostate cancer is a "couple's disease," the coping strategies, subjective distress, and emotional needs of partners are not adequately addressed. To better understand wives' experiences and processes they enact, we recruited 28 low-income Latinas caring for husbands recovering from prostatectomies to participate in interviews at three time points. Their narratives destabilize a common focus on physical side effects and an implicit bias toward men's reactions. We critically examine an overarching process of normalization, with underlying themes working both toward and against normality. We identified dissonance between detailed accounts of major lifestyle changes and professed normalization. We detail the women's purposeful methods to counteract negative impacts on their lives while seeking support externally. A better understanding of women's strategies and coping is critical to design interventions and education to both capitalize on partners' role in recovery while also addressing hidden causes of increased subjective distress.

Profile and predictors of global distress: can the DT guide nursing practice in prostate cancer?

OBJECTIVE: This study examines the ability of the distress thermometer to accurately identify patients with higher symptoms, unmet needs and psychological morbidity. METHODS: Baseline data collected as part of a randomized controlled trial evaluating a nurse-led supportive care intervention for men with prostate cancer commencing radiotherapy at a specialist cancer hospital in Melbourne, Australia. Measures assessed global distress (DT), anxious and depressive symptomatology (HADS), prostate-cancer specific quality of life (EPIC-26), unmet supportive care needs (SCNS-SF34R) and cancer treatment-related concerns (CATS). Following descriptive and correlational analysis, hierarchical multiple regression was employed to examine the contribution of variable sets to explaining variance in DT scores. RESULTS: Less than 20% of men reported DT scores of 4 or higher, indicating overall low distress. The DT accurately identified almost all men reporting HADS score indicative of anxious or depressive symptomatology, suggesting it accurately identifies psychological morbidity. Importantly, the DT identified a further group of distressed men, not identified by HADS, whose distress related to unmet needs and prostate cancer-specific issues, indicating the DT is superior in identifying other forms of distress. While the hierarchical multiple regression confirmed anxious and depressive symptomatology as the best predictor of distress score, many other scales are also good predictors of DT scores, supporting the argument that distress is multi-determined. SIGNIFICANCE OF RESULTS: Nurses can be confident that the DT accurately identifies patients with psychological morbidity and importantly identifies other patients with distress who may require intervention. A distress score of 4 or higher identified participants with higher physical symptomatology, higher unmet needs, more concerns about treatment and poorer quality of life. The low prevalence of distress reaching cut off scores suggests nurses would not be overwhelmed by the outcomes of screening and could use the score to prioritise the patients who need greater attention at entry to radiotherapy services.