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Self-management after prostate cancer treatment: Evaluating the feasibility of providing a cognitive and behavioural programme for lower urinary tract symptoms

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Abstract

• To test the feasibility of a self-management intervention to help men cope with lower urinary tract symptoms as a result of radiotherapy for prostate cancer. • A quasi-experimental design was used incorporating a pre-post-test evaluation. In total, a population of 71 men were screened for moderate to severe urinary symptoms 3 months or longer post-radiotherapy. Of these mean, 22 were recruited into the intervention from an eligible population of 43 symptomatic men. • Urinary symptoms were measured before the intervention and again after 4 months of follow-up through International Prostate Symptom Scores (IPSS) and bladder diaries. • Health-related quality of life was measured in relation to cancer per se and prostate cancer specifically, and confidence to cope was measured by a self-efficacy questionnaire. • The self-management intervention comprised pelvic floor muscle exercises, bladder retraining, patient education and problem solving and coping strategies • Lower urinary tract symptoms, as measured by the IPSS, showed a significant improvement, with a median score change of 5 (P < 0.005). • This was supported by objective changes in median bladder void volume of +7.5 mL (P < 0.05) and the median number of daily voids of -1 (P < 0.005). • In addition, decreases in emotional distress and problems associated with urinary function suggest that the intervention had a positive impact on health-related quality of life. • The provision of such an intervention was feasible within the clinical setting and provided benefits for men. • Symptom change vs those of normative recovery values for IPSS showed an intervention effect. • This intervention could be applied in routine practice and further testing is required in a randomized controlled trial.
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... Systematic reviews of the effectiveness of cancer selfmanagement support for cancer survivors have consistently led researchers to call for focused, disease-specific and patient-targeted programmes [22][23][24]. Previous to the study reported here, our feasibility work found that an augmented symptom management intervention including coaching, bladder retraining and PFME instruction delivered at 3-6 months post-radiotherapy treatment for PCa was feasible within the clinical setting [25]. We hypothesised that in comparison with care-as-usual, at 6 months post-intervention, men who took part in the SMaRT group intervention would report significantly less urinary symptoms, have better symptom-related quality-of-life, less emotional distress and improved confidence to deal with PCa and its associated problems. ...
... EORTC QLQ-C30 for assessing the quality-of-life of cancer patients which is a reliable and valid measure of qualityof-life of cancer patients in multicultural clinical research settings contains five functional scales, global quality-of-life scale and general symptom scales, Cronbach's alpha across scales 0.52-0.89. This tool is used extensively in clinical research studies worldwide and in our feasibility study [25]. ...
... In this study, the usual care group had 1 physician visit face to face 4 weeks after radiotherapy, whereas our care-as-usual group saw the physician at 6 months and had ongoing contact with a CNS. Despite this difference, the change in urinary scores was not at the same level as that found by Dieperink [20] or in our feasibility study [25]. The distinct difference between these studies is the intervention intensity; SMaRT was primarily group based and may not have provided the individualised approach provided by Dieperink [20] in the face-to-face multidisciplinary rehabilitation setting. ...
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Purpose To evaluate the effectiveness of the symptom management after radiotherapy (SMaRT) group intervention to improve urinary symptoms in men with prostate cancer. Methods The randomised controlled trial (RCT) recruited men from one radiotherapy centre in the UK after curative radiotherapy or brachytherapy and with moderate to severe urinary symptoms defined as scores ≥ 8 on the International Prostate Symptom Score (IPSS) questionnaire. Sixty-three men were randomised either; to SMaRT, a 10-week symptom-management intervention including group support, education, pelvic floor muscle exercises, or a care-as-usual group. The primary outcome was the IPSS at 6 months from baseline assessment. Secondary outcomes were IPSS at 3 months, and International Continence Society Male Short Form (ICS), European Organisation for Research and Treatment of Cancer Quality of Life prostate scale (EORTC QLQ-PR25), EORTC QLQ-30 and Self-Efficacy for Symptom Control Inventory (SESCI) at 3 and 6 months from baseline. Analysis of covariance (ANCOVA) was used to analyse the effect of the intervention. Results SMaRT group intervention did not improve urinary symptoms as measured by IPSS at 6-months. The adjusted difference was − 2.5 [95%CI − 5.0 to 0.0], p = 0.054. Significant differences were detected at 3 months in ICS voiding symptoms (− 1.1 [− 2.0 to − 0.2], p = 0.017), ICS urinary incontinence (− 1.0 [− 1.8 to − 0.1], p = 0.029) and SESCI managing symptoms domain (13.5 [2.5 to 24.4], p = 0.017). No differences were observed at 6 months. Conclusions SMaRT group intervention provided short-term benefit in urinary voiding and continence and helped men manage symptoms but was not effective long term.
... Systematic reviews of the effectiveness of cancer self-management support for cancer survivors have consistently led researchers to call for focused, disease-speci c and patient targeted programmes (22)(23)(24). Previous to the study reported here, our feasibility work found that an augmented self-management intervention including coaching, bladder retraining and PFME instruction delivered at 3-6 months post radiotherapy treatment for PCa, was feasible within the clinical setting (25). We hypothesised that in comparison with care-asusual, at six months post intervention men who took part in the SMaRT intervention would report signi cantly less urinary symptoms, have better symptom-related quality-of-life, less emotional distress and improved con dence to deal with PCa and its associated problems. ...
... Physical assessment and personal training for PFME (25). ...
... In this study the usual care group had 1 physician visit face to face 4 weeks after radiotherapy whereas our care-as-usual group saw the physician at 6 months and had ongoing contact with a CNS. Despite this difference the change in urinary scores were not at the same level as that found by Dieperink (20) or in our feasibility study (25). The distinct difference between these studies is the intervention intensity, SMaRT was primarily group based and may not have provided the individualised approach provided by Dieperink (20) in the face-to-face multidisciplinary rehabilitation setting. ...
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Purpose To evaluate the effectiveness of the self-management after radiotherapy (SMaRT) intervention to improve urinary symptoms in men with prostate cancer. Methods The randomised controlled trial (RCT) recruited men from one radiotherapy centre in the UK after curative radiotherapy or brachytherapy and moderate urinary symptoms defined as the International Prostate Symptom Score (IPSS) ≥ 8. 63 men were randomised either to SMaRT, a 10-week self-management intervention including group support, education, pelvic floor muscle exercises, or care-as-usual. The primary outcome was the IPSS at 6 months. Secondary outcomes were IPSS at 3 months, and International Continence Society Male Short Form (ICS), European Organisation for Research and Treatment of Cancer Quality of Life prostate scale (EORTC QLQ-PR25), EORTC QLQ-30 and Self-Efficacy for Symptom Control Inventory (SESCI) at 3 and 6 months. Analysis of covariance (ANCOVA) was used to analyse the effect of the intervention. Results SMaRT did not improve urinary symptoms as measured by IPSS at 6 months. The adjusted difference was − 2.5 [95%CI -5.0 to 0.0], p = 0.054. Significant differences were detected at 3 months in ICS voiding symptoms (-1.1 [-2.0 to -0.2], p = 0.017), ICS urinary incontinence (-1.0 [-1.8 to -0.1], p = 0.029) and SESCI managing symptoms domain (13.5 [2.5 to 24.4], p = 0.017). No differences were observed at 6 months. Conclusions SMaRT provided short-term benefit in urinary voiding and continence, and helped men manage symptoms but was not effective long-term. Face-to-face and supervised approaches may provide more benefit.
... SMA offers a strategy to reduce the effects of PCa and its treatment through prioritizing men's healthcare needs and boosting their motivation for participation in healthcare (McCorkle et al., 2011). The effectiveness of the SMA-based cognitive and behavioural programme on lower urinary tract symptoms in patients with PCa has been shown (Faithfull, Cockle-Hearne, & Khoo, 2011). Also, the SMA-based physical activity programme relieved symptoms among patients with lung cancer undergoing surgery (Granger et al., 2018) and in breast cancer survivors (Damush, Perkins, & Miller, 2006). ...
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Aim The aim of this study was to investigate the effect of the exercise programme on the quality of life of prostate cancer (PCa) survivors. Methods A randomized controlled, parallel trial was conducted from April 2017 to January 2018 on 80 PCa survivors. They were randomly assigned to intervention and control groups (n = 40 in each group). The exercise programme was designed based on the self‐management approach (SMA). The intervention group participated in a 12‐week exercise programme consisting of one session of group exercise and three sessions of individual exercise per week using exercise facilities in the community. Data were collected using the quality of life questionnaires and the follow‐up checklist. Results In the intervention group, statistically significant improvements in physical, role, emotional, social and sexual functions were reported. Also, the patients in this group reported reduced fatigue, insomnia, constipation, diarrhoea, urinary, bowel and hormonal treatment‐related symptoms in comparison with before the exercise programme (p < 0.05). Conclusions Nurses are suggested to plan for improving the participation of PCa survivors in exercise programmes using exercise facilities in the community in order to reduce the complications of treatment and improve their quality of life.
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Reasons for lack of psychosexual care available
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Dietary advice and support in this cohort is especially important. This was emphasised by Christy et al. (2013). This team highlighted how mailed interventions alone can improve dietary patterns 2 years after follow-up. Home base diet and exercise interventions have been used (Demark Wahnefried 2006, 2007). These measures can be successfully used in this cohort. This can also be supported by introduction of a mailed exercise intervention, as demonstrated by Lastayo (2006). This improved mobility and physical fitness in the older age groups, showing how this can be used as part of an exercise intervention. This support can even be given using a different strategy, such as telephone based support (Skolarius 2010).
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In the context of increasing prostate cancer survivorship, evidence of unmet supportive care needs and growing economic health-care restraints, this review examined and evaluated best approaches for developing self-management programmes to meet men's survivorship needs. A search of international literature published in the last 12 years was conducted. Only randomised controlled trials were included in the analysis. Key components of the interventions were evaluated to determine what has been offered, and which elements are most beneficial in improving health outcomes. Methodological issues were also considered. Targeting participant need and promoting motivation to participate and maintain programme adherence were the most important factors to emerge in ensuring positive health outcomes. Both need and motivation are multi-faceted, the components of which are identified and evaluated. Guidance was also identified in relation to delivery design, theoretical mechanisms for change, modes of delivery and facilitator issues. Self-management is a viable and appropriate way of providing health-care solutions to ameliorate men's functional and emotional problems associated with increased prostate cancer survivorship. Integration into clinical practice will require training, resources and commitment and, in addition, economic viability will be difficult to assess since cost comparison with current provision is not straightforward. Nevertheless, from the psychosocial and behavioural studies reviewed there is convincing evidence that can be used to design, implement and evaluate future self-management programmes for men surviving prostate cancer.