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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
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.
... 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. ...
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. ...
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). ...
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.
Enquadramento:
Os sobreviventes de cancro representam um grande desafio para os sistemas de saúde, pela escassez de planos assistenciais a estas pessoas.
Objetivo:
Validar a estrutura e o conteúdo de uma intervenção educacional em enfermagem (intervenção complexa) para promover a adaptação dos sobreviventes de cancro.
Metodologia:
Utilizou-se a técnica e-Delphi modificada, ao longo de três rondas, através de questionários online.
Resultados:
Um conjunto de 27 peritos validaram a inclusão de 33 itens relativos à estrutura e 177 itens relativos ao conteúdo. A intervenção educacional deve ser realizada ao longo de cinco a oito sessões, individualmente, com a possibilidade de integrar um familiar significativo, e de dinâmicas de grupo, integrando os quatro domínios propostos: Adaptação, Atitude/Coping, Emoção/Ansiedade e Recursos.
Conclusão:
O consenso alcançado é essencial para evidenciar o papel dos enfermeiros nesta fase da doença oncológica e para viabilizar a avaliação da eficácia da intervenção educacional em desenvolvimento.
Background and purpose
Significant improvements in the treatment of anal cancer have produced a growing population of anal cancer survivors. These patients often experience late adverse effects related to their treatment. Research has revealed substantial unmet needs because of long-term symptoms and functional impairments after treatment that may negatively affect health-related quality of life. The purpose of the present guidelines is to review the scientific evidence for the management of late adverse effects after (chemo)radiotherapy ([C]RT) for anal cancer and to extrapolate knowledge from other pelvic malignancies treated with pelvic (C)RT so that they may guide the clinical management of late adverse effects.
Materials and methods
Relevant studies were systematically searched in four databases from their inception to June 2020 (no language limitation) and guidelines were searched in 16 databases, focussing on bowel dysfunction, psychosocial aspects, pain, and sexual and urinary dysfunction. The guidelines were developed by a panel of experts using the Oxford Centre for Evidence-based Medicine, levels of evidence, and grades of recommendations.
Scientific evidence
Late adverse effects after (C)RT for anal cancer are associated with a low overall quality of life among survivors. The most pronounced late adverse effects are bowel dysfunction (present in up to 78%), urinary dysfunction (present in up to 45%), and sexual dysfunction (present in up to 90% of men and up to 100% of women). Only indirect data on adequate treatment options of these late adverse effects for anal cancer are available.
Conclusion
Quality of life and late adverse effects should be monitored systematically following treatment for anal cancer to identify patients who require further specialist evaluation or support. Increased awareness of the extent of the problem may serve to stimulate and facilitate multidisciplinary collaboration, which is often required.
Objectives: To understand and define four concepts that are often used synonymously with one another in the applied health science field and related literature: self-care, self-help, self-help groups, and self-management, in order improve physician-patient interactions and communication.
Study design: Non-experimental descriptive archival study using purposive sampling techniques.
Method: Concepts were analyzed through a systematic review of the literature within the field of applied health science. Data was collected from 01/2017 to 08/2017. Commonalities and differences were examined, and definitions were formed for each term and subsequently converted into plain language definitions.
Results: While there is some overlap amongst these terms, definitions were developed for each term individually, and relationships between them were established. The common theme was that the actions of self-help, self-care, self-management and self-help groups are initiated in some manner by the individual. Self-management exists as a subset of self-care and shares many commonalities with self-help. Meanwhile, self-help groups make up a smaller component within the self-help category.
Conclusions: A clearer understanding of each concept, including their overlaps and relationships to one another was established, which can provide specificity for the field. Creating plain language definitions can bridge the gap between academics, physicians, and patients.
El cáncer de próstata es uno de los tumores más comunes diagnosticados en hombres. Su incidencia está relacionada con la edad. La incontinencia urinaria es uno de los efec-tos secundarios más frecuentes de la prosta-tectomía radical que va a suponer en el paciente cambios físicos, psicológicos, en su vida social e incluso en su relación de pareja. En los estudios incluidos, hubo una variación considerable en el tipo de intervención y la intensidad de los tratamientos de fisiotera-pia (ejercicios de suelo pélvico, electroesti-mulación, biofeedback, terapia conductual) y las diferentes formas de evaluación. El objetivo de esta revisión es realizar una evaluación exhaustiva de los estudios que se hayan publicado en los últimos 5 años y que investiguen las diversas técnicas de fisioterapia aplicadas y su efectividad en la incontinencia urinaria en pacientes some-tidos a diferentes tratamientos por cáncer de próstata.Todos los autores reconocen el beneficio de la fisioterapia en la pronta recuperación de la continencia, pero a largo plazo las tasas de mejoría se igualan entre los que han recibido tratamiento y los que no lo han recibido. Considerando que la variable principal en todos los estudios es la calidad de vida, es importante para la salud those who have received treatment and those who have not. Whereas the primary endpoint in all studies is the quality of life, it is important for both physical and mental health of these patients that their recovery will be as soon as possible.
Objective:
Self-management has been proposed as a strategy to help cancer patients optimize their health and wellbeing during survivorship. Previous reviews have shown variable effects of self-management on outcomes. The theoretical basis and psycho-educational components of these interventions has not been evaluated in detail. We aimed to evaluate the evidence for self-management and provide a description of the components of these interventions.
Methods:
We conducted a systematic review of self-management interventions for adults who had completed primary cancer treatment by searching MEDLINE, EMBASE, PsychINFO, CINAHL, Scopus, Cochrane database of systematic reviews, National Institutes of Health clinical trials registry, and Cochrane CENTRAL registry of controlled trials. We included experimental and quasi-experimental designs. Data synthesis included narrative and tabular summary of results; heterogeneity of interventions and outcomes precluded meta-analysis. Study quality was evaluated using the Cochrane Risk of Bias tool or the Risk of Bias of Non-Randomized studies tool.
Results:
41 studies published between 1994 and March 29, 2018 were included. Studies were predominantly randomized controlled trials and targeted to breast cancer survivors. A variety of intervention designs, psychoeducational components, and outcomes were identified. Less than 50% of the studies included a theoretical framework. There was variability of effects across most outcomes. Risk of bias could not be fully assessed.
Conclusions:
There are limitations in the design and research on self-management interventions for cancer survivors which hinders their translation into clinical practice. Further research is needed to understand if these interventions are an important type of support for cancer survivors.
Reasons for lack of psychosexual care available
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).
Men who were recently treated for prostate cancer (N=250) were randomly assigned to a control group, a group education intervention (GE), or a group education-plus-discussion intervention (GED). Both GE and GED increased prostate cancer knowledge. In the year postintervention, men in the GED condition were less bothered by sexual problems than men in the control condition, and they were more likely to remain steadily employed (93.0%) than men in the GE (75.6%) or control (72.5%) conditions. Among noncollege graduates, GED and GE resulted in better physical functioning than the control condition, and GED resulted in more positive health behaviors than the control or GE condition. Among college graduates, controls were comparable with the GE and GED groups in physical functioning and positive health behaviors.
The diagnosis and subsequent treatment of prostate cancer is followed by a range of significant disease specific and iatrogenic sequelae. However, the supportive care needs of men with prostate cancer are not well described in the literature. The present study assesses the supportive care needs of men with prostate cancer who are members of prostate cancer self‐help groups in Queensland, Australia. In all, 206 men aged between 48 and 85 years (mean=68) completed the Supportive Care Needs Survey (SCNS) (62% response). The SCNS is a validated measure assessing perceived need in the domains of psychological needs, health system and information needs, physical and daily living needs, patient care and support, and sexuality. Items assessing need for access to services and resources were also included.
One third of the sample reported a moderate to high need for help for multiple items in the sexuality, psychological and health system and information domains. Younger men reported greater need in the sexuality domain; living in major urban centres was predictive of greater psychological need; being closer to the time of diagnosis was related to greater need for help in the physical and daily living domain; having prostate cancer that is not in remission, having received radiation therapy, and lower levels of education were predictive of greater need for help in patient care and support. Of the total sample, 55% of men had used alternative cancer treatments in the past 12 months, with younger and more educated men more likely to use alternative therapies. Interventions in sexuality, psychological concerns and informational support are priorities for men with prostate cancer. Copyright © 2001 John Wiley & Sons, Ltd.
Voiding and sexual function after treatment are major determinants of quality of life in prostate carcinoma patients. Erectile dysfunction, incontinence, and urinary symptoms, both obstructive and irritative, have a significant negative impact on patient quality of life. This prospective study was undertaken to evaluate voiding, sexual function, and their impact on patients with localized prostate carcinoma who were treated with radical retropubic prostatectomy (RP) and to compare these patients with patients who were undergoing hormonobrachytherapy with external bean radiotherapy (HBTC) and patients who were undergoing hormonobrachytherapy without external beam radiotherapy (HBT).
Objective To quantify the effect of radiotherapy (RT) on urodynamic function 3 months after RT in patients with prostate cancer undergoing definitive external beam RT.Patients and methods Seventeen patients with clinically localized prostate cancer were accrued into a single-arm prospective study. Sixteen of the patients completed a scheduled multichannel video-urodynamic study at baseline and again 3 months after RT; the urodynamic variables were then compared to assess the nature and extent of urodynamic change caused by RT. Correlations were assessed between these quantitative changes and those in self-assessed qualitative urinary function measured by International Prostate Symptom Score (IPSS), Quality of Life assessment index (QoL) and urinary functional enquiry.Results There were significant changes detected by the urodynamic study 3 months after RT in bladder volume at capacity (mean decrease 70 mL) and bladder volume at first sensation when supine (mean decrease 85 mL), and a lower postvoid residual volume (mean 50 mL). There was no significant change in the remaining urodynamic variables (including maximum flow rate and voided volume), nor in bladder compliance, bladder instability or bladder outlet obstruction. The self-assessed qualitative urological function measured by the IPSS, QoL and median urinary frequency/24 h showed no significant change after RT.Conclusions This is the first quantitative study to prospectively evaluate the effect of RT on urodynamics in patients with prostate cancer. Only a few urodynamic variables changed significantly 3 months after RT, while most, including self-assessed qualitative urinary function, did not. This finding corresponds well with the notion that most patients tolerate RT well and that acute RT-induced urinary symptoms resolve successfully, with the return of lower urinary tract function to baseline levels by 3 months after RT.
BACKGROUND
Cancer survivors are at increased risk for developing secondary tumors, diabetes, osteoporosis, and cardiovascular disease, thus making them an important target population for health-related interventions. However, little is known regarding cancer survivors' behaviors and their interest in pursuing healthier diets, exercise, and smoking cessation.METHODSA 65-item survey was mailed to 1667 patients diagnosed with early stage carcinoma of the breast or prostate that requested data regarding demographics, health behaviors, stage of readiness for smoking cessation, exercise, increased fruit and vegetable (F&V) consumption, and decreased fat intake, as well as interest in specific health programs and when, relative to diagnosis, these programs should be offered.RESULTSResponses from 978 cancer survivors suggested that the overwhelming majority (85%) reported their health as good to excellent. The majority of respondents (55%) ate fewer than 5 daily servings of F&Vs, with prostate carcinoma patients reporting eating significantly fewer servings than patients with breast carcinoma (P < 0.001). In contrast, 69% of respondents reported adherence to a low fat diet, again with lower practice rates among prostate carcinoma patients than patients with breast carcinoma (P = 0.006). The majority of respondents (58%) reported routine exercise and 8% were current smokers. Significantly more breast carcinoma patients than prostate carcinoma patients were current smokers (P = 0.03). There was strong interest in health promotion programs across behaviors, and a fair amount of concordance between low fat dietary behaviors and exercise, as well as consumption of five daily servings of F&Vs. The majority of patients expressed a preference for programs that could be delivered via mailed brochure, with 57% of respondents indicating that programs should be initiated at the time of diagnosis or soon after (within 6 months).CONCLUSIONS
The results of the current study suggest that although many cancer survivors already practice healthy life-style behaviors, there is a substantial proportion who do not. Interventions especially are needed to increase daily F&V intake; however, given the fair degree of clustering between dietary and exercise behaviors, multiple risk factor interventions also may be warranted. Among cancer survivors, receptivity is high for health promotion programs, especially those that can be delivered by mail and soon after diagnosis. Cancer 2000;88:674–84. © 2000 American Cancer Society.
Background:
Few intervention studies have been conducted to help couples manage the effects of prostate cancer and maintain their quality of life. The objective of this study was to determine whether a family-based intervention could improve appraisal variables (appraisal of illness or caregiving, uncertainty, hopelessness), coping resources (coping strategies, self-efficacy, communication), symptom distress, and quality of life in men with prostate cancer and their spouses.
Methods:
For this clinical trial, 263 patient-spouse dyads were stratified by research site, phase of illness, and treatment; then, they were randomized to the control group (standard care) or the experimental group (standard care plus a 5-session family intervention). The intervention targeted couples' communication, hope, coping, uncertainty, and symptom management. The final sample consisted of 235 couples: 123 couples in the control group and 112 couples in the experimental group. Data collection occurred at baseline before randomization and at 4 months, 8 months, and 12 months.
Results:
At 4-month follow-up, intervention patients reported less uncertainty and better communication with spouses than control patients, but they reported no other effects. Intervention spouses reported higher quality of life, more self-efficacy, better communication, and less negative appraisal of caregiving, uncertainty, hopelessness, and symptom distress at 4 months compared with controls, and some effects were sustained to 8 months and 12 months.
Conclusions:
Men with prostate cancer and their spouses reported positive outcomes from a family intervention that offered them information and support. Programs of care need to be extended to spouses who likely will experience multiple benefits from intervention.
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.