Enhancing prostate cancer survivorship care through self-management

doi:10.1016/j.urolonc.2017.05.008

Urologic Oncology: Seminars and Original Investigations

Volume 35, Issue 9, September 2017, Pages 564-568

https://doi.org/10.1016/j.urolonc.2017.05.008 Get rights and content

Highlights

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Prostate cancer often leads to long-term quality-of-life impairments.
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Self-management of prostate cancer symptoms is patient-centered.
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Multilingual self-management guides for prostate cancer survivors are available.
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Tailoring self-management to symptom burden and information need appears warranted.

Abstract

The lack of clear roles for prostate cancer survivorship care providers places prostate cancer survivors at significant risk of inappropriate use of services delivered piecemeal by different providers, persistent bothersome symptoms, and silent suffering. Optimizing quality of care for prostate cancer survivors hinges on decreasing fragmentation of care, and providing quality symptom management. This is achieved through comprehensive, appropriate medical, surgical, pharmacological and psychosocial care, coupled with self-management, as highlighted in several recent resources addressing long-term and late effects of treatment. Although further study is warranted, prostate cancer survivors engaging in self-management may reduce the negative impact of prostate cancer in their lives through better quality of care (better symptom management and efficient use of services) and quality of life.

Section snippets

Burdens of prostate cancer survivorship

For most men diagnosed with prostate cancer, long-term and late effects of both diagnosis and treatment can lead to impairments in quality of life [1], [2], [3], [4]. Up to one-third of prostate cancer survivors undergo a medical intervention to evaluate or manage the consequences of the disease (e.g., incontinence and bowel symptoms) [5]. For survivors undergoing expectant management with active surveillance or watchful waiting, periodic prostate-specific antigen testing, physical examination,

Implications of poorly managed prostate cancer–related symptoms

Until recently, there has been limited guidance with respect to which providers should manage which prostate cancer–related symptoms, increasing the likelihood that survivors and their partners will experience fragmented care that fails to meet their needs [10]. The variety of specialists providing follow-up care of survivors includes urologists, radiation and medical oncologists, and even gastroenterologists for bowel-related treatment effects [6], [10], [11]. However, because of its

Increasing focus on self-management to enhance prostate cancer survivorship care

Symptom self-management is a successful approach to activating survivors to use services based on understanding their symptoms and rehabilitation strategies [18], [19]. As such, it can mitigate the overuse and inappropriate use of costly medical interventions via a targeted pursuit of strategies to palliate bothersome symptoms. In fact, suffering could be alleviated when patients feel competent they can manage their symptoms and are able to seek medical care from their PCC or an appropriate

Prostate cancer survivorship guidelines and resources address biopsychosocial needs

Recognizing a growing need to support PCCs, specialists, and patients in survivorship care, several organizations have gathered evidence and expert opinion to create resources. Granular recommendations for the medical, surgical, pharmacological, psychosocial, and self-management approaches to long-term and late effects of treatment are included in the Michigan Cancer Consortium Recommendations for Prostate Cancer Survivorship Care available at www.prostatecancerdecision.org [38]. These

Tailoring self-management recommendations to decrease symptom burden

Although self-management strategies exist to help deal with the side effects of prostate cancer diagnosis and treatment, it is unclear whether they have been widely adopted among survivors. It may be that tailoring is needed to increase survivor engagement in the idea of self-management and to address some of their other issues—including the information needs mentioned earlier. Tailored messaging toward prostate cancer survivors’ information needs and symptom burdens to support self-management

Studying the impact of self-management approaches in prostate cancer survivorship

The extent to which self-management recommendations and engagement with self-management strategies ultimately impact prostate cancer survivor quality of life and health care utilization is unknown. Moreover, whether these approaches effectively improve population-based symptom burdens or associated quality of life, coping, and satisfaction also needs to be better understood. One testable hypothesis is that effective self-management leads to activated, informed patients able to implement

Conclusions

Optimizing quality of care for prostate cancer survivors hinges on activating survivors to learn to manage their symptoms and on decreasing fragmentation of care. The alignment of appropriate medical, surgical, pharmacological, and psychosocial care with self-management, as highlighted in several recent resources addressing long-term and late effects of treatment, can lead to higher quality of life for prostate cancer survivors. However, several challenges to implementing self-management

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Cited by (8)

Patient experiences of self-care management after radical prostatectomy
2021, European Journal of Oncology Nursing
Citation Excerpt :
The core of self-care management is a collaborative partnership between the patient and the healthcare provider that can strengthen the patient's understanding of their condition and symptom management, providing support for the implementation of a treatment regimen and healthy behaviors, and providing information about when and where to seek care (Howell et al., 2020; Riegel et al., 2019b). Self-care management for cancer survivors has generally focused on achieving cure or remission after treatment, not on long-term issues like managing persistent side effects (Howell, 2018; Skolarus et al., 2017). Recommended self-care activities for prostate cancer patients involve tobacco use cessation, physical exercise, altered diet, pelvic floor muscle exercises, and penile rehabilitation (Straczynska et al., 2019).
Prostate cancer is the most common cancer form in Sweden and side effects of the leading treatment, radical prostatectomy, include urinary leakage and erectile dysfunction. Patients are recommended to perform self-care to reduce side effects, but their experiences of performing self-care management after radical prostatectomy are largely unexplored. The aim of this study was to deepen the understanding about patient experiences of support for managing self-care during the first six months after radical prostatectomy.
Eighteen patients were consecutively recruited six months after surgery and individual interviews were conducted. The study had a descriptive qualitative approach and inductive content analysis was used.
Patients described self-care management during the first half-year after surgery as a progression with growth in self-management skills through interconnected phases, from initially striving to get a grasp of the situation and find supportive relationships, to getting grounded in the new situation and taking command of the situation. At six months after surgery, patients had reached a point where they needed to maneuver feelings about long-term consequences.
Standardized routines ensure a certain level of care, but are sparsely adjustable to patients’ progression in self-care management. For sustained self-care behaviors, tailored and interactive support is required from multiple disciplines and peers, in order for a patient to get grounded in and take command of the situation.
Evaluating the Impact of Post-Treatment Self-Management Guidelines for Prostate Cancer Survivors
2019, Journal of Medical Imaging and Radiation Sciences
Citation Excerpt :
In contrast, some participants found the guidelines had little emotional value, with many stating that they had already done their own research. Still, literature supports that equipping prostate cancer survivors with the knowledge to self-manage their symptoms improves their quality of life [10], and it has been shown that accessibility of survivorship information improves the overall well-being of patients [17]. When reviewing the content and language used in the guidelines, this study found that the majority of the guidelines were easily understood by participants.
With a rising number of prostate cancer survivors, transitioning patients to follow-up care has become more relevant in the current Albertan cancer care landscape and has led to a need for better patient education resources surrounding this topic. In response, the Alberta Provincial Genitourinary Tumour Team and Cancer Control Alberta have developed self-management guidelines to aid patients with prostate cancer during this transition. This study aimed to evaluate the effectiveness and impact of the new provincial self-management guidelines in facilitating transition from active curative external beam radiation treatment to primary community care.
This prospective study used convenience sampling to recruit 18 patients with prostate cancer from two major cancer centers in Alberta: Calgary and Edmonton. Participants were given the self-management guidelines within their final week of external beam radiation treatment and a follow-up phone questionnaire 4 weeks later. Participants answered standardized questions regarding the self-management document based on the themes of timeliness, patient-centeredness, safety, effectiveness, and comprehensiveness.
A thematic analysis of the results suggested that the majority of patients were satisfied with the document in all domains, but some expressed concern with the clarity of the document. They suggested improvements such as adding a side effect timeline, adding an appendix or symptom index, further simplifying the language, and coordinating delivery of the guidelines with an in-person education session.
Overall, our findings supported the effectiveness of the guidelines in providing self-management information. If implemented into practice, these guidelines could have a positive impact on the perception of patients with prostate cancer regarding transitioning to follow-up care.
Avec le nombre croissant de survivants du cancer de la prostate, la transition des patients vers les soins de suivi gagne en pertinence dans le paysage des soins du cancer en Alberta et a conduit à un besoin d'améliorer les ressources d’éducation des patients sur ce sujet. En réponse à ce besoin, l’Équipe provinciale des tumeurs génito-urinaires et Cancer Control Alberta ont élaboré des lignes directrices d'autogestion pour aider les patients traités pour un cancer de la prostate durant cette transition. La présente étude vise à évaluer l'efficacité et l'incidence des nouvelles lignes directrices provinciales pour faciliter la transition entre le traitement curatif actif par radiothérapie externe et les soins primaires communautaires.
Cette étude prospective a utilisé l’échantillonnage de commodité pour recruter 18 patients traités pour un cancer de la prostate dans deux centres de cancérologie importants en Alberta: le Cross Cancer Institute à Edmonton et le Tom Baker Cancer Centre à Calgary. Les participants ont reçu les lignes directrices d'autogestion durant leur dernière semaine de radiothérapie et ont répondu à un questionnaire téléphonique quatre semaines plus tard. Les participants ont répondu à des questions normalisées concernant l’à-propos, le centrage sur le patient, la sécurité, l'efficacité et le caractère complet du document d'autogestion.
L'analyse thématique des résultats laisse voir que la majorité des patients sont satisfaits du document dans tous les domaines; certains ont cependant exprimé des préoccupations quant à la clarté du document. Ils ont proposé des améliorations comme l'ajout d'un calendrier des effets secondaires, l'ajout d'une annexe ou d'un index des symptômes, une plus grande simplification du texte et la remise du document dans le cadre d'une séance d’éducation en personne.
Dans l'ensemble, nos conclusions appuient l'efficacité des lignes directrices dans la fourniture d'information d'autogestion. Si elles sont mises en œuvre, ces lignes directrices pourraient avoir une incidence positive sur la perception des patients traités pour un cancer de la prostate envers la transition vers les soins de suivi.
Predictors of prostate cancer survivors’ engagement in self-management behaviors
2023, Canadian Urological Association Journal
Randomised controlled trial to investigate the effectiveness of the symptom management after radiotherapy (SMaRT) group intervention to ameliorate lower urinary tract symptoms in men treated for prostate cancer
2022, Supportive Care in Cancer
Role of preoperative patient education among prostate cancer patients treated by radical prostatectomy
2022, Central European Journal of Urology
Prostate cancer survivorship essentials framework: guidelines for practitioners
2021, BJU International

View all citing articles on Scopus

¹: Dr. Skolarus is supported by a VA HSR&D Career Development Award: 2 (CDA 12-171). Drs. Hawley (PI) and Skolarus (Co-I) are supported by VA HSR&D IIR (12-116).

²: Dr. Wittmann is supported by the Movember Foundation.

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Published by Elsevier Inc.

Seminars articleEnhancing prostate cancer survivorship care through self-management

Highlights

Abstract

Section snippets

Burdens of prostate cancer survivorship

Implications of poorly managed prostate cancer–related symptoms

Increasing focus on self-management to enhance prostate cancer survivorship care

Prostate cancer survivorship guidelines and resources address biopsychosocial needs

Tailoring self-management recommendations to decrease symptom burden

Studying the impact of self-management approaches in prostate cancer survivorship

Conclusions

Eur Urol

J SexMed

J Urol

Prim Care

Urol Oncol

Pat Educ Couns

Jt Comm J Qual Improv

J Pain Symptom Manage

Semin Oncol Nurs

Eur Urol

J Urol

J Sex Med

Urology

Urology

Quality of life and satisfaction with outcome among prostate-cancer survivors

N Engl J Med

Survivorship beyond convalescence: 48-month quality-of-life outcomes after treatment for localized prostate cancer

J Natl Cancer Inst

Long-term functional outcomes after treatment for localized prostate cancer

N Engl J Med

Evaluating long-term patient-centered outcomes following prostate cancer treatment: findings from the Michigan Prostate Cancer Survivor study

J Cancer Surviv

American Cancer Society prostate cancer survivorship care guidelines

CA: a cancer journal for clinicians

Prostate cancer patients' support and psychological care needs: survey from a non-surgical oncology clinic

Psychooncology

Survivorship after prostate cancer treatment: spouses' quality of life at 36 months

Oncol Nurs Forum

Understanding fragmentation of prostate cancer survivorship care: implications for cost and quality

Cancer

Medical costs and productivity losses of cancer survivors—United States, 2008–2011

MMWR Morb Mortal Wkly Rep

Seminars article
Enhancing prostate cancer survivorship care through self-management