Nursing interventions to improve the health of men with prostate cancer undergoing radiotherapy: a review

Patients' perspectives of the skills and competencies of therapy radiographers/radiation therapists (TRs/RTTs) in the UK, Portugal and Malta; a qualitative study from the SAFE Europe project

INTRODUCTION

The role of the Therapy Radiographer/Radiation Therapist (TR/RTT) is to provide radiotherapy to patients with a cancer diagnosis. This includes, not only administration of treatment, but also management of side-effects and provision of support/care. Despite this role being consistent throughout Europe, there is currently no standardisation of education for TRs/RTTs. The SAFE EUROPE project aims to standardize TR/RTT education to enable 'safe and free exchange' of TRs/RTTs across Europe. Consequently, this study aims to explore patients' perspectives regarding the current skills and competencies of TRs/RTTs.

METHODS

From May 2021 to February 2022, semi-structured interviews were conducted with patients who had recently received radiotherapy in the UK, Malta and Portugal. Ethical approval for this study was granted by the NHS Research Ethics Committee with additional local approvals obtained.

RESULTS

Forty-eight participants from the UK (n = 18), Portugal (n = 19), and Malta (n = 11) completed interviews. Participants described high satisfaction with TRs'/RTTs' competence and skills in all three countries. The main theme arising from the analysis was the importance of trust building with TRs/RTTs. Six factors were identified as influencing levels of trust: communication; side-effect management; team consistency; relational skills; patient dignity; and competence. A small number of patients reported feeling rushed and not having their physical and emotional needs met by TRs/RTTs.

CONCLUSION

This multicentre study demonstrated that patients perceive TRs/RTTs in the UK, Malta and Portugal as highly competent and skilled. Practical recommendations are provided to address identified deficits in practice, which can be addressed through adaptation of TR/RTT education/training and clinical practice.

IMPLICATIONS FOR PRACTICE

Recommendations arising from this study are important to ensure that TRs/RTTs have transferable skills that provide consistently high quality care to patients throughout Europe.

Experiences of older patients with cancer from the radiotherapy pathway - A qualitative study

PURPOSE

To explore and describe experiences of older patients with cancer throughout their radiotherapy treatment, from diagnosis until follow-up after treatment.

METHODS

Individual interviews were conducted to explore different phases of radiotherapy. Interviews were recorded and transcribed verbatim. Inductive content analysis was applied. Each interview was coded separately. Then to the codes were analyzed further, and an overall theme was developed.

RESULTS

Twelve older patients with cancer, (7 male, 5 female) aged ≥ 65 related their experiences from radiotherapy treatment. A main theme describes the essence of their experiences; Understanding "just enough". The theme comprises five main categories: Understandable, adapted information is crucial for trusting health services; Previous experiences influence patients' perception and understanding; Involvement of next of kin is crucial to patients' comprehension; Professional treatment decisions and well-organized treatment determines satisfaction and Experiences of cooperation and coordination of services affects dependability.

CONCLUSIONS

Findings from this study describe how understanding "just enough" - not too much nor too little - may assist older patients with cancer in participating in treatment decisions, preventing false beliefs, feeling reassured during treatment and in navigating the complex health care system. Next of kin are important assets for older patients with cancer in understanding "just enough". Cancer nurses may map comprehension of information, as well as reveal patients' previous experiences.

An Exploration of the Rs of Radiobiology in Prostate Cancer

OBJECTIVES

To explore the four Rs of radiobiology (Repair, Reoxygenation, Reassortment, and Repopulation) as a means to understand the effects of ionising radiation on biological tissue and subsequently as the basis for conventional fractionated treatment schedules. These radiobiological principles will form a rationale for combined regimens in prostate cancer treatment involving androgen deprivation therapy and radiation therapy and the associated toxicities of this approach will be discussed.

DATA SOURCES

Electronic databases including CINAHL, MEDLINE, Scopus, professional websites, books and grey literature were searched using Google Scholar.

CONCLUSION

It is important for nurses to understand the four Rs of radiobiology to grasp the effects of ionising radiation on biological tissue as the basis for conventional fractionated treatment schedules in prostate cancer. Men can experience a sequalae of physical and psychological side effects of treatment that can negatively impact quality of life.

IMPLICATIONS FOR NURSING PRACTICE

Men can experience a range of unmet supportive care needs particularly related to informational, sexual, and psychological needs. For men affected by prostate cancer opting for radiation therapy (+/-) androgen deprivation therapy, nurses should ask targeted questions based on the Common Terminology Criteria for Adverse Events related to urinary and bowel function, potency and fatigue, and sexual health. We also recommend the use of holistic needs assessments to tailor self-management care plans. Evidence-based self-management advice should be provided in response to each man's unique needs.

Lower urinary tract symptoms in patients with prostate cancer under and after intensity-modulated radiation therapy

OBJECTIVE

The aim of the present study was to collect data on the characteristics, degree, and natural course of urinary complications, as well as self-care for such complications, in patients during and after prostate intensity-modulated radiation therapy (IMRT).

METHODS

Quality of life data were collected retrospectively for all eligible patients who underwent IMRT. In all eligible patients, urinary symptoms were evaluated using questionnaires and face-to-face interview. Participants were asked to respond to a self-administered questionnaire concerning the core lower urinary tract symptom score during the course of IMRT and up to 12 months after the completion of IMRT.

RESULTS

In all, 29 eligible patients were included in the study. The frequency of urinary symptoms increased over of the course of IMRT, decreased at ≥3 months after completion of IMRT, and disappeared 6 months after IMRT. Responses to the questionnaire revealed a variety of approaches to self-care and adaptations by patients to manage urinary symptoms.

CONCLUSIONS

During and after IMRT for localized prostate cancer, patients often developed more frequent urination and urgency than at the start of IMRT, and recovered 3-6 months after the completion of IMRT. Based on the present study, clinicians and nurses could help convey this information to patients and thus offer better support.

Recognizing European cancer nursing: Protocol for a systematic review and meta-analysis of the evidence of effectiveness and value of cancer nursing

AIM

To identify, appraise and synthesize the available evidence relating to the value and impact of cancer nursing on patient experience and outcomes.

BACKGROUND

There is a growing body of literature that recognizes the importance and contribution of cancer nurses, however, a comprehensive review examining how cancer nurses have an impact on care quality, patient outcomes and overall experience of cancer, as well as cost of services across the entire cancer spectrum is lacking.

DESIGN

A systematic review and meta-analysis using Cochrane methods.

METHODS

We will systematically search 10 electronic databases from 2000, with pre-determined search terms. No language restrictions will be applied. We will include all randomized and controlled before-and-after studies that compare cancer nursing interventions to a standard care or no intervention. Two reviewers will independently assess the eligibility of the studies and appraise methodological quality using the Cochrane Risk of Bias tool. Disagreements will be resolved by discussion and may involve a third reviewer if necessary. Data from included studies will be extracted in accordance with the Template for intervention Description and Replication reporting guidelines. Missing data will be actively sought from all trialists. Data will be synthesized in evidence tables and narrative to answer three key questions. If sufficient data are available, we will perform meta-analyses.

DISCUSSION

This review will allow us to systematically assess the impact of cancer nursing on patient care and experience. This evidence will be used to determine implications for clinical practice and used to inform future programme and policy decisions in Europe.

Physical and emotional health information needs and preferences of long-term prostate cancer survivors

OBJECTIVE

Many men diagnosed with prostate cancer (PC) will experience physical and psychosocial late effects of treatment. Their interest/preferences for receiving information about addressing common sequelae is not well understood. We examined long-term PC survivors' level of interest, whether this differed based upon symptomatology, and their preferred coping information source.

METHODS

N=615 PC survivors (3-8 years post-diagnosis) completed a survey on physical and psychological health and their information interests and preferences related to late effects of cancer treatment.

RESULTS

Over half of PC survivors reported interest in information about late effects of treatment or sexual health, while approximately a quarter were interested in emotional health information. Survivors preferred to receive information about late effects of treatment from their oncologists, sexual health information from their primary care providers (PCP), oncologist, or written/online resources, and emotional health information from their PCP. Information needs were more commonly reported among men with poorer domain-specific health functioning.

CONCLUSION

Long-term PC survivors report significant interest in receiving information about their physical, sexual, and emotional health.

PRACTICE IMPLICATIONS

Medical providers caring for these men should inquire about survivors' information needs and future intervention efforts should consider who delivers the information, dependent upon the type of dysfunction reported.

Symptoms and self-care strategies during and six months after radiotherapy for prostate cancer - Scoping the perspectives of patients, professionals and literature

PURPOSE

Under-diagnosed and uncontrolled symptoms in patients with prostate cancer during radiotherapy can have a negative impact on the individual's quality of life. An opportunity for patients to report their symptoms systematically, communicate these symptoms to cancer nurses and to receive self-care advice via an application in an Information and Communication Technology-platform could overcome this risk. The content in the application must precisely capture symptoms that are significant to both patients and health care professionals. Therefore, the aim of the study was to map and describe symptoms and self-care strategies identified by patients with prostate cancer undergoing radiotherapy, by health care professionals caring for these patients, and in the literature.

METHODS

The study combines data from interviews with patients (n = 8) and health care professionals (n = 10) and a scoping review of the literature (n = 26) focusing on the period during and up to 6 months after radiotherapy.

RESULTS

There was a concordance between the patients, health care professionals, and the literature on symptoms during and after radiotherapy. Urinary symptoms, bowel problems, pain, sexual problems, fatigue, anxiety, depression, cognitive impairment and irregular symptoms were commonly described during the initial treatment period. Self-care strategies were rarely described in all three of the sources.

CONCLUSIONS

The results show which symptoms to regularly assess using an Information and Communication Technology-platform for patients with newly-diagnosed prostate cancer during radiotherapy. The next step is to evaluate the efficacy of using the platform and the accuracy of the selected symptoms and self-care advice included in a smartphone application.

Canadian Nurses' Perspectives on Prostate Cancer Support Groups: A Survey Study

BACKGROUND

Prostate cancer support groups (PCSGs) are community-based organizations that offer information and psychosocial support to men who experience prostate cancer and their families. Nurses are well positioned to refer men to a range of psychosocial resources to help them adjust to prostate cancer; however, little is known about nurses' perspectives on PCSGs.

OBJECTIVE

The aim of this study was to describe nurses' views about PCSGs as a means to making recommendations for advancing the effectiveness of PCSGs.

METHODS

A convenience sample of 101 Canadian nurses completed a 43-item Likert-scale questionnaire with the additional option of providing comments in response to an open-ended question. Univariate descriptive statistics and content analysis were used to analyze the quantitative and qualitative data, respectively.

RESULTS

Participants held positive views about the roles and potential impact of PCSGs. Participants strongly endorsed the benefits of support groups in disseminating information and providing support to help decrease patient anxiety. Online support groups were endorsed as a practical alternative for men who are reluctant to participate in face-to-face groups.

CONCLUSIONS

Findings suggest that nurses support the value of Canadian face-to-face and online PCSGs. This is important, given that nurses can help connect individual patients to community-based sources providing psychosocial support.

IMPLICATIONS FOR PRACTICE

Many men benefit from participating in PCSGs. Aside from positively endorsing the work of PCSGs, nurses are important partners for raising awareness of these groups among potential attendees and can directly contribute to information sharing in face-to-face and online PCSGs.

Patient experiences at diagnosis and psychological well-being in prostate cancer: A Finnish national survey

PURPOSE

Most cases of prostate cancer are diagnosed at an early stage, and men live for many years after diagnosis. Thus, their well-being and quality of life are of great importance. This study investigated patient experiences and psychological well-being in a Finnish national sample of prostate cancer patients who received various types of treatment.

METHOD

In a national sample (50%) of prostate cancer patients diagnosed in Finland in 2004, information was collected on the patients' experiences at diagnosis and choice of treatment (e.g. treatment selection, patient satisfaction with care and information, psychological reactions). In 2009, participants were asked about their experiences, and psychological well-being (psychological symptoms, satisfaction with life) was measured. In total, 1239 completed questionnaires (73%) were accepted for the study. Differences between treatments and predictors of psychological well-being were investigated using descriptive statistics and regression analysis.

RESULTS

Half of the respondents were satisfied with the care and information they received about the cancer and side effects of treatment. Experiences and psychological well-being were most positive among patients who received brachytherapy and poorest among patients who received hormonal therapy. Patients who underwent prostatectomy or brachytherapy were most likely to have been involved in treatment selection. Negative experiences, such as learning of the diagnosis in an impersonal way and dissatisfaction with the information and care received, were predictive of poorer well-being.

CONCLUSIONS

Unmet supportive care and informational needs were common. Experiences and well-being varied between treatments. Patients tended to prefer prostatectomy and brachytherapy. Unmet needs, which would probably be reduced by improvements in care, appear to have a long-lasting impact on patients' psychological well-being.

Using Information and Communication Technology in Home Care for Communication between Patients, Family Members, and Healthcare Professionals: A Systematic Review

Introduction. Information and communication technology (ICT) are becoming a natural part in healthcare both for delivering and giving accessibility to healthcare for people with chronic illness living at home. Aim. The aim was to review existing studies describing the use of ICT in home care for communication between patients, family members, and healthcare professionals. Methods. A review of studies was conducted that identified 1,276 studies. A selection process and quality appraisal were conducted, which finally resulted in 107 studies. Results. The general results offer an overview of characteristics of studies describing the use of ICT applications in home care and are summarized in areas including study approach, quality appraisal, publications data, terminology used for defining the technology, and disease diagnosis. The specific results describe how communication with ICT was performed in home care and the benefits and drawbacks with the use of ICT. Results were predominated by positive responses in the use of ICT. Conclusion. The use of ICT applications in home care is an expanding research area, with a variety of ICT tools used that could increase accessibility to home care. Using ICT can lead to people living with chronic illnesses gaining control of their illness that promotes self-care.

Quality of life in men receiving radiotherapy and neo-adjuvant androgen deprivation for prostate cancer: results from a prospective longitudinal study

AIM

To report a study measuring the quality of life and side effects in men receiving radiotherapy and hormone ablation for prostate cancer up to 1 year after treatment.

BACKGROUND

Prostate cancer incidence is increasing with the result that more men are living longer with the disease and the side effects of treatment. It is important to know the effects this has on their quality of life.

DESIGN

Survey.

METHOD

Between September 2006-September 2007, all men who were about to undergo radical conformal radiotherapy ± neo-adjuvant androgen deprivation for localized prostate cancer were invited to participate in the study; 149 men were recruited. They completed the European Organization on Research and Treatment of Cancer quality of life questionnaire C-30 and Prostate Cancer module PR25 at four time-points.

RESULTS

At 4-6 weeks after radiotherapy, participants experienced the biggest relative decline in global quality of life, social, physical, and role functioning and an increase in treatment side effects. At 6 months postradiotherapy the majority of men experienced an improvement in their side effects. However, a minority of men were experiencing severe side effects of radiotherapy at 1 year post-treatment. Single men and men who had a low quality of life prior to radiotherapy, reported a lower quality of life at 1 year after treatment in comparison to married men.

CONCLUSION

Men with prostate cancer suffer limitations due to the symptoms they experience and disruption to their quality of life. It is essential that nurses develop and deliver follow-up care which is flexible and appropriate to the individual needs of these men.