Cancer in the prostate gland is the most common cancer among men in the UK, with 47 000 men being diagnosed every year (Clinical Services Journal, 2019). It develops gradually and usually has no signs or symptoms for many years, sometimes even decades (NHS, 2018).
Diagnosis can therefore be delayed, and treatment is often not immediately necessary (NHS, 2018). Once the prostate has enlarged enough for symptoms to manifest, patients may notice signs such as an increased urge to urinate, straining while urinating or a feeling that the bladder has not been fully emptied (NHS, 2018) (Figure 1). These symptoms do not necessarily mean that the person has prostate cancer, as prostate enlargement itself can cause these symptoms. However, they should not be ignored, as early-stage prostate cancer can be cured, for example, by removing the prostate gland or via radiotherapy, either as a standalone treatment or alongside hormone therapy (NHS, 2018).
Surgery and radiotherapy have their own side effects, which can significantly affect a person's quality of life. For example, conventional radiotherapy delivers X-ray beams to a tumour site to attack it, but leaves radiation deposits in the surrounding tissues (Rutherford Cancer Centres, 2019), which can lead to short-term and long-term effects, such as diarrhoea, erectile dysfunction and rectal pain, among others (Cancer Research UK, 2016). Researchers have therefore been investigating other therapies that may offer a cure without these side effects (Rutherford Cancer Centres, 2019), as well as lifestyle interventions for men living with and beyond prostate cancer (Lemanska et al, 2019).
As research, diagnostics and treatment for long-term conditions continue to develop and improve, survival rates are on the rise, and the new conversation is increasingly revolving around how to achieve optimal quality of life.
Research and the community
In a new phase II feasibility study published in the British Medical Journal examining both quantitative and qualitative data, it has been reported that men living with prostate cancer have benefitted considerably from pharmacy lifestyle interventions, which improve cardiovascular health and increase physical activity (Lemanska et al, 2019).
Nine community pharmacy teams received training prior to the study to deliver a health assessment, including fitness and strength testing, to men living with and beyond prostate cancer (Robinson, 2019). One hundred and sixteen men with prostate cancer attended the first intervention, which consisted of a personalised risk assessment considering clinical history, cardiovascular risk, strength, fitness, physical activity and diet (Robinson, 2019). An algorithm was then used to generate a personalised lifestyle prescription for each patient, accompanied by an intervention kit.
Follow-up calls were made to the patients at 1 and 6 weeks after the intervention, after which a second intervention was carried out at the 12-week mark; this was attended by 99 of the original 116 patients. The personalised risk assessment was repeated, followed by issue of another lifestyle prescription. This second intervention was then followed up at 3 and 6 months afterwards, with questionnaires, focus groups and interviews. The study found that upper limb and lower limb strength had both increased, and the participants' weight, body mass index and total cholesterol had reduced by the second pharmacy visit (Robinson, 2019).
What lies ahead?
Prostate cancer survival has improved considerably and has tripled in the last four decades, in large part because of more effective diagnosis. This has led to a need to follow diagnosis with effective treatments and efforts to improve the day-to-day lives of the people living with and beyond prostate cancer. Enhancing patients' quality of life is one of the most important aspects of healthcare delivery today.
As care is increasingly being carried out in communities in an effort to reduce avoidable hospital admissions and treat people closer to home, the role of community nurses is becoming increasingly significant. While the community intervention described in this article was delivered by pharmacy teams and was found to be of a feasible design and acceptable to both the pharmacy teams and patients, similar lifestyle interventions will likely become increasingly commonplace, and nurses could be well placed to carry these out. The study carried out by Robinson et al (2019) is being called an essential step towards a randomised controlled trial to test the effectiveness and cost-effectiveness of the intervention.
The National Institute for Health and Care Excellence (2018) recommends that people with prostate cancer who are on androgen-deprivation therapy be encouraged to exercise at least twice a week for 12 weeks to reduce fatigue and improve quality of life (Robinson, 2019). Community nurses play an important role in offering essential information, lifestyle advice such as this and personalised interventions, such as the one described in this article.