Research round up from the clinic - top three articles from September 2015:
1. Intermittent ADT may improve quality of life in men with prostate cancer
Researchers at Laval University in Canada conducted a systematic review and meta-analysis comparing intermittent and continuous androgen deprivation therapy in patients with prostate cancer. Androgen deprivation is the standard therapy for patients with advanced or recurrent prostate cancer. However, this treatment causes adverse effects, alters quality of life, and may lead to castration-resistant disease. Intermittent androgen deprivation has been studied as an alternative
The review by Mangan et al. included the results of 15 trials from 22 articles published between 2000 and 2013. The authors observed no significant difference in overall survival between intermittent and continuous therapy. In addition there was no difference between the two treatment regimens in cancer-specific survival and progression-free survival. Only a minimal difference in patient’s self-reported quality of life was observed between the two treatment regimens, with an improvement in physical and sexual functioning with intermittent therapy. Overall the authors concluded that some quality of life criteria appeared to improve with intermittent therapy, and it can be considered as an alternative option in patients with recurrent or metastatic prostate cancer.
2. Clinician and patient evaluation of nurse-led active surveillance
As part of the Prostate testing for cancer and Treatment (ProtecT) trial a nurse-led active monitoring protocol was developed. The aim of this study by Wade et al. was to assess the acceptability of ProtecT nurse-led AM to men, urologists and research nurses within the ProtecT trial, and to compare these with experiences of standard urologist-led AS care in urology centres outside the ProtecT trial. Interviews were conducted with men receiving active monitoring under nurse-led care and questionnaires completed by urologists and research nurses delivering ProtecT trial care and compared with interviews and questionnaires conducted with men, urologists and specialists nurses from non-ProtecT urology centres (non nurse-led active monitoring clinics).
Results of the interviews and questionnaires indicated the ProtecT trial model of nurse-led active monitoring for men with localised PCa was acceptable to men, urologists and nurses within the trial and of interest to those outside it.
Urologists believed that nurse-led active monitoring had enabled high-quality care to be delivered, whilst also reducing the burden on urologist clinics to the benefit of patients. Nurses believed nurse-led AM enabled them to increase their professional development while providing a high-quality, flexible service to patients. Patients within the ProtecT trial were very positive about nurse-led care because it allowed flexibility, accessibility and had greater continuity of service. Patients outside the ProtecT trial perceived nurse-led care to be acceptable and desirable in relation to using NHS resources cost-effectively. However, a small number of men receiving consultant-led care outside ProtecT trial (3/20) expressed a preference for care from the urologist. At first interview (6-12 months post-diagnosis) a similar number receiving nurse-led care within ProtecT trial (2/22) also expressed preferences for care from the urologist, but these preferences were replaced with a preference for nurse-led care by the time of the third interview (5–6 years post-diagnosis). Urologists and Specialist Nurses outside the ProtecT trial advocated a move towards nurse-led active monitoring, as it offered more efficient use of resources, may improve the quality and consistency of care. In conclusion the authors stated the ProtecT trial active monitoring nurse-led model of care was acceptable to men with localised prostate cancer and clinical specialists in urology.
3. Prostate cancer death risk linked to stress
Jan and colleagues evaluated the association between perceived stress, social support, disease progression and mortality after diagnosis of prostate cancer in Swedish men. The study surveyed more than 4,000 Swedish men treated for clinically localised prostate cancer regarding stress, grief, sleep habits and social support. The authors reported after a mean follow up of around 4 years, around 3% of men with prostate cancer died from prostate cancer and almost 7% had died from other causes. Results of the study showed that men in the highest third of perceived stress were two thirds more at risk of prostate cancer-specific mortality compared to men in the lowest third of perceived stress. In addition, men with high stress levels were also seen to have high frequencies of sleep loss, and lessened social support, contributing negatively to their quality of life.
The authors also reported that their data did not show a relationship between prostate cancer relapse and perceived stress. The authors acknowledge their study does not recommend or prescribe specific interventions, but confirms previous the recommendation of previous studies to target improvements in quality of life.
If you are feeling stressed or have concerns about prostate cancer, our Specialist Nurses can help support you and answer your questions.