Barts Health and St Joseph’s Hospice
Improving continence and quality of life through specialist physiotherapy
Meet Barts Health and St Joseph’s Hospice
The Specialist Oncology Therapy teams at Barts Health and the Therapies team at St Joseph’s Hospice developed a service for prostate cancer patients throughout North East London in a project funded by The Movember Foundation.
The big idea
North East London has a higher incidence rate of prostate cancer than the UK average. Men frequently live for long periods of time with advanced, incurable disease and so are likely to have multiple support needs related to both their treatment (particularly hormone therapy) and the broader psychosocial implications of living with cancer. Barts Health and St Joseph’s Hospice both offer a range of rehabilitation programmes tailored to the specific needs of prostate cancer patients. But both organisations report that men (particularly prostate cancer patients) are reluctant to use palliative and rehabilitation services.
We wanted to support a new specialist prostate cancer physiotherapy service in North East London. This service would promote physical activity and help men manage the side effects of their treatment. Outcomes for men would include improved urinary symptoms, quality of life, levels of physical activity and confidence in self-management.
Making it happen
The initial scoping work found that men didn't have enough information about their condition, available support services, or the importance of exercise, and they weren't being referred to appropriate services.
This project aimed to correct this issue, help men manage the side effects of treatment and promote physical activity using:
- health and wellbeing clinics
- referral to one-to-one physiotherapy sessions for men physically impaired by prostate cancer
- referrals and support to access local exercise services
- education sessions for health professionals providing therapeutic services to men with prostate cancer.
Each patient typically attended between four and six one-to-one sessions and/or was referred onto appropriate services. Within these sessions the physiotherapist could address a host of issues, including common side effects of treatment like fatigue and incontinence. Men could re-access the service as required to ensure they had ongoing support.
In a brand new, innovative service, men were referred to the Prostate Cancer UK Specialist Physiotherapist before radiotherapy. Pre-radiotherapy physiotherapy prepared men’s bladders to optimise the volume of urine they hold, and helped to minimise the impact of radiotherapy on long term continence.
Finding out what works
Within the six month pilot, 193 men and partners/carers were engaged and received rehabilitative assessment, treatment or education. Men across the whole prostate cancer pathway were engaged, showing tailored rehabilitation is appropriate from diagnosis to palliative care.
The physiotherapy service improved urinary symptoms, quality of life, levels of physical activity and confidence in self-management after treatment.
- 17% increase in self-reported global health score
- 57% improvement in lower urinary tract symptoms from moderate to mild
- 209% increase in individual physical activity
- 17% increase in urinary incontinence
- 25% increase in confidence in self-managing side-effects post intervention (and maintained up to six months later)
- 45% decrease in unscheduled GP visits and 100% decrease in hospital admissions over six months
- £3160 per QALY gained
Read the full six month pilot analysis report for more information