Belfast Health and Social Care Trust
Specialist physiotherapy continence service for men with prostate cancer
The big idea
In 2011 a patient questionnaire identified an unmet need in relation to supported management of the side-effects of treatment (most significantly continence, fatigue and erectile dysfunction support).
The survey also found that many of the men did not feel appropriately aware of the potential side effects of the treatments prior to making decisions about this.
Prostate cancer is one of the most common cancers in men (26% of all male cancers). A common side effect of its treatment is urinary incontinence but while there is a female continence service in Northern Ireland, there is no similar service for men.
A local Transforming Cancer Follow-Up (TCFU) prostate audit demonstrated that only 32.6% of men felt that they were supported to make lifestyle changes to maximise their health and wellbeing. This does not reflect the ethos of the NICE Prostate guideline (2014), the Macmillan Consequences of Cancer Treatment document (2013), or the current health and social care board TCFU model.
Specialised Continence Physiotherapy can improve incontinence and is commissioned for women, but not for men, creating a basic health inequality.
This pilot scheme was funded for 18 months by Prostate Cancer UK to assess the continence needs of patients with prostate cancer and to evaluate the outcome of Specialist Physiotherapy interventions with the project testing the best way to deliver this sort of support (for example, how best to get referrals) and make recommendations for a future model.
Finding out what works
We have provided a service for men pre and post radical prostatectomy, to maximise their pelvic floor muscle function and enhance recovery from surgery.
We have also provided treatment for men who have already had surgery or other oncology treatments and have ongoing continence issues.
Interventions have included:
- Pre- op advice
- Digital rectal examination (DRE ) with consent and instruction on correct Pelvic Floor Muscle Exercise (PFME)
- Specific and individual progressive exercise programme prescribed
- Follow up and repeat DRE 2-3 weeks post trial removal of catheter (TROC)
- Regular follow-up to continue with exercise progression working towards functional muscle use.
- EMG biofeedback (electrotherapy treatment)
- Lifestyle advice
- Overactive Bladder (OAB) advice and training
- Constipation advice
- Referral on to Pilates / fatigue management / counselling
- Close communication with nursing and medical staff
Men have seen the following benefits:
- New service provision for them that wasn’t previously available
- Timely access thereby improving quality of life
- Education for improved self management skills
- Assessment and correction of pelvic floor muscle contraction
- Ongoing pelvic floor muscle tuition to gain optimal functional ability
- By providing a continuity of service for surgical patients in that they are seen before and after surgery by the team
- Reassurance and consistent point of contact is established
- Potential improved economic impact (e.g. reduced pad usage, quicker return to employment)
- Enhance the existing urology service
The timeframe from proposal to funding was very short and initial meetings with the urology team regarding project set-up were met with some scepticism.
This seems to have been due to lack of awareness of what physiotherapy can offer for this cohort of patients. We have found that ongoing communication and face-to-face meetings with practice teams has been essential in developing good working relationships.
Feedback from the urology team on the outcomes to date have been extremely positive and we have been supported to continue delivering the service.
- 59% of men examined needed instruction to gain optimal Pelvic Floor Muscle technique - therefore verbal advice alone is not enough – DRE is essential.
- Many men expressed the need for more detailed information about their surgery (particularly those travelling to England for robotic surgery) and post-op expected pathway; this has been highlighted to the urology team and a patient focus group would be helpful to move this forward.
- Prior to the pilot the Holistic Needs Assessment was not routinely used - this has been highlighted as a service need.
- Good multidisciplinary team working is very beneficial for the patients.
- Many patients have benefited from meeting others in the same position as themselves (informal buddy system) - this could be further developed.
- As a regional pilot, many men had to travel quite a distance to attend appointments. This highlights the importance of linking in with other clinic reviews and telephone reviews.
- A Pilates instructor has been funded for oncology patients and several of the men have benefited from attending these classes.
I know the NHS is moving towards patients self managing and I accept that. However we need to know how to self manage and this service is fulfilling that need for education