Meet the teams at Prostate Cancer UK and King’s College London
The teams at Prostate Cancer UK and King’s College, London, who in 2011 were awarded a Knowledge Transfer Partnership grant by the Department of Trade and Industry to design a new service to support men with fatigue due to prostate cancer.
We reviewed the published evidence, and verified that around two-thirds of men with prostate cancer experienced fatigue. Men being treated with hormone therapy and radiotherapy experienced the most severe symptoms, and very few men were offered advice or support to manage their symptoms.
The big idea
Prostate cancer and its treatments can result in severe fatigue before, during and after treatment. Ream and Richardson defined fatigue in people with cancer as “a subjective, unpleasant symptom which incorporates total body feelings ranging from tiredness to exhaustion, creating an unrelenting overall condition which interferes with individuals’ ability to function to their normal capacity”.
As many as 67 per cent of men with prostate cancer report fatigue. The effects of this can be so debilitating as to result in a feeling of a “loss of self”. Fatigue can also have a huge effect on partners’ lives and perhaps not surprisingly lead to mental health issues like depression or anxiety, either in the man or those around him.
We wanted to demonstrate that a telephone support programme using motivational interviewing techniques could significantly improve men’s fatigue levels, ability to manage their symptoms, and social functioning.
I had to make excuses to my golf buddies, say I’d done my back in, rather than admit I was just too tired to carry on playing.
I might have tried before the intervention to do both my car and my wife’s car and then feel disappointed in myself if I either didn’t achieve it or I was so wasted at the end of it that I wasn’t worth talking to or not worth being in the same room as.
Making it happen
We developed a randomised trial to test whether a telephone support programme using motivational interviewing techniques and based around psychological support, self care education and behaviour change, had a positive effect.
76 men were randomised to receive four telephone calls from a trained Specialist Nurse over a 10 week period. We encouraged participants to complete a diary of their symptoms, and the nurse supported them in managing their time to achieve what they needed to, while reducing feelings of fatigue.
Finding out what works
The men in the intervention group reported a significant overall improvement in fatigue levels, its severity and their ability to manage their symptoms. They also reported significant improvements in social functioning. Results for the intervention group included:
- global fatigue levels significantly reduced (p=.002)
- fatigue severity significantly reduced (p=.015)
- fatigue management (coping with fatigue in daily life) significantly improved (p=.006)
- social role functioning significantly improved (p=.008)
- fatigue symptoms significantly improved (p=.029).
The control group experienced no improvement in fatigue and a worsening in physical functioning (p=.011).
After this pilot, The Movember Foundation funded the inclusion of a full Fatigue Support Service as a part of Prostate Cancer UK’s Specialist Nurses’ offer in February 2013. Since then, we've supported around 180 men through the programme. We’re now carrying out longer-term follow up of men who benefited from this programme to discover whether the improvements are sustained. Our initial findings are very positive.
We’re also working to increase men’s awareness of the service, because so far we’ve only reached a tiny proportion of the estimated 200,000 men struggling to get through their days because of prostate cancer related fatigue: that's two thirds of the 300,000 men living with prostate cancer (Macmillan 2015).