Assessing the information and support needs of radical prostate cancer patients and acceptability of a group based treatment review: A questionnaire and qualitative interview study

Aims Current literature suggests the information and support needs of oncology patients undergoing radical radiotherapy to the prostate often remain unmet and can impact quality of life. We aimed to explore the effectiveness of delivery and opportunities for service improvement, including a group based treatment review. Methods: Sixty prostate patients completing radical radiotherapy (mean age 70, range 47-79) in a UK cancer-centre completed a self-designed questionnaire assessing information and support.. To explore views on a group-based-treatment-review, 11% took part in a semi-structured interview. Descriptive data were computed and interviews transcribed and analysed thematically. Results: Eighty-seven percent were satisfied with information and support when delivered by radiographers. However, 26% were only ‘sometimes’ able to complete bladder-filling, suggesting information regarding treatment delays would improve this. 49% preferred both Doctor and Urology nurse reviews whereas 26% preferred nurse only. 70% stated their ‘concerns were always addressed’ by a nurse and 49% by a Doctor. Interviews revealed that a group review was generally acceptable with peer support an influencing factor. Findings: Overall patients felt their needs were being met. Suggestions for improvement (more information on preparation, side effects and delays) will be implemented locally. Future work will explore the feasibility of group reviews in patients undergoing radical radiotherapy to the prostate

Evaluation of deformed image-based dose calculations for adaptive radiotherapy of nasopharyngeal carcinoma

The ultimate goal of adaptive radiotherapy (ART) is to deliver truly customized radiation treatments. Currently, the quality of cone-beam computed tomography (CBCT) images is still inferior to that of conventional CT images in contour delineations and dose calculations for replanning purposes. This retrospective study aims to evaluate the dosimetric accuracy of using deformed conventional CT images for dose calculations, in the hope of inferring the feasibility of ART using planning CT (PCT) images that deformed to up-to-date CBCT images for patients with nasopharyngeal carcinoma (NPC). Thirty consecutive patients with NPC who had undergone 1 replan in their radiotherapy treatments were selected. The pretreatment PCT images were deformed to match the mid-treatment PCT images by deformable image registration. The same volumetric modulated arc therapy plan was then calculated on the deformed PCT images. The resulting dose distributions and dose volume histograms of the tumors and organs at risk (OARs) were compared with the original plan. Five dose levels, D98%, D95%, D50%, D5%, and D2%, were recorded for 9 NPC targets. Four dose levels, Dmax, D10%, D50%, and Dmean, were recorded for 15 OARs. The greatest percentage difference in observed dose for D98%, D95%, D50%, D5%, and D2% of the targets were 1.71%, 1.55%, 0.64%, 0.97%, and 1.13%, respectively. The greatest percentage difference in observed dose for Dmax, D10%, D50%, and Dmean of the OARs were -26.51% (left optic nerve), -17.06% (left optic nerve), 56.70% (spinal cord), and 18.97% (spinal cord), respectively. In addition, 29 of 45 (64%) dosimetric end points of the targets showed statistically significant dose differences (p < 0.05) between the original plan and the plan calculated on deformed images. Forty-nine of 60 (82%) dosimetric end points of the OARs also showed statistically significant dose differences (p < 0.05). Dose calculations using deformed PCT images could result in significant dose uncertainties in target volumes and OARs. Larger dose deviations were found in OARs in comparison with target volumes. The spinal cord and optic nerve showed the greatest percentage dose differences and the clinical significance has yet to be determined. Deformable registration error was believed to be the problem causing the dose deviations. Owing to unknown clinical significanceof dose deviation results obtained from this study, a conventional CT scan is still required for replanning in patients with NPC who are experiencing significant anatomical changes during the course of radiation treatment. [Abstract copyright: Copyright © 2017 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

The psychological impact of prostate cancer after treatment: a critical review of the literature

Aim: This critical review of the literature seeks to understand the psychological impact that treatment interventions may have on prostate cancer (PC) survivors. Materials and Methods: A literature search was conducted using databases of peer-reviewed literature. The search terms used were devised using the building-blocks technique to divide the query into facets. The articles were manually assessed for relevance and appraised using the relevant Critical Appraisal Skills Programme (CASP) tool. Government guidelines and regulations were also used following a manual search on the National Institute for Health and Care Excellence (NICE) website. This process resulted in a total of 12 sources being included in the critical review. Results: The key themes that arose from the review were masculinity, depression, anxiety and psychological implications related to sexual functioning. Psychological impact varies on an individual basis and is influenced by the quality of a patient's experience during and after treatment in relation to sufficient information giving and support. Findings: Open communication should be encouraged by healthcare professionals to assess patient mental wellbeing. The extent of psychological impact varies on an individual basis; however, there are predictive factors that can make an individual more at risk of being affected psychologically post-PC treatment

Exploring the lived experience of gay men with prostate cancer: A phenomenological study

Purpose: Gay men with prostate cancer are an ‘invisible species’ in the research literature despite concerns that the impact of treatment may be more profound and in some ways unique compared to heterosexual men. The aim of this research is to explore the lived experience of gay men with prostate cancer. Method: In-depth interviews were recorded and transcribed verbatim from a purposive sample of eight gay men treated for prostate cancer in Ireland. A qualitative methodological approach employing Giorgi's descriptive phenomenological method was used to collect and analyse data. Findings: Three key aspects emerged representing the essence of the participants lived experience; The experience of diagnosis, treatment decision making, and the impact of treatment, with sub-themes of shock of diagnosis, the generalist nature of information, sexual side effects and incontinence, and masculinity and gay identity. Secondly, the experience of the healthcare service with sub-themes of sexual orientation disclosure and communication with the healthcare team; and thirdly, sources of support and means of coping which included significant others, family & friends, cancer support groups, and gay resources and support services. Conclusion: Gay men with prostate cancer have unmet information and supportive care needs throughout their prostate cancer journey, especially related to the impact of sexual dysfunction and associated rehabilitation, negatively impacting their quality of life. Issues associated with heteronormativity, minority stress, and stigma may influence how gay men interact with the health service, or how they perceive the delivery of care. Healthcare education providers should update prostate cancer education programmes accordingly

Changes to the law on consent in South Africa: implications for school-based adolescent sexual and reproductive health research

BACKGROUND:The National Health Act, No 61, 2003 in South Africa is the first effort made by the government to protect health-related research participants under law. Implemented on March 1, 2012, the law mandates active consent from a parent or legal guardian for all research conducted with research participants under the age of 18 years. This paper focuses on the Act's implications for school-based adolescent sexual and reproductive health research.DISCUSSION:Although well intentioned, the added legal protections in the National Health Act may have the unintended consequence of reducing participation rates in school-based adolescent sexual and reproductive health research, thereby excluding the most at-risk students. The Act may also compromise adolescents' right to dignity and privacy, especially considering the personal nature of research on sex and sexuality. Devolved, discretionary decision-making, which empowers local human research ethics committees to permit a wider range of protective measures, including passive consent, independent adolescent consent or community consultation ought to be considered. The continued and direct involvement of young people in their sexual and reproductive health and well-being is an important principle to uphold.SUMMARY:This paper calls for a re-examination of section 71's ethical guidelines relating to informed consent in the National Health Act, No 61, 2003 in South Africa in order to better serve the interests of South African adolescents in sexual and reproductive health research

Bias of health estimates obtained from chronic disease and risk factor surveillance systems using telephone population surveys in Australia: Results from a representative face-to-face survey in Australia from 2010 to 2013

Background: Emerging communication technologies have had an impact on population-based telephone surveys worldwide. Our objective was to examine the potential biases of health estimates in South Australia, a state of Australia, obtained via current landline telephone survey methodologies and to report on the impact of mobile-only household on household surveys. Methods: Data from an annual multi-stage, systematic, clustered area, face-to-face population survey, Health Omnibus Survey (approximately 3000 interviews annually), included questions about telephone ownership to assess the population that were non-contactable by current telephone sampling methods (2006 to 2013). Univariable analyses (2010 to 2013) and trend analyses were conducted for sociodemographic and health indicator variables in relation to telephone status. Relative coverage biases (RCB) of two hypothetical telephone samples was undertaken by examining the prevalence estimates of health status and health risk behaviours (2010 to 2013): directory-listed numbers, consisting mainly of landline telephone numbers and a small proportion of mobile telephone numbers; and a random digit dialling (RDD) sample of landline telephone numbers which excludes mobile-only households. Results: Telephone (landline and mobile) coverage in South Australia is very high (97 %). Mobile telephone ownership increased slightly (7.4 %), rising from 89.7 % in 2006 to 96.3 % in 2013; mobile-only households increased by 431 % over the eight year period from 5.2 % in 2006 to 27.6 % in 2013. Only half of the households have either a mobile or landline number listed in the telephone directory. There were small differences in the prevalence estimates for current asthma, arthritis, diabetes and obesity between the hypothetical telephone samples and the overall sample. However, prevalence estimate for diabetes was slightly underestimated (RCB value of -0.077) in 2013. Mixed RCB results were found for having a mental health condition for both telephone samples. Current smoking prevalence was lower for both hypothetical telephone samples in absolute differences and RCB values: -0.136 to -0.191 for RDD landline samples and -0.129 to -0.313 for directory-listed samples. Conclusion: These findings suggest landline-based sampling frames used in Australia, when appropriately weighted, produce reliable representative estimates for some health indicators but not for all. Researchers need to be aware of their limitations and potential biased estimates.Emerging communication technologies have had an impact on population-based telephone surveys worldwide. Our objective was to examine the potential biases of health estimates in South Australia, a state of Australia, obtained via current landline telephone survey methodologies and to report on the impact of mobile-only household on household surveys

The psychological impact of prostate cancer after treatment: a critical review of the literature

Introduction: It is well documented that an increasing number of men are now living with and beyond prostate cancer and its treatment. The physical effects of the disease and its treatment are well documented, but less so, the psychological impact of these. Depression and anxiety have been reported in prostate cancer patients1 and men experience unmet needs regarding their psychological wellbeing2. To better understand the needs of men and enable improvements in the care provided, this critical review sought to understand the psychological impact that treatment may have on prostate cancer survivors. Method and Materials: A literature search, for peer-reviewed literature in the last 10 years, was conducted using three reputable databases. PRISMA guidance was used to report the study selection process. Critical appraisal tools were used to appraise each individual study. The data extracted was subject to thematic analysis and narrative synthesis. Results: Analysis revealed three major themes that were used to describe the psychological impact of prostate cancer treatment. 1.) Impact on masculinity 2.) Impact on depression and anxiety and 3.) Psychological impact of sexual dysfunction. All themes could be interlinked and were related to the physical effects of treatment. Analysis also revealed possible influential factors. These being age, marital status and treatment intervention, as well as the presence of specific treatment side effects such as erectile dysfunction, urinary incontinence and bowel incontinence. Conclusion and Discussion: Evidence demonstrates how the physical effects of prostate cancer treatment can impact on psychological wellbeing. Prostate cancer patients should be fully informed of the potential risks to their psychological wellbeing. When assessing the physical effects, practitioners should also explore the psychological impact of these. Advanced communication skills e.g. use of open questioning, are important in establishing specific concerns/needs, and ensuring the support provided is tailored to the individual. Practitioners should also be aware of factors that could increase the risk of psychological impact. Assessment aids that incorporate these, could be useful in recognising at risk individuals

Raising the subject – let’s talk about erectile dysfunction

Introduction: Erectile dysfunction (ED) is a significant side-effect from radical treatment modalities for patients diagnosed with prostate cancer. ED can impact patient’s self-esteem and masculinity [1], resultantly these patients are at a high risk of developing depressive symptoms [2]. ED is not routinely discussed in the radiographer-led review clinics in the author’s clinical department. The team wished to establish if the introduction of the International Index of Erectile Function-5 (IIEF-5) questionnaire in the radiographer-led review clinics would aid patients to raise ED concerns and increase referral rates. Method and Materials: A retrospective baseline audit of 96 patients receiving radical radiotherapy for prostate cancer over a 3-month period was completed to assess if ED had been discussed and the number of patients referred to specialist ED clinics. A prospective service evaluation of all patients receiving radical radiotherapy for prostate cancer over a 3 month period was completed. Patients were asked to return the completed IIEF-5 questionnaire in their review. Responses were discussed, and referral to specialist clinics completed if required. Results: The retrospective baseline audit identified ED was only discussed in 7 reviews of those 96, with 6 patients referred to a specialist clinic. 122 patients have been provided with IIEF-5 in the prospective service evaluation. Patient response to the questionnaires has been mixed, 23 patients have declined to complete the IIEF-5 questionnaire outright. Only 34 patients have returned their completed IIEF-5 questionnaire. From these patients, 29 patients felt ED was not a concern to them and they did not want referral. 5 patients have requested referral to a specialist clinic. Conclusions and Discussion: The evidence-base has identified the importance of healthcare professionals raising the subject of ED with patients [3]. The results have not presently identified an increase in the number of referrals to specialist clinics but the numbers are comparable. IIEF-5 is increasing radiographer and patient awareness leading to the issue being discussed. Further work with focus groups will be conducted to assess and evaluate the appropriateness of the IIEF-5 for these patients