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22758 Couple distress after localised prostate cancer

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Suzanne K Chambers1, Leslie Schover2, Lisa Nielsen3, Kim Halford4, Samantha Clutton3, Robert A Gardiner4, Jeff Dunn3 and Stefano Occhipinti1

1Griffith University, Australia

2The University of Texas M.D. Anderson Cancer Center, United States

3Cancer Council Queensland, Australia

4The University of Queensland, Australia

Introduction/Objective

The experience of a diagnosis of prostate cancer is distressing for both men and their partners. However, it is proposed that the extent of distress in couples coping with prostate cancer can be influenced by a number of dyadic variables. This presentation describes the prevalence of psychological distress in men with prostate cancer and their female partners; and the impact of socio-demographic and psychosocial variables on adjustment outcomes.

Methods

A cross-sectional survey of 189 (47% response) prostate cancer patients who were scheduled for or had undergone surgery for localised prostate cancer and their partners assessed socio-demographic and clinical variables; masculine self-esteem and social intimacy; anxiety and depression; cancer-specific distress; and quality of life.

Results

Overall patients and partners reported low distress; however, female partners were more anxious with 36% reporting mild to severe anxiety, compared to 24% of patients. For men, masculine self-esteem and time since diagnosis were most strongly related to mental health status; urinary bother most influenced physical quality of life. For female partners, the man's psychological distress and his sexual bother were most strongly related to her mental health status; higher social intimacy was most strongly associated with physical quality of life.

Conclusions

Couple distress after prostate cancer is influenced by a number of interacting variables; however patterns for patients and partners differ. For men masculine self-esteem may be most important, whereas for women her partners’ level of distress may matter most. Further research is needed to better understand these interactions, and to identify potential targets for therapy.

23450 An investigation of factors that affect adoption and compliance with post-prostatectomy treatments for erectile dysfunction

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Patrick Lumbroso1, Phyllis Butow Butow1, Michael Lowy2 and Henry Woo3

1The University of Sydney, Australia

2Sydney Men's Health, Australia

3Sydney Adventist Hospital Clinical School, The University of Sydney, Australia

Despite many prostate cancer survivors pre-operatively reporting an interest in receiving treatment for post-radical prostatectomy-related erectile dysfunction, studies show that as many as 50% of men freely decide from the onset not to proceed with any form of therapy. Of those that commence therapy, almost 75% will discontinue treatment within 18 months.

Given the reported success and benefits of post-prostatectomy treatments for erectile dysfunction (PTED), the question remains as to why adoption and compliance rates amongst prostate cancer survivors are not higher. This study aimed to identify and conceptualize those factors influencing prostate cancer survivors to either adopt and/or comply with PTED regimes.

Seventeen men aged 40 to 60 years who had undergone radical prostatectomies were recruited from patient lists of two Sydney-based physicians. Each participated in a semi-structured interview. Following an interpretative phenomenological analysis of their accounts, four themes emerged: experiences in trialling therapies for erectile dysfunction, partner influence, sexual dynamic, and the nature and scope of medical inquiry and advice.

Consolidating the similarities in participant experiences led to the creation of model of participant PTED behaviour. Consistent with other studies, participants reported positive correlations between treatment efficacy, ease of use (both within and outside sexual contexts) and PTED compliance. The strength and nature of relationships with their partners was found to influence treatment adherence, as did access to physicians specialising in male sexual dysfunction.

Despite numerous biopsychosocial factors being reported as influencing treatment adoption and compliance, physicians were found to apply a biomedical model of treatment with behavioural, social and psychological factors being generally overlooked or ignored.

The results of this study provide a useful foundation for future research, particularly in developing interventions that will lead to more efficacious treatment outcomes and higher levels of treatment adherence.

24050 Validation of the distress thermometer against three self-report instruments in Australian men with prostate carcinoma

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Suzanne Chambers1, Leah Zajdlewicz2, Danny Youlden2, Jimmie Holland3 and Jeff Dunn4

1Griffith Health Institute, Griffith University/Cancer Research Centre, Cancer Council Queensland/Prostate Cancer Foundation of Australia, Australia

2Cancer Research Centre, Cancer Council Queensland, Australia

3Memorial Sloane Kettering, United States

4Griffith Health Institute, Griffith University/Cancer Research Centre, Cancer Council Queensland/School of Social Science, The University of Queensland, Australia

Introduction/Objective

The Distress Thermometer (DT) evaluates distress on a single 11-point scale, ranging from 0 (no distress) to 10 (extreme distress). This presentation examines the validity of the DT as a method of detecting distress in Australian men with prostate cancer.

Methods

Receiver operating characteristics analyses were used to evaluate the diagnostic accuracy of the DT compared to 3 “gold standard” scales in 2 prospective studies and 1 cross-sectional study: the Impact of Events Scale – Revised (IES-R, Study 1); the Hospital Anxiety and Depression Scale (HADS, Study 2); and the Brief Symptom Inventory-18 (BSI-18, Study 3).

Results

For Study 1, the DT showed good accuracy against the IES-R at baseline, 1-year and 3 years post-diagnosis (area under curves (AUCs) ranging from 0.84 to 0.88) and sensitivity was high (>85%). The DT also performed well against both the anxiety and depression subscales for HADS at baseline in Study 2 (AUC = 0.84 and 0.82, respectively), but sensitivity was found to decrease substantially after 12 months. For Study 3, validity was high for the anxiety (AUC = 0.90, sensitivity = 90%) and depression (AUC = 0.85, sensitivity = 74%) subscales of the BSI-18; however, comparison with the somatization subscale was less effective (AUC = 0.67, sensitivity = 52%). The cut-off for the DT that maximised sensitivity and specificity varied from >= 3 to >= 6 across the analyses.

Conclusions

Although these results need to be interpreted with some caution due to the relatively small number of distressed cases in each of the samples combined with variation in the optimal cut-off, they consistently point towards the DT being a valid tool to detect anxiety and depression among prostate cancer patients, particularly when it is used close to the time of a PCa diagnosis. The DT is therefore likely to be an appropriate alternative to screen for distress amongst this population compared to longer and more expensive psychometric measures.

24134 Physical activity, health & wellbeing among men with localised prostate cancer in Queensland: baseline data from the living with prostate cancer study

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Suzanne Chambers1, Robert Newton2, Afaf Girfis3, Anna Stiller4, Stephen Lepore5, Cathrine Mihalopoulos6, RA ‘Frank’ Gardiner7, Daniel Galvao2 and Stefano Occhipinti8

1Viertel Centre for Research in Cancer Control, Cancer Council Queensland/Griffith Health Institute, Griffith University, Australia

2Edith Cowan University Health and Wellness Institute, Edith Cowan University, Australia

3Ingham Institute, South Western Sydney Clinical School, The University of New South Wales, Australia

4Viertel Centre for Research in Cancer Control, Cancer Council Queensland, Australia

5Department of Public Health, Temple University, United States

6Deakin Health Economics, Deakin University, Australia

7The University of Queensland Centre for Clinical Research, The University of Queensland/Department of Urology, Royal Brisbane and Women's Hospital, Australia

8Griffith Health Institute, Griffith University, Australia

Aims

Prostate cancer is the most common male cancer in developed countries and diagnosis and treatment-related side effects impact on patients’ quality of life and supportive care needs. These difficulties may be further amplified by physical inactivity and obesity. However there is limited current information available about patients’ exercise patterns and their overall wellness and support needs in the Queensland population. This presentation describes the physical activity levels, quality of life, and supportive care needs of a population-based sample of men with localised prostate cancer in Queensland.

Methods

Recruitment was conducted through the Queensland Cancer Registry, a population-based register of cancer diagnoses in Queensland. A series of previously validated and self-report measures were administered to 463 men recently diagnosed with localised prostate cancer.

Results

Insufficient or no physical activity (67.0% of the sample), overweight/obesity (74.7%), and some need for help in the sexuality domain (55.8%) were prevalent among this population. These characteristics vary with age and may be further complicated by the frequency of other physical health comorbidities, with 86.9% reporting one or more chronic health conditions. Information that was provided by their doctor and family/friends were the most commonly accessed sources of support in relation to their prostate cancer.

Conclusions

This information may assist in identifying areas for intervention and in promoting physical activity. Physical activity and healthy body weight remain key target areas for men with localised prostate cancer. Due to the pattern of help-seeking among these men, there may be an important role for medical practitioners in providing information and referrals in relation to these areas of lifestyle change for their patients.

24218 Localised prostate cancer and the information needs of men to assist in deciding on a treatment option

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Colin Ireland, Barbara Parker, Kevin O'Shaugnessy and Adrian Esterman

The University of South Australia, Australia

Prostate cancer was the most commonly reported cancer in Australia in 2012 with 18560 cases. For many men, the prostate cancer is of low risk with the tumour relatively small, non-aggressive, and entirely within the prostate. There is an abundance of information available regarding active treatment options and the potential complications of each, including surgery, radiotherapy and other less invasive treatments, such as hormone therapy. Watchful waiting and active surveillance are terms that are used to describe the initial absence of active treatment, which could be particularly beneficial for those diagnosed with low risk localised prostate cancer. A recent report from the PIVOT trial in the USA has shown that there was no statistically significant difference after 12 years in the overall survival of men choosing watchful waiting over prostatectomy for low risk localised prostate cancer. The results of the PIVOT trial highlight the fact that many men now have to decide whether or not to undertake active treatment. Deciding on a treatment option can be complex and difficult at stressful time. The information that men require to make such a decision is not well understood, and needs further research.

Research Question

What are the information needs of men to assist in making a decision about treatment when diagnosed with Localised Prostate Cancer?

Objectives

  1. To explore the information men feel would be helpful when they need to make a decision regarding active treatment versus active surveillance.
  2. To identify the preferred timing, format and method of dissemination of this information to men who need to make a decision regarding treatment for localised prostate cancer,
  3. To explore and identify if there are variations for men who live in a metropolitan or country region.

Methods

A qualitative research approach utilising focus groups and individual interviews facilitated this research. Three focus groups, two with men without prostate cancer and one with men who had been diagnosed with prostate cancer, were undertaken. One focus group was undertaken in Metropolitan Adelaide and two focus groups in country South Australia. Individual interviews with health care practitioners from a country region were also undertaken within this research. All sessions were audiotaped and transcribed verbatim. The data was analysed using a thematic analysis.

Results

Preliminary results indicate that men from the study, who did not have prostate cancer, had minimal understanding of their body and the impact of prostate cancer. Participants identified that if faced with the possibility of prostate cancer they would prefer to have information on the disease and treatment options provided before referral to a specialist rather than waiting to be seen. This information needs to be in an easily understandable format. Participants also identified they felt pressured to make a decision regarding treatment when diagnosed. Using the internet to provide this information would be an advantage but there was a preference to have testimonials on the site from men who had previously undertaken the prostate cancer journey, from screening through to treatment.

A key result from the research was that overwhelmingly men did not want to consider active surveillance but rather wanted the cancer removed, despite the results of the PIVOT trial and the potential complications from having active treatment.

Conclusions

Men want timely information about prostate cancer and a capacity to discuss with other men who have undertaken the prostate cancer journey to assist them in this stressful time. Men would rather have the cancer removed than consider active surveillance. Men often felt they had not been given information regarding the care requirements immediately following active treatment. Information needs to be provided needs to be balanced and easily understood by men of all educational levels.

24458 New prostate cancer diagnoses – Improving timeliness of communication with patients general practitioners

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Sue Stanbridge and Sue Osborne

Waitemata District Health Board, New Zealand

At our large District Health Board Hospital, information related to an outpatient consultation is emailed to General Practitioners (GPs) 5 to 21 days after the appointment. This delay can place GPs in a difficult position if their patients seek support, before they have received information regarding the new cancer diagnosis.

Objectives

  1. To create a patient information record to fax to GPs within eight hours of delivery of a prostate cancer diagnosis.
  2. To audit GP satisfaction with the faxed information.

Method

The patient information record, stating method and date of diagnosis; stage; gleason score; PSA; planned radiological investigations and possible treatment options (rated as preferred, potential and unsuitable) was faxed to a patient's GP on the day their diagnosis was delivered.

GP satisfaction with the faxed patient information record was later audited by a feedback questionnaire. Comment was sought on mode of delivery, record content and format.

Results

Half of the GP's contacted responded to the audit. 93% were content with the faxed delivery of patient record; others requested information arrive electronically. 86% were satisfied with the format and 79% found the information provided adequate. 50% indicated receipt of the patient's information record prompted action on their part. This included initiating contact with their patient.

Conclusions

The faxed personalized patient information record has proved a satisfactory method of delivering pertinent and timely information related to a patient's new prostate cancer to GPs. This method of communication has now been extended to suspected renal or bladder tumour diagnoses.

24510 How does psychological resilience “buffer” against depression in prostate cancer patients following diagnosis?

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Vicki Bitsika1, Christopher Sharpley2, Addie Wooten3 and David Christie4

1Bond University, Australia

2Brain-Behaviour Research Group, The University of New England, Australia

3Australian Prostate Cancer Research, Australia

4Brain-Behaviour Research Group, The University of New England, New Zealand

Objective

To (a) investigate the nature of psychological resilience among two samples of prostate cancer patients via factor analysis, (b) determine the effects of the derived factors upon depression in those prostate cancer patients, and (c) plot the trajectory of those effects over the first 5 years following diagnosis.

Methods

Postal surveys of 425 PCa patients were collected from two sites: 189 PCa patients at site 1 and 236 at site 2. Background data plus responses to depression and resilience scales were collected.

Results

Total resilience score was a significant buffer against depression across both sites. Resilience had different factor structures across sites, but only one (common) factor significantly (inversely) predicted depression. Within that factor, only some specific items significantly inversely predicted depression scores, suggesting a very focussed relationship between resilience and depression. Variability in that inverse relationship between resilience responses and depression was noted over time since diagnosis, with peaks in the correlation between the variables during the first 6 months, at 24 and 60 months.

Conclusions

Measures of resilience may be used to screen PCa patients who are at-risk of depression. These patients might benefit from resilience training to enhance their ability to cope effectively with the stress of their diagnosis and treatment. A focus upon specific aspects of overall resilience may be of further benefit in both these processes. These data argue strongly for focussed psychological interventions at various specific periods following a diagnosis of PCa.

24518 Do hormone treatments cause anxiety and depression among prostate cancer patients?

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David Christie1, Christopher Sharpley2 and Vicki Bitsika3

1Brain-Behaviour Research Group, The University of New England & Premion, Australia

2Brain-Behaviour Research Group, The University of New England, Australia

3Brain-Behaviour Research Group, Bond University, Australia

Objective

To investigate the relationship between Hormone Therapy (HT) and incidence on anxiety and depression in prostate cancer patients (PCa).

Methods

526 PCa patients completed a survey about their cancer status, treatments received, anxiety and depression status. Total scores on anxiety and depression inventories, plus symptom profiles that discriminated between patients with current HT, past HT, and never having received HT, were compiled for analysis.

Results

Patients who were currently receiving HT had significantly higher total anxiety and depression scores than patients who had previously received HT or who had never received HT. Analysis of the symptoms of anxiety and depression which distinguished between these groups of patients suggested that patients who had never received HT had significantly lower scores than current or past HT patients. Although several symptoms could be directly allocated to PCa and/or HT, symptom profiles were indicative of clinically significant anxiety and/or depression in patients who were currently receiving, or who had previously received, HT

Conclusion

Current HT may lead to symptoms of anxiety and/or depression which require clinical attention. These effects appear to decrease after completion of HT.

24570 Prioritising care for newly diagnosed men with prostate cancer: Development of a supportive care needs risk factor assessment tool

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David Gray1 and Elizabeth Watt2

1Austin Health

2La Trobe University, Australia

Aims

The primary aim of this review is to identify specific risk factors that predict patient distress and poor health related quality of life (QoL) outcomes following the diagnosis of prostate cancer. The secondary aim is to develop a ‘supportive care needs risk factor assessment tool’ to prioritise contact with men attending Austin Health by a prostate cancer specialist nurse.

Methods

Between 2006 and 2012 a literature search was performed using MEDLINE and Cumulative Index databases in Nursing and Allied Health (CINAHL) using the specific terms: prostate cancer; supportive care; psychosocial factors, and health related quality of life. The initial search revealed over 350 articles. After an exclusion criteria was applied a final 55 articles were included in the review.

Findings

Several factors that contribute to poorer health related QoL outcomes and psychological distress in men newly diagnosed with prostate cancer were identified in the literature review. The most significant factors include: current relationship status (specifically being single); past physical and psychological health issues; employment status (unemployment); lower standard of education; health issues of significant others; logistical issues related to ongoing healthcare (including transport; clinic accessibility); assistance required for activities of daily living and current perception of distress. Questions related to these factors in addition to a distress thermometer have been incorporated into the development of a ‘supportive care needs risk factor assessment tool’.

Conclusions

There are increasing numbers of men attending Austin Health with a new diagnosis of prostate cancer. While the prostate cancer nurse specialist aims to make contact with all of these patients, the use of a supportive care needs risk factor screening tool and distress thermometer may assist in identifying those men who have the greatest need for supportive care early after diagnosis.

24590 Physical activity barriers and facilitators in men with prostate cancer: Influence of androgen deprivation therapy

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Justin Keogh1, Asmita Patel2, Rod MacLeod3 and Jonathan Masters4

1Bond University, Australia

2Human Potential Centre, AUT University, New Zealand

3HammondCare, Greenwich Hospital, Australia

4Auckland City Hospitals, New Zealand

Objective

While physical activity has many benefits for men with prostate cancer, especially those on androgen deprivation therapy (ADT), many do not perform sufficient activity for such benefit. This study examined these men's perceptions of the facilitators and barriers to physical activity, and how ADT may influence these perceptions.

Methods

Two focus groups were conducted, involving 6 ADT and 8 non-ADT survivors, respectively. Each focus group was asked the same three semi-structured questions which examined their barriers and facilitators to physical activity as well as with whom discussions about quality of life and/or physical activity occur. Data was transcribed verbatim and themes reflecting the facilitators and barriers developed using a general inductive thematic approach advocated for health research.

Results

Facilitators to physical activity common to both groups of cancer survivors included clinician and spousal involvement, with comorbidities and increased age cited as barriers by both groups. The ADT group cited personal ownership as a facilitator to physical activity, with fatigue and reduced motivation as additional barriers. The non-ADT group had no additional facilitators to physical activity but cited time constraints as a barrier.

Conclusions

These results highlight the important role that cancer clinicians and spouses can play in promoting physical activity for men with prostate cancer and how ADT may influence their facilitators and barriers. As physical activity has many benefits for these men, especially those on ADT, cancer clinicians and partners should counsel and support these men in making physical activity a regular part of their lives.

24594 A cross-sectional comparison of quality of life between physically active and under-active men with prostate cancer

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Justin Keogh1, Chris Chris Krägeloh2, Daniel Shepherd2, Clare Ryan2, Jonathan Masters3, Sue Osborne4 and Rod MacLeod5

1Bond University, Australia

2Department of Psychology, AUT University, New Zealand

3Auckland City Hospitals, New Zealand

4North Shore Hospital, New Zealand

5HammondCare, Greenwich Hospital, Australia

Objective

The current study sought to examine the potential differences in quality of life (QOL) between physically active and under-active men with prostate cancer.

Methods

Three hundred and forty-eight prostate cancer survivors were invited to participate in the present study. Interested participants completed the WHOQOL-BREF quality of life questionnaire, selected facets of the WHOQOL-OLD questionnaire and the RAPA physical activity questionnaire. Comparisons on all QOL domains (Physical, Psychological, Social and Environmental) and facets (Autonomy, Social Participation and Death and Dying) were performed between men meeting (Active) and not meeting (Under-Active) recommended weekly physical activity levels. To control for confounding variables, significant differences were followed up by an additional two-way analysis of variance (activity level x androgen deprivation therapy – ADT), controlling for age and PSA level.

Results

One hundred and thirty-nine men participated in this project (response rate = 40%). After removing 3 participants with missing data, no significant differences were observed between the Active (n = 73) and Under-Active (n = 63) groups for age, time since diagnosis and most QOL domains and facets (p > 0.05). The Active group had significantly lower PSA levels and greater Social Participation QOL than the Under-Active group (p < 0.05).

Conclusions

The primary finding of this study was that physically active older men with prostate cancer have significantly lower PSA levels and improved social participation than their peers who are under-active. The findings provide additional indirect support for the promotion of physical activity as an important component of cancer survivorship for older men with prostate cancer.

24650 Relationships between perioperative physical activity and post-prostatectomy urinary incontinence: An observational study

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Andrew Hirschhorn1, Bregtje Huijbers2 and Manish Patel3

1School of Science and Health, The University of Western Sydney, Australia

2The University of Groningen, Netherlands

3The Urological Cancer Centre, Australia

Objectives

To determine: i) the influence of preoperative physical activity level (PAL) on post-prostatectomy urinary incontinence (PPUI); and ii) the effect of surgical technique (open retropubic vs robotic-assisted laparoscopic) on PPUI and postoperative PAL.

Methods

A prospective, observational study of men having radical prostatectomy by one urological cancer surgeon (n = 33, 9 open retropubic, 24 robotic-assisted laparoscopic). We assessed PAL over the week preceding surgery and from 2–3 and 5–6 weeks postoperatively with an accelerometer-based physical activity monitor. We assessed PPUI at 3 and 6 weeks postoperatively with a 24-hour pad test. Data were analysed using repeated measures ANOVA.

Results

Mean preoperative PAL was 3695 ± 1697 METS.week-1; 18 men (56%) had ‘high’ preoperative PAL (>3000 METS.week-1) and 14 men (44%) had ‘moderate’ preoperative PAL (601–2999 METS.week-1). There was no significant difference in PPUI between high and moderate preoperative PAL groups (p = 0.663). There was a significant decrease in PPUI from 42 ± 59 mL at 3 weeks to 24 ± 30 mL at 6 weeks postoperatively (p = 0.032), but no significant effect of surgical technique on PPUI (p = 0.190). Mean PAL at 5–6 weeks postoperatively (2691 ± 1778 METS.week-1 remained significantly lower than preoperative PAL (p = 0.002); there was no significant effect of surgical technique on postoperative PAL (p = 0.554).

Conclusions

A higher preoperative PAL did not influence the course of early PPUI. Neither did men having robotic-assisted laparoscopic prostatectomy have faster return to continence or preoperative PAL than men having open retropubic prostatectomy. Men having robotic-assisted laparoscopic prostatectomy may require education that this surgical technique should facilitate early postoperative physical activity.

24658 Which test to use? A comparison of self-report and objective measures of urinary incontinence after radical prostatectomy

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Sean Mungovan1, Andrew Hirschhorn1, Bregtje Huijbers2, Andrew Hirschhorn1 and Manish Patel3

1The Clinical Research Institute, Westmead Private Physiotherapy Services, Australia

2The University of Groningen, Netherlands

3The Urological Cancer Centre, Australia

Objective

To determine relationships between outcomes of a self-report measure of urinary incontinence, the International Consultation on Incontinence Questionnaire – Urinary Incontinence Short Form (ICIQ-UI-SF), and 1-hour (1HPT) and 24-hour (24HPT) pad tests in the early postoperative period after radical prostatectomy.

Methods

A prospective, observational study of men having radical prostatectomy by one high-volume urological cancer surgeon (n = 33). Men attending physiotherapy for perioperative pelvic floor muscle training completed the ICIQ-UI-SF at 3 and 6-week postoperative appointments. Men undertook 24HPTs on the days preceding appointments, and a 1HPT during appointments. Data were analysed using paired t-tests and the Pearson product-moment correlation coefficient.

Results

Outcomes for the ICIQ-UI-SF (3 weeks: 7.8 ± 4.7 points, 6 weeks: 6.1 ± 4.2 points, p = 0.001) and the 24HPT (3 weeks: 42 ± 59 mL, 6 weeks: 24 ± 30 mL, p = 0.032) demonstrated significant change, i.e. improved continence, from 3 to 6 weeks postoperatively. There was no significant difference in 1HPT outcomes from 3 to 6 weeks postoperatively (p = 0.431). At 3 weeks postoperatively there were significant and moderate to strong correlations (p < 0.001, r = 0.484 to 0.672) between all three outcomes of urinary incontinence. At 6 weeks postoperatively, while there remained a significant correlation between ICIQ-UI-SF and 24HPT outcomes (p = 0.005, r = 0.478), neither correlated significantly with 1HPT outcomes (p = ns).

Conclusions

The ICIQ-UI-SF and 24HPT are both sensitive to change and their outcomes significantly correlated across the early postoperative period after radical prostatectomy. The 1HPT may be less useful to quantify early postoperative changes in urinary incontinence and related bother.

24662 A multicomponent theory-based intervention improves uptake of pelvic floor muscle training before radical prostatectomy: A before and after cohort study

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Andrew Hirschhorn1, Gregory Kolt1 and Andrew Brooks2

1School of Science and Health, The University of Western Sydney, Australia

2Western Urology, Australia

Objectives

To assess the effect of a multicomponent theory-based intervention, incorporating patient information guides, an evidence summary, audit and feedback processes and a provider directory, on provision/receipt of preoperative pelvic floor muscle training (PFMT) among patients having radical prostatectomy.

Methods

Provision/receipt of preoperative PFMT was assessed over an 18-month period (9 months pre-intervention, 9 months post-intervention) through: (i) questionnaire surveys of patients having radical prostatectomy at 1 public hospital (n = 30) and 2 private hospitals (n = 94) in Western Sydney, Australia; and (ii) practice audits of associated public sector (n = 4) and private sector (n = 2) providers of PFMT. Self-report urinary incontinence was assessed using the International Consultation on Incontinence Questionnaire – Urinary Incontinence Form (ICIQ-UI Short Form) at 3 months after radical prostatectomy.

Results

There was a significant increase in the proportion of survey respondents receiving preoperative PFMT post-intervention (post-intervention: 30/43 respondents, 70% vs pre-intervention: 37/81 respondents, 46%, p = 0.01). There was a corresponding significant increase in provision of preoperative PFMT by private sector providers (post-intervention: 16.7 ± 3.7 patients per months versus pre-intervention: 12.1 ± 3.6 patients per month, p = 0.02), but not by public sector providers (p > 0.05). Respondents receiving preoperative PFMT had significantly better self-report urinary incontinence (ICIQ-UI Short Form sum-score) at 3 months after radical prostatectomy (5.8 ± 5.1 vs 9.4 ± 5.8, p < 0.001).

Conclusions

The multicomponent theory-based intervention increased provision/receipt of preoperative PFMT among patients having radical prostatectomy. Additional component strategies aimed at increasing utilisation of public sector providers may be necessary to further improve PFMT receipt amongst men having radical prostatectomy in the public hospital system.

24706 Factors associated with the use of complementary and lifestyle therapies in long term prostate cancer survivors: NSW prostate cancer care and outcomes

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David Smith1, Sam Egger1, Suzanne Hughes1, Suzanne Chambers2 and Dianne O'Connell1

1Cancer Council NSW, Australia

2Griffith University, Australia

Objective

To investigate associations between complementary and lifestyle therapy (CALT) use by long term prostate cancer survivors, and demographic and clinical characteristics and psychosocial and health related quality of life (HRQOL) measures.

Methods

1513 men diagnosed with prostate cancer in 2000–2001 were invited to complete a questionnaire about their CALT use for prostate cancer or treatment side effects, 10 psychosocial and 10 HRQOL domains. Odds ratios (ORs) and 95% confidence intervals (CIs) were obtained from logistic regression for CALT use and demographic and clinical characteristics and per one standard deviation increase in psychosocial and HRQOL scores.

Results

996 [66%] men completed the questionnaire; 924 with complete data were included in these analyses. 231 men (25%; 95%CI 22–28) currently used CALT for prostate cancer. CALT users were more likely to be younger (p-trend = 0.003), university educated (vs. high school OR = 1.61; 95%CI 1.11–2.33), support group participants (vs. non-participants 6.50; 2.48–17.03), overseas-born (1.51; 1.02–2.23), have health insurance (p-trend = 0.036), received androgen deprivation therapy (1.90; 1.24–2.92), have decreasing PSA levels (vs. steady levels 2.37; 1.29–4.35) and higher stage disease at diagnosis (p-trend = 0.003). CALT use was associated with higher scores for fear of recurrence (1.28; 1.06–1.55), cancer-specific distress (1.18; 1.01–1.37), hyperarousal (1.17; 1.00–1.36), cognitive avoidance (1.19; 1.02–1.40), anxiety (1.19; 1.02–1.41) and cancer locus of control (1.31; 1.10–1.57) but not with any HRQOL measures.

Conclusions

Health professionals should be aware that a substantial proportion of prostate cancer survivors use CALTs for prostate cancer and that multiple psychosocial, clinical and demographic factors are associated with this use.

24782 A review of the impacts of prostate cancer on the mental health of patients’ partners

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Marie Steinmetz1, Christopher Sharpley2 and Vicki Bitsika1

1Bond University, Australia

2The University of New England, Australia

Objective

Prostate Cancer (PCa) has adverse effects on the mental health of patients, leading to increased mortality from all causes. In addition, some studies have reported adverse effects upon the partners of PCa patients, although there has been no detailed critical review of those studies. This poster presents such a review, identifies the major findings and limitations in studies to date, and raises several issues for further research.

Methods

A search of PsychINFO, Ebsco Megafile Complete and PubMed for the period 1998 to 2013 was conducted using the descriptors prostate cancer, spouse, partner, family, depression, anxiety, stress and counselling. Only articles published in English in refereed journals were included. Participants ranged from 7–164 patient-partner dyads, with a total of 1,281 patient-partner dyads overall.

Results

From 50 articles identified, partners of PCa patients felt challenged by: helping their husbands focus on health; accommodating changes to their marital relationship (especially concerning sexual intimacy); and appreciating the positives in their lives. Effective communication assisted patients and partners cope with the anxiety associated with the diagnosis, but poor communication led to more psychological distress in both patients and their partners. Avoidant coping was associated with increased psychological distress, but positive dyadic coping led to decreased psychological distress in both patients and their partners.

Conclusion

Further research should focus on the issues of: communication needs and styles of patients and their partners; methods of assisting couples to cope effectively with deteriorations in their relationships; and adopting a positive outlook. Methodologies should also include ongoing data-collection from patients and partners rather than only “snap-shot” studies.

24818 The experiences of gay and bisexual men diagnosed with prostate cancer: Results from an online focus group

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Christopher Thomas1, Addie Wootten2 and Priscilla Robinson1

1La Trobe University, Australia

2Australian Prostate Cancer Research Centre, Australia

Objective

To qualitatively identify the experiences, concerns and perceived information needs of gay and bisexual Australian men diagnosed with prostate cancer.

Method

An online focus group was established to elicit the common perceptions, views and a range of opinions concerning the experience of prostate cancer. Participants were Australian men who self identified as gay or bisexual having had a diagnosis of prostate cancer within the last seven years. The focus group conducted across a four week period was asynchronous thereby enabling participant postings to be completed at any time during the study period.

Results

There are a number of areas of concern regarding the trajectory of prostate cancer for gay and bisexual men. These areas of disquiet include: the emotional response to a prostate cancer diagnosis, access to help and support, the impact of incontinence, the impact of sexual changes on identity, the ability to re-evaluate life, changed sexual relationships, finding the right health care professional, resulting issues from aspects of stigma and the ability to improve quality of care by assessing current needs.

Conclusion

Further research needs to be undertaken to assess the degree of distress accompanying the treatment of gay and bisexual men with prostate cancer and interventions to improve outcomes in this often under-served population.

24834 The psychosocial impact of prostate cancer on couples

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Helen M Conaglen, Charis Brown, John V Conaglen and Ross Lawrenson

The University of Auckland, New Zealand

Background

Prostate cancer (PCa) is common and diagnosis and treatment affect not only the patients involved, but their partners as well. Problems for couples with PCa have been outlined in clinical reports but seldom formally studied. Females are reported to be affected by some psychological problems as seriously as their PCa partner.

Aim

To investigate the psychosocial impact of PCa on couples.

Method

This cross-sectional study investigated psychological and sexual function in a sample of 40 couples, 3–6 years post-PCa diagnosis. Couples completed the HADS, a stress scale, DAS, SIS and the FSFI-SF or IIEF-SF; couple's scores were correlated, and comparison made with population standards to understand the impact on couples of PCa.

Results

Most couples reported that chances of sexual problems were ‘somewhat’ or ‘very important’ in choosing a treatment for their PCa. Psychological distress (HADS) was significant in 10% of the women and 5% of men in sample. Stress was also at higher than normal population levels. Despite this most couples were well-adjusted and 80% of relationships were ‘happy’, ‘very happy’ or ‘perfect’. Women reported social intimacy levels comparable to clinic samples needing therapy. 77% of women experienced sexual dysfunction and 12.5% were dissatisfied sexually. Of the 16 men who completed IIEF-SF, 56% had erectile problems. Women's psychological stress/distress correlated with partner's sexual function scores.

Conclusion

The impact of PCa occurs across a relationship affecting men's partners as much or more than the patient. Women should have access to care that assists them to overcome this distress.

24838 Depression, anxiety and stress in men with prostate cancer: Is all well?

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Helen M Conaglen, Charis Brown, John V Conaglen and Ross Lawrenson

The University of Auckland, New Zealand

Background

Prostate cancer (PCa) was the most commonly registered cancer among NZ men in 2007 (15.1% of male registrations). Post-treatment men are commonly affected by erectile dysfunction and urinary incontinence. Significant negative psychological effects on men with PCa have been reported although these are often not recognised.

Aim

To investigate psychological well-being of men treated for PCa.

Method

This cross-sectional study investigated anxiety, depression and stress levels in a sample of 72 men 3–6 years post-PCa diagnosis. Men completed the EORTC-QLQ-C30, HADS, DASS stress scale and EQ-5D; their scores were compared with population standards and reference levels for these measures.

Results

Many men recorded scores in the ‘well’ range. However, 18% of men recorded moderate or severe anxiety or depression on the EQ-5D, 12.5% were anxious and 4.2% depressed as measured by the HADS, with 13.9% of men reporting mild or moderate stress on the DASS scale. 8.3% of men reported low level functioning on the EORTC emotional function sub-scale. Overall 22.2% of men surveyed recorded an elevated score for anxiety, depression or stress on at least one measure. In addition there were a further 13.9% of men taking anti-depressant medication. In total, 36.1% of men with PCa in this sample were experiencing anxiety, depression or stress, or taking medication to counter these effects.

Conclusion

These preliminary results suggest a significantly higher rate of psychological distress in men with PCa even at 3–6 years post-diagnosis and treatment. Clinicians should be aware that PCa patients can experience anxiety, depression and stress, requiring treatment.

24870 An evaluation framework for a wider adoption of self-managed interventions during management of advanced prostate cancer

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Amol Wagholikar1, Nicholas Graves2 and Colleen Nelson3

1The Australian e-Health Research Centre, CSIRO

2Queensland University of Technology

3APCRC-Q, Queensland University of Technology

Objective

To describe a health economic evaluation model to validate effectiveness of self-managed interventions during active surveillance of advanced prostate cancer. Background: Active Surveillance (AS) is one of the interventions used for the management of advanced prostate cancer before and after any radical surgery. The patients who chose AS may use several self-managed interventions such as physical exercise and use of complementary medications. There is a need of evaluating these self-managed interventions from a health economics perspective to assess the impact on patient's health outcomes and make recommendations for wider adoption at a population level. The aim of the research is to describe a health economics based evaluation model to simulate the change in cost and health outcomes as a result of existing as well as any new self-managed interventions.

Methods

An online survey was conducted that showed selenium was the common complementary supplement (55%) used by the patients and about 48% patients did not use any over-the-counter (OTC) drugs. The survey findings were used develop a markov model based on 8 unique health states.

Results

The model was illustrated to determine if wider adoption of clinically proven natural supplements is beneficial. A modelled intervention with an assumed 25% effectiveness showed a gain of 1.07 Quality Adjusted Life Years for a cohort of 1000 patients. Conclusion: The proposed model has provided an effective framework to evaluate existing as well as any new self-managed interventions for advanced stages of prostate cancer.

24878 Understanding “Survivorship” in prostate cancer: An investigation of predictors for “Loss of Masculinity” among RADAR participants

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James Denham1, Chantelle Wilcox1 and Christopher Sharpley2

1The University of Newcastle, Australia

2The University of New England, Australia

Objective

Although patient self-reports are often used to describe how they react to treatment for prostate cancer, consideration of single items or report scales does not allow for an understanding of the overall and more subtle underlying themes that are present across multiple measures. Therefore, this study clarified the “Survival” process by (i) mapping the component structure of patients’ self-reports of adverse symptoms; and (ii) testing those factors as predictors of patients’ masculine identity.

Methods

1,070 men with locally advanced prostate cancer participating in the RADAR randomised controlled trial evaluating duration of androgen suppression and the addition of zoledronate to radiotherapy completed the EORTC QLC-C30 and PR25 scales for their degree of symptom severity on 22 items related to side effects of treatment for prostate cancer at intervals following initial diagnosis up to 36 months later. Principal components analysis was applied to the 22 items, and resulting factors were used in hierarchical regression and analysis of variance models to test their predictive ability for participants’ Loss of Masculinity.

Results

Three discrete factors emerged from the 22 self-report items, comprising: (1) Depression and Anxiety, (2) Urinary problems, and (3) Decrease in sexual interest and activity. When regressed against a single “Loss of Masculinity” target variable, Depression-Anxiety was the most powerful predictor, followed by Decrease in sexual interest and activity. Urinary problems did not significantly predict patients’ masculinity status.

Conclusion

Despite suggestions in the literature that urinary or sexual difficulties pose the greatest challenges to prostate cancer patients’ masculinity, our results suggest that it is the symptoms of depression and anxiety which most cause these patients to lose their sense of being masculine. Evaluation of additional relevant factors is worthwhile because these findings have import for those helping prostate cancer patients cope with their treatment and its side effects.

24886 Exercise programming requirements for men with prostate cancer

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Dennis Taaffe1, Oscar Close2, Kate Bolam2, Prue Cormie3, Nigel Spry4, Robert Newton3 and Daniel Galvão3

1The University of Newcastle, Australia

2The University of Queensland, Australia

3Edith Cowan University, Australia

4Sir Charles Gairdner Hospital, Australia

Objective

Men with prostate cancer are at increased risk for development of co-morbid conditions, which is compounded by treatments such as hormone therapy. Exercise is an effective countermeasure for a number of these disease- and treatment-related adverse effects provided it is performed on a regular basis. Identifying exercise programming preferences may enhance participation and adherence. Therefore, the objective of the study was to ascertain the exercise programming and training requirements of men with prostate cancer.

Methods

A self-administered questionnaire was completed by 193 men participating in prostate cancer support groups in Australia.

Results

The men, aged 45–84 years, predominantly had localised disease (86%) with 36% on hormone therapy. Exercise counselling had not been received by 51%, although the majority viewed exercise as necessary (86%) and were motivated to exercise for health improvement (70%). The main barrier to exercise was poor health status (31%). Exercise counselling was preferred to take place before treatment (56%), by an exercise physiologist/specialist (42%), in person (87%) and at a hospital/medical practice (33%). The preferred activity was walking (53%) and resistance exercise (23%), performed at a moderate intensity (58%), 2–3 times per week (70%) in the morning (63%), and for this to commence before treatment (64%).

Conclusions

The majority of men viewed exercise as a necessary behaviour and preferences regarding exercise type and design were well defined. These findings highlight the need for physicians to refer their patients to exercise physiologists/specialists for exercise counselling and programming to enhance participation and health status.

24930 The effects of exercise on treatment side effects for prostate cancer patients receiving androgen deprivation therapy: A systematic review

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Steve Fraser, Jason Gardner and Patricia Livingston

Deakin University, Australia

Objective

Androgen deprivation therapy is a common treatment for men with prostate cancer; however the side effects can impact on patient health and quality of life. Exercise training has been proposed as a strategy for ameliorating a range of these treatment-related side effects. A systematic review of the literature was conducted on the effects of exercise on treatment-related side effects in men receiving androgen deprivation therapy for prostate cancer.

Methods

An online electronic database search was performed to identify relevant peer-reviewed articles published between January 1980 and December 2012. Eligible study designs included randomised controlled trials as well as uncontrolled trials with pre- and post-test data. Information was extracted regarding participant and exercise intervention characteristics, as well as the effects of exercise on bone health, body composition, physical performance, cardio-metabolic risk, fatigue and quality of life.

Results

Ten studies were included in this review, with exercise interventions involving aerobic and/or resistance training. Exercise training demonstrated benefits in muscular strength, cardiorespiratory fitness, functional task performance, lean body mass and fatigue, however no consistent effects were observed for adiposity. The impact of exercise on bone health, cardio-metabolic risk markers and quality of life are currently unclear.

Conclusions

Among prostate cancer patients treated with androgen deprivation therapy, appropriately prescribed exercise is safe and may ameliorate a range of treatment-induced side effects. Although further research is necessary to consolidate these findings, current evidence supports the inclusion of exercise training in the management for patients receiving androgen deprivation therapy.

24934 Safety and efficacy of exercise by prostate cancer survivors with bone metastases

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Prue Cormie1, Robert Newton1, Nigel Spry2, David Joseph2 and Daniel Galvão1

1Edith Cowan University, Australia

2Sir Charles Gairdner Hospital, Australia

Introduction

Due to concerns of fragility fracture, exercise is a relative contraindication for prostate cancer patients with bone metastases. These patients experience significant functional impairment and muscle atrophy which may lead to an increased likelihood of skeletal complications/falls. Safe exercise prescription may counteract this effect. The aim of this feasibility trial was to determine the safety and efficacy of resistance exercise by prostate cancer survivors with bone metastases.

Methods

Participants included 20 men (72 ± 7 years) with established bone metastases. The exercise group (n = 10) completed a 3-month supervised intervention involving an individualised resistance exercise program based on the location of bone metastases. The usual care group (n = 10) maintained their normal lifestyle. Outcomes included safety of the exercise program, physical function and quality of life.

Results

Two participants from the exercise group withdrew and 3 usual care participants were lost to follow-up (advancing disease requiring further treatment = 3, unrelated events = 2). No skeletal complications occurred in either group. Attendance was high (89% of sessions completed) and participants were able to exercise at an intensity within the target range for cancer survivors (rating of perceived exertion [RPE] = 13.8 ± 1.5; target RPE = 12–16). The exercise program was well tolerated with an average tolerance score of 6.1 ± 0.7 (1 = intolerable, 7 = very tolerable). The change in physical function differed significantly between groups following the intervention (ambulation 10%; strength 9%; aerobic fitness 3%) but not quality of life.

Conclusions

Appropriately designed and supervised resistance exercise is safe and well tolerated by prostate cancer patients with bone metastases and results in improved function.

24938 Including the voices of men to improve outcomes in prostate cancer: a national approach

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Susan Hanson1, David Sandoe OAM2, John Friedsam2, Margaret Bennett2, Sue Sinclair1 and Helen Zorbas AO1

1Cancer Australia, Australia

2Prostate Cancer Foundation of Australia, Australia

In Australia 19,438 men were diagnosed with prostate cancer (2009)1. Increasingly men affected by prostate cancer are seeking to be involved in decision-making about their health. Access to evidence based resources and support will assist in empowering men to navigate the patient journey.

Objective

Australia's leading national cancer agency, Cancer Australia is working collaboratively with Prostate Cancer Foundation of Australia and multidisciplinary teams including consumers as part of the Supporting men with prostate cancer through evidence-based resources and support project to provide access to information and support for men with prostate cancer.

Methods

Multifaceted, multimedia, multi-access including: review of the evidence; consultation from experts including consumers in advisory groups, steering committee and collaborative meetings to provide expert advice on evidence, resource development, peer review and integration of resources spanning the patient journey, and linking to support networks.

Results

Development of:

  • 90 self-sustaining peer support groups particularly in rural and regional areas
  • Resources targeting: younger men <50years, men with advanced prostate cancer, partners and carers, culturally and linguistically diverse communities, Aboriginal and Torres Strait Islander men and, gay men
  • A social media and communications hub and online information

Conclusions

The pathway for men affected by prostate cancer is dependent on presenting factors including, risk, age, stage of disease, and spread. With no one treatment pathway this can lead to increased anxiety in men. Providing resources and support to inform health care decisions will increase health professional and community awareness and understanding of best practice treatment for men affected prostate cancer.

24946 Can exercise prevent treatment toxicity in prostate cancer patients initiating androgen suppression therapy: a randomised controlled trial

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Robert Newton1, Prue Cormie1, Daniel Galvao1, Nigel Spry2 and David Joseph2

1Edith Cowan University, Australia

2Sir Charles Gairdner Hospital, Australia

Introduction

While research has established efficacy of exercise in reversing established adverse side effects of androgen suppression therapy (AST), it is unknown if exercise can immediately attenuate or even prevent treatment toxicity. Previous research has examined the rehabilitative ability of exercise after 2–3 months of AST. This trial aims to determine if it is efficacious to commence exercise at the same time as initiating AST.

Methods

Participants included 61 men (68.4 ± 7.1 years) initiating AST (Lucrin). A two-arm randomised control trial design was utilised involving exercise (n = 31) and usual care (n = 30) groups. The exercise group commenced a 3-month supervised exercise program (2 sessions/week; aerobic and resistance exercise) within 10-days of initiating AST. The usual care group maintained their normal lifestyle for the intervention period. Outcome measures included body composition, physical function, blood markers of cardio-metabolic conditions and bone formation, quality of life and psychological distress.

Results

Seven participants withdrew (11.5%) due to illness (n = 2), travel constraints (n = 2) and not wanting to wait to start exercising (n = 3; i.e.randomised into usual care). No differences existed between groups at baseline. The changes in body composition (whole body and trunk region fat), physical function (muscle strength, aerobic capacity, chair rise ability), the total cholesterol/high density lipoprotein ratio and quality of life (mental health and social function domains) were significantly better in the exercise group following the intervention. No between group differences existed in the change in PSA or testosterone.

Conclusions

Exercise diminishes the adverse side effects of AST during the initial 3-month phase of treatment.

25078 Facing the fallout of prostate cancer treatment – a case study

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Debi Hamilton

Psychologist in private practice – Debi Hamilton Counselling & Consulting, Australia

There are additional profound difficulties for men and their partners facing prostate cancer on top of the fears and challenges generated by any cancer diagnosis. Men often struggle with the changes to self-esteem and intimacy that can accompany disruptions to continence and erectile function. Partners, too, can experience significant difficulties’ they are often even more deeply affected by the changes wrought by prostate cancer, particularly in the first 12 months following diagnosis. This can set up a cycle of withdrawal from communication where neither partner is able to address the changes in intimacy in the relationship. This presentation employs a case study to bring a personal dimension to the research and statistics which have assisted practitioners chart the effects of prostate cancer on men and their partners.

25242 ‘Getting Started’ with PRIAS – patience, reliability, invention, action, success – the Geelong urology experience

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Judith Briody

Geelong Urology, Australia

The PRIAS (Prostate Cancer Research International – Active Surveillance) Project.

“PRIAS presents a program in which selected men with early prostate cancer are managed by a protocolised follow-up strategy”.

The 2009 USANZ PSA Testing Policy formally acknowledged Active Surveillance as a treatment option for suitable men with localised prostate cancer. This led to the Board of Directors of USANZ adopting the PRIAS protocol and partnering with the International PRIAS Project to collect information on men participating in this study.

The Prostate Cancer Foundation of Australia (PCFA) and ‘Movember’ in February 2012 agreed to generously support this initiative.

The study has ethics approval through the Ethics Committee of the Royal Australasian College of Surgeons.

Currently (at 13/03/2013) there are 46 USANZ centres contributing data with 157 men entered. 13 of these men are from Geelong Urology.

Objective

Th aim of my presentation is to:

  • * 
    Create awareness of this project to my ANZUNS colleagues
  • * 
    Encourage their participation in supporting this project
  • * 
    Develop systems to support the consultants who are involved in the care of these men

25258 The evolution of the prostate cancer specialist nurse role in Tamworth, NSW

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Sharon Slack

Tamworth Rural Referral Hospital, Australia

Objective

During the induction of the Prostate Cancer Specialist Nursing Service in Melbourne in 2012, 12 nurses were given the Practice Framework and Competency Standards to work by. In the short time since then, the service of the Tamworth based Prostate Cancer Specialist Nurse has grown from strength to strength. The objective of this abstract is to show how the service has grown and what extended services are now part of the practices of the Prostate Cancer Specialist Nurse in Tamworth, NSW.

Method

Tamworth is the catchment for the New England Area Health Clusters and beyond, for patients diagnosed with prostate cancer. In fact, there is only the one Urologist based within this area, with limited services from a visiting private Urologist/Uro-Oncologist. Using case studies and data collected from everyday contact with patients diagnosed with prostate cancer, it will be shown there was a need for the service in Tamworth, NSW to extend beyond the confines of the public hospital and reach out into the greater area heath service.

Conclusions

While all the Prostate Cancer Specialist Nurses across Australia are bound by the same Practice Framework and Competency Standards, each Prostate Cancer Specialist Nurse brings different experiences and knowledge bases to their individual services. While some are hospital based, others are area health service based. In Tamworth, NSW, the coordination of care, educational and supportive needs of the patient with prostate cancer, as well as the educational needs and the need for ongoing contact with treating teams was identified and this was the driving force behind the evolution of the Prostate Cancer Specialist Nurse Role.

25458 Are commonly used patient-reported outcome assessment instruments for the assessment of quality of life in surgically treated patients really valid?

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Adam Dowrick1, Addie Wootten1, Declan Murphy2 and Anthony Costello3

1Australian Prostate Cancer Research Centre Epworth, Australia

2Australian Prostate Cancer Research Centre, Australia

3Australian Prostate Cancer Research, Australia

Introduction and objectives

Published articles and conference presentations frequently state “we used a validated questionnaire” without a true understanding of what this means. Whether an instrument displays appropriate measurement properties is not a fixed attribute, but is dependent upon the context and population being studied. Little attention has been paid in the urologic literature to explaining the scientific rigour involved in selecting a questionnaire for use with patients with prostate cancer. Our objective is to describe which of the most commonly used PRO instruments have been appropriately validated for use in patients having surgery for localised prostate cancer.

Methods

To select the most commonly used QoL instruments a hand search was conducted of six peer-reviewed journals from January 2000 to August 2012: European Urology, Journal of Urology, BJU International, Lancet Oncology, Journal of Clinical Oncology, and Medical Care. The published measurement properties of the selected instruments were reviewed.

Results

Validation of the EORTC QLQ-PR25 revealed problems with the internal consistency of the bowel and hormonal treatment scales. The current version of the FACT-P has not been validated. The UCLA-PCI, EPIC and Clark instruments have all undergone some validation in samples of patients with localised prostate cancer.

Conclusion

Many of the instruments used to assess outcomes following surgical treatment for localised prostate cancer have not been validated for use in this population. Studies using questionnaires that have not been validated in the population of interest may be subject to measurement error and any conclusions drawn cannot be made with confidence.

25530 Australian men with low risk prostate cancer and their partners’ experience of treatment decision-making and active surveillance

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Amelia Hyatt1, A/Prof Clare O'Callaghan1, Ms Tracey Dryden1, Dr Sue Burney2, Dr Addie Wootten3, Dr Joanne Brooker4, Jane Fletcher2, A/Prof Mark Frydenberg4, A/Prof Declan Murphy1, Mr Alan White5 and A/ Prof Penelope Schofiled1

1Peter MacCallum Cancer Centre, Australia

2Cabrini Institute, Australia

3Royal Melbourne Hospital, Australia

4Cabrini Hospital, Australia

5Prostate Cancer Foundation of Australia, Australia

Objective

Little is known about the experience of treatment decision-making and active surveillance (AS) amongst Australian men diagnosed with low risk prostate cancer (PC), and their partners. It is important to understand the factors influencing men's choice of either curative treatment or AS, and how they and their partners experience AS, so that appropriate support may be offered.

Method

Grounded theory informed design. Following ethics approvals at three Melbourne hospitals, eligible men and their partners were mailed invitations to participate. Newly diagnosed men who chose curative treatment and those who had been on AS for least 3 months, and their partners, were eligible. Consenting participants engaged in semi-structured telephone interviews. Transcribed interviews underwent inductive, cyclic, and comparative analysis. Inter-rater reliability was integrated.

Results

To date 20 men and 11 partners have participated. Emerging findings include: men and partners are commonly distressed by the diagnosis and occasional contradictory treatment recommendations; the AS decision is often recommended or perceived to be made by urologists; AS coping strategies include reflection on evaded incontinence and impotence, distraction, trust in health carers, and either avoiding or gathering information; AS stressors include fear of disease progression and unpleasant biopsies. Partners may consider that men's reactions have priority, and attending medical appointments and living “normally” can help. Consistent, Australian-specific information, including men's comparable experiences, was recommended.

Conclusions

Flexible information resources and support are needed on diagnosis to assist with treatment decision-making involving both men and partners. Interventions should incorporate peer experiences and decisional support.

25754 Musculoskeletal health in prostate cancer patients treated with androgen deprivation therapy: A review of current practice guidelines

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Patrick Owen, Patricia Livingston, Robin Daly and Steve Fraser

Deakin University, Australia

Objective

Prostate cancer, the most commonly diagnosed male cancer in Australia is often treated with androgen deprivation therapy (ADT), however side effects have been shown to accelerate bone and muscle loss; therefore increasing the risk of falls and fractures. A review of the literature was conducted to assess current practice guidelines for maintaining and improving musculoskeletal health in prostate cancer patients treated with ADT.

Methods

An online electronic database search was performed to identify relevant articles published between 2003 and April 2013.

Results

There was strong rationale for medical interventions including regular monitoring of bone health and prescription of bisphosphonates as appropriate. Guidelines for lifestyle modifications to improve bone health were less clear but suggested avoidance of alcohol and smoking, regular physical activity and adequate dietary intake of vitamin D and calcium. Less emphasis was given to maintaining muscular health, and there was little information on the optimal type and dose (intensity, duration, frequency) of exercise to improve musculoskeletal health. Few studies have also investigated the potential role of nutritional supplementation or the combination of exercise and nutrition for maintaining and improving bone and muscle health and function in this population group.

Conclusion

Current practice guidelines for maintaining and improving musculoskeletal health in ADT treated prostate cancer patients are generic and limited to pharmacological interventions for bone health. Detailed guidelines are required for maintaining and improving musculoskeletal health and function in this population. Research on the optimal type and dose of exercise and nutritional supplementation for musculoskeletal health is warranted.