Time for clinicians to take some responsibility for patient CARE over time


If one is to believe a recent blog post on ACCCBuzz (promoting the upcoming annual meeting of the Association of Community Cancer Centers), the average community-based medical oncologist (not to mention the average community-based urologist) apparently makes little attempt to implement high quality guidance about quality of life for men with prostate cancer.

According to the piece on ACCCBuzz, which is primarily focused on issues affecting the management of men with advanced forms of prostate cancer:

  • Only 12 percent of men with prostate cancer have been advised (by anyone) that they might be eligible to participate in a clinical trial specific to their stage of prostate cancer.
  • Referrals to social services, rehabilitation, nutrition counseling, and support groups are “surprisingly low for this group of patients.”
  • The ACCC’s own members report that “few practical tools exist to measure progress or effectiveness of their prostate-specific cancer service line.”
  • The ACCC is only now “examining a number of patient education materials and decision-making tools to assess their usefulness during treatment of metastatic or advanced prostate cancer.”

Even when it comes to the last of those four bullet points, in fact, the ACCC is merely “looking at opportunities to adapt some tools and how they impact care delivery.”

For most of the past 30 years, prostate cancer has been the form of cancer with the highest prevalence among American males, and yet the focus on issues that can profoundly optimize quality of life (as opposed to optimizing physician income levels) is only starting to become a priority outside a small number of carefully selected clinical practices. According to personal communications, we know that even leading physicians at some major, specialized, academic, prostate cancer centers do a pretty poor job of ensuring that men starting on androgen deprivation therapy are well prepared to handle and live with certain types of side effect. We can only imagine the lack of focus on such services at the average community-based cancer clinic.

Here is a list of just four of the very simplest things we know that should be top of mind for any physician who manages men with prostate cancer:

  • Radiation therapy is tiring, and patients need to work on their diet, their fitness, and and their general health if they are not to be debilitated by several weeks of radiation therapy. Patients need to lose weight, build muscle mass, take appropriate exercise, and start eating a heart-healthy diet.
  • Androgen deprivation therapy is associated with a long list of possible side effects, ranging from hot flashes to reductions in sexual function to adverse cardiovascular and mental function effects. The patients needs to understand these issues before being started on such medications.
  • Changes in diet (such as eating less red meat, eating more soy, and other factors) can profoundly impact quality of life and disease progression for some men with prostate cancer; every prostate cancer patient could benefit from a series of meetings with a nutritionist to address the benefits of diet and how to adapt to a diet designed for men with prostate cancer.
  • Many men with advanced or just progressive forms of prostate cancer should be encouraged to enter clinical trials so that we can keep improving their care (as opposed to just going to treating them with minimal “standard care” processes that are widely understood to be far less than satisfactory).

Frankly, The “New” Prostate Cancer InfoLink finds it embarrassing that so little is being done by the medical community to address such factors that can profoundly affect the quality of life of men with prostate cancer. Physicians are not just surgeons and radiation oncologists and medical oncologists. They are also the professional advisors that men with prostate cancer rely on for guidance. It is high time that they all committed to dispensing such good guidance right along with the prescriptions and the interventional treatments. It’s not as though their patients aren’t seeking it.

Oh … and for those men with prostate cancer (and their caregivers) who are interested in learning about access to clinical trials, there will be a “Clinical Trials Education” webinar on September 19, from 6:00 p.m. to 7:30 p.m. EST (3:00 p.m. to 4:30 p.m. Pacific). The webinar will be led by Dr. Tomasz Beer of the  Knight Cancer Institute at the Oregon Health and Science University in Portland, Oregon. The program has been coordinated in association with  ZERO –- the Project to End Prostate Cancer and Us TOO International.

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