Symptom management after initial prostate cancer treatment

A recently published study has provided us with interesting information on how patients can be taught to better “self-manage” post-treatment, problematic symptoms associated with first-line treatment of localized prostate cancer.

Skolarus et al. used a randomized clinical trial to see whether access to an automated telephone symptom management system could improve the self-management of long-term prostate cancer survivors as compared to “usual care”

This randomized clinical trial compared a personally tailored, automated telephone symptom
management intervention to improve self-management among long-term survivors of prostate cancer with usual care (i.e., regular physician appointments and a newsletter about symptom management)

They enrolled 556 prostate cancer patients from four Veterans Affairs hospitals. The patients were all individuals who were “experiencing symptom burden” more than a year after their initial treatment for their prostate cancer, and they were recruited between 2015 and 2017. The patients were then randomized to the intervention group or the “usual care” group, and outcomes were compared over time (from baseline to 5 months and 12 months).

The primary outcome of the study was symptom burden according to the Expanded Prostate Cancer Index Composite-26 or EPIC score.

Here is a summary of the key findings:

  • 278 patients were randomized to the intervention arm.
  • 278 patients were randomized to the “usual care” arm.
  • Most participants were married (54.3 percent), white (69.2 percent), and retired (62.4 percent).
  • The average (mean) age of the patients was 67 years at study entry.
  • Somewhat more patients had had first-line radiation therapy as compared to first-line surgery.
  • At baseline there were no differences in urinary, bowel, sexual, or hormonal domain EPIC scores
    across groups.
  • At 5 months the research team observed
    • Higher EPIC scores in the intervention arm in all domain areas (but the differences were not significant), but
    • Coping appraisal was higher (2.8 v 2.6; P = 0.02) in intervention-arm patients
    • No differences in secondary outcomes
  • In subgroup analyses, intervention participants reported improvement from baseline at 5 and 12 months in their symptom focus area domains.

Skolarus et al. conclude that:

This intervention was well received among veterans who were long-term survivors of prostate cancer. Although overall outcome differences were not observed across groups, the intervention tailored to symptom area of choice may hold promise to improve associated burden.

The ability to use automated telephone systems to help patients cope with symptoms of prostate cancer after treatment (or while on active surveillance) may well represent an interesting opportunity to help patients deal with the problems associated with management of prostate cancer that may range from anxiety to very specific types of question. However, in the opinion of your sitemaster, it would be better still if such an automated system could be linked to some form of nurse hotline for those patients who really need individual assistance.

Editorial note: The “New” Prostate Cancer InfoLink thanks Dr. Ted Skolarus of the University of Michigan for providing us with the full text of this paper .

2 Responses

  1. I can’t even imagine how this would help. Automated?! What could it say that the patient couldn’t find online? Oh well.

    My husband wouldn’t seek any help, much less pick up a phone. His take: “Nothing to see here! Move along!” Right, except just me, lonely, broken-hearted, done with sex at 55. Nothing to see at all. Boo.

  2. Dear Marleen:

    I am sorry that your husband has a less than complete awareness of the impact of his condition on others around him. Obviously that is a major problem for you — even if he can’t see this.

    Luckily for at least some others, their male partners are rather more conscious of how they can help themselves and others around them … and a large part of the “automation” of the system referred to was that it was reaching out to the patients as opposed to the patients needing to initiate interactions.

    There is a lot of useful information that can be provided through automated systems. They may not be perfect, and some people loathe them. Others find them useful. I am not either recommending or “dissing” systems like this. All we are doing here is commenting on the results of the study as reported.

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