Evaluation of an Online Education Resource on Radiation Therapy Created for Patients with Postprostatectomy Prostate Cancer and Their Caregivers

IntroductionRadiation therapy (RT) after prostatectomy is an important curative treatment option for patients with prostate cancer. It can be delivered immediately after surgery as adjuvant treatment, or after biochemical PSA failure as salvage treatment. There is currently a lack of consensus regarding whether salvage RT in the event of biochemical failure or immediate adjuvant RT is the optimal postprostatectomy RT treatment. Although both types of postprostatectomy RT are generally well tolerated, patients may develop some toxicity that can impact their quality of life and the duration and frequency of treatments can be challenging for patients. It is imperative that patients be provided with evidence-based information so that they are able to make a treatment decision most aligned with their values.MethodsTo help address patients' informational needs, an online education resource was created for patients with prostate cancer considering postoperative RT. Patients and their families were asked to evaluate the effectiveness of this resource using a validated purpose-based information assessment.ResultsNineteen patients were approached and 14 participated, but only five patients returned their evaluations (35%). Sixty percent found the information to be important with regards to each of the six commonly identified purposes in the purpose-based information assessment: organizing, understanding, decision-making, planning, emotional support, and discussing. Only one participant found the information hard to understand and had difficulty finding specific information.DiscussionPatients should be encouraged to actively participate in their treatment decision-making process involving postprostatectomy RT. For patients to make well-informed decisions, patients must be provided with clear and accessible information so that they may understand their disease and the treatment options.ConclusionAn online education resource has been developed that most study respondents found clear and helpful for a variety of identified purposes. Overall, this online education resource has the potential to reach a large number of patients and their caregivers who desire specific information and involvement in future treatment decisions.     

Dealing with a troublesome body: A qualitative interview study of men’s experiences living with prostate cancer treated with endocrine therapy

PurposeEndocrine therapy for prostate cancer causes substantial side effects, and previous studies have focused on the impacts on sexuality and masculinity. Little is known about how men experience bodily alterations in everyday life through the course of the prostate cancer and treatment. The aim of this study was to show how men with prostate cancer experience bodily changes and how these alterations influence daily life.MethodThe study was conducted via qualitative interviews with a phenomenological hermeneutic approach. We interviewed ten men (aged 58–83) with prostate cancer who received endocrine therapy as the primary treatment method.ResultsThe results showed that five themes were important for the men’s experiences of their bodily alterations throughout the course of the illness: “something is ‘wrong’”, “when the body becomes troublesome”, “to be well or to be ill”, “dealing with the alterations” and “to talk about cancer and the intimate details”. Initially, the shock of receiving a cancer diagnosis and the physical changes in their bodies were at the forefront of many patients’ minds. Eventually, the impact of the side effects became more evident, which caused problems in everyday life. Yet, the men were able to reflect on the impact of treatment on their everyday lives.ConclusionThis study showed that hormone treatment has a significant influence, both directly and indirectly, on the bodies of prostate cancer patients. The experiences of men with prostate cancer may lead to feelings of loss of identity on an existential level.     

The Influence of Normal Tissue Objective in the Treatment of Prostate Cancer

PurposeThe normal tissue objective (NTO) is a tool used in inverse-planned intensity-modulated radiation therapy to reduce dose spreading to the surrounding tissues. Only a few studies in the present literature are dedicated to understanding the influence of the NTO in radiation therapy planning in patients with prostate cancer or its consequences in the reduction of the dose in the surrounding healthy tissues.Material and methodsOur sample consists of 25 patients submitted to different treatment doses. Averages of plans with and without the NTO were obtained from the dose-volume histogram, and behaviours, comparisons, and quality were assessed considering homogeneity, conformity, and radiation plan indexes.ResultsWe were not able to find significant differences in the conformity index, homogeneity index, and radiation planning index between groups with and without the NTO or between treatment times. We observed a small advantage in NTO plans regarding hot spots in the central region of the planning target volume.ConclusionThe NTO is an important tool used in the optimization of plans; however, possibly due to the anatomical location of the prostate, we failed to find a significant contribution of its use in the treatment of prostate cancer. Further studies, using a larger sample and different NTO parameters, are needed to confirm our results.     

Evaluating the Impact of Post-Treatment Self-Management Guidelines for Prostate Cancer Survivors

BackgroundWith a rising number of prostate cancer survivors, transitioning patients to follow-up care has become more relevant in the current Albertan cancer care landscape and has led to a need for better patient education resources surrounding this topic. In response, the Alberta Provincial Genitourinary Tumour Team and Cancer Control Alberta have developed self-management guidelines to aid patients with prostate cancer during this transition. This study aimed to evaluate the effectiveness and impact of the new provincial self-management guidelines in facilitating transition from active curative external beam radiation treatment to primary community care.MethodsThis prospective study used convenience sampling to recruit 18 patients with prostate cancer from two major cancer centers in Alberta: Calgary and Edmonton. Participants were given the self-management guidelines within their final week of external beam radiation treatment and a follow-up phone questionnaire 4 weeks later. Participants answered standardized questions regarding the self-management document based on the themes of timeliness, patient-centeredness, safety, effectiveness, and comprehensiveness.Results and DiscussionA thematic analysis of the results suggested that the majority of patients were satisfied with the document in all domains, but some expressed concern with the clarity of the document. They suggested improvements such as adding a side effect timeline, adding an appendix or symptom index, further simplifying the language, and coordinating delivery of the guidelines with an in-person education session.ConclusionOverall, our findings supported the effectiveness of the guidelines in providing self-management information. If implemented into practice, these guidelines could have a positive impact on the perception of patients with prostate cancer regarding transitioning to follow-up care.     

An Exploration of the Rs of Radiobiology in Prostate Cancer

ObjectivesTo explore the four Rs of radiobiology (Repair, Reoxygenation, Reassortment, and Repopulation) as a means to understand the effects of ionising radiation on biological tissue and subsequently as the basis for conventional fractionated treatment schedules. These radiobiological principles will form a rationale for combined regimens in prostate cancer treatment involving androgen deprivation therapy and radiation therapy and the associated toxicities of this approach will be discussed.Data SourcesElectronic databases including CINAHL, MEDLINE, Scopus, professional websites, books and grey literature were searched using Google Scholar.ConclusionIt is important for nurses to understand the four Rs of radiobiology to grasp the effects of ionising radiation on biological tissue as the basis for conventional fractionated treatment schedules in prostate cancer. Men can experience a sequalae of physical and psychological side effects of treatment that can negatively impact quality of life.Implications for Nursing PracticeMen can experience a range of unmet supportive care needs particularly related to informational, sexual, and psychological needs. For men affected by prostate cancer opting for radiation therapy (+/-) androgen deprivation therapy, nurses should ask targeted questions based on the Common Terminology Criteria for Adverse Events related to urinary and bowel function, potency and fatigue, and sexual health. We also recommend the use of holistic needs assessments to tailor self-management care plans. Evidence-based self-management advice should be provided in response to each man's unique needs.     

Two Innovative Pharmaceutical Forms of Leuprorelin: Results from 818 Patients with Advanced Prostate Cancer

Objectives

This study set out to examine the efficacy and tolerability of two innovative implant forms of leuprorelin acetate in men with advanced hormone-dependent prostate cancer in everyday clinical practice.

Methods

Data were collected from 818 patients (from 273 centers across Germany) who were pretreated with slow-release luteinizing hormone-releasing hormone (LHRH) agonist formulations and who were about to be switched to the leuprorelin implants. Patients received three injections of 1- or 3-month leuprorelin implant and physicians were asked to complete a case report form specific to each of the three clinic visits. Documented parameters included laboratory measurements, such as testosterone and prostate-specific antigen (PSA) levels, adverse events, and patient- and physician-rated assessments of the therapy.

Results

Compared with baseline, a significant decrease in both testosterone and PSA levels were measured after the first and second injections of leuprorelin implant. These results were confirmed for both the 1-month and 3-month implants in separate analyses. Switching, without treatment interruption, from Trenantone® (Takeda Pharma GmBH, Aachen, Germany) to the leuprorelin implant resulted in a significant decrease in the mean serum testosterone concentrations (P < 0.05) and a nonsignificant increase in the proportion of patients reaching castrate testosterone levels, while the number of patients with PSA values ≤4 ng/mL significantly increased (P = 0.045). Similar results were obtained for patients previously treated with goserelin who switched to leuprorelin implant. For 94% of patients, treating physicians rated the efficacy of leuprorelin implant as “very good” or “good.” Treatment with leuprorelin implant was well tolerated, with only 61 adverse events reported in 42 (5.1%) patients. Patients and physicians rated the tolerability of leuprorelin implant as “very good” or “good” in 95% and 91% of cases, respectively.

Conclusions

These results confirm the efficacy, tolerability, and ease of use of the leuprorelin implants among a large population of men with advanced, hormone-dependent prostate cancer treated in a clinical practice setting.     

MRI Radiomic Analysis of IMRT-Induced Bladder Wall Changes in Prostate Cancer Patients: A Relationship with Radiation Dose and Toxicity

BackgroundThe main purpose of this study was to assess the structural changes in the bladder wall of prostate cancer patients treated with intensity-modulated radiation therapy using magnetic resonance imaging texture features analysis and to correlate image texture changes with radiation dose and urinary toxicity.MethodsEthical clearance was granted to enroll 33 patients into this study who were treated with intensity-modulated radiation therapy for prostate cancer. All patients underwent two magnetic resonance imagings before and after radiation therapy (RT). A total of 274 radiomic features were extracted from MR-T2W–weighted images. Wilcoxon singed rank-test was performed to assess significance of the change in mean radiomic features post-RT relative to pre-RT values. The relationship between radiation dose and feature changes was assessed and depicted. Cystitis was recorded as urinary toxicity. Area under receiver operating characteristic curve of a logistic regression–based classifier was used to find correlation between radiomic features with significant changes and radiation toxicity.ResultsThirty-three bladder walls were analyzed, with 11 patients developing grade ≥2 urinary toxicity. We showed that radiomic features may predict radiation toxicity and features including S5.0SumVarnc, S2.2SumVarnc, S1.0AngScMom, S0.4SumAverg, and S5. _5InvDfMom with area under receiver operating characteristic curve 0.75, 0.69, 0.65, 0.63, and 0.62 had highest correlation with toxicity, respectively. The results showed that most of the radiomic features were changed with radiation dose.ConclusionFeature changes have a good correlation with radiation dose and radiation-induced urinary toxicity. These radiomic features can be identified as being potentially important imaging biomarkers and also assessing mechanisms of radiation-induced bladder injuries.     

Tumour-Targeted Treatment Intensification for Prostate Cancer Using Magnetic Resonance Imaging Guidance

IntroductionLocal control in prostate cancer may be improved with targeted dose escalation to regions with high tumour burden. Multiparametric magnetic resonance imaging (mpMRI) combined with MRI-guided biopsies may aid in defining tumour-dense regions before radiation therapy. Deformable registration techniques may be used to map these tumour regions onto the radiotherapy planning MRI. Radiation therapy delivery techniques such as volumetric modulated arc therapy and high-dose-rate brachytherapy may allow for highly conformal dose escalation, and when coupled with image-guided radiation delivery (ie, cone beam computed technology and fiducial markers), may allow high-precision dose-escalated treatment.MethodsEligible prostate cancer patients were enrolled on a prospective trial of tumour dose escalation. Two strategies were investigated: (1) an integrated boost to external beam radiation for a total tumour dose of 95 Gy in 38 fractions or (2) a focal high-dose-rate boost of 10 Gy before 76 Gy in 38 fractions external beam radiation. Patients underwent MRI-guided biopsy with fiducial marker placement before therapy. mpMRI was acquired and used in conjunction with a non-endorectal coil T2 MRI and computed technology simulation images to define the gross tumour volume via a deformable registration approach for intraprostatic tumour dose escalation.ResultsA case example for each dose escalation strategy illustrates the tumour-targeted approach using MRI guidance.ConclusionsCombining mpMRI sequences with a deformable registration approach may aid in more accurate and reproducible definition of tumour-dense regions. This novel process coupled with daily image guidance may allow high-precision dose-escalated tumour-targeted radiotherapy for prostate cancer.     

Prostate Cancer Patients' Preferences for Intermittent vs. Continuous Androgen Deprivation—A Pilot Institutional Study

IntroductionWith locally advanced, recurrent, and metastatic prostate cancer patients, patient preference between intermittent (IAD) and continuous (CAD) androgen deprivation therapy has not been investigated. The goal of the study was to determine patients' preference for IAD vs. CAD therapy. The secondary aim was to elucidate demographic or treatment variables that may affect a patient's preference for one type of hormonal treatment.Materials and MethodsUsing a tradeoff model that demonstrates the difference in outcome between IAD and CAD, a survey questionnaire was developed and administered to prostate cancer patients at the Odette Cancer Centre at Sunnybrook Health Sciences Centre in Toronto, Ontario, Canada. Only patients who had (1) locally advanced prostate cancer, (2) been previously treated for prostate cancer with relapsing prostate-specific antigen, or (3) slow metastatic disease were asked to participate. Data related to patients' demographic information and their decisional preference factors were collected.Results and ConclusionsOverall, 36 of 53 (68%) patients completed the survey. Most patients favoured IAD (n = 32) over CAD (n = 4). Patients currently on radical treatment (adjuvant hormone therapy and radiation therapy) preferred CAD compared with patients who were not on radical treatment (P = .044). Patients with high (>20 ng/L) pretreatment prostate-specific antigen showed preference for CAD; however, this was not statistically significant (P = 0.07). Patients from both groups viewed quality of life as the strongest influence on their treatment preference, but had diverging opinions on side effects and general well being. The results of this pilot study could serve as a guide for future studies; a larger study combined with qualitative methodology may better address patients' needs and minimize any regret over their hormonal treatment.     

Evidence-based practice in the management of lower limb lymphedema after gynecological cancer

Purpose: Lower limb lymphedema (LLL) is characterized as a physical-functional chronic complication that impacts the quality of life of women who have gone through treatment for gynecological cancer. The present study aims to check the conservative treatments available for lymphedema after gynecological cancer in the context of evidence-based practice. Methods: The selection criteria included papers from May 1993 discussing treatment protocols used in LLL after treatment for gynecological cancer. The search was performed until October 2014 in MEDLINE, SciVerse, and PEDro using “rehabilitation,” “treatment outcome,” “therapeutics,” “clinical protocol,” “gynecologic surgery,” “lower extremity,” “lower limb,” and “lymphedema” as keywords, focused on women with a previous diagnosis of gynecological cancer who received radiation and/or chemotherapy and/or surgery and/or lymphadenectomy as part of their treatment. Results: From 110 studies found, 3 articles that used the complex decongestive therapy (CDT) as a treatment protocol were selected. There were no randomized clinical trials associated with the conservative treatment of LLL post-treatment of gynecological cancer. The three selected articles are retrospective, and had the same outcome – decreased volume of the affected limb lymphedema. Conclusions: Although LLL is more or as frequent and detrimental as upper limb lymphedema post-cancer treatment, there are only a few studies about this subject. Publications are even scarcer when considering studies with interventional approach. Randomized controlled trials are necessary to support rehabilitation resources on lymphedema post-gynecological cancer treatment.     

Evaluating QUANTEC Small Bowel Dose-Volume Guidelines for Rectal Cancer Patients Treated Using a Couch Top Inclined Belly Board

PurposeThe goal of this work was to analyse small bowel (SB) dose-volume following the Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC) guidelines for rectal cancer patients treated using a couch top inclined belly board (iBB). As part of this, the consistency in SB displacement was evaluated using on-treatment cone-beam computed tomographic (CBCT) imaging.MethodsTwenty-four patients with rectal cancer were treated on a commercially available iBB. All patients went through the standard radiochemotherapy protocol in either a pre- or postoperative setup. All patients underwent weekly CBCT imaging during the course of radiation treatment. The planning computed tomographic data sets were used to analyze the quality of SB displacement, and the CBCT data sets were used to assess the reproducibility in SB displacement during treatment. The SB dose volume was evaluated and compared with QUANTEC-recommended dose limitations. Similarly, the impact of body mass index on dose volume and SB displacement was evaluated.ResultsThe SB displacement was assessed respectively as “good” and “very good” by both independent evaluating radiation oncologists. The consistency of SB displacement through the course of radiation treatment was scored as “excellent” for 22 of 24 and 23 of 24 patients by both radiation oncologists, respectively. The QUANTEC recommendation was met for all patients without bowel adhesions; however, the most benefit was observed for patients with body mass index > 23 kg/m².ConclusionsOur study has shown that QUANTEC recommendations for SB dose during rectal cancer treatment can easily be met by treating patients on a couch top iBB. This technique is robust and produces consistent SB displacement.     

What do lymphedema patients expect from a treatment and what do they achieve? A descriptive study

PurposeLymphedema is characterized by swelling and fibroadipose tissue deposition that is a physically, psychologically, and socially debilitating condition due to chronic and progressive nature of the disease. Treatment benefit evaluation from the patient's perspective is important for medical decision-making. The aim of this study is to investigate important treatment goals and benefits of treatment from the patients’ perspective.MethodEighty-one patients with lymphedema, lipoedema, or lipolymphoedema who are currenlty treated or who underwent previous treatment were included in the study. Socio-demographic data was recorded. Important goals and benefit from treatment were assessed with Patients Needs Questionnaire and Patient Benefit Questionnaire which are sub-questionnaires of Patient Benefit Index-Lymphedema.ResultsThe most important expectation and needed item was “To find a clear diagnosis and therapy” (n:59, 72%). The least important item for the lymphedema patients was “To feel more attractive” (n:9, 11%). Most beneficial effect of treatment was “To have no fear that the disease will become worse” (n:37, 45.7%). “To have fewer out of pocket treatment expenses” was rated as the least beneficial effect of treatment (n:24, 29.6%).ConclusionsIt is important to identify patients' needs and expectations. Patients should be referred for treatment according to their needs. The effectiveness of the treatment should be evaluated objectively. Patient education should be considered as a part of the effective treatment to teach patients how to control their lymphedema. A clear diagnosis and access to treatment should be ensured for lymphedema patients. Regulations for health insurance benefit coverage are needed to cover cost of compression garments.     

Perceptions of Radiation Therapists about Providing Psychosocial and Supportive Care to Patients at Peel Regional Cancer Center

BackgroundMany patients with cancer undergoing radiation treatment have unmet psychosocial and supportive care (PSOSC) needs. Radiation therapists (RTs) have a unique opportunity to provide PSOSC, but the published literature is limited regarding their perceptions and beliefs about delivering such care. A survey was designed to evaluate these aspects.MethodsA one-time, cross-sectional survey was distributed to 52 RTs at the Peel Regional Cancer Centre, Mississauga, Ontario, Canada. This survey contained six baseline questions and 34 item statements. The 34 statements spanned three themes: (1) convictions and motivations, (2) preparedness and execution, and (3) resources and facilitators. Participants were asked to rank statements on an eight-point scale, from “strongly disagree” to “strongly agree.”ResultsEighty-three percent of the RTs responded. Respondents reported they were engaged for 6.2 hours per week in supporting patients with PSOSC. This was despite a technical focus of organizing and delivering a course of radiotherapy for each patient, a relatively fixed schedule, and short-duration time slots booked per patient. Overall, respondents reported a moderately strong level of convictions and motivations for including PSOSC in practice. They perceived that they were not using all of their existing PSOSC skills and knowledge on the job and that supporting professional (eg, training and scheduling) and environmental (eg, screening tools, physical environment, and policies) infrastructures for PSOSC were not optimized.ConclusionsA majority of the respondents believed PSOSC to be an integral part of providing quality care to radiation oncology patients. Findings showed that staff members were highly motivated to provide this care and perceived that, with additional support, their capacity to provide such care in a way that is meaningful to patients would increase.     

Assessing the Psychological Impact of Daily Bowel Preparation on Prostate Patients Who Receive Radiation Therapy

PurposeEvidence has shown that the prostate moves depending on filling of the rectum and, to a lesser extent, the bladder; many radiation therapy departments have adopted standardized bladder filling/rectal emptying protocols for radiotherapy treatment. Daily treatments may be delayed until appropriate volumes are attained; the resultant psychological impact of these delays on patients is unknown. The purpose of this study was to determine levels of anxiety, depression, distress, and bother related to bowel preparation for prostate cancer patients undergoing radiation therapy treatment.MethodsA prospective cohort analysis of prostate cancer patients undergoing external beam radiation therapy was completed. Patients were assigned to one of three groups; Group A was standard of care, Group B was standard of care plus increased educational information regarding bowel preparation, Group C was standard of care plus increased educational information regarding bowel preparation plus an anti-flatulent medication. Hospital Anxiety and Depression Scale, Distress Thermometer, and a Bowel Status Bother survey were completed by participants at the start of theircourse of radiation treatment, mid-way through, and at the end. Analysis of variance testing was completed to determine differences in mean scores between the three groups.ResultsMean age of patients (N = 30) was 66 years; 50% of the participants had a university education; 80% were married. Anxiety levels decreased over time in all groups (P = .039) with no difference between groups (P = 0.447). Depression levels across time for each group remained low (P = .577). Overall distress levels associated with bowel preparation were low among each group, and no significant differences were reported (P = .978). All groups reported high rates of quality of life.ConclusionsFindings from this study indicate that collectively across three groups and over time, there were low levels of anxiety, depression, and distress from bowel preparation. Amount, timing, quality, and approach to educational information are important factors to ensure patients feel prepared for their radiation therapy treatments.     

Information for patients with early-stage prostate cancer: a comparison of professionals'' attitudes in Canada and Italy

PURPOSE: To compare information priorities of Canadian to those of Italian health-care professionals in the context of early-stage prostate cancer. METHOD: Oncologists (radiation and medical), nurses, and radiation-therapy technologists in each country were surveyed. Respondents rated the importance of addressing each of 78 questions with a case-scenario patient using either three (Italian survey) or four (Canadian survey) categories; the most important category was defined as "essential" in both countries. At least 67% identical responses on a specific question was considered "agreement." RESULTS: Within each country, questions rated essential by most group members were similar across professions (all pairwise group correlations r>or=0.77, p<0.01); there was much less agreement within each profession between the countries (all pairwise comparisons of the amount of accounted-for variance F(max) >or=1.59, p<0.05). Amongst oncologists, Canadians agreed that 11 questions were essential versus two by the Italians; the Canadians disagreed on the essential nature of 29 questions versus nine by the Italians. More importantly, there was large variation within each group in both countries: individual Canadian oncologists identified from five to 69 questions essential and Italians from zero to 68; each of 75 questions was considered essential by some Canadian oncologists and each of all 78 by some Italians. Similar patterns were evident in the other professions. CONCLUSIONS: Within each profession, the Italians agreed that fewer questions were essential to address and disagreed on the essential nature of fewer questions than their Canadian counterparts. There was, however, marked individual variation in priorities within each profession in each country. Thus, information provided to individual patients in both countries likely differs as a function of the particular professionals seen, and seeing two professionals (from the same or different professions) likely results in confusion for patients.     

A Feasibility Study on the Identification of Postlumpectomy Seromas by a Radiation Therapist Compared with That by Radiation Oncologists in Radiation Therapy Planning for Early Stage Breast Cancer

IntroductionComputed tomography (CT) simulation is currently used to identify the tumour bed in patients with early stage breast cancer requiring whole-breast and boost radiation therapy. Postlumpectomy breast seromas as visible on CT data have been identified as a proxy for the tumour bed. This study aims to quantify the incidence of postsurgical tumour bed seromas identified at CT simulation and report how well a radiation therapist (RT) is able to identify these seromas compared with those contoured by radiation oncologists (ROs).Methods and MaterialsA study was undertaken on electronic patient records and the CT-simulation datasets of early stage breast cancer patients treated in 2013 at the Calvary Mater Newcastle to identify the presence of seromas. Patient and tumour characteristics were reviewed. Data analysed included seroma volumes, as contoured by the ROs, as part of the standard voluming procedure. One RT rated seroma visibility based on the level of difficulty when viewing the seroma.ResultsOut of 108 CT datasets, an RT was able to identify the presence of a seroma in 102 cases vs. 104 as contoured by ROs. The number of observed agreements was 106 (98.15% of the observations), and the number of agreements expected by chance was 98.4 (91.15% of the observations). The Kappa statistics equalled 0.791 (SE of kappa = 0.143). The strength of agreement is considered to be “substantial.”ConclusionRTs play an integral role in contouring during the planning process, and there is scope to expand this role. This research introduced the first step by confirming that a radiation therapist is able to identify seromas on CT-simulation data when compared those contoured by an RO.