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Community care in prostate cancer

Community care in prostate cancer

Prostate cancer is the most common cancer in men, with 112 men diagnosed every day in the UK.1 Due to an ageing population and more men being tested for prostate cancer than ever before, this number is set to rise.

It is vital that the follow-up care of this patient population is tackled now to ensure we are ready for the inevitable increase in demand for community care services. This can be done by ensuring that safe and efficient patient centred care is maintained and financial efficiencies for the NHS remain in place. 

Currently, there are very few community-specific prostate assessment and surveillance nurse-led telephone clinics run in primary care. West Essex and East Berkshire are the only two known in England and the latter was decommissioned in 2011.

Most patients with prostate cancer will have a prolonged survival and should be ‘followed up for life’2 with annual prostate-specific antigen (PSA) blood testing at their local hospital. This generally accepted national practice is currently seen at almost all the hospitals within the NHS. 

The present system means that the uro-oncology nurses meet the needs of their patients by providing information, guiding them through the system and discussing their treatment options  within secondary care services. Community nurses play an important role in post-operative care by offering support on any nursing needs to patients with catheters or experiencing any urinary difficulties. 

Most urology services offer nurse-led clinics within the secondary care setting. These clinics can either be face-to-face or on the telephone. These services are now running at capacity and are looking to discharge stable prostate cancers to their GPs for further follow-up, with fast track back into the system if their prostate cancer should become more active. The National Institute for Clinical Excellence (NICE) 2010 guidelines recommend that “after at least two years, men with a stable PSA and who have had no significant treatment complications, should be offered follow-up outside hospital (for example, in primary care) by telephone or secure electronic communications.”3

Yet this is still not widely available across the UK. Currently, the primary areas that are known for GPs to be routinely following up men with prostate cancer are East Berkshire (since 2011) and Croydon. There are now 2 million people in the UK living with cancer and this set to double to 4 million by 2030.4 Cancer is becoming a long-term condition as more people are surviving cancer but living with the side effects of treatment. These side effects can dramatically alter the lives of these individuals. 

Charities such as Macmillan have recognised the need to address and support those individuals to manage such side effects. Macmillan one-to-one support projects hope to demonstrate the value of secondary prevention and the value of intervention in preventing further co-morbidities developing as a result of cancer treatment through providing support and encouraging self-management for prostate cancer patients. The side-effects of treatment vary from one individual to the next; for example, fatigue is becoming more evident and can be a devastating side-effect of treatment. Physical activity may help to alleviate some of these side effects, and to help Macmillan has developed Move More, a physical activity support and information pack which offers advice and guidance about becoming more active during and after cancer.  For those requiring more specialised psychological support, there are other services available; talking therapies, Macmillan psychologists and local hospice organisations offer self-management courses to help men come to terms with their condition. The relationship charity Relate also offer support to individuals and couples helping them to adjust to changes in their relationships as a result of the disease or treatment.

Though there is support available in the community it varies widely across the UK. There needs to be more done to provide community support services for men with prostate cancer, or many will find themselves left alone to deal with the effects of cancer and its treatment.

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