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Identifying unmet care needs of patients with prostate cancer to assist with their success in coping.

In the United Kingdom, our Health Needs Assessment survey return rate of 42% identified unmet needs in subjects with prostate cancer. Subjects reported the greatest unmet need was related to erectile dysfunction. Other unmet needs were related to incontinence, tiredness, hot flashes, lower urinary tract symptoms, rectal bleeding, and relationship issues.

Key Words: Unmet needs, survivorship, prostate cancer, holistic needs assessments, coping.

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The number of people living longer and surviving a cancer diagnosis is increasing. It is estimated that nearly 14 million Americans diagnosed with cancer are living in the United States (Centers for Disease Control and Prevention [CDC], 2016; de Moor et al., 2013; DeSantis et al., 2014). However, despite successful treatment for cancer, many survivors still experience unmet needs affecting their quality of life (Macmillan Cancer Support, 2016).

In the United Kingdom (U.K.), a major cancer organization--the Macmillan Cancer Support-- identified in 2014 that one out of three patients who complete their cancer treatment will experience moderate to severe side effects from their treatment, and one in four (25%) persons already face poor health or disability after treatment for cancer (Macmillan Cancer Support, 2016). In addition to this, the American Society of Clinical Oncologists and the Institute of Medicine identified the transition from patient to survivor needs careful monitoring, resources, and support (Hewitt, Greenfield, & Stovall, 2006; Shulman et al., 2009).

To improve outcomes in cancer care, the U.K. has developed The Recovery Package as part of the National Cancer Survivorship Initiative (NCSI) (2008, 2013). One key element of the U.K.'s Recovery Package is the Holistic Needs Assessment (HNA), which can be accessed online (London Cancer Alliance, 2013).

In 2016, it became mandatory for all patients with cancer in the U.K. to complete an HNA questionnaire at multiple stages in their cancer journey. The recommended times for patients to complete an HNA are at the start of treatment, during treatment, at the end of treatment, if there is a diagnosis of recurrent cancer, or if transition follows to palliative care (Macmillan Cancer Support, 2014). The aim of this new initiative is to recognize if patients have concerns and identify any unmet needs.

Unmet needs include physical, spiritual, emotional, practical, and social issues. The collection of this information can be tailored to each patient, implemented, and shared among all healthcare disciplines to improve patient care (Goonewardene, Persad, Nanton, Young, & Makar, 2015).

Knowing patients with cancer are living longer after initial treatment, the impact of care on these patients' unmet needs on health services is considerable. To date, however, the unmet needs of patients with cancer have not been researched, recognized, or addressed in-depth. Therefore, it is paramount to understand each patient's experience and personal views throughout the cancer care journey. Patients completing their HNAs will help to identify the physical and psychological needs that exist for each patient. Further, identifying these needs and concerns will allow nurses to help patients make better decision-making choices while supporting more patients to live a more active, fulfilling, and enjoyable life (Henry, Hartley, Simpson, & Doyle, 2014). Most importantly, HNAs identify individual patient needs that require attention, not the clinician's impression of what the patient's needs might be.

In 2014-2015, our urology team treated 1,500 newly diagnosed patients with prostate cancer (excluding patients referred directly to oncology for anti-cancer therapies). Three prostate cancer nurse specialists predominately undertake follow up for all stable patients with prostate cancer. Acknowledging the nurses' need to implement all elements of The Recovery Package into the prostate cancer pathway was a priority for our department. The only method to assess patients' current needs and to develop an enhanced care plan was by gaining direct feedback to determine if they had unmet needs (Snowden et al., 2015). It was important to identify any unmet needs before we implemented The Recovery Package because it would allow us to confirm whether we were capturing the magnitude of patients' needs, preparing the correct plan for management, and auditing the effect of any intervention.

Purpose of Study

The aim of this work was to gain a baseline on our current practice from patients with the diagnosis of prostate cancer and follow them through their treatment, assess whether patients experienced any physical and psychological concerns during and after their treatment, determine when these were likely to occur, and determine whether these concerns were addressed by current interventions or became unmet needs.

Literature Review

A literature review was completed using Medline, CINHAL, PubMed, and Google Scholar to identify publications on the following key words: unmet needs in cancer patients, survivorship in cancer patients, erectile dysfunction (ED), prostate cancer, and holistic needs assessments for unmet needs in patients who completed their prostate cancer treatment. Prostate cancer is the most common cancer in men worldwide (Ferlay et al., 2012; Globocan, 2012; Siegel, Miller, & Jemal, 2015). Harrison, Young, Price, Butow, and Solomon (2009), conducted a systematic electronic review on unmet supportive cancer needs in general, looking at multiple different tumor sites, which reported variable domains at different points.

Key themes identified were in activities of daily living and access to information, both psychosocial and physical. Interestingly, sexuality was least frequently investigated. Hill et al. (2011) compiled a study with 261 patients post-gynecological and breast treatment to assess their sexual concerns. However, in urology, the focus is somewhat different because patients with prostate cancer often have ED, and the majority of research studies in this field investigate sexual dysfunction in more detail. Two research teams studied treatment side effects and their impact on patient quality of life post-treatment for prostate cancer, and in particular, ED (Resnick et al., 2013; Sanda et al., 2008). Smith et al. (2007) and Cormie, Newton, Taaffe, Spry, and Galvao (2013) conducted studies focusing on sexual and psychological unmet needs for treated prostate cancer patients. Both studies imply ED is multifaceted--both physiological and psychological. However, treatment predominately involves pharmacological interventions only addressing the physiological components. Both studies suggest further research should be done to meet patients' psychological needs. Despite this concentration on erectile dysfunction, very little research has been conducted to determine ED interventions to address unmet needs over the long term to improve the patient's quality of life. All the studies reported that sexuality was an unmet need post-treatment for different tumor sites, and health professionals do not address or manage such needs within an acceptable timeframe.

The rationale for conducting this study was to carry out a gap analysis on our current service by gaining baseline knowledge of unmet needs. It is important to ask if these needs are significant and when they occurred, thereby allowing the re-evaluation of our current care pathways and the design of a survivorship component from a patient centered approach to improve patient experience and patient outcomes.

Materials and Methods

This was a service (quality) improvement project involving a gap analysis by auditing the care patients received through their cancer treatment journey, and from the patient perspective if there were identifiable deficiencies in the way care was delivered. Ethical approval was deemed unnecessary; however, an application and approval were received by the hospital to undertake the improvement audit.

Questionnaires were sent to potential subjects who received treatment for prostate cancer during December 2013 and October 2014. Potential subjects were gathered from a retrospective chart review. Prospectively, 250 patients who met the inclusion criteria were mailed a questionnaire with a return stamped addressed envelope. We aimed to achieve a balanced survey of men with all stages of prostate cancer (localized to metastatic) and treatment type to determine if there were differing needs. Fifty potential subjects were selected from five different treatments (active surveillance [A/S], brachytherapy, robotic-assisted radical prostatectomy [RARP], external beam radiotherapy [EBRT], metastatic/hormone deprivation leuteinizing hormone-releasing hormone agonist [LHRH]), ranging from three to 18 months after treatment finished (except patients who were on longterm hormones and still continuing on treatment) to assess symptoms and unmet needs at different timelines in their care pathway.

Potential subjects were identified from searches for radical prostate cancer treatment modalities from theater lists, pathology type from multidisciplinary patient lists, and department prostate cancer databases. Inclusion criteria included potential subjects who received treatment for their prostate cancer within the last three to 18 months. All potential subjects were reviewed on electronic patient records (EPRs) to assess potential subjects' mortality status and any limiting factors that would affect them completing the questionnaire. Potential subjects were excluded on the basis of any major complications after their treatment or if any language/literacy barriers were identified.

A quantitative study design using 10-item Likert scales to measure the outcomes of the subject's answers was used for this study. The questionnaires were anonymous and completed by the subject at home. Subjects mailed their questionnaires in the return, stamped envelope to our department. Demographic data were collected on all subjects to include age, ethnicity, treatment type, and how many months since their treatment (see Table 1).

Subjects' symptom data were collected at three different times during their care: during their initial treatment, on completion of their treatment, and after their treatment. They were also asked about the impact these symptoms had on their daily activities, what support they received during this time, whether they were still experiencing problems that were not addressed, how much education information they received to cope with their side effects, and whether they felt confident in coping and self-managing their symptoms.

Symptoms and Side Effects

Subjects were asked if they experienced any of the following symptoms or side effects (erectile dysfunction [ED], relationship issues [relat], continence [cont], tiredness [tired], hot flashes [flashes], lower urinary tract symptoms [LUTS], rectal bleeding [rectal]) from their treatment at three key stages of their pathway (see Table 2): a) undertaking/during your treatment, b) upon completion of your treatment, and c) still experiencing the symptoms now.

Results

Two hundred and fifty questionnaires were sent to subjects who fit the criteria for the study. One hundred and six surveys (42%) were completed and returned. Thirty percent of subjects stated they experienced side effects during their treatment. Thirty-four percent (34%) experienced symptoms upon completion of their treatment, and 36% are still experiencing unmet needs afterwards.

Symptoms During and After Completion of Treatment

Subjects receiving RARP complained of worsening ED, continence, and LUTS upon completion of their treatment. Subjects felt less tired after their treatment as compared to during their treatment. Relationship issues were similar while undergoing treatment and upon completion (see Table 2).

Subjects receiving EBRT had side effects that were relatively consistent over time and did not appear to depend on whether they were undertaking treatment or had completed it. Hot flashes were the only symptom to markedly increase upon completion of the EBRT because higher risk subjects may continue hormone ablation for longer. Rectal bleeding improved over time.

Subjects receiving brachytherapy are less lethargic during their treatment than other modalities. However, continence, rectal bleeding, LUTS, and ED worsened dramatically upon completion of treatment.

Subjects receiving LHRH agonist therapy complained of a plethora of symptoms. Hot flashes, ED, and tiredness were the most frequently encountered concern in subjects undertaking LHRH agonist therapy. However, over time, these lessened slightly, whereas continence and LUTS continued unchanged.

A/S subjects had fewer symptoms and side effects. ED and LUTS remained the predominate symptoms on completion of their treatments.

Table 2 describes subjects' symptoms experienced at different points in their care pathway. On initiation of treatment, hot flashes were most common in those receiving LHRH agonist therapy (73%), followed by tiredness (53%). This tiredness is mirrored in EBRT subjects who are additionally receiving adjuvant LHRH agonist therapy (54%). ED is a major unmet need in EBRT subjects (50%), LHRH agonist subjects (40%) and robotic prostatectomy subjects (30%). Continence issues were similar in subjects receiving LHRH agonist (27%) and undergoing RARP (26%), with EBRT causing slightly less (21%). LUTS was remarkably consistent across all treatment subjects (19% to 21%), with A/S being slightly higher (25%). Relationship issues were similar in all (4% to 8%) except those who had brachytherapy where no relationship problems were reported. Rectal bleeding was the highest adverse symptom in the radiation therapies; EBRT (13%) and brachytherapy (5%) but unreported in all other subjects.

In the post-treatment phase, ED was the highest adverse effect or need in patients who had RARP (63%), EBRT (54%), or brachytherapy (48%). Hot flashes and tiredness were most common in subjects continuing on LHRH agonists. In those solely on LHRH agonists, hot flashes were frequently reported in 60%, and tiredness was experienced in 40%. After subjects completed EBRT, in which a proportion with higher risk disease may still continue on to receive LHRH agonists, hot flashes were reported in 46% and tiredness in 54%. LUTS was a common symptom after brachytherapy (52%). Continence issues occurred in all subjects but were more severe in the subjects following RARP (41%) and lowest in subjects who were A/S (8%). Rectal bleeding was most prevalent after brachytherapy (10%), for those taking LHRH agonists (7%), and A/S (8%). Relationship issues were relatively similar across the board (4% to 8%) except in A/S subjects where they did not occur.

Unmet Needs from Subjects' Current Symptoms

Subjects continued to experience continuing side effects and symptoms up to 18 months after treatment (see Table 2, row C). ED is most common unmet need in subjects currently experiencing symptoms. The rate of ED appeared to increase consistently over time in subjects who had chosen RARP (70%), brachytherapy (67%), and EBRT (63%). Even subjects on LHRH agonists who have not ranked ED as their greatest concern were experiencing ED in one-third of cases (33%).

Hot flashes are a constant unmet need in subjects on LHRH agonists (73%). Hot flashes were also consistent over time in the EBRT group, though at a lower level (46%), and very low in all other groups.

Tiredness increased in EBRT subjects (63%), and it was a consistent unmet need in subjects receiving LHRH agonist and brachytherapy. Tiredness improved in RARP and A/S subjects.

Continence issues were found to be the highest unmet need in LHRH agonist subjects (33%), and these symptoms worsened over time. Continence improved in the RARP subjects, dropping to equal levels as EBRT subjects during the follow-up period (21%).

LUTS occurred in 43% of brachytherapy subjects in the follow-up period, and were also high in EBRT subjects (33%). Subjects had similar level of LUTS if they had RARP (22%), LHRH agonists (20%), or A/S (17%). Rectal bleeding increased in A/S subjects (18%), followed by EBRT subjects (8%). Symptoms of rectal bleeding improved over time for those in the brachytherapy group (from 10% immediately after treatment to 5% on follow up).

Some subjects experienced unmet needs through all care stages that were inadequately addressed (see Table 3). ED is the greatest unmet need from patients in the widest range of treatment modalities. ED occurs in subjects having had RARP (26%), radiotherapy (EBRT--45%; brachytherapy-14%), LHRH agonists (13%), and A/S (8%). EBRT had the highest proportion of continuous symptoms, affecting all areas with the exception of rectal bleeding. LHRH subjects experienced hot flashes predominately throughout their treatment pathway.

Overall, when questioned, 96% of subjects said they experienced adverse symptoms sometime during their treatment. ED predominated; 34% had ED during their treatment, 48% suffered from ED on completion of their treatment, and 57% still experience ED after treatment.

Coping

Subjects were also asked how confident they were coping with various adverse symptoms (see Table 4). Subjects felt they were best prepared to cope with relationship issues (64%), tiredness (48%), hot flashes (44.5%), and continence problems (44%), but there was still considerable room for improvement. ED remains the predominate problem; 71% of subjects were "not at all confident" to only "moderately confident" in coping with their ED. Only 31% of subjects with ED felt their concerns were "completely" addressed after treatment, and only 41% of subjects felt confident to manage their ED after their consultation (see Table 5).

Information

All subjects have adverse symptoms discussed in consultation with clinicians and receive written information in a standard pack pretreatment. But despite this regulated method, the majority of subjects did not recall receiving information (see Table 6). Patients stated they never received information on hot flashes (n = 64), tiredness (n = 58), or incontinence (n = 56). Rectal bleeding and relationship issues were two areas patients claimed they received particularly poor information. More subjects remember LUTS (n = 73) and ED (n = 74) discussions. Eighty-two percent of subjects knew the contact information for their continence nurse specialist (CNS), but only 50% knew who to contact regarding specific problems. The same number of subjects (82%) felt comfortable asking questions about problems following treatment with their CNS or consultant for personal issues on ED.

Limitations

This study included only subjects receiving a single treatment modality for their prostate cancer, who had no recurrent disease, and who did not have any communication barriers. It is limited to one tumor pathway, so findings are not generalized to all other urologic cancers. Much of the information is historical, and some patients were expected to remember experiences up to 18 months following treatment. Accuracy of recall may therefore be problematic.

Discussion

The Survivorship Initiative focuses on patients living with and beyond cancer, and encourages patients to live a healthier and active life for as long as possible (NCSI, 2012). Henry Marsh, a Cancer Neurosurgeon, wrote in a chapter on successful treatment outcomes that "we have been most successful, however, when our patients return to their homes and get on with their lives and never need to see us again" (Marsh, 2014, p. 34). However, we need to pose the question, how can patients return to normality if they are still experiencing moderate to severe symptoms even up to 18 months after treatment? The majority of all subjects surveyed had experienced adverse symptoms during their cancer journey (96%). Though the majority of symptoms improved for most patients, 36% were still experiencing adverse symptoms long after their treatment. Because their needs were still unaddressed and affected their quality of life, it is reasonable to consider these as unmet needs. ED was predominately the most frequent unmet need, but many subjects on LHRH agonists and EBRT also experienced incontinence, tiredness, and hot flashes, as well as ED.

In all subjects expressing concerns about ED, only 33% felt ED had been completely addressed. Healthcare professionals commonly make assumptions about patients' sexuality without asking the patient, and studies demonstrate that health professionals are more likely to address clinical concerns than those relating to relationships and intimacy (Flynn et al., 2012). This is concerning; if ED is left untreated, it produces important consequences on patients' well-being and quality of life (Becher, 2004; Ream et al., 2008). Hopefully, the use of HNAs will improve this situation by starting the process to successful resolution of unmet needs.

The high level of unmet needs found in this study suggests that designing a more patient-centered approach is needed to support patients and their caregivers through their cancer journey. In particular, more consideration must be given on how information should be delivered to patients to provide them with tools and coping strategies to better manage symptoms. Guleser, Tasci, and Kaplan (2012) noted that patients want to be fully informed about their diagnosis and management needs. It helps to reduce anxiety and encourages self-management. Using medical terms and handing out leaflets may no longer provide adequate information for patients who may experience limited literacy and numeracy skills, and find medical leaflets difficult to understand (Rowlands, Berry, Protheroe, & Rudd, 2015). A new conduit of communication must be devised for patients so they can live with and beyond cancer. Patients' unmet needs will need to be addressed within an acceptable timeframe.

Gaining a real understanding and constructing a "rich picture" into patients' experiences prove the current status quo needs to change. As was evident from the patient survey, there are problems in the method used to educate and disseminate information to our patients. Currently, nurse specialists are present when the physicians break bad news and discuss different treatment options with patients. In the U.K., nurses usually take the patient and family in to a consultation room, and provide them with support and information leaflets on the different treatment options. Patients return in a couple of weeks to meet the oncologist and urologist to decide on the best treatment option for them. Patients normally meet the nurse specialist again, when they are provided with more information about their treatment choice and a more in-depth consultation on side effects and treatment expectations. Nurse specialists see patients post-operatively and give them a recovery pack, which includes leaflets on diet and exercise. It is important for healthcare providers to understand why the majority of patients feel they received very little information (see Table 6).

Previously breaking bad news was always seen as the doctor's role. In the U.K., patients were then given leaflets hoping they would gather more information at their own leisure to ensure understanding (Morse, 2011). However, it is now recommended that consistent and timely dissemination of information helps patients remember what has been said to reduce misunderstandings and protect against psychological distress (Russell & Ward, 2011). Our survey would support that giving leaflets and one-on-one consultation may not necessarily be the best way to disseminate information. Rowlands et al. (2015) found that 43% to 61% of people have levels of literacy and numeracy that are too low to understand health information leaflets and tools provided by health professionals. This may contribute to our patients' responses that they received limited information on how to manage and cope with their side effects or concerns.

Good communication and patient education should be the key focus. If patients are informed and understand what is going to happen, as well as learn about any side effects they may encounter after their treatment, they may have more realistic expectations about their recovery. Therefore, they may be able to cope and confidently undergo the selected treatments (Kinsella et al., 2012b).

After consultation, the majority of patients were confident in coping with the majority of symptoms. Nevertheless, patient feedback identified they were less confident in addressing their ED issues. Our hospital provides an in-depth treatment plan for ED complications of prostate cancer treatment. Every patient is included in this plan, and undergoes assessment and treatment (Kinsella et al., 2012a), so this was a surprising finding of the study. One reason may be related to the more practical interventions for ED and that men feel impotence affects their masculinity (Bokhour, Clark, Inui, Silliman, & Talcott, 2001). Bokhour et al. (2001) conducted a study on men's experiences and quality of life concerns on sexuality after prostate cancer treatment. It was perceived that impotence affected men both physically and psychologically. Men did not see themselves as sexual beings and further expressed concerns as asexual, embarrassment, and fear when engaging with devices during intercourse. This could explain why men express ED as one of their biggest symptoms or concerns throughout their cancer journey and why it then becomes an unmet need. It is already known that most prostate cancer treatments will result in temporary or permanent ED, which will have both a physical and psychological impact on the patient (Chung & Brock, 2013; Forbat, White, Marshall-Lucette, & Kelly, 2011; Mulhall, Bella, Briganti, McCullough, & Brock, 2010). Kinsella et al. (2012a) reported that early support and education for patients receiving treatment for ED following treatment of prostate cancer reduces longterm regret on treatment choice. Knowing this information should prompt us to ensure patients receive support and education as early as is possible to manage and cope with these concerns.

The questionnaire feedback from our subjects has highlighted areas of improvement that were not previously identified as issues. This work also supports the premise for HNAs, which ask individual patients about issues specific to them, thus encouraging healthcare providers to encourage services that are individualized and patient-centered. Patients can be encouraged to report their unmet needs to improve their ability to cope with common issues they may experience.

Conclusions

There is clear evidence that the majority of patients with prostate cancer will experience side effects and symptoms sometime during their treatment (96%). We are not addressing many of these symptoms and side effects adequately within an acceptable timeframe, resulting in patients reporting unmet needs following treatment. By identifying needs that are common to different treatment options in prostate cancer, we can counsel patients better to decide which treatment choice is best for each individual patient knowing the probable outcome. This can decrease any regret caused by side effects of successful treatment in cancer survivors.

In addition, further work needs to be conducted to investigate alternative methods to provide a higher level of communication to our patients that is easy to understand and memorable. Leaflets and consultations are not necessarily the best way to educate and prepare patients. An alternative education program and coping strategies must be considered to provide patients with cancer, caregivers, and survivors the tools to manage their needs.

Implications for Urologic Nursing

Patients are living longer beyond their initial cancer diagnosis. The physical and psychological impact of unmet needs on patients and their caregivers is a concern for survivors of cancer. We should be asking patients specific questions and having patients complete HNAs regularly to assess their needs. Tools, such as HNAs, will help nurses identify and better address patients' concerns and problems within an acceptable timeframe. Current pathways may need redesigning to facilitate this approach.

Research Summary

Introduction

Despite successful treatment for cancer, many survivors still experience unmet needs affecting their quality of life.

Purpose

The purpose of this study was to assess the unmet needs of patients following treatment for prostate cancer.

Methods

This study reviewed prostate cancer patients' experiences at multiple stages in time along their pretreatment and post-treatment journey in the United Kingdom (U.K.). Questions assessed both physical and psychological needs, how much support they received pre-treatment and posttreatment, and how they were able to cope with the sequelae of various treatment modalities.

Results

In this study, 250 questionnaires were sent to subjects who had undergone prostate cancer treatment. Of those, 106 (42%) questionnaires were completed and returned. We found that 96% of subjects experienced adverse effects during and after treatment, and 36% had unmet needs longterm. Unmet needs included erectile dysfunction, incontinence, tiredness, hot flashes, lower urinary tract symptoms, rectal bleeding, and relationship issues.

Conclusion

High level of subject support by healthcare professionals still leads to a considerable number of unmet needs. Improved counseling leads to better treatment choices. Better treatment choices lead to better outcomes. Improvements need to support patients for better quality of life.

Level of Evidence--VI

(Polit & Beck, 2012)

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Paula Allchorne, MBA, RGN, is a Senior/Lead Clinical Nurse Specialist, Guys and St Thomas NHS Foundation Trust and Barts Health NHS Trust, London, England, United Kingdom.

James Green, LLM, FRCS (Urology), is a Consultant Urological Surgeon, Barts Health NHS Trust; and a Visiting Professor, London South Bank University, London, England, United Kingdom.
Table 1.
Demographics--Percentage of Ethnicity and Age Range

           Black   White   Mixed   Asian   Other   Unknown

40 to 50    1       1        0      0        1       0
51 to 60    4.7    13.2      0      0        0       1
61 to 70    4.7    26.4      1      3.7      0       1.8
71 to 80    3.8    22.6      0      0        0       1.8
81 +        1       9.4      0      0        0       1.8

Table 2.
Percentage of Symptoms During, on Completion, and
Up to 18 Months Post-Treatment

Patients Experiencing Symptoms

             RARP   EBRT   BRACHY   LHRH   A/S

ED       A    30     50      24      40    17
         B    63     54      48      33    33
         C    70     63      67      33    25

RELAT    A     4      8       0       7     8
         B     4      8       5       7     0
         C     7      8      10       7     0

CONT     A    26     21       5      27     8
         B    41     21      14      27     8
         C    22     21      19      33     0

TIRED    A    30     54      24      53     8
         B    26     54      19      40     8
         C    15     63      19      47     0

FLASH    A     4     33       5      73     8
         B     7     46       5      60     0
         C    11     46       5      73     0

LUTS     A    19     21      19      20    25
         B    30     21      52      20    25
         C    22     33      43      20    17

RECTAL   A     0     13       5       0     0
         B     0      8      10       7     8
         C     0      8       5       7    18

Key:
A = Initiation of treatment.
B = On completion of treatment.
C = Up to 18 months post-treatment.

Symptoms: ED = erectile dysfunction, CONT = continence,
TIRED = tiredness, FLASH = hot flashes, LUTS = urinary symptoms,
RECTAL = rectal bleeding, RELAT = relationship issues.

Table 3.
Percentage of Subjects Who Experienced Continuing
Symptoms or Problems Throughout the Totality of Their Treatment
(from Initiation of Treatment, Continuation of Treatment, and
Up To 18 Months Post-Treatment)

Unresolved Symptoms--Throughout and on Completion of Treatment

         ED   CONT   TIRED   FLASH   LUTS   RECTAL   RELAT

RARP     26    11      7       0      11      0        0
EBRT     45    21     42      45      21      0        8
BRACHY   14     5      5       0      19      0        0
LHRH     13    20     27      33      13      0        7
A/S       8     0      0       0       8      0        0

Symptoms: ED = erectile dysfunction, CONT = continence,
TIRED = tiredness, FLASH = hot flashes, LUTS = urinary symptoms,
RECTAL = rectal bleeding, RELAT = relationship issues.

Table 4.
Percentage of Subjects' Confidence in Coping with the
Following Symptoms

Unresolved Symptoms--Throughout and on Completion of Treatment

                      ED  CONT  TIRED  FLASH  LUTS  RECTAL  RELAT

Not at all confident  37   17    11    11      15     25      7
Moderately confident  34   39    41    44.5    48     31     29
Completely confident  29   44    48    44.5    37     44     64

Note: ED is the predominate unmet need. Patients were asked "How
confident did you feel coping after your consultation."

Symptoms: ED = erectile dysfunction, CONT = continence,
TIRED = tiredness, FLASH = hot flashes, LUTS = urinary symptoms,
RECTAL = rectal bleeding, RELAT = relationship issues.

Table 5.
Percentage of Subjects' Confidence in Coping with
ED after Consultation

                                      Not at
Coping                                 All     Moderately   Completely

Confidence in coping with your ED       37         34           29
symptoms post treatment

Were your ED symptoms addressed         37         32           31
after your treatment

How confident did you feel coping       24         35           41
with your ED symptoms after your
consultation

Symptoms: ED = erectile dysfunction, CONT = continence,
TIRED = tiredness, FLASH = hot flashes, LUTS = urinary symptoms,
RECTAL= rectal bleeding, RELAT = relationship issues.

Table 6.
Recall of Information

Number of Patients Who Remembered Receiving Information on
How to Manage Their Symptoms (N = 106)

             ED   CONT   TIRED   FLASH   LUTS   RECTAL   RELAT

Leaflets     19    24     24      19      22       7      14
Nurse        28    21     18      20      29       9      10
Consultant   24    15     15       7      20       8       6
Internet      3     4      4       4       2       1       2
None         43    56     58      64      47      78      74

Symptoms: ED = erectile dysfunction, CONT = continence,
TIRED = tiredness, FLASH = hot flashes, LUTS = urinary symptoms,
RECTAL = rectal bleeding, RELAT = relationship issues.
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Title Annotation:Research/Quality Improvement Project
Author:Allchorne, Paula; Green, James
Publication:Urologic Nursing
Geographic Code:4EUUK
Date:Sep 1, 2016
Words:6396
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