New Recommendations for Post-Treatment Care of Prostate Cancer Survivors
Guidelines aid transition from specialty to primary care
Many of the more than 2.5 million men in the U.S. who have received treatment for prostate cancer deal with the often disabling side effects of surgery and of radiation and hormonal therapies.
To aid in the transition of these patients from specialty to primary care for long-term management of problems such as urinary incontinence and sexual and bowel dysfunction, updated guidelines for prostate cancer survivorship care have been published in the Journal of Men’s Health. The article is available free on the journal’s Web site until September 4, 2014.
The Michigan Cancer Consortium convened a multidisciplinary panel of clinicians, public health experts, patients, and consumers from across the state to update the Consortium’s 2009 Guidelines for the Primary Care Management of Prostate Cancer Post-Treatment Sequelae.
The modified recommendations now include the following elements: 1) patient-reported symptom assessment; 2) distinctions between medical and self-management strategies for prostate cancer treatment-related side effects; 3) recommendations for involving partners in survivorship care; and 4) care coordination strategies for primary and specialty care providers. Online guidance for medical therapy and self-management resources are also provided.
Key recommendations include the following:
- Treatment-related symptom assessment: Primary care providers should assess the severity of symptoms due to prostate cancer and its treatments during routine clinical care. Instruments include the Expanded Prostate Cancer Index Composite (EPIC)–Short Form, its abridged Clinical Practice (EPIC-CP) version, and others.
- Managing urinary-control problems: Men experiencing urinary problems may benefit from pyridium, alpha-adrenergic blockers (e.g., tamsulosin), and anticholinergic therapy (e.g., oxybutynin). Patients may be referred to a local physical therapist to explore pelvic-floor rehabilitation options.
- Managing sexual side effects: Using EPIC to understand pre- and post-operative function provides an objective measure of sexual health recovery. Approaches to recovery include pharmacologic therapy, self-management techniques, device use, and referral for specialized care.
- Managing bowel symptoms after radiation therapy: Frequent and/or loose stools are often effectively treated with antidiarrheals, such as loperamide, which can also decrease urgency. Fiber supplements can help patients who have either loose stools or constipation. Bleeding may be reduced with fiber supplements, stool softeners, and dietary modifications to avoid constipation. Topical steroids, topical sucralfate, and 5- aminosalicylic acid enemas can also decrease bleeding.