Patient activation and patient-reported outcomes of men from a community pharmacy lifestyle intervention after prostate cancer treatment

Agnieszka Lemanska,Ralph Manders,Gary Warner,John Marshall,Zachariah Nazar,Lauren Turner,Kevin Noble,Bruce A Griffin,John M Saxton,Sara Faithfull,Karen Poole

doi:10.1007/s00520-021-06404-5

Abstract

PurposeTo report patient activation, which is the knowledge, skills, and confidence in self-managing health conditions, and patient-reported outcomes of men after prostate cancer treatment from a community pharmacy lifestyle intervention.MethodsThe 3-month lifestyle intervention was delivered to 116 men in nine community pharmacies in the UK. Patient Activation Measure (PAM) was assessed at baseline, 3 and 6 months. Prostate cancer-related function and quality of life were assessed using the European Prostate Cancer Index Composite (EPIC-26) and EuroQOL 5-dimension 5-level (EQ5D-5L) questionnaires at baseline and 6 months. Lifestyle assessments included Mediterranean Diet Adherence Screener (MEDAS) at baseline, 3 and 6 months and Godin Leisure Time Exercise Questionnaire (GLTEQ) at baseline and 3 months.ResultsPAM score increased from 62 [95% CI 59–65] at baseline to 66 [64–69] after the intervention (p = 0.001) and remained higher at 6 months (p = 0.008). Scores for all the EPIC-26 domains (urinary, bowel and hormonal) were high at both assessments, indicating good function (between 74 [70–78] and 89 [86–91]), except sexual domain, where scores were much lower (21 [17–25] at baseline, increasing to 24 [20–28] at 6 months (p = 0.012)). In EQ5D-5L, 3% of men [1–9] reported self-care problems, while 50% [41–60] reported pain and discomfort, and no significant changes over time. Men who received androgen deprivation therapy, compared with those who did not, reported higher (better) urinary incontinence scores (p < 0.001), but lower (worse) scores in the urinary irritative/obstructive (p = 0.003), bowel (p < 0.001) and hormonal (p < 0.001) domains. Poor sexual function was common across all age groups irrespective of prostate cancer treatment.ConclusionsThe intervention led to significant improvements in patient activation, exercise and diet. Community pharmacy could deliver effective services to address sexual dysfunction, pain and discomfort which are common after prostate cancer.

Highlights

IntroductionAndrogen deprivation therapy (ADT), have been shown to negatively affect prostate cancer-related function and quality of life [1]
Prostate cancer treatments, and androgen deprivation therapy (ADT), have been shown to negatively affect prostate cancer-related function and quality of life [1]
This study provides new insights into the impact of a community pharmacy-based lifestyle intervention on important health-related quality of life domains in men treated for prostate cancer

Summary

Introduction

Androgen deprivation therapy (ADT), have been shown to negatively affect prostate cancer-related function and quality of life [1]. Because most men (80%) live 10 years or more after cancer diagnosis, and prostate cancer is classed as a long-term condition, men are more likely to require greater support from. Extended author information available on the last page of the article primary care and community health and wellbeing services for their long-term needs [3]. Community health and wellbeing services, and community pharmacies, could become important points of contact for men to consult about erectile dysfunction, urinary, bowel or hormonal problems such as weight gain, depression or lack of energy which are common after prostate cancer [4]. As outlined in the long-term plan for the primary care reform in the UK (2019) [5], further research and policy changes are needed to optimise the role of community pharmacies in addressing long-term health-related needs of cancer survivors.

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Discussion

Conclusion