Prostate cancer survivorship and psychosexual care.

Abstract

There have been a number of papers recently that raise significant issues in the treatment of erectile dysfunction in the survivorship population. Cancer survivorship is an increasing issue. Currently, within the UK, 250 000 patients have prostate cancer. According to the National Cancer Institute in the USA, cancer survivorship encompasses the ‘physical, psychosocial, and economic issues of cancer from diagnosis until the end of life’ (Geiger et al. 2008). These unmet needs and large numbers of patients are a significant burden on the healthcare system (Richards et al. 2011). To identify and address this, the National Cancer Survivorship Initiative was created (Maher 2013). As part of their work, ‘key’ shifts in attitude towards care were noted. The focus of this work conducted by the National Cancer Survivorship Initiative was to help patients to get back to a normal life once cured. Normal life – this can be extended to include normal sexual function. There are three points that need to be addressed here. First, while we are monitoring the patient for recurrence, are we addressing their co-morbidities? Beehler et al. (2009) demonstrated survivors had many primary care visits, but no contact with ‘holistic’ care support, for example dieticians, nutritionists, exercise rehabilitation. Presence of serious co-morbidity has also been closely linked to health-related quality of life. Khan et al. (2010) demonstrated a robust follow-up system of primary care is required as part of this. Furthermore, erectile dysfunction was studied by Neese et al. (2003). Educational materials were used as part of the study, to determine the impact. Despite this, 43% of men found their partners did not encourage them to find other sources of support. This work was also covered by Schover et al. (2012), who conducted a survey style intervention and discovered sexual counselling is very often the key. Further contributing to this ‘unspoken’ epidemic, Baker et al. (2005) demonstrated 68.1% of patients involved were concerned that their disease had recurred, with psychological problems focusing on fear. This indicates a valid role for healthcare professionals in prevention of depression and anxiety within this cohort. Despite this, not many have psychosexual counsellors available to address this need as part of a structured survivorship programme. Only 43% of men said their partners had encouraged them to find help with sexual impairment (Neese et al. 2003). This can be an area, which patients, are not comfortable discussing themselves. This could be addressed by adequate Survivorship care and guidelines, which are lacking. Great steps forward have been taken by addition of a section to the European Association of Urology congress on Prostate Cancer Survivorship and Supportive Care, but this can be further developed and supported, with the development of guidance for this cohort.