Abstract
PurposeTo evaluate the effectiveness of the symptom management after radiotherapy (SMaRT) group intervention to improve urinary symptoms in men with prostate cancer.MethodsThe randomised controlled trial (RCT) recruited men from one radiotherapy centre in the UK after curative radiotherapy or brachytherapy and with moderate to severe urinary symptoms defined as scores ≥ 8 on the International Prostate Symptom Score (IPSS) questionnaire. Sixty-three men were randomised either; to SMaRT, a 10-week symptom-management intervention including group support, education, pelvic floor muscle exercises, or a care-as-usual group. The primary outcome was the IPSS at 6 months from baseline assessment. Secondary outcomes were IPSS at 3 months, and International Continence Society Male Short Form (ICS), European Organisation for Research and Treatment of Cancer Quality of Life prostate scale (EORTC QLQ-PR25), EORTC QLQ-30 and Self-Efficacy for Symptom Control Inventory (SESCI) at 3 and 6 months from baseline. Analysis of covariance (ANCOVA) was used to analyse the effect of the intervention.ResultsSMaRT group intervention did not improve urinary symptoms as measured by IPSS at 6-months. The adjusted difference was − 2.5 [95%CI − 5.0 to 0.0], p = 0.054. Significant differences were detected at 3 months in ICS voiding symptoms (− 1.1 [− 2.0 to − 0.2], p = 0.017), ICS urinary incontinence (− 1.0 [− 1.8 to − 0.1], p = 0.029) and SESCI managing symptoms domain (13.5 [2.5 to 24.4], p = 0.017). No differences were observed at 6 months.ConclusionsSMaRT group intervention provided short-term benefit in urinary voiding and continence and helped men manage symptoms but was not effective long term.
Highlights
Prostate cancer (PCa) is one of the most commonly diagnosed cancers in men and accounts for 26% of all new UK male cancer cases [1]
Men were stratified for the type of radiotherapy treatment (EBRT vs BT) and randomisation was provided by a registered clinical trials unit
Three participants in the intervention group withdrew prior to the first session due to travel issues, one control and one intervention participant were lost to follow-up, one intervention participant had missing International Prostate Symptom Score (IPSS) scores at final assessment and one control participant died
Summary
Prostate cancer (PCa) is one of the most commonly diagnosed cancers in men and accounts for 26% of all new UK male cancer cases [1]. Quality-of-life in men living with and beyond PCa can be impacted by long-term side effects post-treatment, with the prevalence of erectile dysfunction (87%,) urinary symptoms (20%) and bowel disturbance (14%) occurring up to 12 years after PCa treatment [6]. In a USA study of Medicare claims, the adjusted risk of grade 2–4 (moderate to severe) urinary symptoms after radiotherapy for PCa was OR 2.49 (95% CI: 2 to 3.11) times that of men without treatment at 10 years [7]. A recent UK population study exploring self-reported symptoms and quality of life in 13,097 men 18–42 months post-PCa diagnosis found 13.5% of men reported moderate to severe bother with urinary symptoms and those with urinary bother were more likely to have poorer mental health OR 2.89 (2.54 to 3.27) and severe psychological distress OR 3.69 (3.12–4.38) [8]. Whilst interventions are available for acute symptoms, long-term urinary symptoms after PCa are often poorly addressed reducing men’s ability to socialise and impacting men’s daily activities [9]
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