Abstract
BackgroundThis study aimed to explore the opinions of healthcare professionals regarding the management of men with advanced prostate cancer with particular emphasis on treatment timing and sequencing; treatment adverse-effects and exercise a supportive therapy.MethodsSemi-structured interviews with a purposively selected group of healthcare professionals involved in prostate cancer care within the NHS, conducted over the phone or face to face. A total of 37 healthcare professionals participated in the interviews including urologists, clinical oncologists, medical oncologists, clinical nurse specialists, general practitioners, physiotherapists, exercise specialists, service managers, clinical commissioners and primary care physicians.ResultsThe availability of newer treatments for advanced prostate cancer as well as results from the STAMPEDE and CHAARTED trials has resulted in new challenges for patients and HCPs. This includes the impact of an increased workload on oncologists, a potential lack of clinical continuity between urology and oncology and uncertainties regarding optimal selection, timing and sequencing of chemotherapy and second-line treatment. Fitness for treatment in advanced prostate cancer populations remains a significant barrier to accessing therapies for patients with a poor performance status. Among this, muscle wastage can significantly affect performance status and consequentially compromise cancer therapy. Exercise was regarded as a potential therapy to mitigate the adverse-effects of treatment including the prevention or reduction in muscle wastage.ConclusionsThere is a lack of data guiding clinicians in this post STAMPEDE and CHAARTED era, work is needed to reassess and optimize the prostate cancer care pathway as it evolves. Exercise should be explored as a therapeutic option to mitigate the effects of long term ADT. Further study from a wider cohort of both prostate cancer care specialists and patients will aid in establishing a highly functioning pathway with optimal individualised care.Trial registrationSustained exercise TrAining for Men wIth prostate caNcer on Androgen deprivation: the STAMINA programme (RP-DG-1213-10,010). REC Reference: 15/SW/0260 IRAS Project ID: 178340 Hospital ID: STH 18391 approved on 24/08/2015.
Highlights
This study aimed to explore the opinions of healthcare professionals regarding the management of men with advanced prostate cancer with particular emphasis on treatment timing and sequencing; treatment adverse-effects and exercise a supportive therapy
Until 2010, docetaxel chemotherapy remained the only therapy for castrate resistant prostate cancer (CRPC) which demonstrated a significant survival benefit (18.9 months vs 16.5 months in the docetaxel groups vs mitoxantrone group) [1, 2]
Improvements in survival of men with the use of docetaxel at earlier stages of metastatic (M1) prostate cancer have been demonstrated in the recent multicentre randomized controlled trials STAMPEDE and CHAARTED [9,10,11] .The introduction of docetaxel upon initiation of androgen deprivation therapy (ADT) had a significant survival benefit when compared to the ADT group alone in hormone-sensitive M1 disease (57.6 vs 44.0 months, 95% CI 0.47 to 0.81; P < 0.001) [9]
Summary
This study aimed to explore the opinions of healthcare professionals regarding the management of men with advanced prostate cancer with particular emphasis on treatment timing and sequencing; treatment adverse-effects and exercise a supportive therapy. In 2015 changes in clinical practice followed and an increasing number of men will receive chemotherapy earlier in their prostate cancer care pathway. This rapid growth in treatment options since 2010 and the uncertainty around the efficacy of newer agents in the post-docetaxel setting (due to earlier exposure to docetaxel) presents oncologists and urologists with issues concerning the optimal sequencing and adherence to subsequent treatment regimens as well as potential adverse-effects of cytotoxic agents and the impact on quality of life (QoL) [12]. Establishing coherent and optimised care pathways offers obvious benefits for impacting treatment outcomes, and creates a culture of ownership, responsibility and accountability within the clinical team [13]
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