ProsCan For Men: Randomised Controlled Trial Of A Decision Support Intervention For Men With Localised Prostate Cancer

Main Category: Prostate / Prostate Cancer
Also Included In: Urology / Nephrology;  Cancer / Oncology
Article Date: 03 Sep 2008 - 1:00 PDT

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UroToday.com - With advances in treatment for prostate cancer and the often deleterious side-effects of treatment, newly diagnosed men are faced with difficult treatment decisions. For men with localised disease, the complexity of treatment decision-making is enhanced by the notion that some tumours are indolent in nature and therefore unlikely to ever cause clinical concern or death if left untreated. As a result, many men experience high treatment decision-related distress and for some men this can persist even up to 12 months after treatment. Therefore, supporting men to make informed treatment decisions is of primary interest.

In Australia the specialist nurse role has been identified in national cancer strategy documents as a key strategy for facilitating psychosocial support and promoting adjustment for people affected by cancer. We have therefore developed a decision support and psycho-education intervention utilising the prostate care nurse model, ProsCan for Men. This intervention is the first support intervention to be trialled internationally that combines decision support with the specialist nurse model for prostate cancer patients.

ProsCan for Men utilises a tele-based method of delivery to ensure broader reach of the intervention owing to the geographical dispersion of the Queensland population. Furthermore, the tele-based approach provides greater potential for ProsCan for Men to translate into existing health services, such as Cancer Helplines.

Planning and development of ProsCan for Men, including development of the Nurse Counsellor Manual and patient resources and piloting, occurred over a 16 month period. Results from the pilot study have been encouraging. The pilot sample showed significant decreases in decisional conflict and intrusive thoughts (p<.001; p<.005) and these decreases were greater than those found in a comparison sample of men who did not receive the intervention.

The randomised controlled trial (RCT) of ProsCan for Men has been underway since September 2005. Three hundred and fifty men per condition (700 men in total) have been recruited after diagnosis and before treatment and randomised to 1) the tele-based nurse delivered five session decision support and psychosocial intervention or 2) usual care. Recruitment required significant support from both clinicians in Queensland and the Urological Society of Australia and New Zealand. Data collection from the RCT will be completed in 2011. Multilevel modelling and growth mixture modelling will be applied to analyse longitudinal differences in outcome. We anticipate that publications on the early results of the RCT will be available in 2009.

The following publications describe ProsCan for Men in more detail:

Chambers SK, Ferguson M, Gardiner RA, Nicol D, Gordon L, Occhipinti S, Aitken J. ProsCan for Men: Randomised controlled trial of a decision support intervention for men with localised prostate cancer. BMC Cancer 2008, 8:207.

Steginga SK, Ferguson M, Clutton S, Gardiner RA, Nicol D. Early decision and psychosocial support intervention for men with localised prostate cancer: an integrated approach. Supportive Care in Cancer 2008, 16:821-829.

ProsCan for Men is supported by grants from the Cancer Council Queensland and the National Health and Medical Research Council.

Our work in supporting men newly diagnosed with prostate cancer has led to the development of a sexuality support intervention for couples following surgery for prostate cancer, ProsCan for Couples. We will be undertaking a RCT of ProsCan for Couples in 2008. The following publication describes the protocol for this study:

Chambers SK, Schover L, Halford K, Clutton S, Ferguson M, Gordon L, Gardiner RA, Occhipinti S, Dunn J. ProsCan for Couples: Randomised controlled trial of a couples-based sexuality intervention for men with localised prostate cancer who receive radical prostatectomy. BMC Cancer 2008, 8:226.

Written by Megan Ferguson, MD, as part of Beyond the Abstract for UroToday.com

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