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BLOG: Reflections of a Prostate Cancer Specialist Nurse

Chris_McNamara
Community Manager
Community Manager
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Reflections of a Prostate Cancer Specialist Nurse

Kerry S PCSN.jpegKerry Santoro, Prostate Cancer Specialist Nurse (Southern Adelaide Local Health Network) says that around 200 prostate cancer patients are diagnosed within her local health network each year, and that generally they remain in contact for a period of three years, meaning that at any one time Kerry is managing up to 600 patients on a rolling basis, consulting with 10 to 20 each day1.

Boxhall and Dougherty (also from Adelaide) aimed their research at focus groups in order to seek men’s opinions and experiences with a specialist nurse. There was unanimous agreement that support services provided through a nurse, who worked as part of the clinical team, was beneficial. The study found that men appreciated the opportunity for further discussion where they felt less constrained by time pressures2.

According to a study by Turner et al, the nurse should give the patient psychological support prior to surgery, because the main risks of the procedure include incontinence and erectile dysfunction. General well being and risk factors for surgery are assessed and education is provided by nurses. Any anxieties the patient or their carers may have, also has the opportunity to be addressed at this time3.

The power of social network tools (e.g. Facebook) and telecommunication (cell phones) can also be harnessed to facilitate communication and strengthen supportive communities that can provide both practical and emotional support for care pressed for time, so being able to post health updates and requests for assistance to a broad range of family and friends could be a great resource4.

Education too, forms a significant part of the role, with the abovementioned nurse Kerry often outlining both how the disease behaves, the benefits and shortfalls of various treatment options, while also connecting patients with other relevant health services.

She facilitates involvement with clinical trials and research, keeps abreast of the latest research, and also engages closely with her fellow staff and local support groups for Prostate Cancer.

Duties range from patient-facing focus in close consultation with urologists at SALHN, while other days will involve phone consults, the management of other significant projects and “upgrading guidelines and protocols”1. Nurses have traditionally been the profession most concerned with holistic care. As educators, nurses can provide accurate information, dispel myths, and correct misinformation3.

Cockle-Hearn et al’s study sought to explore the relative predictive impact of prostate-specific dimensions of nursing care on the scope and extent of men’s unmet supportive care needs across seven countries within Europe5. Data in the study shows that nurse provision leads to improvements in the management of chronic problems; increases patient knowledge and self-management; improved patient symptoms; and can lead to reduced use of acute services.

Men with prostate cancer diagnoses also place importance on expert knowledge. In Boxhall’s study (above) the practitioner was always alert to practice boundaries when counselling men through decision-making processes and was cautious not to “give an opinion” even when often asked by men at this vulnerable time. Nursing experience, not gender, was more important to this group of men, even given the intimate issues surrounding this disease2.

Further to the educational aspect of the nursing role, there is also an increasing focus on nurse-led clinics that focus on “cancer survivorship”, an area that Kerry describes as part of an “emerging field”, and one that allows her to ensure “continuity of care” while monitoring symptoms and side-effects that may have resulted from cancer treatment1.

Survivorship results in a requirement for healthcare monitoring and challenges providers of cancer care to effectively respond to men’s long-term supportive care needs. In addition to disease and treatment characteristics, lack of contact with a nurse or advice and support from a nurse has been associated with men’s unmet needs. Current services may not be addressing on-going concerns that have an impact on men’s long-term distress. It’s evident that access to supportive nursing care can influence patient outcomes, and there are areas of care, in particular after treatment, that nursing could improve5.

Post-surgical treatment may involve wound care, catheter management, preparing patients for their results and dealing with any anxieties around PSA results and follow up3.

Clinical care includes advice on symptoms of infection, continence products, erectile dysfunction, strictures, post-treatment depression, allied health care resources, and domestic supports. Viewed from the nurse’s perspective, this role has evolved to additionally include liaison, counselling, advocacy, and research. The specialist nurse is seen to complement medical care in providing information, emotional support, and practical assistance with managing treatment side effects2.

A fundamental shift is required in survivorship care to improve outcomes for men with prostate cancer, especially after treatment is completed. Furthermore, more consistent provision of nurses across the care pathway, with training to address sexual dysfunction and psychological care, should be a priority for enhancing supportive care5.

For those who receive radiation therapy the specialist nurse may allay any anxieties around treatment side-effects or discomfort. In more advanced prostate cancer hormonal treatment in the form of injections may need to be administered. These are associated with significant physical and psychological side effects necessitating psychosocial support3.

Men in Cockle-Hearn’s study reported higher levels of unmet need in relation to specific treatment modalities, including chemotherapy and radical prostatectomy, which was strongly predictive of need for help with physical and daily living issues and unmet sexuality needs.

Whether after-care is received from primary care, urology, and oncology it is important that all professionals recognise the extent of long-term consequences experienced by cancer patients. Services therefore need to provide effective and targeted supportive care for men after prostate cancer treatment to meet this expanding population of survivors5.

As discussed in detail above, specialist cancer nursing is widely recognized as an essential part of cancer care, meeting information needs, providing technical expertise, coordination and offering emotional support. Studies in the UK have also demonstrated a clear relationship between positive patient experience and specialised cancer nurse access6. Patient satisfaction with health-care provision is an important measure in assessing the structure and process of cancer care. Lack of this care is associated with reduced quality-of-life including decline in post-treatment physical function5.

Nursing can be emotionally taxing like when having to break bad news such as return of disease (recurrence). Communication is key and an “advanced nursing level” is required for the role, as such a corresponding level of “autonomy and independence” will also be needed from the nurse1. Autonomy and empowerment have been recognised as key ‘magnet factors’ in attracting and keeping high quality staff6. The importance of working in a team with doctors, other nurses and administration staff should also not be discounted. Nurse Kerry perhaps sums up best how rewarding specialist nursing can be though, when she says, “The thanks that I get from men and their families, for just being that point of contact, for supporting them, for caring for them throughout their pathway is very satisfying.”

 

References:

  1. Kerry Santoro, Prostate cancer specialist nurse from the Southern Adelaide Local Health Network. Australian nursing and midwifery journal. 18 May 2021.
  2. Boxhall S, Dougherty M. An evaluation of a specialist nursing role for men with prostate cancer. Urologic Nursing 2003; 23(2); 148-152.
  3. Turner, B. Diagnosis and treatment of patients with prostate cancer: the nurse's role. Nursing Standard 2007; 21(39): 48-56.
  4. Chambers S, Pinnock C, Lepore S, Hughes S, O’Connell D (2011) A systematic review of psychosocial interventions for men with prostate cancer and their partners. Patient Educ Couns 85(2): e75–e88.
  5. Cockle-Hearne, J et al. The impact of supportive nursing care on the needs of men with prostate cancer: a study across seven European countries. Br J Cancer 2013; 109; 2121-30.
  6.  Leary A et al. The specialist nursing workforce caring for men with prostate cancer in the UK. Int J of Urol Nurs 2016; 10 (1): 5–13.

 

Kalli Spencer.png

 

 

 About the Author

Kalli Spencer

MBBCh, FC Urol (SA), MMed (Urol), Dip.Couns (AIPC)

Kalli is an internationally renowned Urological Surgeon, specialising in oncology and robotic surgery. He trained and worked in South Africa, before relocating to Australia where he has worked at Macquarie University Hospital and Westmead Hospital. His passion for what he does extends beyond the operating room, through public health advocacy, education and community awareness of men’s health, cancer and sexuality.

Kalli has been involved with the Prostate Cancer Foundation of Australia for many years, advocating for improved cancer care and facilitating community prostate cancer support groups.

 

 

Help is Available
 

Prostate Cancer Specialist Telenursing Service:

If your life has been impacted by prostate cancer, our Specialist Telenursing Service is available to help. If you would like to reach out to the PCFA Prostate Cancer Specialist Telenurse Service for any questions you have about your prostate cancer experience, please phone 1800 22 00 99 Monday - Friday 9am - 5pm, Wednesday 10am-8pm (AEST).

 

Prostate Cancer Support Groups:

PCFA is proud to have a national network of affiliated support groups in each state and territory of Australia consisting of men and women who have a passion for assisting others who encounter prostate cancer. This network is made up of over 170 affiliated groups who meet locally to provide one-to-one support, giving a vision of life and hope after treatment. Call us on 1800 22 00 99 to find your local group.

 

MatesCONNECT Telephone-based peer support:

MatesCONNECT is a telephone-based peer support program for men affected by prostate cancer. If you’ve recently been diagnosed with prostate cancer, our MatesCONNECT service can connect you to a trained volunteer who understands what you’re going through. All of our volunteers have been through prostate cancer. Simply call us on 1800 22 00 99 to be connected with a volunteer.

 

Newly diagnosed? or need to find more information -Access the PCFA resources here!

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