Liam Bourke1, Stephen A Boorjian2, Alberto Briganti3, Laurence Klotz4, Lorelei Mucci5, Matthew J Resnick6, Derek J Rosario7, Ted A Skolarus8, David F Penson9. 1. Health and Wellbeing Research Institute, Sheffield Hallam University, Sheffield, UK. Electronic address: l.bourke@shu.ac.uk. 2. Department of Urology, Mayo Clinic, Rochester, MN, USA. 3. Division of Oncology/Unit of Urology, Urological Research Institute, IRCCS Ospedale San Raffaele, Milan, Italy. 4. Sunnybrook Health Sciences Centre, Toronto, ON, Canada. 5. Harvard School of Public Health, Department of Epidemiology, Boston, MA, USA. 6. Department of Urologic Surgery, Center for Surgical Quality and Outcomes Research, Vanderbilt University Medical Center, Nashville, TN, USA. 7. University of Sheffield, Department of Oncology, Sheffield, UK. 8. Department of Urology, University of Michigan, VA Health Services Research and Development Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA. 9. Vanderbilt University Department of Urologic Surgery and VA Tennessee Valley Healthcare System, Nashville, TN, USA.
Abstract
CONTEXT: Long-term survival following a diagnosis of cancer is improving in developed nations. However, living longer does not necessarily equate to living well. OBJECTIVE: To search systematically and synthesise narratively the evidence from randomised controlled trials (RCTs) of supportive interventions designed to improve prostate cancer (PCa)-specific quality of life (QoL). EVIDENCE ACQUISITION: A systematic search of Medline and Embase was carried out from inception to July 2014 to identify interventions targeting PCa QoL outcomes. We did not include nonrandomised studies or trials of mixed cancer groups. In addition to database searches, citations from included papers were hand-searched for any potentially eligible trials. EVIDENCE SYNTHESIS: A total of 2654 PCa survivors from 20 eligible RCTs were identified from our database searches and reference checks. Disease-specific QoL was assessed most frequently by the Functional Assessment of Cancer Therapy-Prostate questionnaire. Included studies involved men across all stages of disease. Supportive interventions that featured individually tailored approaches and supportive interaction with dedicated staff produced the most convincing evidence of a benefit for PCa-specific QoL. Much of these data come from lifestyle interventions. Our review found little supportive evidence for simple literature provision (either in booklets or via online platforms) or cognitive behavioural approaches. CONCLUSIONS: Physical and psychological health problems can have a serious negative impact on QoL in PCa survivors. Individually tailored supportive interventions such as exercise prescription/referral should be considered by multidisciplinary clinical teams where available. Cost-effectiveness data and an understanding of how to sustain benefits over the long term are important areas for future research. PATIENT SUMMARY: This review of supportive interventions for improving quality of life in prostate cancer survivors found that supervised and individually tailored patient-centred interventions such as lifestyle programmes are of benefit.
CONTEXT: Long-term survival following a diagnosis of cancer is improving in developed nations. However, living longer does not necessarily equate to living well. OBJECTIVE: To search systematically and synthesise narratively the evidence from randomised controlled trials (RCTs) of supportive interventions designed to improve prostate cancer (PCa)-specific quality of life (QoL). EVIDENCE ACQUISITION: A systematic search of Medline and Embase was carried out from inception to July 2014 to identify interventions targeting PCa QoL outcomes. We did not include nonrandomised studies or trials of mixed cancer groups. In addition to database searches, citations from included papers were hand-searched for any potentially eligible trials. EVIDENCE SYNTHESIS: A total of 2654 PCa survivors from 20 eligible RCTs were identified from our database searches and reference checks. Disease-specific QoL was assessed most frequently by the Functional Assessment of Cancer Therapy-Prostate questionnaire. Included studies involved men across all stages of disease. Supportive interventions that featured individually tailored approaches and supportive interaction with dedicated staff produced the most convincing evidence of a benefit for PCa-specific QoL. Much of these data come from lifestyle interventions. Our review found little supportive evidence for simple literature provision (either in booklets or via online platforms) or cognitive behavioural approaches. CONCLUSIONS: Physical and psychological health problems can have a serious negative impact on QoL in PCa survivors. Individually tailored supportive interventions such as exercise prescription/referral should be considered by multidisciplinary clinical teams where available. Cost-effectiveness data and an understanding of how to sustain benefits over the long term are important areas for future research. PATIENT SUMMARY: This review of supportive interventions for improving quality of life in prostate cancer survivors found that supervised and individually tailored patient-centred interventions such as lifestyle programmes are of benefit.
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