Summary

Prostate cancer is the most common type of cancer among men in the United Kingdom (UK).1 Care following radiotherapy and/or surgery involves regular follow-up appointments, often with a specialist in a hospital.2 Men with prostate cancer may find it difficult to attend hospital appointments and may see a different healthcare professional each time.3 4 In addition, appointments may be too short to discuss sensitive issues such as incontinence. To overcome some of these challenges, The Christie NHS Foundation Trust introduced community-based  prostate cancer clinics led by specialist nurses.2 The seven community clinics across Greater Manchester, Lancashire and Cheshire support approximately 85% of men who have undergone treatment for prostate cancer at the trust.5 In addition, the service has been well-received by men with prostate cancer.2

Challenge

Prostate cancer is the most common cancer diagnosis among men in the UK, with an estimated 48,500 new diagnoses made every year.1 The 10-year survival rate for prostate cancer is almost 80%, following improvements in diagnosis and advances in treatment.1

Men who have undergone radiotherapy and/or surgery for prostate cancer require regular follow-up appointments with a specialist, often in a hospital outpatient setting.2 During these appointments, the specialist will discuss the results of blood tests used to monitor treatment effectiveness and offer advice on side effects and any additional concerns.

Men with prostate cancer may find it difficult to attend hospital appointments if they have to travel long distances, lack suitable transport or struggle with hospital parking.3 4 In addition, hospital appointments may be too short to discuss important issues such as treatment side effects and emotional wellbeing.3 6 Men with prostate cancer have also reported that they often see a different healthcare professional at each appointment, making it difficult to disclose and discuss sensitive issues, such as sexual dysfunction or incontinence, which can be side effects of prostate cancer treatment.3 4 7

Solution

In 2014, The Christie NHS Foundation Trust piloted a community-based prostate cancer clinic led by a specialist nurse, with support from Prostate Cancer UK and the Movember Foundation.2 The service has since expanded to seven clinics, which offer support to men with prostate cancer who have undergone treatment in Greater Manchester, Cheshire or Lancashire.5 Appointments are hosted in general practice and community health centres close to the person’s home and last longer than hospital appointments.8

Before their first appointment, the men are asked to arrange a blood test with their general practitioner.9 They then meet with a specialist nurse to discuss the test results and any questions or concerns they may have. If additional care and support are needed, the specialist nurse will refer the person back to the care team at The Christie hospital, a large cancer centre in Manchester.8

Patient empowerment is a key component of the specialist nurse-led prostate cancer clinic.5 Men with prostate cancer learn to understand their blood test results, which further empowers them to advocate for themselves when they are discharged back into primary care.

What has been achieved

The pilot community prostate cancer clinic:

  • freed up over 800 hospital appointments
  • supported more than 650 men in the community
  • received a rating of ‘good’ or ‘very good’ from all men participating in the initiative.2

The Christie NHS Foundation Trust now offers community-based follow-up for all men who have undergone radiotherapy and/or surgery for prostate cancer. The service employs five specialist nurses, and men with prostate cancer will see the same nurse at each appointment. The nursing team sees approximately 260 men per month, representing around 85% of men with prostate cancer who have undergone treatment at the trust.5

Next steps

The Christie NHS Foundation Trust is hoping to expand these clinics and to reach more men with prostate cancer across Greater Manchester, Lancashire and Cheshire. It is also considering use of digital solutions to send men with prostate cancer reminders to arrange regular blood tests.

Further information

Contact

Jane Booker (Urology Specialist Nurse, The Christie NHS Foundation Trust)

jane.booker3@nhs.net

References:

  1. Cancer Research UK. 2020. Prostate cancer statistics. Available here: https://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/prostate-cancer#heading-Five [accessed: November 2020]
  2. Prostate Cancer UK. Community based follow up clinics. Available here: https://prostatecanceruk.org/for-health-professionals/our-work-with-trusts/the-christie-nhs-foundation-trust-community-based-follow-up-clinics [accessed: November 2020]
  3. . O’Brien R, Rose PW, Campbell C, et al. 2010. Experiences of follow-up after treatment in patients with prostate cancer: a qualitative study. BJU International 106(7): 998-1003
  4. Casey R, Powell L, Braithwaite M, et al. 2017. Nurse-Led Phone Call Follow-Up Clinics Are Effective for Patients With Prostate Cancer. Journal of patient experience 4(3): 114-20
  5. Booker J. 2020. Interview with Marissa Mes and Catherine Hodge at The Health Policy Partnership [Video Call]. 19/11/2020
  6. Fitch M, Zomer S, Lockwood G, et al. 2019. Experiences of adult cancer survivors in transitions. Supportive Care in Cancer 27(8): 2977-86
  7. King AJL, Evans M, Moore THM, et al. 2015. Prostate cancer and supportive care: a systematic review and qualitative synthesis of men's experiences and unmet needs. European Journal of Cancer Care 24(5): 618-34
  8. The Christie NHS Foundation Trust. 2020. Urology: Prostate cancer. Available here: https://www.christie.nhs.uk/patients-and-visitors/services/urology/tumour-sites/prostate-cancer [accessed: November 2020]
  9. The Christie NHS Foundation Trust. Prostate follow-up at Ashton Primary Care Centre. Available here: https://www.christie.nhs.uk/media/2011/legacymedia-2141-1058-ashton-prostate-follow-up.pdf [accessed: November 2020]