A multi-centre investigation of delivering national guidelines on exercise training for men with advanced prostate cancer undergoing androgen deprivation therapy in the UK NHS

Abstract

BackgroundNational guidelines (NICE-CG175) recommended 12 weeks of supervised exercise training for men treated with androgen deprivation therapy (ADT) for prostate cancer to counter debilitating adverse effects of castration. As with other chronic conditions where exercise is indicated, it is uncertain if these services are being delivered in the health services. The aim of this multi-centre investigation was to examine what exercise referral is currently available for men on ADT as provided by the NHS and if a supervised, individually-tailored exercise training package (as per the national NICE guidelines CG175) is embedded within prostate cancer care.MethodsA multi-centre investigation of current National Health Service (NHS) care involving a web-based survey of NHS prostate cancer care, five focus groups involving 26 men on ADT and 37 semi-structured interviews with healthcare professionals (HCPs) involved in the management of prostate cancer. Descriptive statistics and thematic analysis evaluated quantitative and qualitative data, respectively. Qualitative methods followed COREQ standards.ResultsHCPs and men on ADT asserted that medical castration has a serious and debilitating impact on many features of men's quality of life. There is support for exercise training programmes as part of cancer care and patients would support their initiation soon after diagnosis. Involving the Multidisciplinary Team (MDT) is proposed as key to this. Critically, traditional values in oncology would need to be overcome for widespread acceptance. Specialist further training for HCPs around behaviour change support could encourage this. Given that these schemes are seen as a fundamental part of cancer care, it is felt the NHS should commission and support provision. 79 representatives of 154 NHS trusts (51%) provided survey data on current delivery: only 17% could provide supervised exercise as per CG175.ConclusionsEvidence-based national exercise guidelines are not being delivered to men on ADT as intended. Traditional values in oncology and the need for NHS financial support are seen as major barriers to provision of current best practice guidelines. Despite this both HCPs and men on ADT are in favour of such programmes being a fundamental part of their cancer care.

Barriers and facilitators to physical activity in men with prostate cancer: A qualitative and quantitative systematic review

“…There is a need to consider each individual's treatment plan when trying to engage that individual with PA . The treatment‐related barriers consistently reported by men with prostate cancer in the reviewed studies were incontinence caused by radiotherapy or radical prostatectomy, and treatment‐related fatigue, primarily relating to treatment with chemotherapy or hormone therapy, and occasionally also associated with receipt of radiotherapy or radical prostatectomy …”

“…The consultant, nursing team, exercise physiotherapy team, and accredited exercise physiologists all have potential roles to play in this regard. Men with prostate cancer in these studies sometimes describe a need to have the benefits of PA communicated to them by someone that they consider a medical authority . Moreover, as described above, this is sometimes related to a concern that PA is contraindicated for someone with a prostate cancer diagnosis .…”

“…There is a need to consider each individual's treatment plan when trying to engage that individual with PA. 19,51,[53][54][55]57,58,[60][61][62] The treatment-related barriers consistently reported by men with prostate cancer in the reviewed studies were incontinence caused by radiotherapy or radical prostatectomy, 51,53,54,57,58,60,61 and treatmentrelated fatigue, primarily relating to treatment with chemotherapy or hormone therapy, and occasionally also associated with receipt of radiotherapy or radical prostatectomy. 19,51,54,55,58 5.2 | Self-determination and its relationship with prostate cancer-related events This theme did not so much pertain to a direct facilitator or barrier but describes an experiential process that was deemed a relevant concept that was well grounded in the primary data. Participants in these reviewed studies often reported that their PA levels dropped significantly when they were diagnosed with prostate cancer and received treatment, 19,[49][50][51]54,55,58 accompanied by a loss of PA self-efficacy.…”

“…In order to obtain behaviour change, interventions must try to modify the underlying reasons why prostate cancer patients do not engage in sufficient PA . This challenge is a multidimensional one, encompassing several crucial factors including patient motivation, patient capability, social support, financial governance, organisational culture, organisational processes, and the availability of relevant expertise . Each of these dimensions is likely to require specific research attention.…”

“…In order to obtain behaviour change, interventions must try to modify the underlying reasons why prostate cancer patients do not engage in sufficient PA. 17,18 This challenge is a multidimensional one, encompassing several crucial factors including patient motivation, patient capability, social support, financial governance, organisational culture, organisational processes, and the availability of relevant expertise. 18,19 Each of these dimensions is likely to require specific research attention. In this review, we have focused on the individual patient and their direct environment-eg, internal psychological experience or interaction with peers, partners, clinical care team, or physical environment-as opposed to any wider structural barriers or facilitators.…”