Download Document - Herts Valleys CCG

Holistic Needs Assessment Protocol for Prostate Cancer Follow-up
(Annual)
PROSTATE CANCER
ACTION
Introduction:
Practice Nurse to introduce her/himself to patient, review patients End of Treatment Summary & Follow Up
Protocol and confirm that it is the correct patient. Offer partner or carer to be present at consultation
Discuss patients immediate concerns
Discuss and explain PSA and any other relevant blood test results and action as per patient protocol.
Assess for specific prostate cancer disease or treatment related issues:
Lower Urinary Tract Symptoms (LUTS): Treatments for prostate cancer may cause problems which affect the
lower urinary tract. These symptoms can vary in severity and frequency and for some men they will be very
troublesome. Access to self-management strategies and specialist continence services when necessary are
available. when assessing the patient please consider the following:

Using the International Prostate Symptom Score (IPSS) to identify and monitor LUTS

Exclude symptoms of urinary tract infection (UTI), if a UTI is indicated then send a mid-stream urine
sample for analysis and treat appropriately

Encourage regular pelvic floor exercises, re-educate and offer factsheet

Discuss lifestyle changes - Maintaining a healthy weight, avoiding constipation and avoiding heavy
lifting will reduce the pressure on the pelvic floor. If the patient smokes, encourage them to stop as
coughing puts pressure on the pelvic floor
Advise to drink plenty of fluids and avoid or reduce fizzy drinks, caffeine and alcohol as these may
also irritate the bladder

Discuss pharmacological management with GP and/or Prostate Cancer Specialist Nurse

Consider referral onto to the Hertfordshire Community NHS Trust Adult Bladder and Bowel Care
Services
RATIONALE
To ensure that the patient is fully
aware of the purpose, duration and
frequency of follow up
To ensure that follow up care is
patient centred which takes into
account the individual needs of
the patient and his partner/carer
To monitor PSA in accordance with
End of Treatment Summary &
Follow Up Protocol
To ensure that troublesome
symptoms related to disease or
treatment are assessed, diagnosed
and treated appropriately
Adult Bladder & Bowel Care Service
Park Drive Health Centre
Park Drive
Baldock
SG7 6EN
Phone: 01462 492502
Fax No: 01462 491052
A referral form, patient and healthcare professional information can be downloaded from their
website by visiting:
www.hertschs.nhs.uk
Bowel symptoms: Radiotherapy and brachytherapy can cause the lining of the bowel to become inflamed,
which can lead to symptoms such as loose stools, frequency, urgency and bloating. These symptoms usually
settle down after a few months but can return years later. When assessing the patient please consider the
following:
 Eating less fibre in the diet for a short while may be of benefit. The patient may need guidance on
types of food to eat; suggest white bread, white pasta, white rice, potatoes without skin and lean
white meat
 The men would have been given a diet sheet from their Cancer Centre prior to their treatment, if they
follow this again for a short while symptoms are likely to improve
 If symptoms persisting or rectal bleeding is present discuss with GP and/or Prostate Cancer Specialist
Nurse and consider further investigations with specialist teams with expertise in radiation induced
enteropathy
Sexual dysfunction: Prior to treatment men and their partner’s would have been made aware of the potential
difficulties they may encounter following treatment. They may experience a reduction in or loss of erectile
function, loss of libido, pain on orgasm. There are various treatments and support available, please consider
the following when assessing the patient:



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Explore with the patient whether sexual dysfunction is an issue for him or his partner
Men with prostate cancer get free medical treatment for problems with erections and sexual function
Phosphodiesterase type 5 (PDE5) inhibitors should be considered first. However, there are other
ways to manage erectile dysfunction which include intraurethral inserts, penile injections, vacuum
devices and penile prostheses.
Offer patient appointment with GP to discuss treatments for erectile dysfunction and consider referral
to the Erectile Dysfunction Clinic within West Herts NHS Trust. This can be done through the GP or
through the Prostate cancer Specialist Nurse

Offer psychological support with the Prostate Cancer Specialist Nurse at the Spring and Starlight
Wellbeing Centres or in complex cases refer for Psychosexual Counselling at West Herts NHS Trust:
Jan Tarrant
Clinical Administrator
Psychosexual Service
St Albans Sexual Health Centre
St Albans City Hospital
Waverly Road
St Albans
AL1 5PN
Tel: St Albans 01727 897333 or Watford 01923 217206
www.sexualhealthwestherts.co.uk
Hot Flushes: Hot flushes are a common side effect for men who are on hormone deprivation; they will differ in
frequency and severity. If troublesome then please consider the following:

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Patients may recognise a trigger to the hot flushes
Lifestyle changes - stopping smoking, maintaining a healthy weight, drink 1 – 1.5 litres of water a day,
reduce caffeine, reduce spicy food
Wear cotton cloths and use cotton sheets
Consider herbal remedies such as Sage Tea or Evening Primrose Oil. Acupuncture may also help,
this can be accessed through the Prostate Cancer Specialist Nurse at the Spring and Starlight
Wellbeing Centres
Offer the PCUK booklet ` Living with hormone therapy, a guide for men with prostate cancer`
Fatigue: Fatigue is a common side effect following a diagnosis of cancer and its treatment. It is not usually
relieved by resting and it is recognised that fatigue can impact on the physical, emotional and social aspects
of an individual’s wellbeing. Regardless of the cause there is help and support available. Please consider the
following:
 Explore with the patient the impact fatigue is having on his day to day life
 Things which may help – taking regular exercise, prioritise and plan activities, eat a regular well
balanced diet
 Offer Macmillan Fatigue booklet
 Consider referral to the Wellbeing Services at the Spring and Starlight Wellbeing Centres; Fatigue
Workshop and Physiotherapy sessions
Promote supported self-management and wellbeing services and refer as applicable to:
 Prostate Cancer Wellbeing Service – Prostate Cancer Wellbeing Clinic and Prostate Cancer
To promote an empowerment and
self-management model of care

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Wellbeing Course
Tina Smith, Prostate Cancer Specialist Nurse, 07921 388795 [email protected]
Hertfordshire smoking cessation service. Tel: 0800 389 3998. www.smokefreehertfordshire.nhs.uk
Local prostate cancer support group:
Friends of Prostate Sufferers , Chorleywood, Tel: 01923 282105, www.thefops.org.uk
Aylesbury Vale Prostate Cancer Support Group, Tel: 01442 822161, www. goo.gl/Ge5LRO
National Support Services:
Metro Walnut Support provides support for gay and bisexual men with prostate cancer
Simon Faulkner on 07947 826 853 (Mon to Thurs 10-4), [email protected],
www.metrocentreonline.org
www.prostatecancer.org
www.bladderandbowelfoundation.org
www.rada.org.uk
www.macmillan.org.uk
Carer Support – Carers play an important role in supporting men with prostate cancer, there are numerous
individual and groups sessions available within the Spring and Starlight Wellbeing Centres which may be of
benefit. Carers will also be offered an assessment using the Carer Support Needs Assessment Tool
(CSNAT). The assessment tool has been developed to identify the support that is most appropriate to the
individual in their role as a carer.
Document consultation and update patient held record as appropriate
Arrange next appointment and ask patient to have PSA blood test 2 weeks before next appointment
Offer open access and support as required
with the overall aim of improving
health, independence and
confidence
To ensure that individual carers
needs are identified and
To ensure that individualised
Code this review as: Holistic Needs Assessment – Vision/Emis - 389H & SystmOne - XabVD
Note: For purposes of audit and service claims if PSA testing not indicated (e.g. End of life stage) please code - Lab test
not necessary – Vision/Emis & SystmOne - 411.. and enter details including reason in the free text