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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: 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: 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 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