I am a New Zealand urology nurse specialist with a special interest in prostate cancer. Fifteen years ago I established a small company which gave me the opportunity to develop a nursing service intended to identify and meet the needs of patients undergoing urology surgery.
I practice in Tauranga, a stunning seaside city in the aptly named region ‘Bay of Plenty.’ We have a large public hospital and a smaller more intimate private hospital called “Grace” which strives to be a centre of excellence in urology. The surgical treatments offered for men with prostate cancer are robotic-assisted laparoscopic prostatectomy, radical prostatectomy, brachytherapy and cryotherapy. We also have a brand new state-of-the-art Radiation Oncology Unit.
In August 2015, with the support of the (PCFNZ) Prostate Cancer Foundation of NZ, Abbvie and the New Zealand Urology Nurses Society (NZUNS) I attended the Prostate Cancer World Conference in the sunny North Queensland city of Cairns. It was my third conference which is usually convened in Melbourne, Australia. This year the organisers broke with tradition and the balmy Cairns temperatures really did provide welcome respite to those of us enduring a long, cold southern hemisphere winter!
The conference started extremely well with the official welcome being hosted on Green Island, Great Barrier Reef. Networking began in earnest on the boat trip out to the reef with a great turn out of delegates who spent the afternoon snorkelling and diving in the Gin clear water with its stunning variety of sea life and coral readily accessible.
The conference ‘proper’ began the following day at the Cairns convention centre with the programme offering three streams: Clinical Urology, Translational science, Nursing & Allied Health. The event brought together approximately 650 delegates (from 26 countries) with world leaders in prostate cancer presenting their expertise and current research across all facets of care.
I found the programme of tremendous interest and very relevant to nurses. In this article I would like to focus on lectures of interest to me and share some of “the pearls of wisdom” gleaned.
On Day 1, Prof. Suzanne Chambers, clinical psychologist and author of “Facing the Tiger: Advice for Men and the People Who Love Them” spoke on the latest advances in psychological care for men with localised prostate cancer. Suzanne is a wonderful speaker who opened my eyes further to the prevalence of high levels of distress, depression and increased risk of suicide among men diagnosed with prostate cancer. I was surprised to learn that eight years after diagnosis, 30-40% of men had ongoing health-related distress, worry, low mood and insomnia. Almost half (47%) also reported at least some unmet sexuality support need.
Prof. Chamber’s talk galvanised me into action and I returned home to establish a database of counsellors and psychologists with a special interest in caring for prostate cancer patients. Recognising that high levels of early distress predict later ongoing distress, I now ask all men to complete a “Distress Thermometer” (DT) as part of their rehabilitation assessment. The DT is a validated tool designed to predict cancer distress (the prostate cancer version of the DT and associated validation data is available from Prostate Cancer Foundation of Australia).
Another Day 1 highlight was a workshop which offered the audience many tips on networking in a conference environment. The speaker urged the audience to avoid looking at how contacts can benefit them, instead recommending they be the person that connects other people together. We were encouraged to practise asking questions (but not ‘closed’ ones), not fill awkward silences (you end up oversharing) connect people to one another, and ask “How can I help you?” rather than look to how people can help me. This workshop achieved its desired outcome with everyone conversing freely by the end of the session. Strangers were prepared to approach others and start a conversation based on commonalities. There was wonderful interaction and this set the tone for getting people together for the rest of the conference.
On Day 2 I particularly enjoyed the lively and informative panel on “Challenging prostate cancer cases.” The multidisciplinary panel included a urologist, radiotherapist, medical oncologist, psychologist, nurse specialist, exercise physiologist, general practitioner and the president of Prostate Cancer Foundation of Australia. This panel discussion highlighted the importance of a team approach in caring for men with prostate cancer, with each panellist lending their perspective on the best approach for care. It takes a skilled team to provide holistic support to men on a prostate cancer treatment pathway. Treatment often starts, but does not end solely with a skilled surgeon!
Role of physiotherapy
A highlight from Day 3 was the presentation by Continence physiotherapist Dr. Irmina Nahon titled “Prehab physiotherapy – the best practice.” Her presentation highlighted the benefits of preprostatectomy assessment and a change in thinking in the way we teach men pelvic floor exercises. She described a new hypothesis: that training the urethral sphincter will improve continence outcomes for men having radical prostatectomy. She stated that health professionals need to move away from giving ‘anal cues’ when delivering pelvic floor muscle training, instead focussing on instructions which selectively recruit the urethra. In summary the correct verbal cues for teaching men are to perform pelvic floor contractions that will shorten the penis, lift the testicles and stop the flow of urine.
A subject close to my heart, Dr. Favil Singh presented a wonderful talk titled “Pre-Surgical exercise programming to improve outcomes for men undergoing prostatectomy.” He said that if we could squeeze all the benefits of exercise into one pill, it would be the most prescribed pill in the world. Exercise has been shown to counteract the negative side effects of treatment, shorten recovery times and improve quality of life. Preliminary investigations by Dr. Singh and his team at Edith Cowan University show that targeted pre-surgical exercise intervention is well tolerated by prostate cancer patients and results in considerable improvements in neuromuscular strength and cardiovascular fitness. Despite the numerous adverse effects of prostate cancer treatment, exercise has the potential to provide a buffering effect in preserving functional capacity.
The 2016 Asia Pacific Prostate Cancer Conference will return to the Melbourne Convention Centre, Victoria, Australia from 1 to 3 September. Make sure you save the date.
By Judy Kelly, Rn, Grace Hospital, Urology Dept., Tauranga (NZ)