The role of the nurse: prostate cancer in the elderly
Prostate cancer (PCa) is a significant health issue, particularly in elderly men, who constitute the majority of new diagnoses. With increasing life expectancy, managing prostate cancer in older adults presents unique challenges. Drawing on the insights of key studies, this article examines the impact of frailty on PCa outcomes, the considerations for risk assessment and management, and the crucial role of nurses in the care of elderly PCa patients.
Current and future treatment strategies
There are several treatment options for the elderly patient that can be tailored to suit their disease characteristics and their personal needs. These may include active surveillance, watchful waiting, radiation therapy, surgical interventions and systemic hormone treatments. Raja et al., conducted a systematic review to consolidate the evidence for current management in patients with mHSPC, for example. They identified that the landscape of mHSPC management, includes the important role of combination therapies, with emerging treatment modalities becoming available, such as theranostics. These strategies aim to improve survival rates and quality of life for elderly patients.
Outcomes in older patients with prostate cancer
Kim F.T. Jochems et al. conducted a systematic review to investigate the outcomes of studies in older patients with PCa. The team provided a comprehensive analysis showing that older patients often face worse outcomes compared to younger counterparts. Factors such as comorbidities and decreased functional status play significant roles.
The review also highlights the underrepresentation of older adults in clinical trials, which hampers the availability of age-specific data for making informed treatment decisions.
Impact of frailty on PCa outcomes
Frailty is a condition characterised by decreased physiological capacity which put a person at greater risk of harm from external stressors. Evidence has established that frailty significantly affects the prognosis of elderly PCa patients, irrespective of their treatment. Yi-Ying Pan et al. have identified that frail patients undergoing radiotherapy experience higher mortality rates and poorer overall survival compared to their non-frail counterparts.
Similarly, Jeongok Park et al. conducted a scoping review on androgen deprivation therapy (ADT) on frailty. ADT, while effective in managing advanced PCa, may result in significant side effects, including osteoporosis, cardiovascular issues, and cognitive decline, which further contribute to the frailty of elderly patients. Both Pan et al. and Jeongok et al.’s work draw attention to the need for incorporating frailty assessments into treatment planning to identify patients at higher risk and to tailor interventions accordingly. Both teams identify that recognising and addressing the potential risks of PCa treatment in frail patients is crucial for optimising outcomes.
Risk assessment and management in elderly men with advanced PCa
Effective management of prostate cancer in elderly men requires a balanced approach that considers life expectancy, comorbidities, functional status, and patient preferences. Jeffrey W. Shevach et al.’s systematic review aimed to consolidate the evidence on risk assessments for consideration in management of elderly men with PCa. The team emphasised the importance of individualised care plans. This research brought attention to concerns about over-treatment, as more aggressive therapies might pose more risks than benefits for older patients. The review advocates for careful consideration of ADT and other treatments due to their potential to adversely affect the quality of life in elderly patients.
The role of exercise in improving outcomes
Exercise has been shown to mitigate some of the adverse effects of PCa treatment. Francesca Giallauria et al. conducted a systematic review in exercise training for elderly patients. This research showed that regular physical activity can improve physical function, reduce treatment-related side effects, and enhance overall quality of life in elderly cancer patients. The evidence demonstrated that implementing exercise regimens as part of a comprehensive care plan can be particularly beneficial for elderly PCa patients, helping to combat frailty and improve resilience.
The role of the nurse in caring for elderly PCa patients
Nurses are pivotal in managing PCa in the elderly, functioning as advocates, educators, and care coordinators. Their role extends beyond clinical care to include psychosocial support, patient education and navigation of the healthcare system.
Key areas of expertise that nurses provide include:
- Frailty assessment and management: Nurses are instrumental in performing comprehensive frailty assessments using validated tools such as the Frailty Index or the Geriatric Assessment. These assessments help identify patients at higher risk of adverse outcomes, allowing for the development of tailored care plans that address their specific needs.
- Patient education and support: Education is a critical component of nursing care. Nurses provide patients and their families with
information about the disease, treatment options, potential side effects, and strategies to manage symptoms. They also offer emotional support, helping patients cope with the psychological burden of a cancer diagnosis and treatment. - Coordination of care: Given the complexity of managing PCa in the elderly, nurses often act as care coordinators, ensuring seamless
communication between different healthcare providers. They help s0chedule appointments, facilitate referrals to specialists and allied health, and monitor patients’ progress throughout the treatment journey. - Symptom management: Effective symptom management is essential for maintaining the quality of life in elderly PCa patients. Nurses play a crucial role in monitoring symptoms, administering medications, and providing interventions to alleviate pain, fatigue, and other treatment-related side effects.
- Advocacy: Nurses advocate for the needs and preferences of elderly patients, ensuring that their voices are heard in treatment decisions. They also advocate for more inclusive research and policies that address the unique challenges faced by this population.
Conclusion
Managing PCa in the elderly requires a nuanced approach that considers the complexities of aging, frailty and individual patient needs. Nurses, with their holistic approach to wellbeing, are essential in delivering comprehensive, patient-centred care. By conducting frailty assessments, providing education and support, coordinating care, managing symptoms and advocating for patients, nurses significantly contribute to improving the outcomes and quality of life for elderly PCa patients. Integrating these roles within the healthcare team ensures that elderly patients receive the best possible care tailored to their specific circumstances and needs.
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Mrs. Nicole Klok, Oncology Nurse, Medisch Spectrum, Twente, Enschede (NL)
Dr. Natasha Roberts, Specialist Nurse, Royal Brisbane and Women’s Hospital, Brisbane (AU)