Clinical FeaturesMen’s HealthOncology

Developing a Cancer Survivorship Pathway for Men

Prostate cancer is the most common male cancer in Ireland. One in eight men in Ireland will be affected by the disease and over 3,500 men are diagnosed with prostate cancer here every year. However, prostate cancer also has one of the best survival rates of all cancers. Thanks to early detection and advances in treatment, there are over 26,000 prostate cancer survivors in Ireland today with 90% of men diagnosed with the disease surviving.

The consequences of cancer and its treatment can result in significant, often lifelong, effects on health and quality of life. Male cancer survivors may experience effects of cancer treatment that can have a considerable impact on masculinity such as erectile dysfunction, weight gain and muscle loss, sleep disturbance and continence issues, and the psychological impact of change of body image, which is further compounded by the lack of supports to express this distress. The health care system will be able to respond to these needs in a more coordinated way if a cancer survivorship pathway is formalised with particular emphasis being placed upon dealing with troublesome symptoms, supporting individuals to transition through the various stages of the cancer journey, encouraging the active participation of patients in care and helping individuals to live well with, through and beyond a cancer diagnosis.

At a recent stakeholder workshop held to examine the unmet needs of men affected by cancer in Ireland, contributors highlighted the glaring issues and disparities facing male cancer survivors, and particularly emphasised the challenge of supporting men to engage with cancer survivorship services to derive an optimal outcome for their illness. In line with this, Cork University Hospital and University College Cork Cancer Trials Group in association with the Irish Cancer Society (ICS) are working together to help improve the experiences, quality of life and outcomes of men impacted by advanced genitourinary cancer. The Irish Cancer Society funded Liam Mc Trial (short for Linking In with Advice and supports for Men with Metastatic Cancer) will pilot a dedicated integrated survivorship research programme aimed at better engaging with and supporting men in Ireland postcancer treatment. As part of this new initiative, the trial team seek to address the key gaps and unmet survivorship needs of men affected by cancer. The initial phase of the Liam Mc Trial commencing in November 2023 will focus on men with genitourinary cancer malignancies (cancers of the urinary and reproductive system such as prostate, bladder and testicular cancer) with selected eligible patients referred by their hospital teams.

An important aspect of the programme is to demonstrate how to improve the survivorship supports and services for underserved communities of men who have not traditionally been the focus of such initiatives and are recognised as experiencing disparities in terms of cancer incidence, prognosis, outcome and/or quality of life. Unfortunately, there are many such communities, but these might include, for example, members of the Travelling community, the LGBT+ community, ethnic minority and migrant communities, communities with social disadvantage and/or socioeconomic challenges, or specific mental health issues likely to impact their ability to have a positive outcome from a cancer diagnosis. The focus of this programme will be centred on provision of evidence to drive improvement in the survivorship supports and services for those cancers that yield a significant burden on quality of life due to morbidity related to tumour burden, local treatment effects, and/or systemic treatment effects such as androgen deprivation, and for which there are still considerable challenges and resources issues.

The LIAM Mc trial will aim to address some of the most common unmet needs of male cancer survivors (physical, social, or psychosocial) and address their cancer-related symptoms within a holistic and person-centred approach. Recruitment of participants will include a gateway introduction which will allow the men to express any concerns or discuss areas where they require more support. In the initial phase, the project team will enroll a cohort of advanced or metastatic prostate cancer survivors as they often experience a significant burden from the side effects of treatment and their advanced cancer status. The larger expansion phase will enrol men with any advanced genitourinary malignancy. The programme, which will be underpinned by a robust research infrastructure, will coordinate resources, be readily accessible and seek to develop and improve evidence-based post-treatment services for these men.

The Cork University Hospital-based research trial will see men receive specialist nurse and dietician support weekly, as well as twiceweekly physiotherapy sessions to empower them to maintain physical activity so important for quality of life. This will be complemented by access to social work and psychological supports to ensure their practical and emotional as well as physical needs are met. Based out of the state-of-the-art cardio rehab gym at Cork University Hospital (CUH), it will be supported by the UCC Cancer Trials Group and overseen by a team of researchers from UCC and CUH under the direction of Consultant Medical Oncologist Dr Richard Bambury, and Lecturer Practitioner in Nursing Dr Brendan Noonan.

Written by Dr Brendan Noonan, Lecturer Practitioner, School of Nursing and Midwifery, University College Cork

Read the full magazine: HPN November

Catch up on our previous features: Clinical Features

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