The role of routine follow-up visits of prostate cancer survivors in addressing supportive care and information needs: a qualitative observational study.

PURPOSE: To understand the role of routine follow-up visits in addressing prostate cancer survivors' supportive care and information needs. METHODS: We audio-recorded follow-up visits of 32 prostate cancer survivors. Follow-up visits were analyzed according to the Verona Network of Sequence Analysis. We categorized survivors' cues, concerns, and questions into five supportive care domains and divided the responses by the healthcare professionals into providing versus reducing space that is to determine whether or not the response invites the patient to talk more about the expressed cue or concern. RESULTS: Prostate cancer survivors mostly expressed cues, concerns, and questions (in the health system and information domain) about test results, potential impotence treatment, follow-up appointments, and (their) cancer treatment during follow-up visits. Survivors also expressed urinary complaints (physical and daily living domain) and worry about the recurrence of prostate cancer (psychological domain). Healthcare professionals were two times more likely to provide space on cues and concerns related to the physical and daily living domain than to psychological related issues. CONCLUSION: Follow-up visits can serve to address prostate cancer survivors' supportive care and information needs, especially on the health system, information, and physical and daily living domain. Survivors also expressed problems in the psychological domain, although healthcare professionals scarcely provided space to these issues. We would like to encourage clinicians to use these results to personalize follow-up care. Also, these data can be used to develop tailored (eHealth) interventions to address supportive care and information needs and to develop new models of survivorship care delivery.

Preventing, identifying, and managing medication-related osteonecrosis of the jaw: a practical guide for nurses and other allied healthcare professionals.

BACKGROUND: Medication-related osteonecrosis of the jaw (MRONJ) is an infrequent, but potentially serious, adverse event that can occur after exposure to bone-modifying agents (BMAs; e.g., bisphosphonates, denosumab, and antiangiogenic therapies). BMAs are typically used at higher doses to prevent skeletal-related events in cancer patients and at lower doses for osteoporosis/bone loss. MRONJ can cause significant pain, reduce quality of life, and can be difficult to treat, requiring a multiprofessional approach to care. METHODS: We reviewed the literature and guidelines to summarize a practical guide on MRONJ for nurses and other allied healthcare professionals. RESULTS: While there is a risk of MRONJ with BMAs, this should be considered in relation to the benefits of treatment. Nurses and other allied healthcare professionals can play a key role alongside physicians and dentists in assessing MRONJ risk, identifying MRONJ, counseling the patient on the benefit-risk of BMA treatment, preventing MRONJ, and managing the care pathway of these patients. Assessing patients for MRONJ risk factors before starting BMA treatment can guide preventative measures to reduce the risk of MRONJ. Nurses can play a pivotal role in facilitating multiprofessional management of MRONJ by communicating with patients to ensure compliance with preventative measures, and with patients' physicians and dentists to ensure early detection and referral for prompt treatment of MRONJ. CONCLUSIONS: This review summarizes current evidence on MRONJ and provides practical guidance for nurses, from before BMA treatment is started through to approaches that can be taken to prevent and manage MRONJ in patients receiving BMAs.

Vesico-urethral anastomosis (VUA) evaluation of short- and long-term outcome after robot-assisted laparoscopic radical prostatectomy (RARP): selective cystogram to improve outcome.

The role of a cystogram to assess the vesico-urethral anastomosis (VUA) after robot-assisted laparoscopic radical prostatectomy (RARP) has been debated. Early catheter removal without cystogram was reported to be associated with a trend towards an increased risk of acute urinary retention (AUR). In two cohorts we studied the effects of VUA leakage on cystogram and functional outcome after RARP. Cohort A contained 1390 consecutive men that routinely underwent a cystogram after RARP. Transurethral catheter (TUC) was removed in the absence of VUA leakage or minimal leakage on subsequent repeat cystogram. Outcome was compared to a group of 120 men that underwent cystography 7-10 days after RARP but had the TUC removed independent of cystography findings (cohort B). Outcome was assessed by early clinical follow-up and quality of life (QOL) questionnaires at 6 months. Men in cohort B had an increased risk of AUR and 6 months voiding complaints when compared to cohort A. The incidence of AUR and voiding complaints was associated with grade 2-3 leakage on cystography in cohort B but not in cohort A. Grade 2-3 leakage on cystogram was more likely in men with larger prostates larger and preoperative voiding complaints. Selective cystogram in men with larger prostates and preoperative lower urinary tract symptoms (LUTS) may prevent early AUR and voiding complaints after RARP when prolonged TUC use is applied.

Taking the lead: sharing best practice in intravenous bisphosphonate use in urological cancers.

PURPOSE: Bisphosphonates relieve metastatic bone pain, prevent, reduce and delay skeletal morbidity in metastatic bone disease and are recommended in European guidelines but safety concerns, specifically renal dysfunction and osteonecrosis of the jaw, necessitate specific precautions when administered intravenously. Pan-European guidance for nurses at the forefront of patient-focussed cancer care is required to minimise patient risk. METHODS: A panel of urology and oncology nurses from seven European countries collaborated to decide what constituted best practice for bisphosphonate administration when indicated for prevention of skeletal-related events in patients with advanced urological malignancies. RESULTS: The panel agreed that urology, oncology, and home-care nurses who are at the forefront of patient-focussed care are well placed to ensure best practice is followed but across Europe nurses have insufficient training on bisphosphonate administration for urological cancers. Based on extensive clinical experience in administering bisphosphonates the panel propose best practice for identifying those patients who could benefit, for example those with bone pain or at risk of fracture, and for minimising risk of adverse events by checking renal function, adjusting dosing, ensuring adequate hydration, and regularly assessing dental health, as well as providing information and support. CONCLUSIONS: Sharing this best practice across Europe could assist nurses who care for patients with urological cancers and bone metastases or indeed those caring for cancer patients in general, to take the lead, or at least be aware of what is the best practice that helps to ensure effective and safe IV bisphosphonates administration to patients under their care.

Vas deferens urethral support improves early post-prostatectomy urine continence.

Urine continence is often impaired after radical prostatectomy. Few randomized studies prove the efficacy of novel surgical approaches. Vas deferens urethral support (VDUS) during robot-assisted laparoscopic prostatectomy (RALP) was studied for improvement of early postoperative urine continence in a single-centre prospective double-blind randomized study with a power of 90% to detect a 30% decrease in early incontinence. 112 men were randomized, and 108 could be analyzed (VDUS n = 54, noVDUS n = 54). VDUS improved early continence by 40% at 1 month (59% vs. 35%, P = 0.02); 6 months postoperatively this was 72% vs. 62%, P = 0.41. A 24-h pad test at 1 day, 3 days, and 1 week showed decreased amounts of urine loss in the VDUS group. The ICIQ-SF score was significantly lower for the VDUS group within the first month after surgery. VDUS had no impact upon quality of life questionnaire analyses for overall and lower urinary tract symptom-related quality of life but showed a significant improvement in the social domain of the EORTC-QLQ-C30 questionnaire. VDUS moderately improved early urine continence within 1 month after RALP.