Delivering personalised and evidence-based exercise support to men with metastatic prostate cancer via the internet - A pilot RCT examining intervention impact on behaviour change and quality of life
Both physical activity and psychological support can greatly improve quality of life for men with metastatic prostate cancer. Although it is suggested men are more likely to follow physical activity guidelines than utilise psychological support, traditional supervised exercise is often unavailable and/or underutilised. The key is ensuring physical activity is accessible and affordable, but also individualised, evidence-based and safe. This study will provide personalised physical activity advice through an innovative web-based platform. It will be evaluated to ensure it works as intended and is well received by users and has the potential for significant impact through increased reach and uptake.
Despite the high morbidity experienced by men with metastatic prostate cancer, and evidence that unmet supportive care needs are higher in this group compared to patients with localised disease (Couper et al, 2010; Sanda et al, 2008), there has been little intervention research aiming to improve quality of life and functional capacity for these patients. Where interventions have been trialled, the focus has predominantly been on psychological interventions, and many of these have had limited success (Chambers et al, 2017).
One potentially promising intervention is physical activity support. Physical activity has been shown to improve both the physical and mental health of men with metastatic prostate cancer (Bourke et al, 2014; Cormie et al, 2013; Moe et al, 2017). It has also been suggested that men may be more likely to adhere to physical activity interventions than psychological interventions, since the performance of physical activity and the outcomes associated with it (building strength and endurance) align with traditional masculine values (Galvao et al, 2016). However, a key challenge is providing physical activity support to men in a way that is easily accessible and affordable, while also individualised, evidence-based and safe. This novel study will address this issue by providing evidence-based physical activity advice through an innovative web-based platform.
While there are some face-to-face programs available, many men live too far away, are too unwell or lack funds to attend face-to-face sessions, especially on an ongoing basis. Our research team, which consists of experts in prostate cancer, exercise physiology, psychology, medicine and telehealth is well placed to develop an alternative support system that will be available to men with metastatic disease via the internet.
Once the website is developed the next step will be to conduct preliminary research to ensure it works as intended and is well received by the initial users.
Megan Crumbaker & Anthony Joshua
Bipolar androgen therapy (BAT) in men with metastatic castrate-refractory prostate cancer
This study will test the benefit of monthly testosterone injections for metastatic prostate cancer (cancer which has spread outside the prostate) patients on long-term testosterone reducing drugs. Benefits may include an anti-cancer effect, improvements in quality of life and potential for cancer cells to respond positively to drugs that have failed previously. The research will test the possible benefits and increase understanding about this treatment. Additionally, the study aims to improve the ability to select patients who can benefit most from this treatment due to changes in their tumour that might make them more responsive.
Statins in Metastatic Castration-Resistant Prostate Cancer (CRPC)
Patient perception of adherence to treatment advice in urogenital and prostate cancers: a qualitative exploration
It is important people with urogenital and prostate cancers complete their planned treatment and follow-up. However little is known about how this is for patients and how we can help them complete their treatments. We will explore patients’ thoughts about the advice they have been given and what may help or hinder their ability to adhere to treatment advice. We will use this information to develop better support to help patients complete treatments and improve clinical outcomes.
To achieve optimal patient and disease outcomes in urogenital and prostate cancers it is important patients complete the planned course of anti-cancer treatment(s) and continue regular follow-up and disease surveillance. Adherence to supportive care intervention advice has the potential to alleviate symptoms and ensure that patients are able to complete planned anti-cancer treatment. However, at present little is known about what patients are told about adherence and their perception of this advice. We know little about the barriers and facilitators to adherence to treatment advice in the cancer setting.
It is recognised that treatments resulting in a high side-effect and symptom burden over a prolonged duration of use are likely to result in lower adherence. Risk factors for lower adherence to treatment have been identified more generally in the healthcare literature, including lower literacy, lower health literacy, comorbid illness, and poly pharmacy. However, these factors have not been assessed within urogenital and prostate cancer populations.
This study aims to explore patient adherence to treatment (anticancer, supportive care, follow-up) advice across urogenital and prostate cancers.
ANZUP co-operative multi-centre cystectomy database (ACCEPT)
Removal of the bladder as treatment for bladder cancer may be necessary to cure the disease. However this remains one of the most major procedures performed by urologic surgeons and carries significant risks for patients. Despite this, there is a currently a lack of quality research to identify ways to improve patient outcomes. The purpose of this study is to set up Australia’s first national secure online database to allow investigators to analyse treatments currently used by urologists and their associated outcomes and complications after bladder removal. This information will then be used to formulate future randomised controlled trials.
Radical cystectomy involves significant risk of morbidity and mortality. The risk of any complication is significantly more than 50% and recent reported mortality ranges between less than 1% and more than 8%.[ref] Specific complications after radical cystectomy from previous studies include infection (25%)4, intestinal obstruction (23%)4, wound complications (15%)4, thromboembolic events (8%)4, intestinal anastomotic leakage (3%)2. Other complications include significant bleeding, lymphocoele formation, and erectile and sexual dysfunction [ref]. The primary objective is to create a bi-national (Australia and New Zealand) prospective clinical audit to collect data on outcomes after radical cystectomy surgery and secondarily to hypothesise from acquired data whether specific interventions may achieve improved peri-operative care and outcomes for patients.
Exercise Medicine Prior to Open Radical Cystectomy: Feasibility and Preliminary Efficacy