Within the United States, prostate cancer is the second most commonly diagnosed solid tumor malignancy, accounting for approximately 220,800 cases in 2015, resulting in approximately 28,000 deaths, with approximately 11,000 initial diagnoses being advanced disease, ie, disease radiologically confirmed as outside of the prostate. A survey has recently been conducted to better understand patient and caregiver perceptions regarding the symptoms associated with advanced prostate cancer and how both patient and caregiver experiences impacted their therapeutic decision making with their clinicians, including both physicians and nurses. Unfortunately, even though the survey suggests that 97% of men with advanced prostate cancer acknowledge they are comfortable talking to their clinicians about their prostate cancer symptoms, less than half actually do specifically detail their complaints or concerns regarding their symptoms at each visit.
In fact, almost one-third (30%) of men with prostate cancer-related bone metastases experienced pain for 7 months or more before they received a confirmatory diagnosis that their prostate cancer had metastasized to the bones.
The International Prostate Cancer Symptoms Survey is a global survey commissioned by the International Prostate Cancer Coalition (IPCC) with the support of Bayer HealthCare. Ten countries, including representation from North America, Europe, and Asia, participated. In the United States, 410 patients with advanced prostate cancer and 95 caregivers were surveyed online and via phone by Harris Poll between February 12 and April 13, 2015, and the United States is the first country site to report its findings.
Key US results include nearly 7 in 10 men living with prostate cancer (68%) admitted to sometimes ignoring symptoms such as pain. There are multiple factors that could contribute to this finding. For example, 55% acknowledged that they felt their daily pain and discomfort is just something they have to live with, 22% reported they feel mentioning their pain makes them feel weak or depressed, while 71% of survey respondents admitted that they were not sure of the exact cause of their pain (cancer- or noncancerous-related).
Although early stage prostate cancer usually causes no symptoms, symptoms oftentimes emerge as the disease progresses, and the most common site for metastases is the bone. The survey noted, if asked directly, men with advanced disease and their caregivers, describe difficulty walking or climbing stairs, unexplained new onset of pain, troubled sleep, changes in daily physical activities, and new usage of over-the-counter pain relievers—which may all reflect signs of advancing prostate cancer. These symptoms can have a major impact on daily quality of life, but men with advanced disease do not always recognize these symptoms, and even if they do, it is clear from the survey that they and their caregivers are not always forthcoming in communicating with their clinical team of physicians and nurses. Importantly, the physician and nursing team should also reflect upon strategies and sensitivities to improve this communication.
Improved patient-caregiver communication with the nurse-physician team truly matters, as approximately 90% of men with advanced prostate cancer will develop bone metastases, impairing not only survival but also quality of life. Caregivers can provide a perspective on their loved one’s disease that patients themselves oftentimes lack.
The survey documented that although only 44% of patient respondents reported that pain often limits their activities, one-third more caregivers (74%) reported that their loved one’s pain often significantly limited their activities. Therefore, diagnosing and treating bone-related symptoms at the earliest onset is of critical importance for patients with advanced prostate cancer. A multidisciplinary approach, inclusive of the nurse, physician, caregiver, and patient perspective will lead to enhanced shared decision making when it comes to assessing the benefits of approved therapies, ensuring that these therapies are not initiated too late, or worse case scenario, not ever administered.
Achieving clarity and efficiency of communication for all stakeholders of patient care ensures that the connectivity between symptomatology and advanced disease is best understood and that discussion for timely therapy can ensue. When asked what would motivate survey respondents to share their pain symptoms with their physicians and nurses, they reported several factors.
- If it helped increase quality of life (80%);
- If it kept the cancer from getting worse (68%); and
- If it helped increase activity levels (68%).
The survey addresses the importance for men to be proactive and speak up about their symptoms when they have appointments with their doctor. The IPCC and Bayer recently introduced Men Who Speak Up, a nationwide movement to increase awareness of the symptoms of advancing prostate cancer and supply informational tools and resources to help men take action regarding their disease by ensuring and facilitating comfortable and productive conversations with the entire health care team, which should improve therapeutic decision making.