The effects of multidisciplinary rehabilitation: RePCa—a randomised study among primary prostate cancer patients

Abstract

Background:The objective of this study is the effectiveness of multidisciplinary rehabilitation on treatment-related adverse effects after completed radiotherapy in patients with prostate cancer (PCa).Methods:In a single-centre oncology unit in Odense, Denmark, 161 PCa patients treated with radiotherapy and androgen deprivation therapy were randomly assigned to either a programme of two nursing counselling sessions and two instructive sessions with a physical therapist (n=79) or to usual care (n=82). Primary outcome was Expanded Prostate Cancer Index Composite (EPIC-26) urinary irritative sum-score.Before radiotherapy, pre-intervention 4 weeks after radiotherapy, and after a 20-week intervention, measurements included self-reported disease-specific quality of life (QoL; EPIC-26, including urinary, bowel, sexual, and hormonal symptoms), general QoL (Short-form-12, SF-12), pelvic floor muscle strength (Modified Oxford Scale), and pelvic floor electromyography. Intension-to-treat analyses were made with adjusted linear regression.Results:The intervention improved, as compared with controls, urinary irritative sum-score 5.8 point (Cohen's d=0.40; P=0.011), urinary sum-score (d=0.34; P=0.023), hormonal sum-score (d=0.19; P=0.018), and the SF-12 Physical Component Summary, d=0.35; P=0.002. Patients with more severe impairment gained most. Pelvic floor muscle strength measured by electromyography declined in both groups, P=0.0001.Conclusion:Multidisciplinary rehabilitation in irradiated PCa patients improved urinary and hormonal symptoms, and SF-12 physical QoL.

Integrative review on the non‐invasive management of lower urinary tract symptoms in men following treatments for pelvic malignancies

“…86 demonstrated improvements in variables related to the UI symptom, intensity, frequency, difficulty and limitation of activity after 24 weeks of PFMT (p ≤ 0.0001). These results were further confirmed by Dieperink in an RCT of Danish population ( n  = 161) stratified to multidisciplinary rehabilitation after RT/ADT, where nursing counselling sessions and therapist‐guided instructive sessions resulted in significant improvements of LUTS symptoms vs. standard care 75.…”

“…Two small studies have assessed the effects of PFMT and multidisciplinary rehabilitation after RT/ADT, and both demonstrated significant improvements with PFMT in this patient group 75, 77. Faithfull et al.…”

“…Dieperink et al. demonstrated that in post‐RT/ADT patients, therapist‐guided instructive sessions resulted in significant improvements of LUTS symptoms vs. standard care 75.…”

Effects of radiation therapy on the structure and function of the pelvic floor muscles of patients with cancer in the pelvic area: a systematic review

“…Two papers compared the irradiated subjects to non-cancer, non-irradiated subjects [28,29] and two more to subjects with cancer but who did not receive radiation [36,37], and three others compared to preradiation measures [38][39][40]. Two articles rated "low to moderate quality" [40,29], two rated "good quality" [36,28], and three of "excellent quality" [38,39,37] (Table 2). In a retrospective cohort study by Theisen et al [40], resting and maximal squeeze pressure data measured by anal manometry was reported (Table 4).…”

“…Consequently, a trend toward a higher proportion of low-strength scores is likely for the subjects who received RT. Dieperink et al [38], in 2013, presented a RCT where pre-RT baseline measures were available. With the collaboration of the authors, additional paired t tests (data available in Table 5) were conducted, and it was acknowledged that when measured digitally using the Oxford scale, maximal PFM contraction, static strength, and dynamic strength were not significantly different pre-to postradiation.…”