New ‘Vitality Index’ Tool Empowers Men with Locally Advanced Prostate Cancer to Understand the Impact of Treatments on their Lifestyle

A new tool launched today at the Section of Oncology of the British Association of Urological Surgeons (BAUS) and British Prostate Group Annual Meeting will enhance informed discussions between men with locally advanced prostate cancer and physicians/specialists nurses, helping them to consider men’s individual preferences and how treatment options can impact men’s lives.

 Men with locally advanced prostate cancer have a significant risk of their disease progressing of suffering cancer-related death. ^[i] As there is much debate about the most appropriate treatment, these men need to be able to balance the treatment benefits against a spectrum of side effects associated with the alternative strategies. ^[ii] Importantly, research has shown that men who incorporate quality of life considerations into their decisions tend to feel better about their treatment choices, are more satisfied overall with their care and experience less regret.
^[iii]

 Professor Lesley Fallowfield, Director of Cancer Research UK ’s Psychosocial Oncology Group commented, “Treatment choice is a highly complex decision making process for both the physician and the patient and requires the availability of information and discussion at a time when the patient is anxious, vulnerable and in need of reassurance.  Currently, few patients are being offered choice despite the fact that the different treatments vary in their side effect profile and the subsequent impact on a man’s quality of life.”

A recent Department of Health research has shown that 76 per cent of the public and healthcare professionals feel that involving patients in decisions about their illness or treatment should be a priority.  In addition, 88 per cent of patients feel that they need more information to make decisions and choices about their treatment or care. ^[iv]

The tool will elicit a man’s individual quality of life preferences and priorities through discussion of the relative importance of the side effects and the trade-offs between them.  The Vitality Index was developed as a result of healthcare professionals’ input and a review of published clinical evidence highlighting critical side effects to be considered when discussing their treatment options.

Dr Heather Payne, Consultant Oncologist, Middlesex Hospital , London said, ‘‘The Vitality Index has been piloted with locally advanced patients of varied ages, backgrounds and experience of prostate cancer.  These men found the Vitality Index a useful resource in discussing and making an informed and balanced treatment choice with their healthcare profession.”  Dr Payne added, “The Vitality Index is important as healthcare professionals often under estimate the need for treatments to be tailored to an individual’s preference.  Certain side effects may have far more relevance to the decision-making process for some patients than the physician is aware.”

The rationale for developing the Vitality Index is supported by the Department of Health’s NHS Cancer Plan and the NICE Guidance on Cancer Services: Improving Outcomes in Urological Cancers which advocate that an appropriate management strategy depends crucially on an individual’s values and attitudes, and the importance of shared decision making with well informed patients. ^{[v] , [vi]}

Notes

The Vitality Index project is funded by an AstraZeneca unrestricted educational grant.

Prostate cancer is the most common cancer to be found in elderly men in the UK . Over 27,000 men in the UK alone, are diagnosed with prostate cancer each year. ^[vii]

Locally advanced prostate cancer is when the cancer has spread beyond the prostate capsule and so cannot be cured by surgery alone.

Active treatment for men with locally advanced prostate cancer includes radiotherapy alone, radiotherapy in combination with hormone therapy, or hormone therapy alone. There are two types of hormone treatments: Luteinising Hormone-Releasing Hormone Agonists (LHRHas) and Anti-Androgens.

References:

 Abrahamsson P-A. Treatment of locally advanced prostate cancer – a new role for antiandrogen monotherapy? Eur Urol 2001; 39 (suppl 1): 22–28

Sculpher, M. et al. Patients’ preference for the management of non-metastatic prostate cancer: Discrete choice experiment. BMJ 200 Feb 14; 328:382-4

Barry, M.J, et al. Committee 13: Quality of Life.  World Health Organisation Compendium

‘Choice, Responsiveness and Equity National Consultation.  MORI Research Study Conducted for The Department of Health, October – November 2003’

NHS Cancer Plan, The Department of Health, 2001

National Institute of Clinical Excellence (NICE) Guidance on Cancer Services: Improving Outcomes in Urological Cancers, September 2002

Office for National Statistics (ONS) from data supplied by the regional cancer registries in England; Information and Statistical Division of the Directorate of Information Services NHS in Scotland; Welsh Cancer and Intelligence and Surveillance Unit; Northern Ireland Cancer Registry

 (22/1/05)