RESUMEN

PURPOSE OF THE RESEARCH: To evaluate nursing practice in Flanders (Belgium) regarding skin care during radiotherapy and the effect of the introduction of an evidence based protocol on daily nursing practice. METHODS AND SAMPLE: Nurses working at radiotherapy departments in Flanders were invited to complete a 58-item questionnaire. The survey was undertaken in 2001 (n=67) and end of 2006 (n=89). Following the survey in 2001 an evidence based skin care protocol was made available for radiotherapy nurses and presented at their respective radiotherapy services. The questionnaire asked to what extend they advised their patients about skin care topics grouped in four sections: prevention, erythema, dry desquamation, moist desquamation. KEY RESULTS: The surveys revealed large varieties in the management of skin reactions although there seems to be less variety and more consensus in the 2006 survey. Regarding preventive advice and the advice in case of erythema, dry desquamation and/or moist desquamation a major improvement was observed in the adoption of key principles such as washing and hydrating the irradiated site and the use of occlusive dressings and the omission of outdated techniques such as talcum powder, Eosin 2% and Gentian violet. CONCLUSIONS: The management of skin reactions does not always correspond with current scientific knowledge. However, the results of this study show that the dissemination and implementation of a skin care protocol enhanced standardization in Flanders, improved adheration to evidence based guidelines and lead to the disappearance of outdated ritualistic practices.

Asunto(s)

Protocolos Clínicos , Enfermería Oncológica/organización & administración , Educación del Paciente como Asunto/organización & administración , Pautas de la Práctica en Enfermería/organización & administración , Radiodermatitis/enfermería , Cuidados de la Piel , Adulto , Bélgica , Distribución de Chi-Cuadrado , Protocolos Clínicos/normas , Práctica Clínica Basada en la Evidencia/organización & administración , Femenino , Adhesión a Directriz/organización & administración , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Investigación en Evaluación de Enfermería , Personal de Enfermería en Hospital/educación , Personal de Enfermería en Hospital/organización & administración , Personal de Enfermería en Hospital/psicología , Guías de Práctica Clínica como Asunto , Radiodermatitis/etiología , Radiodermatitis/prevención & control , Radioterapia/efectos adversos , Autocuidado , Cuidados de la Piel/métodos , Cuidados de la Piel/enfermería , Cuidados de la Piel/normas , Encuestas y Cuestionarios

RESUMEN

AIM: To evaluate the psychometrics of the EORTC QLQ-PR25, a questionnaire assessing the health-related quality of life of prostate cancer patients. METHODS: The QLQ-PR25 and the QLQ-C30 were administered to 642 prostate cancer patients from 13 countries treated with curative or palliative intent. The QLQ-PR25 assesses urinary, bowel and sexual symptoms and functioning, and the side-effects of hormonal treatment. RESULTS: Five hundred and nine patients were available for the final analysis. Multitrait scaling analyses confirmed the hypothesised scale structure of the QLQ-PR25. Internal consistency reliability was good (coefficient alpha=0.70-0.86) for the urinary symptoms and sexual function scales, but lower for the bowel function and side-effects of hormonal treatment scales (alpha<0.70). The module discriminated clearly between clinically distinct patient subgroups, and was responsive to changes in health status over time. CONCLUSION: In general, the QLQ-PR25 demonstrates acceptable psychometric properties and clinical validity. Some caution should be used in interpreting the bowel function and side-effects of hormonal therapy scales; results can be reported at the individual item and scale level.

Asunto(s)

Neoplasias de la Próstata/psicología , Calidad de Vida , Encuestas y Cuestionarios , Adulto , Anciano , Anciano de 80 o más Años , Enfermedades Gastrointestinales/etiología , Humanos , Masculino , Persona de Mediana Edad , Cooperación del Paciente , Satisfacción del Paciente , Psicometría , Disfunciones Sexuales Fisiológicas/etiología , Incontinencia Urinaria/etiología

RESUMEN

Given the lack of evidence from randomized controlled trials and large prospective studies, controversy exists regarding the optimal treatment strategy for early stage prostate cancer. The impact of various treatments on health-related quality of life has become an increasingly important but controversial issue. The literature on health-related quality of life following brachytherapy, an increasingly used treatment option that can have short- and long-term side effects influencing patient health-related quality of life is reviewed. Urinary, bowel and sexual health-related quality of life issues related to this treatment are addressed. The authors findings suggest that brachytherapy with or without external beam radiotherapy and/or hormonal treatment has a considerable impact on short-term health-related quality of life but this impact diminishes in the long-term. However, in certain subgroups of patients, brachytherapy has long-term effects on bowel, bladder and sexual function. Clinicians should ensure that patients are aware of these consequences on long-term health-related quality of life.

RESUMEN

PURPOSE: The aim of this study was to evaluate whether the inclusion of health-related quality of life (HRQOL), as a part of the trial design in a randomized controlled trial (RCT) setting, has supported clinical decision making for the planning of future medical treatments in prostate cancer. MATERIALS AND METHODS: A minimum standard checklist for evaluating HRQOL outcomes in cancer clinical trials was devised to assess the quality of the HRQOL reporting and to classify the studies on the grounds of their robustness. It comprises 11 key HRQOL issues grouped into four broader sections: conceptual, measurement, methodology, and interpretation. Relevant studies were identified in a number of databases, including MEDLINE and the Cochrane Controlled Trials Register. Both their HRQOL and traditional clinical reported outcomes were systematically analyzed to evaluate their consistency and their relevance for supporting clinical decision making. RESULTS: Although 54% of the identified studies did not show any differences in traditional clinical end points between treatment arms and 17% showed a difference in overall survival, 74% of the studies showed some difference in terms of HRQOL outcomes. One third of the RCTs provided a comprehensive picture of the whole treatment including HRQOL outcomes to support their conclusions. CONCLUSION: A minimum set of criteria for assessing the reported outcomes in cancer clinical trials is necessary to make informed decisions in clinical practice. Using a checklist developed for this study, it was found that HRQOL is a valuable source of information in RCTs of treatment in metastatic prostate cancer.

Asunto(s)

Neoplasias de la Próstata/terapia , Calidad de Vida , Ensayos Clínicos Controlados Aleatorios como Asunto , Determinación de Punto Final , Estado de Salud , Humanos , Masculino , Proyectos de Investigación

RESUMEN

Health-related quality of life is an increasingly important issue in the treatment of prostate cancer. External beam radiotherapy is a frequently-used treatment option which can have short- and long-term side effects influencing the patients' quality of life. In this review the urinary, intestinal and sexual health-related quality of life issues related to treatment with external beam radiotherapy are addressed. Recent research reports allow us to provide an overview on both the short- and long-term of a patient's cancer experience. External beam radiotherapy has different effects on bowel, bladder and sexual function. This review suggests that external beam radiotherapy has a considerable short-term effect on bowel and sexual functioning, and that urinary function is rarely affected. In the long-term there is still a small, but non-negligible, effect on bowel functioning. Sexual function is greatly affected by external beam radiotherapy in the long-term. Recent radiotherapy treatment techniques, such as conformal external beam radiotherapy, tend to give better health-related quality of life outcomes. However, this needs confirmation by more studies in the short- and long-term including health-related quality of life measurements.