Quality statement 4: Managing adverse effects of treatment

Quality statement

Men with adverse effects of prostate cancer treatment are referred to specialist services.

Rationale

Treatments for prostate cancer have various adverse effects that can continue after the treatment is completed. Adverse effects include sexual dysfunction, loss of libido, impotence, urinary incontinence, radiation‑induced enteropathy, hot flushes, osteoporosis, cardiovascular complications, gynaecomastia and fatigue. These adverse effects can also have an emotional and psychological impact on men. Specialist services that provide interventions such as counselling, drug therapy, radiotherapy, physiotherapy and aerobic exercise can help to manage adverse effects of treatment and substantially improve the man's quality of life.

Quality measures

Structure

Evidence of local arrangements to ensure that men with adverse effects of prostate cancer treatment are referred to specialist services.

Data source: Local data collection and the National Prostate Cancer Audit.

Process

Proportion of men with adverse effects of prostate cancer treatment who use specialist services.

Numerator – the number in the denominator who use specialist services.

Denominator – the number of men with adverse effects of prostate cancer treatment.

Data source: Local data collection and the National Prostate Cancer Audit.

What the quality statement means for service providers, healthcare professionals and commissioners

Service providers (such as hospitals, specialist urological cancer multidisciplinary teams and specialist prostate cancer services) ensure that systems are in place for men with adverse effects of prostate cancer treatment to be referred to specialist services.

Healthcare professionals refer men with adverse effects of prostate cancer treatment to specialist services.

Commissioners (such as clinical commissioning groups and NHS England area teams) have pathways in place to ensure that men with adverse effects of prostate cancer treatment are referred to specialist services.

What the quality statement means for patients and carers

Men who have side effects from prostate cancer treatment are referred to specialist services (such as erectile dysfunction or continence services) to help stop or ease the side effects.

Source guidance

  • Prostate cancer (2014) NICE guideline CG175, recommendations 1.3.31 (key priority for implementation), 1.3.34, 1.3.37 (key priority for implementation), 1.4.3, 1.4.8, 1.4.13, 1.4.14, 1.4.16, 1.4.18 and 1.4.19

Definitions of terms used in this quality statement

Adverse effects

Adverse effects include:

  • sexual dysfunction

  • loss of libido

  • impotence

  • urinary incontinence

  • radiation‑induced enteropathy

  • hot flushes

  • osteoporosis

  • cardiovascular complications

  • gynaecomastia

  • fatigue

  • weight gain

  • metabolic syndrome.

[Adapted from Prostate cancer (NICE guideline CG175)]

Specialist services

The specialist services include erectile dysfunction services, continence services and psychosexual counselling.

[Adapted from Prostate cancer (NICE guideline CG175)]

Equality and diversity considerations

Older men may need encouragement to engage with specialist services as they tend not to use the health service as much as other people.

Gay and bisexual men, and transgender women have a risk of developing prostate cancer. Healthcare professionals should be aware of their psychosexual needs, lifestyle and the impact of different treatment options.