Follow up of men post-prostatectomy: who is responsible?

Abstract

Introduction: Men living with prostate cancer represent a large, at-risk population deserving access to comprehensive follow-up services stemming from chronic aspects of living with the disease. Current research about the quality and accessibility of prostate cancer follow-up services is limited.

Objective: The purpose of this study was to describe the patient, provider, and health plan characteristics speculated to influence prostate cancer follow-up care.

Method: A cross-sectional descriptive study of men living with prostate cancer, treated by radical prostatectomy within the past 3 to 5 years was conducted. Subjects were surveyed regarding follow-up care, type of providers visited, current health status, late-term effects, health behaviors, and health plan requirements. Data obtained analyzed associations among patient, provider, and health plan characteristics in relation to the use of post-prostatectomy follow-up services.

Results: Post-prostatectomy, all men participated in follow-up visits to a cancer care provider (urologist) and were monitored for recurrence by prostate-specific antigen (PSA) testing. Fewer men had rectal examinations performed. For nearly half of the men, the general medical provider duplicated the PSA test, indicating a lack of coordination among providers. Almost all men had health insurance; no subjects identified barriers to care because of health plan rules or out-of-pocket expenses. Persistent late effects included urinary incontinence (60%) and erectile dysfunction (71.9%). No significant associations were found among patient, provider, and health plan characteristics to their utilization.

Conclusions: In this study, men living with prostate cancer post-prostatectomy received ongoing follow-up health care, some of which was duplicated. Most experienced late adverse effects and many had other health problems. Nurses are uniquely positioned to assume a central role in promoting access to comprehensive, non- duplicative post-prostatectomy follow-up care. Additionally, nurses can provide effective counseling, advocacy, and education for men living with prostate cancer.