Long-term follow-up 3 years after a randomized rehabilitation study among radiated prostate cancer survivors

Abstract

Purpose

In the Rehabilitation of Prostate Cancer (RePCa) study, the intervention reduced early adverse effects in prostate cancer 6 months after radiotherapy. This 3-year follow-up study assesses late adverse effects, evaluates rehabilitative long-term effects and identifies patients who benefit the most.

Design

RePCa was a randomized clinical trial with multidisciplinary rehabilitation (n = 79) or usual care (n = 82). The intervention during the first 6 months consisted of consultations by nurses and physiotherapists focusing on psychosocial support and physical activity, respectively. Here we report the 3-year follow-up. Data consisted of disease-specific quality of life (EPIC-26), general quality of life (SF-12) and pelvic floor strength measured by electromyography.

Results

One hundred forty-three patients (92%) responded. The primary outcome urinary irritative sum-score was no longer significantly different between groups. In patients with moderate-severe urinary problems at baseline, we observed a significant long-term effect on the urinary irritative sum-score in favour of the intervention (+ 13.4 points P = .014). More patients had moderate-severe bowel problems in the control group (n = 10; 14%) compared to the intervention group (n = 2; 3%) (P = .016). Pelvic floor strength deteriorated significantly in both groups.

Conclusion

The short-term rehabilitation was beneficial but of limited benefit in the long term for all patients. A significant and clinically relevant effect was found in irradiated prostate cancer patients with moderate-severe urinary problems at baseline. In both groups, pelvic floor strength was weakened during follow-up.

Impact for cancer survivors

Prior research showed patients benefit from early rehabilitation. Identification of patients with moderate-severe urinary problems followed by a focused rehabilitation during the first 6 months after radiotherapy results in long-term improvement. Radiated patients have to be aware of their pelvic floor strength.

Implications for Cancer Survivors

Patients can be informed that they benefit from early rehabilitation, and they cannot expect larger changes in adverse effects within the first years, but they have to be aware of their pelvic floor strength. Future rehabilitation studies could be applied mainly to patients with assessed rehabilitation needs after radiotherapy and intensified with long-term follow-up.

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Acknowledgements

A special thanks to the patients who participated in the study for their valuable contributions. Thank you to Anders Michael Nielsen for English proof-reading.

Funding

The study was initiated on behalf of the AgeCare Academy of Geriatric Cancer Research www.agecare.org and supported by REHPA, Danish Centre of Rehabilitation and Palliative Care www.rehpa.dk.

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All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by Karin B. Dieperink. Analysis was interpreted by all authors. The first draft of the manuscript was written by Karin B. Dieperink, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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Correspondence to Karin B. Dieperink.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Dieperink, K.B., Hansen, S., Wagner, L. et al. Long-term follow-up 3 years after a randomized rehabilitation study among radiated prostate cancer survivors. J Cancer Surviv (2020). https://doi.org/10.1007/s11764-020-00958-9

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Keywords

  • Prostate cancer
  • Radiotherapy
  • Rehabilitation
  • Late adverse effects
  • Pelvic floor
  • Quality of life