5 steps to implementing personalised healthcare for prostate Cancer patients.

Personalised healthcare is at the core of the approach to prostate cancer here at The Focal Therapy Clinic .

The charity Prostate Cancer UK gave evidence last month to Parliament’s Health and Social Care Committee, for the latter’s inquiry entitled “How can the Government improve cancer outcomes in England?” In its evidence, PCUK provided eleven key recommendations to the Government, which included :

    • A shift away from symptoms awareness, which is reflective of later stage diagnosis to instead focusing on raising the awareness of a man’s risk to prostate cancer, within primary care as well as with the public.
    • A focus on reducing the number of late stage incurable diagnoses, to the more curable stages of diagnosis.
    • A standardisation of national data collection that includes equipment and health inequalities.

Its final recommendation was a call to increase the level of personalised care: “More needs to be done on personalised care to achieve the commitment made by the Government. There are likely to be very good examples of personalised care happening across England that can be utilised as a learning exercise. The Government should look to these models, understand the challenges and solutions and use that information to inform future commitments and investment in this area of cancer care to support NHS Trusts that are struggling. “

So what does Prostate Cancer UK or the NHS mean by personalised care?

A handbook was published by the NHS in 2020 which outlined what personalised care pathways would look like for cancer patients. It set out requirements for Cancer Alliances to work with local systems to ensure that every patient has access to personalised care interventions from diagnosis by 2021. Interventions include: “Personalised Care and Support Planning based on Holistic Needs Assessments, Health and Wellbeing Information and Support, and End of Treatment Summaries (collectively formerly known as a ‘recovery package’).

In its evidence to the Health and Social Care Committee, Prostate Cancer UK referenced the National Cancer Patient Experience Survey, stating

“In summary, the NCPES shows variation and poor levels of access to care plans. Health and wellbeing information and support for men diagnosed with prostate cancer rates highly but, again, there is huge variation in what men experience. More could be done to ensure all men have a high quality experience beyond their diagnosis.”

At the same time as personalised care is accepted as a healthcare strategy and providers are attempting to implement it (with varying outcomes), medical technology is enabling personalised treatment for prostate cancer, based on increasing understanding of individual patients’ genetic makeup combined with precise diagnostic information and targeted interventions.

The challenge with all of this information is to translate it into truly personalised care and treatment. This is something clinical and non-clinical practioners must address all the time, and – captured in a recent review on prostate imaging which posed the question “do we Treat the patient or the scan?”

Combining personalised care with personalised treatment underpins all patient engagement at the Focal Therapy Clinic. Our practice is based on five elements:n

    1. Providing a second opinion

The majority of our patients have had a diagnosis of prostate cancer and a recommendation for treatment when they approach us, and are actively seeking a second opinion on their treatment options. These men are well informed and well motivated to share information and express concerns and aspirations – giving us an ideal starting point for establishing a personalised care plan for managing their prostate cancer.

    1. Patient advocacy

All patients work with one of our patient advocates, who listens, learns and supports each patient throughout their experience  with our clinic. Our patient advocate team have spoken with hundreds of men over the last two years, and have developed a comprehensive picture of what is happening to men who are diagnosed with early-stage prostate cancer across the country and how to reduce, and sometimes eliminate, the fear, uncertainty and doubt underlying their treatment decisions.

The patient advocate is the first port of call at our clinic, providing prospective patients with

    • empathy and support for the journey they are undertaking
    • Patient advocacy is a core element of our entire approach, from initial enquiry through to MDT and treatment.
    1. A Whole Man approach

Understanding who each patient is – his lifestyle, what he cares about, his relationships, how he spends his time, and his aspirations for the future  – is critical to us in supporting the management of his prostate cancer. TFTC Consultant Urologist Marc Laniado emphasises the importance of discussing mental health issues with his patients, and giving men “permission” to talk about how they feel and their ability to cope with having prostate cancer. When it comes to treatment decisions, many men are not counselled about long-term side effects of individual treatments, which can impact mental health. “Often men are caught between a rock and a hard place” says Marc. “While they want to get rid of their cancer, they don’t want to lose sexual or urinary function. It’s a balancing act, and men are best able to cope with this when they have the information they need at the right time and in the right place”. Consultant Urologist Alan Doherty adds, “understanding what a man is capable of behaviourally and what support he has to sustain successful behaviours is crucial to a positive treatment outcome”.

    1. Advanced diagnostic technology & clinical practice

Imaging – our practice relies on state-of-the-art prostate imaging to plan for biopsy, confirm diagnosis and guide treatment. The quality of reporting we undertake is unrivalled and provides the clinical team a basis for determining a personalised treatment plan.

Biopsying  –  our clinical team rely on state-of-the-art trans-perineal MR/US fusion biopsies to give them the highest level of accuracy in sampling tissue and confirming the location, size and severity of each patient’s prostate cancer.

    1. The MDT

All FTC patients are presented to a fortnightly MDT meeting where their diagnostic information, overall health and wellbeing and lifestyle aspirations are discussed and reviewed in detail by a consulting team including patient advocate, technologist, radiologist, consulting urologist. Treatment recommendations are reached by consensus and actively communicated with each patient. Over the last two years these meetings have taken place online which, according to FTC Consultant Urologist Tum Dudderidge, delivers enhanced benefits for patients who, while not in attendance and unable to advocate for themselves, can access images and recorded content from the meeting.

Tim adds: “if you’re in an MDT and all of those (patient specific) issues are clearly recorded, then the MDT has a chance to be aware of that. Otherwise, there’s a danger that people make assumptions about a patient’s longevity, about activity, about what the patient’s interests are. And then the MDT might come out with a recommendation, which is too focused, and doesn’t allow the breadth of discussion that should happen for every patient, regardless of their age or what assumptions we might make about their lifestyle.”

What is your expectation of personalised care and treatment? We’d love to hear from you.