NICE guidelines recommend 12 weeks of supervised exercise training for men with prostate cancer treated with androgen deprivation therapy (ADT) to counter the adverse effects of castration. However, a new study published in PLoS One, has found that the provision of exercise training as recommended is not happening in practice.
The multi-centre investigation involved a web-based survey of NHS prostate cancer care, five focus groups involving 26 men on ADT and 37 semi-structured interviews with healthcare professionals (HCPs) involved in the management of patients with prostate cancer.
Patients confirmed that medical castration has a serious and debilitating impact on quality of life. There was general support for exercise training programmes as part of cancer care and patients would support their initiation soon after diagnosis.
Of 154 NHS trusts, only 51% provided survey data on current delivery and only 17% could provide supervised exercise as per NICE recommendations.
It was felt that clinicians might be quite conservative as to the possible benefits of exercise training, particularly in elderly patients with metastatic cancer. These opinions were considered a potential barrier to the integration of exercise training in standard treatment. The importance of educating HCPs in behaviour change techniques, including specific approaches such as motivational interviewing, were highlighted as a key issue.
The authors concluded that there is substantial variability in the delivery of exercise training to this population across the UK and compliance with NICE recommendations is poor. Where available, clinical teams should be making appropriate referrals for their patients, they said.
Further research is likely needed to explore how to embed these services where referrals are not already happening, they added.