Guidelines On How To Handle CYTH4 Before Time Runs Out

9 The diagnosis and treatment toxicities also affect the patients' immediate families,10 particularly through psychological distress related to anxiety, depression11 12 and psychosexual problems.13 Thus, the assessment and management of the adverse treatment effects, related psychosocial needs (also affecting their partners) and the impact on the management of other comorbid conditions is, for many patients, complex and prolonged. Current usual care and evidence base Patients with prostate cancer are normally followed up in out-patient clinics in hospital for up to 5?years, to monitor and manage the risk of recurrence, and the physical symptoms following treatment.14 However, current practice is not underpinned by robust evidence, and is notoriously variable between hospitals.15 In the absence of reliable empirical evidence, the GS 1101 National Institute for Health and Care Excellence (NICE) guidelines recommend that unless significant treatment complications develop, after 2?years, their follow-up care should take place out of hospital.16 However, recommendations on the type of follow-up to be undertaken are notably missing from the guidelines. In the last decade and a half, attempts have been made to address the lack of empirical evidence regarding the efficacy and cost-effectiveness of prostate cancer follow-up. Early initiatives showed that by involving primary and community care, the utilisation of specialist care may be reduced, especially for the more elderly patients.17 Also, patients perceive they receive more care from the general practitioner (GP),18 while their quality of life remains similar between hospital and primary care follow-up. However, notable concerns were reported about the continuity of care, the miscommunication between hospitals and GPs and the integration of prostate specific antigen (PSA) testing. A number of hospital-based alternatives have been proposed, such as hospital group clinics,19 nurse face-to-face and telephone clinics20�C22 and e-health technology based follow-up.23�C25 Such approaches fail to address the issues about the capacity and scope of specialist secondary care teams, which may struggle to offer, assess and manage a holistic range of physical, psychosocial and educational needs of patients. Recently, improvements in e-health platforms facilitating the communication between hospital and primary care, especially surrounding the safe monitoring of PSA levels and cancer recurrence, have revived efforts to consider a primary-care-led model of follow-up.26 Nurse-led interventions have been consistently shown to be effective in a range of diseases, from diabetes and depression,27 28 to various cancers,29 and, more specifically, when interventions were administered in primary care settings.