How Nurses Help Patients With Prostate Cancer During Radiation Treatment

"I like to make sure patients know the benefit of having that open communication and really telling us what’s going on.” —Jessica Fox, RN

During an episode of of The Vitals, Jessica Fox, RN, a radiation oncology nurse with the Providence Cancer Institute in Portland, Oregon, discussed some of radiation’s common adverse effects (AEs) for patients with prostate cancer, including irritable bowel symptoms; urinary urgency, frequency, and burning; erectile dysfunction; ejaculatory change; and fatigue. She also highlighted the role of nurses in educating patients on these AEs and the fact that they vary in intensity and duration across patients.

Nurses can explain the spectrum of potential AEs, reassure patients that most AEs are manageable, and provide education on managing AEs, according to Fox. She also underscored the importance of establishing a strong rapport with patients, as experienced nurses specializing in prostate cancer can leverage their knowledge to ease patient anxieties, offer evidence-based guidance on managing AEs, and tailor support based on individual needs and concerns.

Can you please describe the experience, typical AEs, and treatment tolerance for patients with prostate cancer who are treated with radiation therapy?

[AEs] are a big piece of radiation. It’s a typical concern of patients, and it’s a big part of the [job of a] radiation oncology nurse.

[Once a patient comes into our clinic after deciding to go with treatment], we have set aside time [for them to] sit down and really focus on understanding what they’re about to go through. Of course, they’ve already talked about that with the doctor, but it helps bring it all home on the day of treatment, so we spend about 30 minutes with patients [for this discussion].

Of course every clinic [is] different, but this is our practice, and I think it’s pretty consistent throughout the region. We sit down with them, with a nurse, and we have a printout for them. We speak to multiple learning styles, so some patients [prefer to] read, [whereas others prefer] conversation. But we review all the [AEs].

A takeaway message for them is to understand that everything is on a spectrum. Not one patient experiences everything to their full degree. That really helps ease their mind initially, to know that all these scary things that we might be telling them, [they can] take with a grain of salt. They have that awareness of what may or may not happen to them.

The [prostate cancer AEs] that we go over...are irritated bowel symptoms, which...might be an increase in gut motility [due to] that tissue being irritated with the radiation, so we [might] find some diarrhea or looser stools. Then, as expected, [there are] those irritated urinary symptoms patients often go through— again, on a spectrum but irritative. [This means] they can have increased frequency...some burning with urination, and... this sensation of incomplete bladder emptying. Of course, these are all things we want to know about. We make sure to communicate that with them early on, even though they are considered normal going through treatment. Nurses and doctors want to know what’s going on, because there’s often things that we can do to help them through these irritating [AEs].

For the patient experience, this sit-down is a really important piece of their treatment, because it establishes an early rapport with the nursing staff in the clinic. We have core nurses who are here 5 days a week, so they’re going to be familiar faces that these patients see. And talking with a lot of patients throughout their...treatment, they really appreciate that we [can] understand where they’re at right from the get-go, what their baseline is, how they
learn, what their concerns are, and we follow them every day throughout treatment. We make sure we have the open-door policy. Just because they don’t have a scheduled appointment with us or a doctor doesn’t mean they can’t stop at the nurse’s desk and pull us aside to say, “Hey, I’m having these concerns. What can I do?” or [to tell us that] things have changed.” From a radiation standpoint, what I’ve learned being in this role is that that’s really unique. We have that ability to tailor the education [and] experience for each of these patients coming through the clinic.

Are these AEs relatively easily manageable in the long and short term?

Patients often ask this question, as well. It’s really hard to give them an exact answer, because everyone is different. Our bodies all tolerate treatment differently. And this is on a spectrum of [AEs] and a spectrum of severity.

But as a blanket statement, for the most part, patients are pretty surprised that it is very tolerable. I think they come in being really scared of radiation and what those [AEs] might be. But they find that with that collaborative effort, medication management, and time— which I usually say is the best medicine for radiation—they find it to be pretty tolerable.

Are there any other AEs oncology nurses should know about?

[For] patients undergoing prostate therapy of any kind, one of their big concerns is erectile dysfunction. That’s typically something the doctor discusses in full with them, because there are some aspects that are very individualized to patients. But there’s certainly a risk, whether that’s in the short term [or] some ejaculation changes. This can translate to the long term, as well. [Of course], there are medications and things the doctor can work with...and better explain to them what can be happening and how that’s going to change.

Lastly, the big takeaway with radiation—no matter what type—is fatigue. Patients often experience this on some part of the spectrum, no matter what part of your body you’re getting irradiated. This is the only systemic effect that we typically see, but that fatigue can affect their lives on a day-to-day basis, so it’s important to highlight that.

Any of the [AEs] that we discussed with them in that moment are typically on a bell curve.... [AEs] are typically cumulative, so after the first couple treatments, they may or may not feel any difference. But over time, they do start to rear their head—fatigue being that primary one. We usually tell them that 1 to 2 weeks after the completion of radiation is when they start to see things slowly dissipate, so that peak is going to be actually after radiation. That’s a big eye-opener for a lot of patients. They’re surprised about that.

How can patients benefit from nurses who have specialized expertise in specific types of cancer, such as prostate cancer?

The expertise is really helpful to ease their mind. The [AEs] and how [they] affect their daily life is a big stressor, so having this back- ground and specializing in prostate cancer...is really helpful to guide them and provide them with our anec- dotal and research-based evidence on how patients do and what we can do to help them.

That’s a big takeaway and what we drive home really early on, as well. If we don’t know what’s going on and we don’t work together, we can’t help them. There are still lots of over-the-counter remedies and medications that can help them through the process with their concerns, specifically [AEs], so having that background and rapport is really helpful.

What advice would you give oncology nurses caring for patients undergoing radiation therapy?

I like to make sure patients know the benefit of having that open communication and really telling us what’s going on, and that doesn’t have to be [AE]-related. It can be just what’s going on in life. Many people are working through treatments or have financial concerns, and the nurses in the clinic are here as your conduit. We can go to the doctor. We can connect you with a social worker. If you have questions about medications or other treatments you’re receiving from other clinics, we can help connect you with the pharmacist. Having patients know that there’s someone there to walk the road with you and to really utilize them is a [huge] takeaway.