A multi-centre investigation of delivering national guidelines on exercise training for men with advanced prostate cancer undergoing androgen deprivation therapy in the UK NHS

BackgroundNational guidelines (NICE-CG175) recommended 12 weeks of supervised exercise training for men treated with androgen deprivation therapy (ADT) for prostate cancer to counter debilitating adverse effects of castration. As with other chronic conditions where exercise is indicated, it is uncertain if these services are being delivered in the health services. The aim of this multi-centre investigation was to examine what exercise referral is currently available for men on ADT as provided by the NHS and if a supervised, individually-tailored exercise training package (as per the national NICE guidelines CG175) is embedded within prostate cancer care.MethodsA multi-centre investigation of current National Health Service (NHS) care involving 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 prostate cancer. Descriptive statistics and thematic analysis evaluated quantitative and qualitative data, respectively. Qualitative methods followed COREQ standards.ResultsHCPs and men on ADT asserted that medical castration has a serious and debilitating impact on many features of men's quality of life. There is support for exercise training programmes as part of cancer care and patients would support their initiation soon after diagnosis. Involving the Multidisciplinary Team (MDT) is proposed as key to this. Critically, traditional values in oncology would need to be overcome for widespread acceptance. Specialist further training for HCPs around behaviour change support could encourage this. Given that these schemes are seen as a fundamental part of cancer care, it is felt the NHS should commission and support provision. 79 representatives of 154 NHS trusts (51%) provided survey data on current delivery: only 17% could provide supervised exercise as per CG175.ConclusionsEvidence-based national exercise guidelines are not being delivered to men on ADT as intended. Traditional values in oncology and the need for NHS financial support are seen as major barriers to provision of current best practice guidelines. Despite this both HCPs and men on ADT are in favour of such programmes being a fundamental part of their cancer care.【背景】英国国家卫生与临床优化研究所指南（NICE-CG175）推荐，针对接受雄激素剥夺治疗（androgen deprivation therapy, ADT）的前列腺癌患者，应开展为期12周的监督式运动训练，以抵消去势治疗引发的衰弱性不良反应。与其他推荐运动干预的慢性疾病一样，目前尚不确定卫生服务体系中是否能够提供此类运动服务。本项多中心研究的目的为，调研英国国民保健制度（National Health Service, NHS）目前为接受ADT治疗的前列腺癌患者提供的运动转诊服务现状，并验证符合NICE-CG175指南要求的监督式个体化定制运动训练方案是否已嵌入前列腺癌诊疗流程中。 【方法】本项针对当前NHS前列腺癌诊疗服务的多中心研究，涵盖三项研究内容：针对NHS前列腺癌诊疗的网络问卷调查、26名接受ADT治疗的患者参与的5组焦点小组访谈，以及对37名参与前列腺癌诊疗的医护人员（healthcare professionals, HCPs）开展的半结构化访谈。研究分别采用描述性统计与主题分析法对定量数据与定性数据进行分析，定性研究方法符合定性研究报告统一标准（COREQ）规范。 【结果】医护人员与接受ADT治疗的患者均表示，药物去势治疗会严重影响男性的多项生活质量维度，且会引发衰弱症状。受试者均认可运动训练方案作为癌症诊疗组成部分的价值，且患者支持在确诊后尽快启动此类运动干预。研究提出，整合多学科团队（Multidisciplinary Team, MDT）参与是落实该方案的关键。至关重要的是，若要实现该方案的广泛推广，需破除肿瘤学领域的传统观念桎梏。针对医护人员开展行为改变支持相关的专项进阶培训，可助力该方案的落地。鉴于此类运动方案被视为癌症诊疗的核心组成部分，学界普遍认为NHS应委托并支持此类服务的提供。154家NHS医疗机构中共有79名代表（占比51%）提交了当前服务开展情况的调研数据，其中仅17%的机构能够提供符合CG175指南要求的监督式运动服务。 【结论】目前针对接受ADT治疗的前列腺癌患者，循证国家运动指南并未得到预期落实。肿瘤学领域的传统观念桎梏与NHS的资金支持缺口，被视为当前最佳实践指南落地的两大主要障碍。尽管存在上述障碍，医护人员与接受ADT治疗的患者均支持将此类运动方案作为前列腺癌诊疗的核心组成部分。