From cooking to kegels: daily lessons for prostate cancer patients drop care costs

CBC

14 hours ago

A new study that found a daily dose of information which helps men cope with the physical and mental distress of prostate cancer is also saving Nova Scotia's health system money.
"This is one of those rare interventions that improves outcomes and reduces costs," wrote Gabriela Ilie, a co-author who is a research psychologist and professor at Dalhousie University's medical faculty, in a recent email about the "patient empowerment program," or PEP.
The program created in 2019 by Ilie and radiation oncologist Dr. Rob Rutledge includes pelvic exercises to improve bladder control, aerobic and strength exercise routines, and instruction on how to maintain intimacy despite lost sexual capacity.
The six months of videos — delivered by email — also teaches meditation methods and provides "mostly plant-based" cooking lessons. Participants may sign up for a "buddy system" to offer mutual support as men recover from radiation, surgeries and hormone therapies.
The cost-effectiveness study, carried out between 2020 and 2022 and released June 13 in the Canadian Urological Association Journal, concluded that 66 men participating made an average of about 11 visits to seek medical help, versus 16 for the 62 men receiving "standard care" over a one-year period.
"That's a reduction of about four fewer medical visits per man, a meaningful shift when scaled across the medical system," wrote Ilie in an email.
Health benefits, cost savings
Using medical billing data, the researchers said that created a "direct savings" of about $661 per patient over a year, after taking into account the program's costs. The total billings for participants over the year averaged about $1,195, versus about $1,856 for non-participants, the paper says.
Ilie said the study also observed "a 31 per cent reduction in... psychological distress at 12 months among the participants."
Earlier peer-reviewed research on PEP has shown improved urinary function and weight loss among the men who followed the video regimes created by Ilie and Rutledge — who are married.
While surgery, radiation and hormone treatments can lead to a cure in prostate cancer treatment, Rutledge and Ilie argue the health system has failed to provide support after diagnosis, even as research shows men often struggle with mental health issues.
Surgery can often damage the nerve ends near the prostate, a walnut-sized gland above the genitals. This injury can limit the ability of men to have erections — which research has indicated often leads to feelings of guilt, loss and inadequacy. Treatments also often lead to having incontinence, increasing social isolation and depression.
To counter this, the PEP videos created by the researchers is a carefully orchestrated routine including text message reminders for the pelvic exercises.
'Sense of optimism'
Joseph Lynton, a retired psychotherapist who participated in the study, said he joined on his surgeon's advice after a "life-changing" operation to remove the prostate gland and surrounding tissues.
The 72-year-old said he found himself feeling self-conscious — and at times isolated — due to his incontinence.
Once in the PEP program, Lynton said it helped him gained a "sense of optimism" as he listened to other participants in zoom calls sharing information and worked "religiously" at the prescribed pelvic exercises, referred to as kegels, to combat incontinence.
"Losing your prostate can affect a very sensitive and important part of your masculinity ... I would say that I did feel a certain degree of depression and I think being part of the program helped me through that," he said.
Lynton also said he would have needed further treatments for his mental health without the program. "When I joined the program, I felt I didn't need that [clinical treatment for anxiety] anymore," he said.
Rutledge and Ilie spend many of their spare hours working on the videos and have widened their application to pilot projects with other cancer patients.
Wider application
While the initial concept for the program attracted philanthropic support through the Soillse Research Fund, created by Frank and Debbi Sobey, they say their research is suggesting the "empowerment" method could be used more widely in the public health system.
They are seeking support from Nova Scotia Health's cancer care division to help fund a larger pilot project, said Rutledge.
Jill Flinn, senior director, of Nova Scotia Health's cancer care program said in an email that the research findings have been reviewed and "it is clear the program has had and continues to have a positive impact on the lives and well-being of patients with prostate cancer and their families."
"Their request for cancer care program funding will be reviewed, along with other requests."
Oncologist Dr. Christopher Booth, a co-chair of an international study on the impact of exercise on recurrence of colon cancer, said in a recent email there's a growing body of evidence that "simple, cost-effective interventions that are empowering for patients" are improving wellness during treatment.
His group's recently released colon cancer study found that patients who participated in a supervised exercise program after completing their chemotherapy were 28 per cent less likely to have their colon cancer return than patients in the control group.
Booth, who is also a researcher at Queen's University in Kingston, Ont., said health administrations are "interested in these interventions but current funding streams are still largely aligned around 'traditional' forms of cancer therapy."
"It will take new thinking and investment in this space," he said.