A genuine opportunity exists to improve the quality of life of men with prostate cancer on androgen deprivation therapy (ADT) but robust ‘real-world’ research is crucial to inform NHS practice. Finding ways of supporting men on ADT to take up and continue exercising is essential to reduce side-effects which can include severe fatigue, loss of strength and increased fat-mass.
STAMINA is a five year research project funded by the National Institute for Health Research (NIHR) in the UK. The programme is designed to evaluate the effectiveness of a long term supported exercise intervention in men with advanced prostate cancer who have undergone medical castration with ADT.
This is the largest study of its kind to date and is the result of over a decade of collaborative research.
We propose a system-level change in care-delivery for prostate cancer which will include:
Understanding variations in current NHS prostate cancer pathways and exercise provision for men on ADT
Developing, optimising and testing STAMINA service-level intervention- including training health care professionals and exercise professionals to integrate exercise into patient care
Evaluating the effectiveness and cost-effectiveness between STAMINA and usual care, and estimating the demand for, and willingness to pay for, an extended exercise programme
Prostate cancer is the most common cancer in men in the UK with around 46,700 men diagnosed each year. Prostate cancer is now the second most common cancer for men to die from, after lung cancer, with 11,819 men dying every year in the UK, this equates to one man dying every 45 minutes.
More than 50% of men diagnosed with prostate cancer in the UK each year are aged 70 and over and incidence rates for prostate cancer are projected to rise in the UK each year as the population ages.
Half of men with prostate cancer will be treated with ADT.
ADT works by reducing the levels of testosterone to prevent prostate cancer cells from growing. While effective, the side effects of ADT can have a detrimental impact on a person's quality of life. Some of the side effects include:
Loss of muscle strength
Increased fat mass
Increased risk of diabetes and cardio vascular disease
However, many of these side effects can be managed through supervised aerobic and resistance exercise.
The National Institute of Health and Clinical Excellence (NICE) guidance recognises the benefits of exercise for men on ADT and recommends 12 weeks of supervised resistance, as well as aerobic exercise at least twice a week for 12 weeks to reduce fatigue and improve quality of life.
Exercise interventions delivered by specialist staff in non-NHS research centres have demonstrated short-term improvements over a 12 week period, but very few treatment centres are currently able to support a routine exercise intervention as it is not standardised or embedded in cancer care. As such, even the short term benefits that are appreciated will dissipate without ongoing support.
Men currently on ADT inform us they would welcome exercise with support embedded in their standard prostate cancer care rather than as an add-on. It is our goal to develop this.
STAMINA is partnered with Nuffield Health, one of the UK’s leading not-for-profit healthcare organisations. Nuffield Health will be providing tailored exercise interventions to improve quality of life for men with advanced stage prostate cancer.