title: Follow up of men post-prostatectomy: who is responsible?
abstract: BACKGROUND
  Men living with prostate cancer represent a large, at-risk population deserving access to comprehensive follow-up services stemming from chronic aspects of living with the disease. Current research about the quality and accessibility of prostate cancer follow-up services is limited.
  
  
  OBJECTIVE
  The purpose of this study was to describe the patient, provider, and health plan characteristics speculated to influence prostate cancer follow-up care.
  
  
  METHODS
  A cross-sectional descriptive study of men living with prostate cancer, treated by radical prostatectomy within the past 3 to 5 years was conducted. Subjects were surveyed regarding follow-up care, type of providers visited, current health status, late-term effects, health behaviors, and health plan requirements. Data obtained analyzed associations among patient, provider, and health plan characteristics in relation to the use of post-prostatectomy follow-up services.
  
  
  RESULTS
  Post-prostatectomy, all men participated in follow-up visits to a cancer care provider (urologist) and were monitored for recurrence by prostate-specific antigen (PSA) testing. Fewer men had rectal examinations performed. For nearly half of the men, the general medical provider duplicated the PSA test, indicating a lack of coordination among providers. Almost all men had health insurance; no subjects identified barriers to care because of health plan rules or out-of-pocket expenses. Persistent late effects included urinary incontinence (60%) and erectile dysfunction (71.9%). No significant associations were found among patient, provider, and health plan characteristics to their utilization.
  
  
  CONCLUSIONS
  In this study, men living with prostate cancer post-prostatectomy received ongoing follow-up health care, some of which was duplicated. Most experienced late adverse effects and many had other health problems. Nurses are uniquely positioned to assume a central role in promoting access to comprehensive, non- duplicative post-prostatectomy follow-up care. Additionally, nurses can provide effective counseling, advocacy, and education for men living with prostate cancer.
authors.affiliation: Yale University School of Nursing, New Haven, CT, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Ercolano
mesh_terms: D000223:Adaptation, Psychological; D000359:Aftercare / Q000458:organization & administration*; D000368:Aged; D000704:Analysis of Variance; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D007172:Erectile Dysfunction / Q000517:prevention & control; D006297:Health Services Accessibility; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment / Q000458:organization & administration*; D015404:Nursing Methodology Research; D010344:Patient Advocacy; D010353:Patient Education as Topic; D010414:Pennsylvania; D024382:Professional Role; D011468:Prostatectomy / Q000009:adverse effects / Q000451:nursing / Q000523:psychology* / Q000534:rehabilitation; D011471:Prostatic Neoplasms / Q000523:psychology / Q000601:surgery; D011795:Surveys and Questionnaires; D014549:Urinary Incontinence / Q000517:prevention & control