الفهرس 
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Abstract
Cancer prostate (PCa) is one of the most common types of cancer. It is a malignant tumor that usually caused by many epigenetic alteration that lead to uncontrolled proliferation, differentiation and invasion to nearby tissues. It is a heterogeneous disease with incidence rates that vary substantially across the world, from 6.3 to 83.4 per 100,000 people. It is treat with various types of treatment includes surgery, adjuvant chemotherapy, and radiation therapy; however, it is burdened by many side effects. Progress of the disease, severity of its symptoms, and side effects decrease significantly the quality of life (QoL) in those patients.
Intensity Modulated Radiotherapy (IMRT) is the most popular form of external beam radiation therapy for prostate cancer and an advanced variant of 3D-CRT therapy, which directed towards the prostate from different angles, and their intensity can be changed to protect neighboring normal tissues from radiation dosages, resulting in fewer adverse effects.
Despite advances in conformal techniques, radiation induced prostate toxicity remains a significant source of morbidity. Radiation therapy side effects on the prostate are classified as acute and chronic. Acute or short term side effects occur during treatment or just after its completion, and usually resolve within four to six weeks as dysuria, diarrhea, anorectal pain, skin erythema, insomnia and fatigue. Late adverse effects are observed several months to years after completion of treatment and may be permanent, these side effects includes; urinary incontinence, fecal incontinence and sexual dysfunction.
Oncology nurses are in an ideal position to enhance their patient’s quality of care as they spend large portions of time with the patient. She acts as teachers, care providers, researchers, consultants, and managers. Therefore, the nurses have a major role in developing effective instructional programs for prostatic cancer patients to manage their acute radiotherapy side effects and assisting patients in performing effective action taken.
The aim of the study was:
Evaluate the effect of an instructional module on acute side effects of intensity modulated radiotherapy for patients with cancer prostate.
literature review, and used to assess patient’s knowledge about cancer prostate, acute side effects of intensity modulated radiotherapy and action taken. It included three parts as the following:
Part 1: Patient’s knowledge related to cancer prostate
Part 2: Knowledge related to side effects of radiotherapy
Part 3: Knowledge related to action taken for side effects
Tool III: Cancer prostate: Acute radiotherapy side effects& action taken: structured interview schedule: This tool was developed based on literature review to assess severity of acute radiotherapy side effects as well as patient actions toward these side effects and outcome of this action. It divided into four parts as the following:
Part 1: QUFW94 questionnaire.
Part 2: Action taken toward acute intensity modulated radiotherapy side effects.
Part 3:Urine culture& microbial resistance
Part 4:Anorectal pain visual analog scale
The study was carried out on four phases.
Phase I: Assessment phase: Initial assessment of all patients (study and control group) was carried out once the patient immediately scheduled for radiotherapy using tools I to collect sociodemographic and clinical data as medical and surgical history, smoking history, causes of previous hospitalization, present complaints, time of starting treatment, prescribed medication, date finishing treatment, also knowledge assessment about cancer prostate, radiotherapy action and effect as well as side effects using tool II and assessment of acute radiotherapy side effects, action taken and outcome for this side effects using tool III.
Phase II: Planning phase: Priorities and outcome were formulated based on the assessment phase and review of the relevant literatures, the content was organized according to a feasible learning sequence (from easy to difficult) to enhance patients’ understanding. A colored booklet was developed in simple Arabic language to be distributed to each patient of the study group.
Phase III: Implementation:An instructional module was implemented individually for each patient of the study group in the above mentioned setting in 5 sessions; each session was continued for 45-60 minutes. These sessions were carried out within first week of radiotherapy. Patient was asked to bring one of the family members to attend instruction for follow up of patient at home.
Phase IV: Evaluation phase:
• All patients in both groups were evaluated pre radiotherapy application, immediately after treatment is finished and the first month (every two weeks) post application of the instructional module. Each patient in the study and control group was interviewed to evaluate his knowledge using the tool II and patients were followed also two months post instructional module to evaluate the degree of severity of side effects and action taken using tool III.
The main results of this study were:
The majority of patients in both control and study group among the age group of (50-60) years, married, illiterate, came from ruralareas, and had insufficient monthly income to fulfill the daily requirements.
All patients study group, and the highest percentage of control group (95.6%) had no family history of cancer.
The highest percentage of the study and control group patients (37.8, 33.3%) had diabetes mellitus, and (48.9%, 46.7%) respectively took analgesics as an over counter medication. Also all the study group patients and the highest percentage of the control group (88.9%) smoked cigarette.
All control group (100%) had un satisfactory level of knowledge regarding radiation therapypre and post instructional module, However the majority (80.0%) of the study group patients showed marked improvement in their knowledge post program application with significant difference (P=<0.001*).
All control group (100%) had moderate side effectspre and post programapplication, however the study group patient showed marked improvement in overall severity of side effects post program application. The difference was highly statistically significant within the study group patients(X2c=90.00, P=0.000*).
All patients among both control and study group (57.8%, 53.3%) respectively had moderate anorectal pain pre program implementation. However, the study group patients showed marked improvement in severity of pain as nearly two third (64.4%) had mild pain postprogram application. The difference was highly statistically significant between control and study group patients post program application(p <0.001*).
All control group (100%) had un satisfactory level of practice pre and post educational program, However There was an improvement post program application as the majority of study group (95.6%) had satisfactory level of practice. The difference was highly statistically significant within the study group patients (P= <0.001*).Furthermore, it was observed that there was significant difference between control and study group patients post program application(P= <0.001*).
There was no statistically significant relationship between overall knowledge and age (p=1.000), whereas there are statistically significant relationship between overall knowledge and level of education and occupation respectively (p= 0.006*, 0.016*)
There was no statistically significant relationship between action taken and age, level of education and occupation respectively (p=1.000, 0.121, 0.665)
Conclusion:
Instructional module has been proven to be effective in reducing the acute intensity modulated radiotherapy side effects for the study group patients than control group
Recommendations
• Pre intensity modulated radiotherapy sessions, the developed illustrated booklet should be available and distributed to all patients with prostate cancer
• Replication of the study on large proportionally sampling to attain more generalized results.