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ADT affects long-term quality of life in patients with prostate cancer
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The physical adverse effects associated with continuous androgen deprivation therapy persisted long-term in patients with nonmetastatic prostate cancer, according to study results.
Approximately 50% of men with prostate cancer will receive ADT, and most of those men will undergo the treatment for 2 to 3 years, according to study background. ADT is associated with several adverse effects that affect the quality of life in patients, such as sexual dysfunction, fatigue, anemia, osteoporosis and muscle loss.
Shabbir M.H. Alibhai, MD, MSc, FRCPC, of the department of medicine at the University Health Network in Toronto, and colleagues previously evaluated the physical effects of ADT after 12 months. Researchers evaluated data from the same cohort for an additional 2 years to examine long-term adverse effects of the therapy.
The analysis included 87 men with nonmetastatic prostate cancer who received continuous ADT and two age- and education-matched control groups, one composed of 86 men with prostate cancer who did not receive ADT and one composed of 86 healthy men. The mean age of all participants in the population was 69 years.
Researchers assessed the study’s primary outcome of objective physical function with a 6-minute walk test, grip strength test and the Timed Up and Go (TUG) test. Participants also completed the 36-Item Short-Form Health Survey (SF-36) of the Medical Outcomes Study for quality-of-life analyses.
Researchers compared baseline results of these tests with follow-up assessments at 3, 6 and 12 months in the first year, and then every 6 months thereafter for the next 2 years.
Overall, declines observed after the first year of ADT generally persisted during the next 2 years independently of age.
The distance in the 6-minute walk test improved initially before stabilizing in both control groups, but remained stagnant for ADT users (P = .003).
Grip strength was stable in control groups, but declined steeply in the ADT group by the 3-month mark before plateauing from that point through the 36-month mark (P = .0041).
There was a gradual decline in TUG scores during the course of 36 months in the ADT group; however, TUG scores remained unchanged in both control arms (P = .0008).
Aggregate physical quality of life was stable in both control cohorts, but it declined over time for the ADT users (P = .0001). Aggregate mental quality of life remained stable in all the cohorts.
“A reasonable interpretation of our findings is that most of the deleterious effects of ADT on physical function in middle-aged and older men is seen with 6 months of ADT use,” the researchers wrote. “An additional 12 to 30 months of ADT does not appear to lead to much additional decline. …This may be particularly relevant to clinicians who are debating the merits of shorter or longer courses of ADT because it provides more information about physical toxicities of ADT.”
The researchers said most of the population was well educated and highly functional at baseline, suggesting effects may be worse in men with lower baseline levels.
“These results will help clinicians and patients better understand the risks of ADT,” the researchers concluded. “Moreover, they reinforce the need for greater adoption of exercise programs among ADT users, regardless of whether they are new or established users, to reverse or prevent these declines.” – by Anthony SanFilippo
Disclosure: The researchers report honoraria and clinical trial support from AbbVie, Amgen, Astellas, Bayer, BNIT, Ferring, Janssen, Medivation and Sanofi.
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