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Gudenkauf LM, Gray S, Gonzalez BD, Sachdeva A, Autio K. Balancing Hormone Therapy: Mitigating Adverse Effects of Androgen-Deprivation Therapy and Exploring Alternatives in Prostate Cancer Management. Am Soc Clin Oncol Educ Book 2024; 44:e433126. [PMID: 38788186 DOI: 10.1200/edbk_433126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2024]
Abstract
Androgen-deprivation therapy (ADT) is well established as the standard of care in metastatic prostate cancer (PCa) management; however, ADT has significant adverse effects (AEs) that must be addressed. This review aims to highlight opportunities to mitigate AEs of ADT and explore alternatives in PCa management. Specifically, we discuss behavioral and pharmacologic strategies for mitigating ADT AEs as well as ADT-sparing approaches for hormone-sensitive and castration-resistant PCa. Equipped with effective mitigation strategies and possible alternatives, clinicians and researchers can optimize health-related quality of life for patients currently receiving ADT for PCa and consider treatments that spare patients from AEs of ADT.
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Affiliation(s)
- Lisa M Gudenkauf
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | - Struan Gray
- Salford Royal and The Christie NHS Foundation Trusts, Manchester, United Kingdom
- Genito-urinary Cancer Research Group, Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
| | - Brian D Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | - Ashwin Sachdeva
- Genito-urinary Cancer Research Group, Division of Cancer Sciences, The University of Manchester, Manchester, United Kingdom
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Karen Autio
- Department of Genitourinary Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
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Raines C, Noorvash B, Posadas EM, Sandler HM, Freedland SJ, Gresham G. Applications of wearable activity monitors for prostate cancer survivors: A systematic scoping review. Contemp Clin Trials 2024; 143:107563. [PMID: 38723860 DOI: 10.1016/j.cct.2024.107563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 04/04/2024] [Accepted: 05/01/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Wearable technology is used to monitor and motivate physical activity (PA) and provides continuous, objective PA and sleep data outside the clinical setting. We reviewed the literature to understand how wearables are integrated into prostate cancer (PC) investigations in order to identify current practices, gaps, and research opportunities. METHODS We conducted a literature search for articles using wearables, among PC survivors published between 2012 and 2022. We extracted study details, interventions and outcomes, participant baseline characteristics, and device characteristics and grouped them by study type: randomized control trials (RCTs) and non-randomized studies. RESULTS Of 354 articles screened, 44 met eligibility criteria (23 RCTs, and 21 non-randomized). 89% used wearables to monitor PA metrics, 11%, sleep metrics, and 6.8%, both. Most studies involved exercise (70% RCTs, 9% non-randomized studies) or lifestyle interventions (30% RCTs, 9% non-randomized studies). Intervention delivery methods included personalized computer-based (48%), in-person (e.g., trainer) (20%), and education web or print-based (20%). Interventions occurred at the participant's home (48%) or at a gym (20%). 57% of the studies evaluated the feasibility and acceptability of the wearable as an activity-measuring device or as part of a remotely delivered computer-based intervention. Studies used wearables to monitor adherence to PA interventions, motivate behavior change, to assess patient outcomes (e.g., patient function, quality of life, mood), or as data collection tools. CONCLUSIONS Wearables are primarily being used to assess daily activity and monitor adherence to exercise interventions in clinical studies involving PC survivors. Findings suggest that they are feasible for use in this population. More research is needed to understand how to integrate wearables into routine clinical care, expand their use to predict clinical outcomes, or to deliver tailored interventions for PC survivors.
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Affiliation(s)
- Carolina Raines
- Cancer Research Center for Health Equity, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America.
| | - Brandon Noorvash
- Cancer Research Center for Health Equity, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America.
| | - Edwin Melencio Posadas
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America.
| | - Howard M Sandler
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America.
| | - Stephen J Freedland
- Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America.
| | - Gillian Gresham
- Cancer Research Center for Health Equity, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America.
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Cornford P, Robijn E, Rogers E, Wassersug R, Fleure L. Fatigue in Prostate Cancer: A Roundtable Discussion and Thematic Literature Review. EUR UROL SUPPL 2024; 63:119-125. [PMID: 38596782 PMCID: PMC11001642 DOI: 10.1016/j.euros.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 04/11/2024] Open
Abstract
Context Cancer and its treatments cause fatigue in up to 90% of men with advanced prostate cancer. As men with prostate cancer are surviving longer, cancer-related fatigue is becoming increasingly important for clinicians to understand and proactively manage. Objective The aim of this work is to identify knowledge gaps that may support healthcare professionals to recommend personalised fatigue management strategies. Evidence acquisition This manuscript is based on a roundtable discussion held during the European Association of Urology 2022 Annual Symposium, combined with a review of the literature. Five core themes were generated from the roundtable: (1) meaning of fatigue in prostate cancer patients, (2) impact of fatigue, (3) association between fatigue and treatment selection, (4) benefits of managing fatigue, and (5) barriers to exercise. Evidence synthesis Cancer-related fatigue has complex underlying aetiology and is a subjective experience that may be under-reported. Some studies have shown that techniques such as education, cognitive behavioural therapy, guided imagery, and progressive muscle relaxation can result in clinically meaningful improvements in fatigue. However, the largest body of evidence, and a theme echoed in the roundtable discussions, was the benefit of exercise on fatigue. Despite the benefits of exercise, for some men, objective barriers to exercise exist and knowledge of benefits does not automatically translate into implementation and adherence. Conclusions Understanding the specific health needs of individual patients and their desired health outcomes is essential to identify personalised strategies for minimising fatigue. As an outcome of the roundtable meeting, we developed a quick reference guide for healthcare providers. A high-resolution copy can be downloaded from https://patients.uroweb.org/library/fatigue-in-prostate-cancer-patients-guide/. Patient summary This article is based on dialogue between a group of specialists, patients, and caregivers, which took place at a roundtable meeting during the European Association of Urology 2022 Annual Symposium. The group discussed how healthcare providers can best support their patients who experience fatigue. The group subsequently developed a guide to help healthcare providers during appointments.
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Affiliation(s)
- Philip Cornford
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Esther Robijn
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Eamonn Rogers
- European Association of Urology, Arnhem, The Netherlands
| | | | - Louisa Fleure
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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Lee K, Park J, Oh EG, Lee J, Park C, Choi YD. Effectiveness of a Nurse-Led Mobile-Based Health Coaching Program for Patients With Prostate Cancer at High Risk of Metabolic Syndrome: Randomized Waitlist Controlled Trial. JMIR Mhealth Uhealth 2024; 12:e47102. [PMID: 38300697 PMCID: PMC10870207 DOI: 10.2196/47102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2023] [Revised: 10/29/2023] [Accepted: 12/20/2023] [Indexed: 02/02/2024] Open
Abstract
BACKGROUND Androgen deprivation therapy (ADT), a standard treatment for prostate cancer (PC), causes many physical side effects. In particular, it causes metabolic changes such as fasting glucose abnormalities or accumulation of body fat, and its continuation can lead to metabolic syndrome (MetS), which is closely related to diabetes and cardiovascular disease. Therefore, it is important to maintain and practice a healthy lifestyle in patients with PC. OBJECTIVE This study aims to evaluate the effectiveness of a nurse-led mobile-based program that aims to promote a healthy lifestyle in patients with PC undergoing ADT with MetS risk factors. METHODS This was a single-blind, randomized, waitlist control interventional study. A total of 48 patients were randomly assigned to the experimental and waitlist control groups at the urology cancer clinic of a tertiary general hospital in South Korea. The inclusion criteria were patients who had undergone ADT for >6 months, had at least 1 of the 5 MetS components in the abnormal range, and could access a mobile-based education program. The experimental group attended a 4-week mobile-based program on exercise and diet that included counseling and encouragement to maintain a healthy lifestyle, whereas the control group was placed on a waitlist and received usual care during the follow-up period, followed by the intervention. The primary outcome was a change in the lifestyle score. The secondary outcomes were changes in 5 MetS components, body composition, and health-related quality of life. The outcomes were measured at 6 weeks and 12 weeks after the initiation of the intervention. Each participant was assigned to each group in a sequential order of enrollment in a 4×4 permuted block design randomization table generated in the SAS (SAS Institute) statistical program. A linear mixed model was used for statistical analysis. RESULTS A total of 24 participants were randomly assigned to each group; however, 2 participants in the experimental group dropped out for personal reasons before starting the intervention. Finally, 46 participants were included in the intention-to-treat analysis. The experimental group showed more positive changes in the healthy lifestyle score (β=29.23; P≤.001), level of each MetS component (fasting blood sugar: β=-12.0; P=.05 and abdominal circumference: β=-2.49; P=.049), body composition (body weight: β=-1.52; P<.001 and BMI: β=-0.55; P<.001), and the urinary irritative and obstructive domain of health-related quality of life (β=14.63; P<.001) over time than the waitlist control group. CONCLUSIONS Lifestyle changes through nurse-led education can improve level of each MetS components, body composition, and ADT side effects. Nurses can induce positive changes in patients' lifestyles and improve the self-management of patients starting ADT through this program. TRIAL REGISTRATION Clinical Research Information Service KCT0006560; http://tinyurl.com/yhvj4vwh.
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Affiliation(s)
- Kyoungjin Lee
- College of Nursing and Brain Korea 21 FOUR Project, Yonsei University, Seoul, Republic of Korea
- College of Nursing, Kyungbok University, Namyangju, Republic of Korea
| | - Jeongok Park
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Eui Geum Oh
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - JuHee Lee
- Mo-Im Kim Nursing Research Institute, College of Nursing, Yonsei University, Seoul, Republic of Korea
| | - Chang Park
- Department of Population Health Nursing Science, College of Nursing, University of Illinois at Chicago, Chicago, IL, United States
| | - Young Deuk Choi
- College of Medicine, Yonsei University, Seoul, Republic of Korea
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Patel KR, Wade CE, Rais-Bahrami S. Too hot or too cold? Finding the Goldilocks scenario for prostate cancer patients suffering from hot flashes. Prostate Cancer Prostatic Dis 2024:10.1038/s41391-024-00786-3. [PMID: 38225448 DOI: 10.1038/s41391-024-00786-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2023] [Revised: 12/19/2023] [Accepted: 01/03/2024] [Indexed: 01/17/2024]
Affiliation(s)
- Kartik R Patel
- Department of Urology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Caroline E Wade
- Department of Urology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA
| | - Soroush Rais-Bahrami
- Department of Urology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA.
- Department of Radiology, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA.
- O'Neal Comprehensive Cancer Center, University of Alabama at Birmingham Heersink School of Medicine, Birmingham, AL, USA.
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Myers JS, Manson A, Billinger SA, Hamilton-Reeves J, Parker W, Maliski SL. Staying Strong and Healthy During Androgen Deprivation Therapy. Cancer Nurs 2024; 47:43-55. [PMID: 35984916 PMCID: PMC10232673 DOI: 10.1097/ncc.0000000000001151] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Androgen deprivation therapy (ADT) for prostate cancer is associated with cardiovascular comorbidities and numerous adverse effects decreasing health-related quality of life. Both exercise and dietary interventions have shown promise in reducing ADT-related negative sequelae. However, feasibility for personalized combined exercise/nutrition/education interventions is not well established. OBJECTIVE The purpose of this randomized, controlled, mixed-methods pilot study was to evaluate the feasibility of a nurse-led, telephone-delivered education, exercise, and nutrition intervention, Staying Strong & Healthy, to minimize ADT-related cardiovascular/metabolic risks and symptoms. METHODS Staying Strong & Healthy involves individually tailored education, exercise (aerobic and resistance), and nutrition intervention delivered over 6 months and was compared with attention control. The primary quantitative outcome measure was change from baseline in low-density lipoprotein. Secondary outcomes included change in lipid levels (total cholesterol, high-density lipoprotein, low-density lipoprotein, and triglycerides), fasting blood glucose, hemoglobin A 1c , health-related quality of life, and diet quality. Assessments were performed at baseline, 6 months, and 12 months. RESULTS Feasibility was demonstrated by low attrition rates and high participant satisfaction. No between-group differences were demonstrated in the cardiovascular/metabolic outcomes. Significant within-group improvements were noted for high-density lipoprotein and hemoglobin A 1c in the intervention group. CONCLUSION The study results indicate that participation in a personalized, nurse-delivered exercise, nutrition, and educational intervention is feasible and acceptable to men with prostate cancer receiving ADT. IMPLICATIONS FOR PRACTICE Future randomized controlled research powered to detect significant differences is needed to confirm the impact of the Staying Strong & Healthy intervention on reduction of the cardiovascular/metabolic impact of ADT for men with prostate cancer.
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Affiliation(s)
- Jamie S Myers
- Author Affiliations: University of Kansas School of Nursing (Drs Myers, Manson, and Maliski); University of Kansas School of Health Professions (Dr Billinger); and University of Kansas Medical Center (Drs Hamilton-Reeves and Parker), Kansas City
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Tulk J, Rash JA, Thoms J, Wassersug R, Gonzalez B, Garland SN. Androgen deprivation therapy and radiation for prostate cancer-cognitive impairment, sleep, symptom burden: a prospective study. BMJ Support Palliat Care 2023; 13:e454-e463. [PMID: 34330793 DOI: 10.1136/bmjspcare-2021-003098] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2021] [Accepted: 07/20/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVES This paper (1) sought to compare sleep, mood and physical symptom profiles of men with prostate cancer (PCa) who experienced subjective and objective cancer-related cognitive impairment (CRCI) during the first year of treatment and (2) examine if fluctuations in mood and physical symptoms are associated with change in subjective or objective CRCI. METHODS This prospective observational cohort study examined 24 new patients with PCa receiving androgen deprivation therapy (ADT) and radiation therapy (RT) during the first 12 months of treatment. Participants completed subjective and objective assessments of cognition, sleep continuity and self-report measures of insomnia, fatigue, depression and anxiety. Independent sample t-tests, correlations and hierarchical regressions were used to compare groups, explore associations, and assess change over time. Effects are reported as corrected Cohen's d (dc). RESULTS Men with objective CRCI reported worse subjective time asleep (dc=0.47) and more depression (dc=0.55). Men with subjective CRCI reported worse insomnia (dc=0.99), hot flashes (dc=0.76), sleep quality (dc=0.54), subjective total sleep time (dc=0.41), wake after sleep onset (dc=0.71), sleep efficiency (dc=0.49), fatigue (dc=0.67) and objectively estimated sleep latency (dc=0.72) than men without subjective CRCI. Declines in perceived cognition was associated with higher anxiety (p=0.05), fatigue (p≤0.01) and symptoms of insomnia (p=0.01). Finally, subjective time awake during the night (p=0.03) and fatigue (p=0.02) were associated with subjective cognitive decline, controlling for objective change. CONCLUSIONS Subjective concerns of CRCI appear more critical to patient experience than objective measurements in men with PCa who have received RT and ADT. Interventions to improve sleep may result in an improved perception of cognition.
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Affiliation(s)
- Joshua Tulk
- Department of Psychology, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Joshua A Rash
- Department of Psychology, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - John Thoms
- Discipline of Oncology, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Richard Wassersug
- Department of Cellular & Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | - Brian Gonzalez
- Health Outcomes and Behavior Program, Moffitt Cancer Center, Tampa, Florida, USA
| | - Sheila N Garland
- Department of Psychology, Memorial University, St. John's, Newfoundland and Labrador, Canada
- Discipline of Oncology, Memorial University, St. John's, Newfoundland and Labrador, Canada
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Tombal B, Collins S, Morgans AK, Hunsche E, Brown B, Zhu E, Bossi A, Shore N. Impact of Relugolix Versus Leuprolide on the Quality of Life of Men with Advanced Prostate Cancer: Results from the Phase 3 HERO Study. Eur Urol 2023; 84:579-587. [PMID: 37833178 DOI: 10.1016/j.eururo.2023.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/22/2023] [Accepted: 09/10/2023] [Indexed: 10/15/2023]
Abstract
BACKGROUND Relugolix, an oral gonadotropin-releasing hormone receptor antagonist, demonstrated testosterone suppression to castrate levels in men with advanced prostate cancer (PCa) in the HERO study. Since advanced PCa and its treatments can impact patients' daily life, it is imperative to understand the impact of systemic therapy on patient health-related quality of life (HRQOL). OBJECTIVE To report the HRQOL for patients on relugolix compared with those on leuprolide in on-treatment and testosterone recovery periods of the HERO study. DESIGN, SETTING, AND PARTICIPANTS A phase 3 randomized controlled study was conducted in 934 patients with advanced PCa. INTERVENTION Patients underwent 2:1 randomization and received relugolix 120 mg orally once daily or leuprolide 3-mo injections for 48 wk. Testosterone recovery was evaluated in a patient subset. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS HRQOL evaluations were based on the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire (EORTC QLQ-C30) and the Prostate Cancer Module (EORTC QLQ-PR25) during treatment and testosterone recovery phases. In a post hoc analysis, predictors of HRQOL deterioration were evaluated. RESULTS AND LIMITATIONS No statistically significant differences between the two groups were found in changes from baseline to the end of treatment in either the EORTC QLQ-C30 or the EORTC QLQ-PR25 instrument. During the testosterone recovery phase, hormonal treatment-related symptoms scores were lower for relugolix than for leuprolide, suggesting a lower burden of hormone-related symptoms associated with a treatment that has more rapid testosterone recovery after treatment cessation. Limitations include low patient numbers in the testosterone recovery group. CONCLUSIONS Oral relugolix is a therapeutic option with similar patient-reported HRQOL to leuprolide, providing an oral option for androgen deprivation therapy associated with a more rapid testosterone reduction. PATIENT SUMMARY In men with advanced prostate cancer, relugolix had similar health-related quality of life to leuprolide.
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Affiliation(s)
- Bertrand Tombal
- Institut de Recherche clinique, Université catholique de Louvain, Brussels, Belgium.
| | - Sean Collins
- Department of Radiation Medicine, Medstar Georgetown University Hospital, Washington, DC, USA
| | | | | | | | - Emily Zhu
- Myovant Sciences, Inc., Brisbane, CA, USA
| | - Alberto Bossi
- Department of Radiotherapy, Institut Gustave Roussy, Villejuif, France
| | - Neal Shore
- Carolina Urologic Research Center, Myrtle Beach, SC, USA
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Kaakour D, Fortin B, Masri S, Rezazadeh A. Circadian Clock Dysregulation and Prostate Cancer: A Molecular and Clinical Overview. Clin Med Insights Oncol 2023; 17:11795549231211521. [PMID: 38033743 PMCID: PMC10683379 DOI: 10.1177/11795549231211521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Accepted: 10/15/2023] [Indexed: 12/02/2023] Open
Abstract
Circadian clock dysregulation has been implicated in various types of cancer and represents an area of growing research. However, the role of the circadian clock in prostate cancer has been relatively unexplored. This literature review will highlight the potential role of circadian clock dysregulation in prostate cancer by examining molecular, epidemiologic, and clinical data. The influence of melatonin, light, night shift work, chronotherapy, and androgen independence are discussed as they relate to the existing literature on their role in prostate cancer.
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Affiliation(s)
- Dalia Kaakour
- Division of Hematology/Oncology, Department of Medicine, University of California, Irvine, Orange, CA, USA
| | - Bridget Fortin
- Department of Biological Chemistry, University of California, Irvine, Irvine, CA, USA
| | - Selma Masri
- Department of Biological Chemistry, University of California, Irvine, Irvine, CA, USA
| | - Arash Rezazadeh
- Division of Hematology/Oncology, Department of Medicine, University of California, Irvine, Orange, CA, USA
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Qin Z, Zang Z, Yu J, Lv J, Li N, Zhang J, Yang M, Kwong JSW, Pang R, Wang J, Cui Z, Yu Y, Wang H, Zhu Y, Yuan Y, Li X, Wu Y, Wu J. Acupuncture versus sham acupuncture and usual care for Antiandrogen-Induced hot fLashes in prostate cancer (AVAIL): study protocol for a randomized clinical trial. BMC Complement Med Ther 2023; 23:388. [PMID: 37891531 PMCID: PMC10612187 DOI: 10.1186/s12906-023-04218-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND Hot flashes are the common and debilitating symptom among prostate cancer (PCa) patients undergoing androgen deprivation therapy (ADT). Strong evidence from multiple rigorously designed studies indicated that pharmacological option such as venlafaxine provides partial relief, but the tolerability is poor when dose is not tapered. Hence, alternative therapy is needed. Previous studies reported that acupuncture may be helpful in the management of hot flashes. However, the insufficient randomized controlled trial limited the quality of evidence. METHODS Five hospitals will recruit 120 acupuncture naïve patients with moderate-to-severe hot flashes after prostate cancer received ADT in China from February 2023 to December 2024. Participants will be randomly 2:1:1 allocated to the 18 sessions of verum acupuncture at true acupuncture points plus usual care, 18 sessions of non-penetrating sham acupuncture at non-acupuncture points plus usual care, or usual care alone over 6 weeks. The primary outcome measure is the change of mean weekly hot flashes symptom severity score (HFSSS) at the end of treatment compared with baseline. EXPECTED RESULTS AND CONCLUSION We will be able to measure the effectiveness of acupuncture for patients with PCa suffering from ADT-induced hot flashes and whether acupuncture is superior to sham acupuncture and usual care. The proposed acupuncture treatment might provide an alternative option for those patients. TRIAL REGISTRATION Clinicaltrials.gov (NCT05069467).
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Affiliation(s)
- Zongshi Qin
- School of Public Health, Peking University, Beijing, China
- Peking University Clinical Research Institutes, Beijing, China
| | - Zhiwei Zang
- Department of Acupuncture, Yantai Hospital of Traditional Chinese Medicine, Yantai, China
| | - Jianyong Yu
- Department of Urology, Yantai Hospital of Traditional Chinese Medicine, Yantai, China
| | - Jianqin Lv
- Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Ning Li
- Department of Integrative Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jialing Zhang
- School of Chinese Medicine, Hong Kong Chinese Medicine Clinical Study Centre, Hong Kong Baptist University, Hong Kong, Hong Kong SAR, China
| | - Mingxiao Yang
- Department of Medicine, Integrative Medicine Service, Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Joey S W Kwong
- Department of Health Policy, Department of Clinical Epidemiology, National Center for Child Health and Development, Tokyo, Japan
| | - Ran Pang
- Department of Urology, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China
| | - Jianfeng Wang
- Department of Urology, China-Japan Friendship Hospital, Beijing, China
| | - Zhengyu Cui
- Department of Chinese Medicine, Shanghai East Hospital, Tongji University, Shanghai, China
| | - Yongpei Yu
- Peking University Clinical Research Institutes, Beijing, China
| | - Haibo Wang
- Peking University Clinical Research Institutes, Beijing, China
| | - Yidan Zhu
- Peking University Clinical Research Institutes, Beijing, China
| | - Yifang Yuan
- School of Public Health, Peking University, Beijing, China
- Peking University Clinical Research Institutes, Beijing, China
| | - Xiao Li
- Department of Urology, Jiangsu Cancer Hospital & Jiangsu Institute of Cancer Research & Nanjing Medical University Affiliated Cancer Hospital, Nanjing, China.
| | - Yangfeng Wu
- Peking University Clinical Research Institutes, Beijing, China.
| | - Jiani Wu
- Department of Acupuncture, Guang'anmen Hospital, China Academy of Chinese Medical Sciences, Beijing, China.
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Mangar S, Abbadasari M, Carollo A, Esposito G, Ahmed H, Shah T, Dimitriou D. Understanding Sleep Disturbances in Prostate Cancer-A Scientometric Analysis of Sleep Assessment, Aetiology, and Its Impact on Quality of Life. Cancers (Basel) 2023; 15:3485. [PMID: 37444596 DOI: 10.3390/cancers15133485] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2023] [Revised: 06/12/2023] [Accepted: 06/23/2023] [Indexed: 07/15/2023] Open
Abstract
Prostate cancer is the most commonly diagnosed cancer in the United Kingdom. While androgen-deprivation therapy is the most common treatment for prostate cancer, patients undergoing this treatment typically experience side effects in terms of sleep disturbances. However, the relation between prostate cancer and sleep and the way in which sleep interventions may benefit oncological patients is underinvestigated in the literature. The current study aims to review in a data-driven approach the existing literature on the field of prostate cancer and sleep to identify impactful documents and major thematic domains. To do so, a sample of 1547 documents was downloaded from Scopus, and a document co-citation analysis was conducted on CiteSpace software. In the literature, 12 main research domains were identified as well as 26 impactful documents. Research domains were examined regarding the link between prostate cancer and sleep, by taking into account variations in hormonal levels. A major gap in the literature was identified in the lack of use of objective assessment of sleep quality in patients with prostate cancer.
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Affiliation(s)
- Stephen Mangar
- Department of Clinical Oncology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W6 8RF, UK
- Sleep Education and Research Laboratory, UCL Institute of Education, London WC1H 0AA, UK
| | - Monica Abbadasari
- Sleep Education and Research Laboratory, UCL Institute of Education, London WC1H 0AA, UK
| | - Alessandro Carollo
- Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy
| | - Gianluca Esposito
- Department of Psychology and Cognitive Science, University of Trento, 38068 Rovereto, Italy
| | - Hashim Ahmed
- Department of Surgery and Cancer, Imperial College London, London W6 8RF, UK
- Imperial Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W2 1NY, UK
| | - Taimur Shah
- Department of Surgery and Cancer, Imperial College London, London W6 8RF, UK
- Imperial Urology, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London W2 1NY, UK
| | - Dagmara Dimitriou
- Sleep Education and Research Laboratory, UCL Institute of Education, London WC1H 0AA, UK
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Myers JS, Siengsukon C, Sherman J, Shen X, Ptomey LT, Montgomery R, Bock K, Rice A, Parker WP, Maliski S. Androgen Deprivation and Sleep Disturbance: A Mixed Methods Pilot Study of Remote Assessment and Intervention. Cancer Nurs 2023; 46:259-269. [PMID: 35439217 PMCID: PMC9582038 DOI: 10.1097/ncc.0000000000001100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Men receiving androgen deprivation therapy (ADT) for prostate cancer (PC) are at risk for cardiovascular comorbidities and cognitive changes. Interventional research involves in-person assessment of physical fitness/activity and cognitive function, which has been negatively affected by the COVID-19 pandemic. Androgen deprivation therapy-related hot flashes and nocturia increase risk for insomnia. Insomnia is associated with fatigue and may exacerbate ADT-related cognitive changes. OBJECTIVES The purpose of this mixed-methods pilot was to (1) determine feasibility/acceptability of remotely assessing physical fitness/activity, cognitive function, and sleep; (2) deliver telehealth cognitive behavioral training for insomnia (teleCBT-I) to improve sleep; and (3) garner qualitative feedback to refine remote procedures and teleCBT-I content. METHODS Fifteen men with PC receiving ADT completed a 4-week teleCBT-I intervention. Videoconferencing was used to complete study assessments and deliver the weekly teleCBT-I intervention. RESULTS Self-report of sleep quality improved ( P < .001) as did hot flash frequency ( P = .04) and bother ( P = .025). Minimal clinically important differences were detected for changes in insomnia severity and sleep quality. All sleep logs indicated improvement in sleep efficiency. Remote assessment of fitness/cognitive function was demonstrated for 100% of participants. Sufficient actigraph wear time allowed physical activity/sleep assessment for 80%. Sleep actigraphy did not demonstrate significant changes. CONCLUSIONS Remote monitoring and teleCBT-I are feasible/acceptable to men with PC on ADT. Further research to confirm teleCBT-I efficacy is warranted in this population. IMPLICATIONS FOR PRACTICE Preliminary efficacy for teleCBT-I interventions was demonstrated. Remote assessments of physical fitness/activity, sleep, and cognitive function may enhance clinical trial access for rural or economically disadvantaged PC survivors.
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Affiliation(s)
- Jamie S Myers
- Author Affiliations: University of Kansas School of Nursing (Drs Myers and Maliski); and Department of Physical Therapy and Rehabilitation Science and Athletic Training (Dr Siengsukon and Ms Bock), Department of Internal Medicine (Mr Sherman, Dr Ptomey, and Ms Rice), Department of Radiation Oncology (Dr Shen), Biostatistics and Data Science (Dr Montgomery), and Urologic Surgery (Dr Parker), University of Kansas Medical Center, Kansas City
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Mafla-España MA, Torregrosa MD, Beamud-Cortés M, Bermell-Marco L, Rubio-Briones J, Cauli O. Comparison of Frailty Criteria, Cognitive Function, Depressive and Insomnia Symptoms in Men with Localized and Advanced Prostate Cancer under Androgen Deprivation Therapy. Healthcare (Basel) 2023; 11:healthcare11091266. [PMID: 37174808 PMCID: PMC10178148 DOI: 10.3390/healthcare11091266] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/21/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Prostate cancer (PCa) is considered one of the most important medical problems in the male population, with a very high incidence after the age of 65. Frailty represents one of the most critical issues facing healthcare due to its inherent relationship with poor healthcare outcomes. The physical phenotype of frailty syndrome based on Fried criteria has been associated with poor outcomes, morbidity, and premature mortality. To date, there are few studies that have analyzed frailty syndrome in patients with localized and advanced (mPCa) disease under androgen-deprivation therapy. OBJECTIVE Our goal was to assess whether there are differences in frailty criteria between mPCa and localized PCa. We also evaluated the role of other geriatric variables such as depressive and insomnia symptoms, which are frequently reported in cancer patients. METHODS In this cross-sectional study, frailty syndrome was evaluated in both groups, as well as its possible relationship with cognitive functions, depressive and insomnia symptoms, and other clinical variables related to PCa and its treatment. Frailty was defined on Fried's criteria: low lean mass, weakness, self-reported exhaustion, low activity level, and slow walking speed; prefrailty was defined as having one or two of those criteria and frailty as having three or more, depressive symptoms were defined by the Yesavage scale, cognitive functions with the Mini-Mental examination test, and insomnia symptoms by the Athens scale and self-reported health status. RESULTS The prevalence of prefrailty/frailty was slightly higher in mPCa compared to localized PCa (81.5% versus 72.3%, respectively), however by analyzing each of the frailty criteria, two of them were significantly reduced in mPCa compared to localized PCa patients, e.g., gait speed (p = 0.001) and muscle strength (p = 0.04). The reduced gait speed and muscle strength in mPCa were not due to the increased age in mPCa group, or to an increase in comorbidities or shorter time under androgen-deprivation therapy. The symptoms of insomnia were significantly higher in mPCa patients compared to those with localized PCa (p < 0.05) whereas cognitive functions or depressive symptoms were not significantly different between the two groups. CONCLUSION Patients with mPCa under androgen-deprivation therapy display higher alterations in gait speed and muscular strength and insomnia symptoms, thus interventions should be aimed to reduce these alterations in order to limit adverse outcomes related to them and to improve quality of life in these patients.
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Affiliation(s)
- Mayra Alejandra Mafla-España
- Nursing Department, University of Valencia, 46010 Valencia, Spain
- Frailty Research Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
| | | | | | | | | | - Omar Cauli
- Nursing Department, University of Valencia, 46010 Valencia, Spain
- Frailty Research Organized Group (FROG), University of Valencia, 46010 Valencia, Spain
- Chair of Healthy, Active and Participative Ageing, University of Valencia, 46010 Valencia, Spain
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14
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Russell N, Hoermann R, Cheung AS, Zajac JD, Grossmann M. Effects of oestradiol treatment on hot flushes in men undergoing androgen deprivation therapy for prostate cancer: a randomised placebo-controlled trial. Eur J Endocrinol 2022; 187:617-627. [PMID: 36806623 DOI: 10.1530/eje-22-0318] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Revised: 08/03/2022] [Accepted: 09/05/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Most men undergoing androgen deprivation therapy (ADT) for prostate cancer experience hot flushes. Current treatments have low or limited evidence of efficacy. It is likely that oestradiol depletion is the mediator of these hot flushes, and transdermal oestradiol might be an effective treatment. DESIGN This is a 6-month randomised, placebo-controlled trial with the hypothesis that oestradiol would reduce hot flush frequency and intensity and improve quality of life (QoL). METHODS Seventy-eight participants receiving ADT were randomised to 0.9 mg of 0.1% oestradiol gel per day or matched placebo. Hot flush frequency and severity were assessed by 7-day diary at baseline, month 1, month 3, and month 6. QoL was assessed by validated questionnaire. RESULTS Oestradiol reduced daily hot flush frequency, with a mean adjusted difference (MAD) of -1.6 hot flushes per day (95% CI: -2.7 to -0.5; P = 0.04). The effect on weekly hot flush score was non-significant, with a MAD -19.6 (95% CI: -35.5 to -3.8; P = 0.11). On per protocol analysis, E2 significantly reduced daily hot flush frequency, with a MAD of -2.2 hot flushes per day (95% CI: -3.2 to -1.1; P = 0.001), and weekly hot flush score, with a MAD of -27.0 (-44.7 to -9.3; P = 0.02). Oestradiol had no significant effect on QoL. CONCLUSION We confirmed our hypothesis of a clinical effect of assignment to oestradiol to reduce hot flush frequency in men with castrate testosterone due to ADT. Transdermal oestradiol could be considered for men with burdensome hot flushes in whom other treatments have failed as long as the risk of breast effects and fat gain are considered.
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Affiliation(s)
- Nicholas Russell
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Australia
- Department of Endocrinology, Austin Health, Heidelberg, Australia
| | - Rudolf Hoermann
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Australia
| | - Ada S Cheung
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Australia
- Department of Endocrinology, Austin Health, Heidelberg, Australia
| | - Jeffrey D Zajac
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Australia
- Department of Endocrinology, Austin Health, Heidelberg, Australia
| | - Mathis Grossmann
- Department of Medicine (Austin Health), The University of Melbourne, Heidelberg, Australia
- Department of Endocrinology, Austin Health, Heidelberg, Australia
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15
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Evaluating Patterns and Factors Related to Sleep Disturbances in Prostate Cancer Patients. Healthcare (Basel) 2022; 10:healthcare10050832. [PMID: 35627969 PMCID: PMC9140820 DOI: 10.3390/healthcare10050832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/21/2022] [Accepted: 04/28/2022] [Indexed: 11/17/2022] Open
Abstract
Prostate cancer patients may experience disturbed sleep as a result of their diagnosis or treatment. This study sought to evaluate disturbed sleep and excessive daytime sleepiness in newly diagnosed patients and those receiving androgen deprivation therapy (ADT). This study was conducted with 74 patients. Subjective data using the Pittsburgh Sleep Quality Index (PSQI) and Epworth Sleepiness Scale (ESS) and actigraphy data on ADT/ADT-naïve patients were collected. The prevalence of poor sleep quality, determined from PSQI and ESS scores, was 50% and 16.7% respectively. Those on ADT (n = 20) had poorer sleep quality as determined by significantly higher PSQI scores (70 vs. 40% scoring > 5) and were more likely to have poor sleep quality, sleep latency, and sleep efficiency than ADT-naïve patients (n = 40). Actigraphy data showed that ADT patients slept significantly longer (7.7 vs. 6.8 h), experienced a higher Fragmentation Index (48.3 vs. 37.4%), and had longer daytime nap duration (64.1 vs. 45.2 min) than ADT-naïve patients. The use of objective measures such as actigraphy in the clinical arena is recommended and may be used as a valuable tool for research into sleep assessment in prostate cancer patients.
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16
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Al Maqbali M, Al Sinani M, Alsayed A, Gleason AM. Prevalence of Sleep Disturbance in Patients With Cancer: A Systematic Review and Meta-Analysis. Clin Nurs Res 2022; 31:1107-1123. [PMID: 35484919 PMCID: PMC9266067 DOI: 10.1177/10547738221092146] [Citation(s) in RCA: 27] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Sleep disturbance is one of the most common and troubling symptoms that harm the quality of life throughout all phases of treatment and stages of the illness among patients with cancer. The aim of this meta-analysis is to examine the present status of sleep disturbance prevalence in patients with cancer. The following databases were searched: PubMed, CINAHL, MEDLINE, EMBASE, PsycINFO, from inception to April 2021. Prevalence rates were pooled with meta-analysis using a random-effects model. A total of 160 studies (N = 46,279) published between 1998 and 2021 met the inclusion criteria. The overall prevalence of sleep disturbance was 60.7% (26,448/46,279 participants, 95% CI 58.1–63.3%) with significant heterogeneity between studies (p < .000, τ2 = .0000, I2 = 96.4%). This meta-analysis highlights the importance of developing optimal monitoring strategies to reduce sleep disturbance and improve the quality of life of cancer patients.
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Affiliation(s)
| | - Mohammed Al Sinani
- Imperial College London, London, UK.,Ministry of Health, Al Buraimi, Oman
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17
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Amidi A, Buskbjerg CD, Damholdt MF, Dahlgaard J, Thorndike FP, Ritterband L, Zachariae R. Changes in sSleep following iInternet-dDelivered cCognitive-bBehavioral tTherapy for iInsomnia in Women tTreated for bBreast cCancer: A 3-year fFollow-up Assessment. Sleep Med 2022; 96:35-41. [DOI: 10.1016/j.sleep.2022.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Revised: 04/19/2022] [Accepted: 04/25/2022] [Indexed: 10/18/2022]
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18
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Sparasci D, Napoli I, Rossi L, Pereira-Mestre R, Manconi M, Treglia G, Marandino L, Ottaviano M, Turco F, Mangan D, Gillessen S, Vogl UM. Prostate Cancer and Sleep Disorders: A Systematic Review. Cancers (Basel) 2022; 14:cancers14071784. [PMID: 35406556 PMCID: PMC8997021 DOI: 10.3390/cancers14071784] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Revised: 03/23/2022] [Accepted: 03/29/2022] [Indexed: 12/24/2022] Open
Abstract
Simple Summary Longer survival times for prostate cancer patients due to efficient treatments consisting of local radiotherapy, prostatectomy and androgen-deprivation therapy, as well as androgen-receptor-targeted agents, increases the importance of side effect management. Sleep disturbances are higher in this group than the general population and no clear mechanism(s) explains this. This systematic review finds a reported effect in 14 of 16 included studies on sleep quality changes for these patients. All reported treatments showed some kind of negative effect on sleep quality, including ADT. Limitations are discussed and recommendations made for progressing the understanding and then for mitigation strategies of these side effects. Abstract Prostate cancer (PCa) treatment involves multiple strategies depending on the disease’s stage. Androgen deprivation therapy (ADT) remains the gold standard for advanced and metastatic stages. Sleep quality has been suggested as being additionally influenced also by local radiotherapy, prostatectomy and androgen-receptor (AR)-targeted agents. We performed a systematic review exploring the landscape of studies published between 1 January 1990 and 31 July 2021, investigating sleep disturbances in PCa patients receiving active treatments, including the influence of hormonal therapy on sleep quality as a factor affecting their quality of life. Out of 45 articles identified, 16 studies were selected, which recruited patients with PCa, undergoing active treatment in either a prospective longitudinal or cross-sectional study. Development of sleep disorders or changes in sleep quality were reported in 14 out of 16 trials included. Only five trials included objective measurements such as actigraphy, mostly at one time point and without a baseline assessment. Limitations to be addressed are the small number of existing trials, lack of randomized trials and heterogeneity of methodologies used. This systematic review outlines the lack of prospective trials investigating sleep disorders, with a rigorous methodology, in homogeneous cohorts of PCa patients. Future trials are needed to clarify the prevalence and impact of this side effect of PCa treatments.
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Affiliation(s)
- Davide Sparasci
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (D.S.); (M.M.)
| | - Ilenia Napoli
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (I.N.); (L.R.); (R.P.-M.); (L.M.); (M.O.); (F.T.); (D.M.); (S.G.)
- Radiation Oncology Unit, Department of Biomedical, Dental Science, Morphological and Functional Imaging, University Hospital Messina, 98122 Messina, Italy
| | - Lorenzo Rossi
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (I.N.); (L.R.); (R.P.-M.); (L.M.); (M.O.); (F.T.); (D.M.); (S.G.)
| | - Ricardo Pereira-Mestre
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (I.N.); (L.R.); (R.P.-M.); (L.M.); (M.O.); (F.T.); (D.M.); (S.G.)
- Institute of Oncology Research (IOR), 6500 Bellinzona, Switzerland
| | - Mauro Manconi
- Sleep Medicine Unit, Neurocenter of Southern Switzerland, Ente Ospedaliero Cantonale (EOC), 6900 Lugano, Switzerland; (D.S.); (M.M.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland;
- Department of Neurology, University Hospital Inselspital, 3010 Bern, Switzerland
| | - Giorgio Treglia
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland;
- Academic Education, Research and Innovation Area, General Directorate, Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, 1005 Lausanne, Switzerland
| | - Laura Marandino
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (I.N.); (L.R.); (R.P.-M.); (L.M.); (M.O.); (F.T.); (D.M.); (S.G.)
- Department of Medical Oncology, IRCCS San Raffaele Hospital, 20132 Milan, Italy
| | - Margaret Ottaviano
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (I.N.); (L.R.); (R.P.-M.); (L.M.); (M.O.); (F.T.); (D.M.); (S.G.)
- Department of Clinical Medicine and Surgery, University Federico II of Naples, 80138 Naples, Italy
| | - Fabio Turco
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (I.N.); (L.R.); (R.P.-M.); (L.M.); (M.O.); (F.T.); (D.M.); (S.G.)
- Department of Oncology, Division of Medical Oncology, University of Turin San Luigi Gonzaga Hospital, Regione Gonzole, 10043 Orbassano, Italy
| | - Dylan Mangan
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (I.N.); (L.R.); (R.P.-M.); (L.M.); (M.O.); (F.T.); (D.M.); (S.G.)
- Division of Population Health, University of Manchester, Manchester M13 9PL, UK
| | - Silke Gillessen
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (I.N.); (L.R.); (R.P.-M.); (L.M.); (M.O.); (F.T.); (D.M.); (S.G.)
- Faculty of Biomedical Sciences, Università della Svizzera Italiana, 6900 Lugano, Switzerland;
| | - Ursula Maria Vogl
- Oncology Institute of Southern Switzerland (IOSI), Ente Ospedaliero Cantonale (EOC), 6500 Bellinzona, Switzerland; (I.N.); (L.R.); (R.P.-M.); (L.M.); (M.O.); (F.T.); (D.M.); (S.G.)
- Correspondence:
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19
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Araújo N, Costa A, Lopes-Conceição L, Ferreira A, Carneiro F, Oliveira J, Braga I, Morais S, Pacheco-Figueiredo L, Ruano L, Cruz VT, Pereira S, Lunet N. Androgen deprivation therapy and cognitive decline in the NEON-PC prospective study, during the COVID-19 pandemic. ESMO Open 2022; 7:100448. [PMID: 35344749 PMCID: PMC8898674 DOI: 10.1016/j.esmoop.2022.100448] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/25/2022] [Accepted: 02/20/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- N Araújo
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - A Costa
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - L Lopes-Conceição
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal
| | - A Ferreira
- Instituto Português de Oncologia do Porto, Rua Dr. António Bernardino de Almeida, Porto, Portugal
| | - F Carneiro
- Instituto Português de Oncologia do Porto, Rua Dr. António Bernardino de Almeida, Porto, Portugal
| | - J Oliveira
- Instituto Português de Oncologia do Porto, Rua Dr. António Bernardino de Almeida, Porto, Portugal
| | - I Braga
- Instituto Português de Oncologia do Porto, Rua Dr. António Bernardino de Almeida, Porto, Portugal
| | - S Morais
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal. https://twitter.com/samanthafmorais
| | - L Pacheco-Figueiredo
- Instituto de Investigação em Ciências da Vida e Saúde, Escola de Medicina da Universidade do Minho, Campus de Gualtar, Braga, Portugal
| | - L Ruano
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal. https://twitter.com/lmruano
| | - V T Cruz
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal
| | - S Pereira
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal; Instituto Português de Oncologia do Porto, Rua Dr. António Bernardino de Almeida, Porto, Portugal
| | - N Lunet
- EPIUnit - Instituto de Saúde Pública, Universidade do Porto, Porto, Portugal; Laboratório Para a Investigação Integrativa e Translacional em Saúde Populacional (ITR), Porto, Portugal; Departamento de Ciências da Saúde Pública e Forenses e Educação Médica, Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, Porto, Portugal.
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The relationship between sleep hygiene, mood, and insomnia symptoms in men with prostate cancer. Support Care Cancer 2022; 30:4055-4064. [PMID: 35064327 DOI: 10.1007/s00520-021-06680-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 11/03/2021] [Indexed: 01/27/2023]
Abstract
PURPOSE Insomnia symptoms are commonly experienced by men after prostate cancer (PCa) treatment. Here we explored how sleep hygiene behaviours and psychological symptoms are associated with insomnia symptoms in PCa patients. METHODS An online survey was posted on social media and sent to mailing lists of PCa and general cancer organisations. The survey collected information on demographic, sleep hygiene, and psychological symptoms using validated questionnaires. RESULTS Data from 142 participants were compared based on the absence (age = 68.3 ± 8.9 years) and presence (age = 66.6 ± 9.0 years) of insomnia symptoms. Participants with insomnia symptoms had significantly higher levels of anxiety, depression, fatigue, and sleepiness as well as poorer sleep hygiene than those without insomnia symptoms. Control variables (age, number of comorbidities, and BMI) accounted for 11.9% of the variance in insomnia symptoms. Including treatment history contributed to an additional 1.6% of the variance in insomnia symptoms. Adding sleepiness, fatigue, anxiety, and depressive symptoms to the model explained an additional 44.6% of the variance in insomnia symptoms. Furthermore, including the sleep hygiene item 'I think, plan, or worry when I am in bed' and 'I sleep in an uncomfortable bedroom' explained an additional 3.6% of the variance in insomnia symptoms. CONCLUSIONS Poor sleep hygiene, fatigue, sleepiness, anxiety, and depressive symptoms were all associated with worse insomnia symptoms in PCa patients. Improving sleep hygiene and treating psychological conditions may potentially help prevent and/or alleviate insomnia symptoms in PCa patients.
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21
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Garland SN, Savard J, Eisel SL, Wassersug RJ, Rockwood NJ, Thoms J, Jim HSL, Gonzalez BD. A 2-year prospective analysis of insomnia as a mediator of the relationship between androgen deprivation therapy and perceived cognitive function in men with prostate cancer. Cancer 2021; 127:4656-4664. [PMID: 34411294 DOI: 10.1002/cncr.33850] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 07/05/2021] [Accepted: 07/15/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND Androgen deprivation therapy (ADT) may affect cognitive function in men with prostate cancer (PCa). This study examined whether insomnia symptoms mediate the relationship between ADT and perceived cognitive function and whether depressive symptoms, fatigue severity, and physical activity moderate the strength of this relationship. METHODS This was a prospective study of ADT recipients (n = 83) who were matched with control patients with PCa who were not on ADT (n = 92) and with controls with no history of cancer (n = 112) over a 2-year follow-up period. Perceived cognitive function and satisfaction were assessed with the Everyday Cognition Scale. Insomnia was assessed with the Insomnia Severity Index. Multilevel mediation analyses were conducted to estimate the indirect effect of ADT on perceived cognitive function through insomnia symptoms. Exploratory moderated mediation analyses assessed whether the indirect effect of ADT on perceived cognitive function through insomnia symptoms was dependent on levels of fatigue, depression, or physical activity. RESULTS Insomnia symptoms significantly mediated the relationship between receipt of ADT and perceived cognitive function (P < .001) and satisfaction with cognition (P < .001) after controlling for comorbidities. Men with greater fatigue had a more pronounced association of ADT with insomnia severity. Men with greater depressive symptoms had a stronger association between insomnia severity and worse perceived cognitive function. Physical activity was not a significant moderator of the relationship between ADT and perceived cognitive function. CONCLUSIONS Insomnia influenced the relationship between ADT and perceived cognitive abilities. Interventions to address insomnia, fatigue, and depression may improve perceived cognitive function.
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Affiliation(s)
- Sheila N Garland
- Department of Psychology, Memorial University, St. John's, Newfoundland and Labrador, Canada.,Discipline of Oncology, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Josée Savard
- School of Psychology, Université Laval, Quebec City, Quebec, Canada.,Laval University Cancer Research Center, Quebec City, Quebec, Canada
| | - Sarah L Eisel
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Richard J Wassersug
- Department of Cellular and Physiological Sciences, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - John Thoms
- Discipline of Oncology, Memorial University, St. John's, Newfoundland and Labrador, Canada
| | - Heather S L Jim
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Brian D Gonzalez
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
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22
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Feng LR, Barb JJ, Allen H, Regan J, Saligan L. Steroid Hormone Biosynthesis Metabolism Is Associated With Fatigue Related to Androgen Deprivation Therapy for Prostate Cancer. Front Cell Dev Biol 2021; 9:642307. [PMID: 34079794 PMCID: PMC8166231 DOI: 10.3389/fcell.2021.642307] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 04/06/2021] [Indexed: 11/13/2022] Open
Abstract
Background Androgen deprivation therapy (ADT) is a cornerstone treatment for prostate cancer. Despite the clinical benefits, ADT is associated with multiple adverse effects including fatigue. The goal of the study was to examine metabolomic changes to better understand cancer-related fatigue specific to ADT treatment. Methods A total of 160 plasma samples collected from participants with (+ADT, n = 58) or without neoadjuvant ADT (−ADT, n = 102) prior to radiation therapy for treatment of non-metastatic localized prostate cancer were included in the study. Fatigue and sleep-related impairment were measured using the Patient Reported Outcomes Measurement Information System. Plasma metabolites were identified and measured using untargeted ultrahigh-performance liquid chromatography/mass spectrometry metabolomics analyses. Partial least square discriminant analysis was used to identify discriminant metabolite features, and the diagnostic performance of selected classifiers was quantified using AUROC curve analysis. Pathway enrichment analysis was performed using metabolite sets enrichment analyses. Findings Steroid hormone biosynthesis pathways, including androstenedione metabolism as well as androgen and estrogen metabolism, were overrepresented by metabolites that significantly discriminated samples in the +ADT from the −ADT group. Additional overrepresented metabolic pathways included amino acid metabolism, glutathione metabolism, and carnitine synthesis. Of the metabolites that were significantly different between the groups, steroid hormone biosynthesis metabolites were most significantly correlated with fatigue severity. Sleep-related impairment was strongly correlated with fatigue severity and inversely correlated with ADT-induced reduction in androsterone sulfate. Conclusions Patients with non-metastatic prostate cancer receiving neoadjuvant ADT prior to radiation therapy reported relatively more severe fatigue. Increased fatigue in this population may be attributable to sleep-related impairment associated with alterations in steroid hormone biosynthesis. Findings in this study provide a basis for further research of changes in sleep patterns and their role in this specific subcategory of cancer-related fatigue caused by the treatment.
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Affiliation(s)
- Li Rebekah Feng
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| | - Jennifer J Barb
- Clinical Center, National Institutes of Health, Bethesda, MD, United States
| | - Hannah Allen
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| | - Jeniece Regan
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
| | - Leorey Saligan
- National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, United States
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23
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Morgans AK, Renzulli J, Olivier K, Shore ND. Risk of Cognitive Effects in Comorbid Patients With Prostate Cancer Treated With Androgen Receptor Inhibitors. Clin Genitourin Cancer 2021; 19:467.e1-467.e11. [PMID: 33893042 DOI: 10.1016/j.clgc.2021.03.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 03/11/2021] [Accepted: 03/13/2021] [Indexed: 12/18/2022]
Abstract
Prostate cancer (PC) is primarily a disease of older men. As the risk of neurocognitive decline increases as people age, cognitive dysfunction is a potential complication in men with PC, imposing detrimental effects on functional independence and quality of life. Importantly, risk of cognitive decline may increase with exposure to androgen deprivation therapy and other hormonal therapies. Particular consideration should be given to patients with castration-resistant PC (CRPC), many of whom require continuous, long-term androgen deprivation therapy combined with a second-generation androgen receptor inhibitor. Non-comparative evidence from interventional trials of androgen receptor inhibitors in men with non-metastatic CRPC suggests differential effects on cognitive function and central nervous system-related adverse events within this drug class. Drug-drug interactions with concomitant medications for chronic, non-malignant comorbidities differ among ARIs and thus may contribute further to cognitive impairment. Hence, establishing baseline cognitive function is a prerequisite to identifying subsequent clinical decline associated with androgen receptor-targeted therapies. Although brief, sensitive screening tools for cancer-related cognitive dysfunction are lacking, mental status can be ascertained from the initial medical history and neurocognitive examination, progressing to more in-depth evaluation when impairment is suspected. On-treatment neurocognitive monitoring should be integrated into regular clinical follow-up to preserve cognitive function and quality of life throughout disease management. This review summarizes the multiple factors that may contribute to cognitive decline in men with CRPC, awareness of which will assist clinicians to optimize individual treatment. Practical, clinic-based strategies for managing the risks for and symptoms of cognitive dysfunction are also discussed.
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Affiliation(s)
- Alicia K Morgans
- Department of Medicine (Hematology and Oncology), Northwestern University Feinberg School of Medicine, Chicago, IL.
| | - Joseph Renzulli
- Department of Urology, Yale School of Medicine, New Haven, CT
| | - Kara Olivier
- Department of Medical Oncology, Massachusetts General Hospital Cancer Center, Boston, MA
| | - Neal D Shore
- Department of Urology, Carolina Urologic Research Center, Atlantic Urology Clinics, Myrtle Beach, SC
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24
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Analysis of Brain Functions in Men with Prostate Cancer under Androgen Deprivation Therapy: A One-Year Longitudinal Study. Life (Basel) 2021; 11:life11030227. [PMID: 33802213 PMCID: PMC8000211 DOI: 10.3390/life11030227] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/07/2021] [Accepted: 03/09/2021] [Indexed: 12/24/2022] Open
Abstract
The relationship between cognitive decline and androgen deprivation therapy (ADT) under luteinizing hormone-releasing hormone (LHRH) analogues is unclear, and there is a scarcity of longitudinal studies considering the interaction between cognition, depressive symptoms and sleep quality in men with prostate cancer (PCa) treated with ADT. This study aimed to determine if there were differences in the scores obtained in cognitive assessment, depressive symptoms, and sleep quality after one year of ADT and determine the interrelations between sleep, mood, and cognitive status. A prospective longitudinal observational study was designed, in which a cohort of men (mean age was 70.8 years) newly treated with androgen-deprivation therapy was assessed in the first six months of treatment and 12 months later. Analysis of cognitive function by the Mini-Mental State Examination (MMSE) scores indicated a significant (p < 0.05) increase after one year of treatment and by the Brief Scale for Cognitive Evaluation (BCog) scores indicated no changes in the scores before and after one year of treatment. Analysis of depressive symptoms with the Geriatric Depression Scale and sleep quality with the Athens Insomnia Scale (AIS) scores showed significant (p < 0.05) changes after one year of treatment with ADT, with men describing more depressive symptoms and more sleep disturbances. No statistically significant differences were found in the cognitive performance between men with impaired sleep or depression results and those without them. Our study showed no clinical evidence of the relationship between ADT under luteinizing hormone-releasing hormone (LHRH) analogues and cognitive deterioration in 1-year follow-up, but there are impairments in the sleep quality in men with PCa undergoing ADT and an increase in depressive symptoms which has important implications for clinicians as they would impair quality of life and adherence to treatment.
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25
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Galvin KT, Garland SN, Wibowo E. The Association between Insomnia and Orgasmic Difficulty for Prostate Cancer Patients - Implication to Sex Therapy. JOURNAL OF SEX & MARITAL THERAPY 2020; 47:174-185. [PMID: 33225866 DOI: 10.1080/0092623x.2020.1848947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Sexual dysfunction and insomnia are common side effects of prostate cancer (PCa) treatment, but the link between these symptoms has not been explored. We explore here the association between various sexual parameters and insomnia symptoms in PCa patients. Data were collected via an online survey with recruitment through various PCa organizations. One hundred and forty two patients (age = 67.3 ± 8.9 years) completed the survey. The majority were in a relationship (84.6%), of Caucasian ethnicity (83.1%), and 33% had previously received androgen deprivation therapy (ADT). Control variables-age, number of comorbidities, past ADT use, body mass index, depression, anxiety, fatigue and daytime sleepiness-explained 58.2% of the variance for insomnia symptoms. Including orgasm difficulty in the models accounted for an additional 2.1% in the variance in insomnia symptoms. Conversely, the control variables listed above together with insomnia symptoms predicted 37.7% of the overall variance in orgasm difficulty in PCa patients. These data suggest that sexual rehabilitation programs for PCa patients should assess insomnia symptoms, and therapies to improve sexual function or sleep quality may be beneficial in both functions given the relationship between sleep and orgasm functions in this population.
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Affiliation(s)
| | - Sheila N Garland
- Department of Psychology and Discipline of Oncology, Memorial University, St. John's, Canada
| | - Erik Wibowo
- Department of Anatomy, University of Otago, Dunedin, New Zealand
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26
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Delpachitra S, Campbell A, Wibowo E. Preference for sleep management strategies among prostate cancer patients: An Aotearoa/New Zealand perspective ✰. Cancer Treat Res Commun 2020; 25:100219. [PMID: 33120315 DOI: 10.1016/j.ctarc.2020.100219] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Revised: 09/28/2020] [Accepted: 10/05/2020] [Indexed: 12/23/2022]
Abstract
INTRODUCTION Many men with prostate cancer (PCa) experience insomnia symptoms post-treatment. We explore here PCa patients' preference for strategies to manage their sleep. PATIENTS AND METHODS A brief online survey was launched on Facebook and promoted by Prostate Cancer Foundation New Zealand. The survey contained validated questionnaires on various sleep-related parameters, as well as questions about sleep management strategies. RESULTS We recruited 82 PCa patients (67.9 ± 6.3 years old). Participants with high insomnia severity index (ISI) scores reported significantly worse daytime sleepiness, more severe fatigue, being less of a "morning person", and more frequent dreaming. Most participants (71-95%) were open to trying behavioural strategies for improving sleep hygiene, especially by improving their sleeping conditions and having a consistent sleep-wake schedule. Insomnia severity and past use of androgen deprivation therapy were significant predictors for the number of sleep treatments used. Participants with a high ISI were more likely to have used medication, CBT, and herbal remedies or supplements for treating sleep issues than those with low ISI. Furthermore, in patients who had not used these treatments options, those with a high ISI were more willing to try CBT and hypnosis compared to those with a low ISI. Reasons for not willing to try various sleep treatments were documented. CONCLUSION Most PCa patients are willing to adjust their behavior or lifestyle to improve their sleep habits/behaviours. Patients with severe insomnia are more likely to have both used and express willingness to try, interventions to improve sleep, with preferences for CBT and hypnosis.
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Affiliation(s)
- Shenyll Delpachitra
- Department of Anatomy, University of Otago, 270 Great King St, Dunedin, New Zealand - 9016.
| | - Angela Campbell
- WellSleep, Department of Medicine, University of Otago, Wellington, New Zealand.
| | - Erik Wibowo
- Department of Anatomy, University of Otago, 270 Great King St, Dunedin, New Zealand - 9016.
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27
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Duthie CJ, Calich HJ, Rapsey CM, Wibowo E. Maintenance of sexual activity following androgen deprivation in males. Crit Rev Oncol Hematol 2020; 153:103064. [DOI: 10.1016/j.critrevonc.2020.103064] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Revised: 05/12/2020] [Accepted: 07/12/2020] [Indexed: 01/14/2023] Open
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28
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Piraux E, Caty G, Renard L, Vancraeynest D, Tombal B, Geets X, Reychler G. Effects of high-intensity interval training compared with resistance training in prostate cancer patients undergoing radiotherapy: a randomized controlled trial. Prostate Cancer Prostatic Dis 2020; 24:156-165. [PMID: 32719354 DOI: 10.1038/s41391-020-0259-6] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 07/10/2020] [Accepted: 07/17/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Exercise training has shown beneficial effects in the management of radiotherapy-related side effects in prostate cancer (PCa) patients undergoing radiation therapy (RT). However, the optimal modality of the exercise programs have not been yet determined. The aim of this randomized controlled trial was to investigate the effects of high-intensity interval training (HIIT) and resistance training (RES) compared to usual care (UC) on cancer-treatment-related fatigue (CTRF) (primary outcome), quality of life, depression, daytime sleepiness, insomnia, sleep quality, functional exercise capacity and executive function in PCa patients during RT. METHODS PCa patients undergoing RT with or without ADT were randomized in HIIT, RES or UC. Both exercise programs included three sessions per week during 5-8 weeks. HIIT consisted of 8-15 × 60 s intervals (≥85% maximal heart rate). RES was performed with 1-3 sets of 8-12 repetitions for each large muscle groups. The primary outcome was changed in CTRF measured with the Functional Assessment of Chronic Illness Therapy-Fatigue. RESULTS Seventy-two subjects (69.1 ± 8.2 years) completed the study. No exercise-related adverse events occurred. HIIT (p = 0.012) and RES (p = 0.039) training attenuated increases in CTRF compared to UC. Functional exercise capacity, evaluated by the 6-min walk test, increased after HIIT (p = 0 = 0.43) and RES (p = 0.041) compared to UC (+0.1%). No other secondary variables were different between groups. CONCLUSIONS Both intervention groups displayed beneficial effects on CTRF and functional exercise capacity in PCa patients undergoing RT. In addition, HIIT and RES are both safe with an excellent attendance rate to the exercise sessions.
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Affiliation(s)
- Elise Piraux
- Pôle de Neuro Musculo Skeletal Lab, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium. .,Pôle de Pneumologie, ORL & Dermatologie, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium. .,Clinical Neuroscience, Institute of Neurosciences, Université catholique de Louvain, Brussels, Belgium.
| | - Gilles Caty
- Pôle de Neuro Musculo Skeletal Lab, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.,Clinical Neuroscience, Institute of Neurosciences, Université catholique de Louvain, Brussels, Belgium.,Service de médecine physique et réadaptation, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Laurette Renard
- Department of Radiation Oncology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - David Vancraeynest
- Pôle de Recherche Cardiovasculaire, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.,Division of Cardiology, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Bertrand Tombal
- Service d'urologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
| | - Xavier Geets
- Department of Radiation Oncology, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Molecular Imaging, Radiotherapy and Oncology, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium
| | - Gregory Reychler
- Pôle de Pneumologie, ORL & Dermatologie, Institut de Recherche Expérimentale et Clinique, Université catholique de Louvain, Brussels, Belgium.,Haute Ecole Léonard de Vinci, PARNASSE-ISEI, Brussels, Belgium.,Secteur de kinésithérapie, Cliniques universitaires Saint-Luc, Brussels, Belgium.,Service de Pneumologie, Cliniques universitaires Saint-Luc, Brussels, Belgium
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29
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Wong RL, Morgans AK. Integration of Patient Reported Outcomes in Drug Development in Genitourinary Cancers. Curr Oncol Rep 2020; 22:21. [PMID: 32036478 DOI: 10.1007/s11912-020-0890-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Patient reported outcomes (PROs) are increasingly utilized in cancer drug development, and are of particular importance in genitourinary cancers due to symptom burden, multiple treatment options with similar efficacy, and often prolonged duration of disease. Here we review current data and perspectives related to use of PROs in drug development for genitourinary cancers, including insights on the regulatory process for drug approval. RECENT FINDINGS The FDA is committed to incorporating PRO data into the regulatory process for development and approval of new cancer drugs, but challenges exist due to lack of standardization of PRO instrument choice and analytic approach, missing data, and difficulty isolating treatment effect from disease-related effects. We review guidance for standardization of PRO methodology that is nonetheless tailored to disease state and anticipated effects of treatment. PRO and efficacy data should be simultaneously analyzed and reported for best clinical practice. Multiple disease-specific PRO instruments exist for genitourinary cancers. While clinicians, researchers, and regulatory bodies alike recognize the importance of PROs in cancer drug development, challenges remain regarding implementation of best practices.
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Affiliation(s)
- Risa L Wong
- Department of Medicine, Division of Oncology, University of Washington, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Alicia K Morgans
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.
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30
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Guo PP, Li P, Zhang XH, Liu N, Wang J, Chen DD, Sun WJ, Zhang W. Complementary and alternative medicine for natural and treatment-induced vasomotor symptoms: An overview of systematic reviews and meta-analyses. Complement Ther Clin Pract 2019; 36:181-194. [PMID: 31383438 DOI: 10.1016/j.ctcp.2019.07.007] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 07/18/2019] [Accepted: 07/18/2019] [Indexed: 01/26/2023]
Abstract
BACKGROUND AND PURPOSE Vasomotor symptoms (VMS) are very common in menopausal populations and cancer patients and can cause physical and mental discomfort. We aim to summarize the findings of systematic reviews and meta-analyses (SRs/MAs) that assessed the effectiveness of complementary and alternative medicines(CAMs)on VMS to provide solid evidence for future practice. METHODS PubMed, Embase, the Cochrane Library, and Web of Science were searched from inception to May 2019 to identify relevant SRs/MAs. The methodological quality of SRs/MAs and evidence levels of the outcomes were assessed. RESULTS A total of 29 SRs/MAs were reviewed. Evidence has shown that acupuncture, hypnosis, paced respiration, cognitive behavioural therapy, genistein, soy isoflavones, S-equol, combined preparations of black cohosh, and omega-3 supplements could significantly reduce VMS. The methodological quality of the SRs/MAs was moderate or high. CONCLUSION CAMs might be beneficial for reducing VMS, but the evidence levels were not high. Several priorities for future practice were identified.
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Affiliation(s)
- Ping-Ping Guo
- Nursing school, Jilin University, Changchun, Jilin province, 130021, China.
| | - Ping Li
- Department of Developmental Pediatrics, the Second Hospital of Jilin University, Changchun, Jilin province, 130041, China.
| | - Xue-Hui Zhang
- Nursing school, Jilin University, Changchun, Jilin province, 130021, China.
| | - Na Liu
- Nursing school, Jilin University, Changchun, Jilin province, 130021, China.
| | - Jie Wang
- Nursing school, Jilin University, Changchun, Jilin province, 130021, China.
| | - Dan-Dan Chen
- Nursing school, Jilin University, Changchun, Jilin province, 130021, China.
| | - Wei-Jia Sun
- Nursing school, Jilin University, Changchun, Jilin province, 130021, China.
| | - Wei Zhang
- Nursing school, Jilin University, Changchun, Jilin province, 130021, China.
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Chen SSS, Cheng TC, Chiu LP, Tasi LY, Huang SS, Tsay SL. Predictors for lower urinary tract symptoms and the urinary specific quality of life in prostate cancer patients: One-year follow-up. J Chin Med Assoc 2019; 82:482-487. [PMID: 31180946 DOI: 10.1097/jcma.0000000000000110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Prostate cancer (PCa) is the most frequently diagnosed cancer and is becoming a growing concern in global epidemiology. Quality of life of patients has become a major outcome for cancer care but limited study investigated quality of life of PCa patients. Our study is to investigate predictors for treatment outcomes of lower urinary tract symptoms (LUTS), nocturia, and the urinary specific quality of life (uQoL) in PCa patients one year following treatment. METHODS A prospective study of 131 consecutive patients was conducted with outcome measurements before treatment, at 3 months, 6 months, and one year following therapy. We utilized the International Prostate Symptom Score questionnaire to collect data. Generalized estimating equations were performed to identify predictors for major outcomes of LUTS, nocturia, and uQoL. RESULTS LUTS increased slightly over time, but nocturia and uQoL were improved from baseline to 12 months. Results of the interaction analysis indicated that patients with TNM stage 3 compared with those with stage 2 had a reduction in LUTS from diagnosis to 6 months. Patients who received surgery or radiation compared to hormone therapy had worse nocturia from diagnosis to 6 months compared to those of patients who received hormone therapy. Higher body mass index (BMI) decreased the uQoL from diagnosis to 3 months, and higher prostate-specific antigen (PSA) level deteriorated the uQoL from diagnosis to 12 months. CONCLUSION TNM stage and BMI affected the LUTS. Patients undergone a prostatectomy or radiation therapy showed more frequency of nocturia, BMI and PSA were also risk factors for nocturia. Moreover, patients' age, BMI, and PSA affected uQoL. In such patients, we recommend close monitoring of patients' specific characteristics such as TNM stage, BMI, and PSA for a better quality of life.
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Affiliation(s)
- Saint Shiou-Sheng Chen
- Division of Urology, Taipei City Hospital, Taipei, Taiwan, ROC
- National Yang-Ming University, School of Medicine, Taipei, Taiwan, ROC
| | - Tse-Chou Cheng
- Division of Urology, Chi-Mei Medical Center, Liouying, Taiwan, ROC
- College of Nursing & Health Sciences, Dayeh University, Changhua, Taiwan, ROC
| | - Li-Pin Chiu
- Division of General Surgery, Taipei City Hospital, Taipei, Taiwan, ROC
| | - Li-Yun Tasi
- College of Nursing & Health Sciences, Dayeh University, Changhua, Taiwan, ROC
| | - Sheng-Shiung Huang
- College of Nursing & Health Sciences, Dayeh University, Changhua, Taiwan, ROC
| | - Shiow-Luan Tsay
- College of Nursing & Health Sciences, Dayeh University, Changhua, Taiwan, ROC
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Comparison of Mindfulness-Based Cognitive Therapy (MBCT) with Acceptance and Commitment Therapy (ACT) On the Severity of Fatigue, Improvement of Sleep Quality and Resilience in a Patient with Prostate Cancer: A Single-Case Experimental Study. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2019. [DOI: 10.5812/ijcm.88416] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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33
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Papachristou N, Barnaghi P, Cooper B, Kober KM, Maguire R, Paul SM, Hammer M, Wright F, Armes J, Furlong EP, McCann L, Conley YP, Patiraki E, Katsaragakis S, Levine JD, Miaskowski C. Network Analysis of the Multidimensional Symptom Experience of Oncology. Sci Rep 2019; 9:2258. [PMID: 30783135 PMCID: PMC6381090 DOI: 10.1038/s41598-018-36973-1] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2018] [Accepted: 11/22/2018] [Indexed: 02/07/2023] Open
Abstract
Oncology patients undergoing cancer treatment experience an average of fifteen unrelieved symptoms that are highly variable in both their severity and distress. Recent advances in Network Analysis (NA) provide a novel approach to gain insights into the complex nature of co-occurring symptoms and symptom clusters and identify core symptoms. We present findings from the first study that used NA to examine the relationships among 38 common symptoms in a large sample of oncology patients undergoing chemotherapy. Using two different models of Pairwise Markov Random Fields (PMRF), we examined the nature and structure of interactions for three different dimensions of patients’ symptom experience (i.e., occurrence, severity, distress). Findings from this study provide the first direct evidence that the connections between and among symptoms differ depending on the symptom dimension used to create the network. Based on an evaluation of the centrality indices, nausea appears to be a structurally important node in all three networks. Our findings can be used to guide the development of symptom management interventions based on the identification of core symptoms and symptom clusters within a network.
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Affiliation(s)
- Nikolaos Papachristou
- Centre for Vision, Speech and Signal Processing, University of Surrey, Guildford, UK.
| | - Payam Barnaghi
- Centre for Vision, Speech and Signal Processing, University of Surrey, Guildford, UK.
| | | | | | | | | | - Marilyn Hammer
- Department of Nursing, Mount Sinai Medical Center, New York, USA
| | - Fay Wright
- School of Nursing, Yale University, New Haven, USA
| | - Jo Armes
- Centre for Vision, Speech and Signal Processing, University of Surrey, Guildford, UK.,School of Health Sciences, University of Surrey, Guildford, UK
| | - Eileen P Furlong
- School of Nursing, Midwifery and Health Systems, University College Dublin, Dublin, Ireland
| | - Lisa McCann
- University of Strathclyde, Glasgow, Scotland
| | - Yvette P Conley
- School of Nursing, University of Pittsburgh, Pittsburgh, USA
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Wibowo E, Wassersug RJ, Robinson JW, Matthew A, McLeod D, Walker LM. How Are Patients With Prostate Cancer Managing Androgen Deprivation Therapy Side Effects? Clin Genitourin Cancer 2018; 17:e408-e419. [PMID: 30745202 DOI: 10.1016/j.clgc.2018.12.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 12/11/2018] [Accepted: 12/11/2018] [Indexed: 01/22/2023]
Abstract
BACKGROUND Androgen deprivation therapy (ADT) for prostate cancer has numerous side effects. Clinical guidelines for side effect management exist; however, these are not always integrated into routine practice. What remains undocumented and therefore the objective of this study, is to describe patients' willingness to employ established strategies. PATIENTS AND METHODS Study participants were 91 men who had attended an educational program (ie, attend a class plus read a book), designed to prepare patients for managing ADT side effects. Three months later, patients completed the ADT Management Strategies Inventory, to determine use of strategies. Descriptive analyses were conducted. RESULTS At the time of class attendance, the average ADT duration was 133 days. Patient preferences for a variety of strategies for each side effect are presented. Highlights include: a high degree (> 65%) of patients using or willing to use exercise to manage medical risks and physical side effects. Forty percent of patients continued to engage in non-penetrative sexual activities, despite reduced sexual desire and erectile dysfunction. CONCLUSIONS When educated about options, patients are willing to use a wide array of ADT management strategies. Consequently, health care providers should ensure that patients know about side effects and how to manage them. Exercise appears to be the single best strategy to encourage, because it is helpful in managing many side effects (eg, weight gain, muscle weakening, fatigue) and reducing medical risks of ADT (eg, cardiovascular disease, type II diabetes, and osteoporosis). A general trend was patient's preference for behavioral and lifestyle strategies over pharmacologic interventions.
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Affiliation(s)
| | | | - John W Robinson
- University of Calgary, Calgary, AB, Canada; Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Andrew Matthew
- Princess Margaret Cancer Centre, Toronto, ON, Canada; University of Toronto, Toronto, ON, Canada
| | - Deborah McLeod
- Nova Scotia Health Authority, Halifax, NS, Canada; Dalhousie University, Halifax, NS, Canada
| | - Lauren M Walker
- University of Calgary, Calgary, AB, Canada; Tom Baker Cancer Centre, Calgary, AB, Canada.
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Carlson LE, Toivonen K, Flynn M, Deleemans J, Piedalue KA, Tolsdorf E, Subnis U. The Role of Hypnosis in Cancer Care. Curr Oncol Rep 2018; 20:93. [DOI: 10.1007/s11912-018-0739-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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36
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Coelingh Bennink HJT, Zimmerman Y, Verhoeven C, Dutman AE, Mensinga T, Kluft C, Reisman Y, Debruyne FMJ. A Dose-Escalating Study With the Fetal Estrogen Estetrol in Healthy Men. J Clin Endocrinol Metab 2018; 103:3239-3249. [PMID: 29931320 DOI: 10.1210/jc.2018-00147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2018] [Accepted: 06/15/2018] [Indexed: 12/28/2022]
Abstract
CONTEXT Luteinizing hormone-releasing hormone (LHRH) agonists have replaced estrogens for endocrine treatment of advanced prostate cancer (PC) because of cardiovascular side effects. The fetal estrogen estetrol (E4) may be safer for PC treatment and is expected to decrease testosterone (T) and prevent estrogen deficiency. OBJECTIVE To investigate the safety and T-suppressive effect of E4 in healthy men. DESIGN Double-blind, randomized, placebo-controlled, dose-escalating study. SETTING The study was conducted at a phase I clinical unit (QPS, Netherlands). PARTICIPANTS Healthy male volunteers aged 40 to 70 years. INTERVENTION(S) Three treatment cohorts of 15 volunteers with placebo (n = 5) and E4 (n = 10). Estetrol doses tested were 20, 40, and 60 mg/d. Subjects were treated for 4 weeks. MAIN OUTCOME MEASURES Subjective side effects, pharmacodynamic effects on hemostatic variables, lipids, glucose, bone parameters, and endocrine parameters related to T metabolism. RESULTS Total and free T decreased dose-dependently and significantly. Nipple tenderness occurred in 40% and decrease of libido occurred in 30% of E4-treated men. The unwanted estrogenic effects on hemostasis were small, dose dependent, and in some cases significant. Lipid and bone parameters showed a favorable trend. CONCLUSION The effect of E4 on testosterone levels is insufficient for standalone PC treatment. Taking all clinical and pharmacodynamic variables into consideration, a daily dose of 40 mg E4 seems safe for further evaluation of endocrine PC treatment in combination with LHRH analogs.
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Affiliation(s)
| | | | | | | | | | | | - Yacov Reisman
- Department of Urology, Amstelland Hospital, AM Amstelveen, Netherlands
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Russell N, Hoermann R, Cheung AS, Ching M, Zajac JD, Handelsman DJ, Grossmann M. Short-term effects of transdermal estradiol in men undergoing androgen deprivation therapy for prostate cancer: a randomized placebo-controlled trial. Eur J Endocrinol 2018; 178:565-576. [PMID: 29549104 DOI: 10.1530/eje-17-1072] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2017] [Accepted: 03/15/2018] [Indexed: 01/02/2023]
Abstract
OBJECTIVE There is increasing recognition that, in men, some biological actions attributed to testosterone (TS) are mediated by estradiol (E2). This study used two low doses of daily transdermal E2 gel to assess the effects on circulating E2 concentrations in men with prostate cancer with suppressed endogenous E2 production arising from androgen deprivation therapy (ADT). Secondarily, we aimed to assess short-term biological effects of E2 add-back without increasing circulating TS. DESIGN 28-day randomised, placebo-controlled trial. METHODS 37 participants were randomised to either 0.9 or 1.8 mg of 0.1% E2 gel per day or matched placebo gel. Fasting morning serum hormones, quality of life questionnaires, and treatment side effects were evaluated at baseline, days 14 and 28. Hot flush diaries and other biochemical measurements were completed at baseline and study end. RESULTS Transdermal E2 significantly raised serum E2 from baseline to day 28 compared to placebo in the 0.9 mg dose group (median: 208 pmol/L; interquartile range: 157-332) and in the 1.8 mg dose group (median: 220 pmol/L; interquartile range: 144-660). E2 treatment reduced hot flush frequency and severity as well as beta carboxyl-terminal type 1 collagen telopeptide. CONCLUSION In men with castrate levels of E2 and TS, daily transdermal E2: 0.9-1.8 mg increased median serum E2 concentrations into the reference range reported for healthy men, but with substantial variability. E2 treatment reduced hot flushes and bone resorption. Larger studies will be required to test whether low-dose E2 treatment can mitigate ADT-associated adverse effects without E2-related toxicity.
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Affiliation(s)
- Nicholas Russell
- Department of Medicine (Austin Health)The University of Melbourne, Heidelberg, Australia
- Department of EndocrinologyAustin Health, Heidelberg, Australia
| | - Rudolf Hoermann
- Department of Medicine (Austin Health)The University of Melbourne, Heidelberg, Australia
| | - Ada S Cheung
- Department of Medicine (Austin Health)The University of Melbourne, Heidelberg, Australia
- Department of EndocrinologyAustin Health, Heidelberg, Australia
| | - Michael Ching
- Pharmacy DepartmentAustin Health, Heidelberg, Australia
| | - Jeffrey D Zajac
- Department of Medicine (Austin Health)The University of Melbourne, Heidelberg, Australia
- Department of EndocrinologyAustin Health, Heidelberg, Australia
| | - David J Handelsman
- ANZAC Research InstituteUniversity of Sydney, Concord Hospital, Concord, NSW, Australia
| | - Mathis Grossmann
- Department of Medicine (Austin Health)The University of Melbourne, Heidelberg, Australia
- Department of EndocrinologyAustin Health, Heidelberg, Australia
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