An Educational Program to Help Patients Manage Androgen Deprivation Therapy Side Effects: Feasibility, Acceptability, and Preliminary Outcomes

Androgen deprivation therapy (ADT), a common treatment for prostate cancer, is associated with physical, psychological, and sexual side effects that reduce patients’ quality of life. The authors designed an educational program to prepare patients for managing these side effects. This paper describes an implementation model for national dissemination of the program, testing its feasibility and acceptability at the institutional and patient level. Postprogram changes in patients’ self-efficacy to manage side effects and side effect bother are also explored. Patients on or anticipating ADT enrolled in the educational program. Pre and post intervention questionnaires measured patient satisfaction with the program, side effect bother, and self-efficacy to manage ADT side effects. The ADT Educational Program was deemed feasible and acceptable. Five of six targeted sites successfully launched the program with sufficient patient enrolment. Patient attendees were highly satisfied. Self-efficacy, bother, and use of management strategies were interrelated. Lower bother was associated with increased self-efficacy and more use of management strategies, and increased bother was associated with lower self-efficacy and less use of management strategies. Based on pre–post scores, improvements in patients’ self-efficacy to manage ADT side effects were also observed. Results demonstrate that this brief educational program is feasible and acceptable to patients and cancer care institutions. The program appears to promote self-efficacy and the uptake of ADT management strategies for ADT side effects. The results of this study support the program implementation and suggest that improvements in self-efficacy after program participation may help patients adapt to ADT side effects.

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A preliminary evaluation of the TrueNTH androgen deprivation therapy educational program.

Journal of Clinical Oncology ◽

10.1200/jco.2017.35.5_suppl.219 ◽

2017 ◽

Vol 35 (5_suppl) ◽

pp. 219-219

Author(s):

Erik Wibowo ◽

Richard J Wassersug ◽

John W Robinson ◽

Andrew Matthew ◽

Deborah L McLeod ◽

...

Keyword(s):

Quality Of Life ◽

Weight Gain ◽

Side Effects ◽

Androgen Deprivation Therapy ◽

Self Efficacy ◽

Educational Program ◽

Hot Flashes ◽

Androgen Deprivation ◽

Dyadic Relationship

219 Background: Androgen deprivation therapy (ADT) is the most common systemic treatment for prostate cancer (PCa), but has many adverse effects that reduce patients’ quality of life and that of their partners. In 5 Canadian cities, we offer an educational program designed to help PCa patients and their partners manage ADT side effects as well as maintain a strong dyadic relationship despite changes that accompany ADT. Methods: Patients on or about to start ADT and their partners participate in a 1.5 hour educational session. Patients receive a copy of the 2014 book, Androgen Deprivation Therapy: An essential guide for men with prostate cancer and their partners (DEMOS Health, NY) which discusses how to manage ADT side effects and how to make effective lifestyle changes to maintain a good quality of life. To date, 358 patients and 220 partners have attended the ADT class. A subset (32%) of participants elected to complete questionnaires at baseline and again 2 to 3 months later to assess the program efficacy. Results: At the time of the ADT class, patients who have been on ADT for ≥ 2 months had more frequent side effects (e.g., hot flashes and breast tenderness), and were more bothered by hot flashes. They also reported worse self-efficacy for managing weight gain and diabetes than those who have been on ADT for < 2 months. However, at 2 to 3 months after the class, patients’ self-efficacy for managing ADT side effects improved, despite experiencing more side effects and more bother associated with those side effects. Notably, patients who were on ADT for a shorter duration (< 2 months), who have attended the class, had less bother associated with hot flashes and better self-efficacy for managing weight gain than those who had been on ADT longer before attending the class. Conclusions: The TrueNTH ADT Educational Program potentially dampens side effect bother and improves self-efficacy for two of the most troublesome adverse effects of ADT, hot flashes and weight gain respectively. The program is most beneficial when offered to patients just starting on ADT. Future analyses will focus on exercise behaviour and dyadic relationship to assess the program’s effectiveness in encouraging a healthy lifestyle and maintain strong dyadic bonds in the face of ADT.

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Androgen deprivation therapy educational program: A Canadian true nth initiative.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.3_suppl.243 ◽

2016 ◽

Vol 34 (3_suppl) ◽

pp. 243-243

Author(s):

Erik Wibowo ◽

Lauren M Walker ◽

Shawn Wilyman ◽

Andrew Matthew ◽

Deborah L McLeod ◽

...

Keyword(s):

Prostate Cancer ◽

Side Effects ◽

Androgen Deprivation Therapy ◽

Side Effect ◽

Educational Program ◽

Research Evaluation ◽

Androgen Deprivation ◽

Lifestyle Changes ◽

Dyadic Relationship

243 Background: Androgen deprivation therapy (ADT) is commonly prescribed for advanced prostate cancer (PCa) patients, but ADT has many side effects that can impair patients’ quality of life. In various Canadian cities, we are running an educational program to help PCa patients and their partners deal with the side effects of ADT, and maintain a strong relationship with each other while on ADT. Methods: Patients, who are about to start or have been on ADT, and their partners are invited to attend an educational program. Each patient is given a copy of the book Androgen Deprivation Therapy: An essential guide for men with prostate cancer and their partners (Wassersug et al., 2014) and attends a 1.5 hour educational class, where they learn strategies for managing ADT side effects and how to effectively make healthier lifestyle changes using goal-setting exercises. At the end of the class, participants are given the option to attend a monthly follow-up session. To evaluate the effectiveness of the program, participants are asked to complete questionnaire package before attending the class and again 2-3 months later. Results: As of August 2015, 179 patients and 113 partners have attended the ADT Educational Program at Victoria, Vancouver, and Calgary. About 40% of patients returned for the follow-up session. 62 attendees participated in the research evaluation portion of the program. Uniquely designed for this study, the questionnaire package assesses ADT side effect frequency, bother associated with side effects, use of management strategies, and self-efficacy regarding side effect management. An assessment of physical activity and relationship adjustment, and feedback about the class are also included. Conclusions: Patients and partners appreciate being informed about ADT side effects managements and how to make healthier lifestyle changes while on ADT. It remains to be seen how effective the program is in limiting the bother from ADT side effects and helping couples maintain a strong dyadic relationship in the fact of the challenges brought on by ADT. Good enrollment in the in-person program in the 3 cities has propelled the development of the program in Halifax and Toronto starting in fall 2015, and an online version to be available in early 2016.

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The influence of an androgen deprivation therapy educational program on dyadic quality and intimacy for prostate cancer patients and their partners.

Journal of Clinical Oncology ◽

10.1200/jco.2018.36.7_suppl.178 ◽

2018 ◽

Vol 36 (7_suppl) ◽

pp. 178-178

Author(s):

Erik Wibowo ◽

Richard J Wassersug ◽

John W Robinson ◽

Andrew Matthew ◽

Deborah L McLeod ◽

...

Keyword(s):

Prostate Cancer ◽

Side Effects ◽

Physical Exercise ◽

Androgen Deprivation Therapy ◽

Educational Program ◽

Androgen Deprivation ◽

Dyadic Adjustment ◽

Dyadic Relationship ◽

Relationship Duration ◽

The Relationship

178 Background: Androgen deprivation therapy (ADT) is a common treatment for advanced prostate cancer (PCa), but ADT typically impairs men’s sexual function and couples’ relationships. We offer an educational program to help PCa patients and their partners manage ADT related side effects and to maintain a strong dyadic relationship while the patient is on ADT. Methods: Patients and partners attended a one time 1.5 hour ADT Class. Patients received a copy of the book Androgen Deprivation Therapy: An essential guide for men with prostate cancer and their partners (DEMOS Health, NY), which covers how to manage ADT side effects and make healthy lifestyle changes. We emphasize the importance of physical exercise in preventing or reducing many of the side effects of ADT. 79 couples (patients = 68.8±7.5 years old, partners = 64.9±8.8 years old; relationship duration = 34.6±16.4 years) completed the Dyadic Adjustment Scale, the Personal Assessment of Intimacy in Relationships, and the Godin Leisure-Time Exercise questionnaires at baseline and again 2-3 months later to assess their relational intimacy and dyadic quality. At baseline 73% of patients either had not started or been on ADT for < 3 weeks. Results: Attending the ADT Educational Program was associated with improved dyadic adjustment and relational intimacy but age, relationship duration, baseline strain in the relationship and physical exercise all influence these effects. Specifically, dyadic cohesion improved in patients ≥68 years old. Recreational intimacy increased in patients ≤60 years old and for those in a relationship ≥50 years. Recreational intimacy also improved in partners who had been in a 20-49 years relationship or those reporting at baseline little strain in their relationship. Dyadic cohesion was maintained in participants who increased their frequency of physical exercise. For the above results, all P < 0.05. Conclusions: The ADT Educational Program improves dyadic cohesion and relational intimacy for some patients and partners but age, relationship duration, baseline quality of the relationship, and physical exercise frequency appear to influence the effectiveness of the program.

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Androgen deprivation therapy promotes an obesity-like microenvironment in periprostatic fat

Endocrine Connections ◽

10.1530/ec-19-0029 ◽

2019 ◽

Vol 8 (5) ◽

pp. 547-558 ◽

Cited By ~ 5

Author(s):

Stefano Mangiola ◽

Ryan Stuchbery ◽

Patrick McCoy ◽

Ken Chow ◽

Natalie Kurganovs ◽

...

Keyword(s):

Prostate Cancer ◽

Adipose Tissue ◽

Side Effects ◽

Androgen Deprivation Therapy ◽

Cancer Progression ◽

Tissue Level ◽

Androgen Deprivation ◽

Clinical Settings ◽

Prostate Cancer Development ◽

Transcriptional Changes

Prostate cancer is a leading cause of morbidity and cancer-related death worldwide. Androgen deprivation therapy (ADT) is the cornerstone of management for advanced disease. The use of these therapies is associated with multiple side effects, including metabolic syndrome and truncal obesity. At the same time, obesity has been associated with both prostate cancer development and disease progression, linked to its effects on chronic inflammation at a tissue level. The connection between ADT, obesity, inflammation and prostate cancer progression is well established in clinical settings; however, an understanding of the changes in adipose tissue at the molecular level induced by castration therapies is missing. Here, we investigated the transcriptional changes in periprostatic fat tissue induced by profound ADT in a group of patients with high-risk tumours compared to a matching untreated cohort. We find that the deprivation of androgen is associated with a pro-inflammatory and obesity-like adipose tissue microenvironment. This study suggests that the beneficial effect of therapies based on androgen deprivation may be partially counteracted by metabolic and inflammatory side effects in the adipose tissue surrounding the prostate.

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Prevalence and predictors of cannabis use among men receiving androgen-deprivation therapy for advanced prostate cancer

Canadian Urological Association Journal ◽

10.5489/cuaj.5911 ◽

2019 ◽

Vol 14 (1) ◽

Author(s):

Ahmad Mousa ◽

Michele Petrovic ◽

Neil E. Fleshner

Keyword(s):

Prostate Cancer ◽

Side Effects ◽

Androgen Deprivation Therapy ◽

Advanced Prostate Cancer ◽

Symptom Relief ◽

Therapeutic Benefit ◽

Androgen Deprivation ◽

Cannabis Use ◽

Testosterone Levels ◽

Treatment Side Effects

Introduction: Prostate cancer patients receiving androgen-deprivation therapy (ADT) often experience a combination of disease symptoms and treatment side effects. The therapeutic use of cannabis to alleviate these side effects has not been studied, despite increasing patient interest. With the increasing availability of cannabis, it is important for clinicians to understand the prevalence, predictors, and perceived benefits of cannabis use among patients with prostate cancer. Methods: A total of 222 men undergoing ADT were assessed in this two-part study. In part one, the cannabis-use questionnaire was administered to 56 men, probing demographics, usage habits, perspectives, and degrees of symptom relief related to cannabis use. In part two, 191 cryopreserved urine samples were retrieved and analyzed for the presence of tetrahydrocannabidiol (THC) metabolite 11-nor-Δ9-THC-COOH. The respondents were then stratified into two groups, users vs. non-users, and statistical analyses were conducted. Results: Questionnaire data revealed that 23.2% of surveyed men had recently used cannabis. In contrast, 5.8% of men had detectable levels of THC metabolite in their urine. Combined questionnaire and urine data revealed that cannabis users were significantly younger (p=0.003) and had lower testosterone levels (p=0.003) than non-users. The majority of men experiencing common ADT side effects reported some degree of relief following cannabis use. Conclusions: Cannabis use among men with advanced prostate cancer receiving ADT is more prevalent than in the general population and the majority of other oncological cohorts. Lower testosterone levels and reported therapeutic benefit among cannabis users warrants confirmation in appropriate clinical trials.

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