TY - JOUR
T1 - Metabolic, cardiac, and bone health testing in patients with prostate cancer on androgen-deprivation therapy
T2 - A population-based assessment of adherence to therapeutic monitoring guidelines
AU - Mousa, Ahmad
AU - Nguyen, David Dan
AU - Lalani, Aly Khan
AU - Satkunasivam, Raj
AU - Aminoltejari, Khatereh
AU - Hird, Amanda
AU - Roy, Soumyajit
AU - Morgan, Scott C.
AU - Malone, Shawn
AU - Kokorovic, Andrea
AU - Lavallée, Luke T.
AU - Huynh, Melissa
AU - Shayegan, Bobby
AU - Jiang, Di Maria
AU - Gotto, Geofrey
AU - Breau, Rodney H.
AU - Kulkarni, Girish S.
AU - Zlotta, Alexandre
AU - Wallis, Christopher J.D.
N1 - Publisher Copyright:
© 2024 The Author(s). Cancer published by Wiley Periodicals LLC on behalf of American Cancer Society.
PY - 2025/1/1
Y1 - 2025/1/1
N2 - Background: Androgen-deprivation therapy (ADT) remains a cornerstone in treatment for patients with advanced prostate cancer. ADT is associated with several adverse effects, including osteoporosis, metabolic syndrome, and cardiovascular events, leading to guidelines recommending routine testing to monitor for these toxicities. There is a lack of data assessing adherence to these recommendations. Methods: The authors conducted a retrospective cohort study using administrative data from Ontario, Canada between 2008 and 2021. They identified all older men (aged 65 years and older) who received ADT for prostate cancer using comprehensive provincial health databases. The primary outcomes were the use of testing for lipids, dysglycemia (glucose), bone health serum, and bone density between 6 weeks before and 1 year after the initiation of ADT. Results: In total, 29,097 patients were examined, of whom 52.8% were prescribed ADT by urologists, 37.9% were prescribed ADT by radiation oncologists, 2.8% were prescribed ADT by medical oncologists, and 2.4% were prescribed ADT by other physicians. Adherence to guidelines was low: only 21.3% of patients received a bone density scan, 41.2% underwent bone health–related serum tests, 51.3% completed a lipid profile, and 65.9% underwent dysglycemia testing within 1 year of diagnosis. Overall, only 11.9% of patients received all of the recommended investigations. Adherence to testing did not appear to improve over time (2008–2021) or with guideline publication. Patient (age) and physician (specialty) factors had important associations with adherence to testing. Conclusions: Most patients receiving ADT for prostate cancer do not receive recommended testing to monitor for treatment-related toxicity. Further study is required to address barriers to therapeutic monitoring of men on ADT and to reduce treatment-associated adverse events.
AB - Background: Androgen-deprivation therapy (ADT) remains a cornerstone in treatment for patients with advanced prostate cancer. ADT is associated with several adverse effects, including osteoporosis, metabolic syndrome, and cardiovascular events, leading to guidelines recommending routine testing to monitor for these toxicities. There is a lack of data assessing adherence to these recommendations. Methods: The authors conducted a retrospective cohort study using administrative data from Ontario, Canada between 2008 and 2021. They identified all older men (aged 65 years and older) who received ADT for prostate cancer using comprehensive provincial health databases. The primary outcomes were the use of testing for lipids, dysglycemia (glucose), bone health serum, and bone density between 6 weeks before and 1 year after the initiation of ADT. Results: In total, 29,097 patients were examined, of whom 52.8% were prescribed ADT by urologists, 37.9% were prescribed ADT by radiation oncologists, 2.8% were prescribed ADT by medical oncologists, and 2.4% were prescribed ADT by other physicians. Adherence to guidelines was low: only 21.3% of patients received a bone density scan, 41.2% underwent bone health–related serum tests, 51.3% completed a lipid profile, and 65.9% underwent dysglycemia testing within 1 year of diagnosis. Overall, only 11.9% of patients received all of the recommended investigations. Adherence to testing did not appear to improve over time (2008–2021) or with guideline publication. Patient (age) and physician (specialty) factors had important associations with adherence to testing. Conclusions: Most patients receiving ADT for prostate cancer do not receive recommended testing to monitor for treatment-related toxicity. Further study is required to address barriers to therapeutic monitoring of men on ADT and to reduce treatment-associated adverse events.
KW - androgen-deprivation therapy
KW - bone mineral density
KW - dysglycemia
KW - dyslipidemia, hypogonadism
KW - prostate cancer
UR - http://www.scopus.com/inward/record.url?scp=85206011846&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85206011846&partnerID=8YFLogxK
U2 - 10.1002/cncr.35606
DO - 10.1002/cncr.35606
M3 - Article
C2 - 39396120
AN - SCOPUS:85206011846
SN - 0008-543X
VL - 131
JO - Cancer
JF - Cancer
IS - 1
M1 - e35606
ER -