Page 9 - CUA 2020_Pediatric

Unmoderated Posters 2: Uro-Oncology, Pediatrics, Sexual Dysfunction, Transplant

Introduction: Androgen deprivation therapy (ADT) is a common prostate UP-2.19
cancer (PCa) treatment but has numerous adverse effects that reduce Real-world practice patterns of androgen deprivation therapy
patients’ quality of life. The ADT Educational Program helps prepare (ADT): How do physician characteristics and socio-demographics
patients to manage ADT side effects. The program consists of a single, affect intermittent ADT use?
1.5-hour, professionally facilitated class plus the CUA-endorsed book Douglas C. Cheung , Lisa Martin , Maria Komisarenko , Christopher
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Androgen Deprivation Therapy: An Essential Guide for Prostate Cancer Dharma , Girish S. Kulkarni , Shabbir M. Alibhai , Antonio Finelli 1
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Patients and their Loved Ones. Here, we describe the dissemination of 1 Department of Surgery, Division of Urology, University Health Network,
the program in both an in-person and online format. Toronto, ON, Canada; ICES, Toronto, ON, Canada; Division of Internal
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Methods: Launched in person in 2014, the initial implementation study Medicine and Geriatrics, University Health Network, Toronto, ON,
collected pre- and post-intervention data from 94 patients about side effect Canada
bother, self-efficacy in managing side effects, and patient satisfaction with Introduction: Level 1 evidence supports intermittent androgen depriva-
the program. Feasibility and acceptability of the in-person program were tion therapy (IADT) as non-inferior to continuous ADT (CADT) in non-
assessed in a national dissemination strategy across 14 program sites. metastatic biochemically recurrent prostate cancer (PC), while sparing
Launched in 2018, the online program has been evaluated for feasibility adverse events. However, due to concerns about the trial definitions, clini-
and acceptability, with a full-scale evaluation currently being conducted. cal practice and guidelines vary. We evaluate the real-world use of IADT.
Results: Evaluation data support the feasibility and acceptability of the Methods: We used population-level data at ICES to identify Ontario men
ADT Education Program. Data demonstrate that the in-person program age ≥65 who were diagnosed with PC (1997–2012) and initiated ADT
is associated with significant improvements in patients’ self-efficacy to for ≥6 months. Neoadjuvant/adjuvant therapy was excluded. After induc-
manage ADT side effects. Patient satisfaction with the in-person and tion, lapses in ADT ≥6 months (initial gap) and ≥3 months (subsequent
online programs are similarly high. A total of 14 sites and 29 facilitators gaps) were used to identify IADT. A five-year minimum followup ensured
have been trained to offer the program; 13 sites in Canada and one in patients had the opportunity to become intermittent. Adjustment for dis-
the United States. The program is currently offered monthly online and ease stage/likely metastatic disease was based on a de novo presentation
in-person at six sites. with ADT vs. prior local therapy. Predictors of IADT were assessed using
Conclusions: The ADT Educational Program is feasible and acceptable multivariable logistic regression.
to patients and cancer care institutions. The program improves patient Results: We identified 8544 patients with 1404 (16%) ever on IADT.
self-efficacy and their uptake of evidence-based strategies for managing Use varied from 11.4–24.8% across health regions. IADT patients were
ADT side effects. Explorations have begun to bring the program to Europe younger, less comorbid, had higher income, and were more likely to
and Australia. have prior therapy. They were more often started in later calendar years,
by higher-volume physicians and by those who graduated more than 10
UP-2.18 years previously. After a mean followup of 8.3 years, 81% and 47% of
Has androgen deprivation therapy for patients receiving radical IADT patients experienced second and third gaps (14 and 20 months
prostatectomy been adequately studied? A systematic review long), respectively. In multivariable analyses, highest income quintile (vs.
and meta-analysis lowest; odds ratio [OR] 1.44, 1.19–1.74) and prior local therapy (OR
Ameeta Nayak , Ana Flaman , Ranjeeta Mallick , Luke T. Lavallée 1,2,4 , 1.85; 1.57–2.18) predicted IADT. Physicians over 10 years in practice
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Dean Fergusson , Rodney H. Breau 1,2,4 were more likely to prescribe IADT (OR 1.52; 1.18–1.97), as were radia-
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1 Clinical Epidemiology Program, Ottawa Hospital Research Institute, tion oncologists (vs. urologists; OR 2.13; 1.70–2.68). Case volume was
Ottawa, ON, Canada; Faculty of Medicine, University of Ottawa, associated with IADT for radiation oncologists (OR 1.65; 1.07–2.54).
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Ottawa, ON, Canada; Ottawa Urologic Oncology Research, Ottawa, Conclusions: IADT remains underuses. Radiation oncologists, higher case
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ON, Canada; Division of Urology, Department of Surgery, The Ottawa volume, and greater experience predicted IADT as did patient income
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Hospital, Ottawa, ON, Canada quintile and prior local therapy.
Introduction: Androgen deprivation therapy (ADT) improves outcomes
for patients with clinically localized disease receiving radiation. We UP-2.20
reviewed the evidence evaluating neoadjuvant and adjuvant ADT for Health-related quality of life in advanced prostate cancer
patients receiving radical prostatectomy. patients on androgen deprivation therapy
Methods: MEDLINE, EMBASE, and the Cochrane Library were searched Douglas C. Cheung , Ayesha Syeda , Diana E. Magee , Amanda Hird ,
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from inception to September 2019. Randomized trials comparing ADT Lisa Martin , Maria Komisarenko , Karen Bremner , Shabbir M. Alibhai ,
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with radical prostatectomy vs. prostatectomy alone in patients with pros- Girish S. Kulkarni , Antonio Finelli , Murray Krahn 2
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tate cancer were included. The primary outcomes were cancer recurrence 1 Department of Surgery, Division of Urology, University Health Network,
and overall survival. Pathologic outcomes in patients treated with ADT Toronto, ON, Canada; Toronto Health Economics and Technology
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prior to surgery were also evaluated. Assessment Collaborative, University of Toronto, Toronto, ON,
Results: Eleven studies evaluated the effects of 3–6 months of neoadju- Canada; Division of Internal Medicine and Geriatrics, University Health
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vant ADT (n=2322). Neoadjuvant ADT significantly decreased the rate of Network, Toronto, ON, Canada
positive surgical margins (relative risk [RR] 0.48; 95% confidence inter- Introduction: Patient-reported outcomes (PRO; both preference- and non-
val [CI] 0.41–0.56) and T3 disease (RR 0.75; 95% CI 0.64–0.89). There preference-based) are critical to measuring health-related quality of life
was no difference in pooled overall or progression free survival with (HRQoL) and providing effective and cost-effective care. However, limited
neoadjuvant ADT (RR 1.3; 95% CI 0.8–2.1; RR 0.99; 95% CI 0.7–1.3, longitudinal information is available to evaluate the HRQoL associated
respectively). Four studies evaluated the effects of adjuvant ADT (n=5198), with advanced prostate cancer (PC) and androgen deprivation therapy
of which two studies evaluated anti-androgen and one studied diethylstil- (ADT). The Patient Oriented Prostate Utility Scale (PORPUS) is a vali-
bestrol monotherapy. The use of adjuvant ADT demonstrated no difference dated disease-specific instrument to assess patient preferences across ten
in pooled overall or progression free survival (RR 1.0; 95% CI 0.9–1.1; domains of prostate cancer care.
RR 0.8; 95% CI 0.6–1.0, respectively). Methods: PORPUS-P (psychometric) and PORPUS-U (utility) scores were
Conclusions: For patients treated with radical prostatectomy, neoadju- prospectively measured in prostate cancer patients at our tertiary care
vant trials only evaluated short-term ADT and adjuvant trials have not center (2003–2016). All patients that started ADT were included and
assessed contemporary ADT. Longer-term, contemporary ADT have not stratified by those receiving primary ADT vs. after local therapy. Scores
been adequately studied for patients treated with radical prostatectomy. were pooled based on pre/post-ADT timing and type. Mixed models
were completed to assess patient and disease characteristics predictive
of PORPUS scores, after adjusting for repeated patient measurements.
CUAJ • June 2020 • Volume 14, Issue 6(Suppl2) S65