Page 36 - Poster Sessions] CUA 2022 Annual Meeting Abstracts

2022 CUA Abstracts

MP-5.2 scope, mission, and governance of COSHI. A 360° survey was distributed
Hormonal stimulation therapy in men with azoospermia prior to to 12 participating cancer centers to characterize SH care in oncology in
sperm retrieval: Systematic review and meta-analysis Canada. Responses were collated and descriptive results reported.
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Mary Ellene Boulos , Emma Cain , Karla Solo , Nancy Santesso 2,3 Results: Eleven of 12 institutions responded to the survey. All sites reported
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1 Michael G. DeGroote School of Medicine, McMaster University, some form of SH care: seven have cancer-specific clinics (gyne, prostate,
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Hamilton, ON, Canada; Department of Health Research Methods, colorectal); two offer SH care for all cancers; and four offer SH education
Evidence, and Impact, McMaster University, Hamilton, ON, Canada; classes. Seven sites have in-person clinics and two offer virtual services.
3 Michael G. DeGroote Cochrane Canada and McMaster GRADE Centres, MDs (urologists) deliver SH care at nine sites, RNs at six, and psycholo-
McMaster University, Hamilton, ON, Canada gists at three. At least some SH-related PROs are collected at seven sites.
Introduction: Hormonal stimulation therapy is commonly administered to Eight sites reported that SH was a “gap in care” and all reported limited
men with azoospermia prior to sperm retrieval. Controversy exists regarding to no community-based SH resources.
the potential benefits and risks of preoperative hormonal therapy. Conclusions: The 360° survey confirms gaps, discrepancies, or absence
Methods: We conducted a systematic review of randomized controlled of SH care across selected Canadian cancer centers. Results underscore
trials and non-randomized studies that compared hormonal stimulation the need for an organization such as COSHI, with its goals to improve
to none among adult men with azoospermia undergoing sperm retrieval. SH care across Canada.
We searched MEDLINE, EMBASE, CENTRAL, and LILACS databases
from inception to June 2021. We performed a pairwise meta-analysis MP-5.5
with a random-effects model to calculate a risk ratio (RR) for binary Disproportional signal of sexual dysfunction reports associated
outcomes, including sperm retrieval, pregnancy, and live births. We used with finasteride use: A pharmacovigilance analysis of VigiBase
the ROBINS-I tool to assess the risk of bias of non-randomized studies David-Dan Nguyen , Peter Herzog , Eugene B. Cone , Muhieddine
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1,2
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and assessed the certainty of evidence using GRADE. Labban , Kevin C. Zorn , Bilal Chughtai , Shehzad Basaria , Dean
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Results: Eighteen non-randomized studies included 1868 azoospermic Elterman , Quoc-Dien Trinh , Naeem Bhojani 3
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patients undergoing hormonal stimulation therapy compared to 2428 1 Division of Urological Surgery and Center for Surgery and Public Health,
patients with none prior to sperm retrieval. Gonadotrophins were com- Brigham and Women’s Hospital, Harvard Medical School, Boston,
monly used, followed by aromatase inhibitors and clomiphene. There MA, United States; Faculty of Medicine and Health Sciences, McGill
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is low certainty evidence for a slight increase in sperm retrieval with University, Montreal, QC, Canada; Division of Urology, Centre hos-
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hormone therapy (RR 1.10, 95% confidence interval [CI] 0.90–1.34), and pitalier de l’Université de Montréal (CHUM), Université de Montréal,
little to no effect in clinical pregnancy (RR 1.09, 95% CI 0.80–1.50). Few Montreal, QC, Canada; Department of Urology, Weill Cornell Medical
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studies measured live births, resulting in very low certainty evidence for College/New York Presbyterian, New York, NY, United States; Research
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a reduction in live births with hormonal therapy (RR 0.86, 95% CI 0.65– Program in Men’s Health: Aging and Metabolism, Brigham and Women’s
1.13). Side effects were measured in three studies: two reported none Hospital, Harvard Medical School, Boston, MA, United States; Division
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and one reported similar numbers in each group. Studies did not measure of Urology, University Health Network (UHN), University of Toronto,
other important outcomes, such as quality of life or mental health. Toronto, ON, Canada
Conclusions: The evidence suggests there may be a slight increase in Introduction: Finasteride, a 5α-reductase inhibitor, is used in the man-
sperm retrieval but little to no effect on pregnancy when providing hor- agement of alopecia and benign prostatic hyperplasia (BPH). Previous
monal stimulation to men with azoospermia prior to sperm retrieval. In reports suggest that some men taking finasteride experience a constella-
addition, the effect on live births is uncertain. Future randomized con- tion of adverse events, including sexual dysfunction. We investigated the
trolled trials could strengthen the current evidence base. association of sexual dysfunction with finasteride use
Methods: We conducted a pharmacovigilance study using VigiBase, the
MP-5.4 World Health Organization’s global database of individual case safety
A 360-degree view of sexual health services at selected reports. We used the reporting odds ratio (ROR), a surrogate measure
institutions across Canada: The need for the Canadian Oncology of association used in disproportionality analysis, with 95% confidence
Sexual Health Initiative (COSHI) intervals (CI). Extensive sensitivity analyses included stratifying by indica-
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Sydney Sparanese , Ryan Flannigan , Andrew Matthew , Celestia S. tion (BPH and alopecia) and age (<45 and ≥45); comparing finasteride
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Higano , Eugenia Wu , Steven Guirguis , Monita Sundar 2 signals to those of drugs with different mechanisms but similar indications
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1 Department of Urologic Sciences, University of British Columbia, (minoxidil for alopecia and tamsulosin for BPH); comparing finasteride to
Vancouver, BC, Canada; Prostate Cancer Supportive Care Program, a drug with a similar mechanism of action (dutasteride); and comparing
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Vancouver Prostate Centre, Vancouver, BC, Canada; Department of reports of sexual dysfunction before and after 2012.
Surgical Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada Results: We identified 7700 reports of sexual dysfunction in finasteride
Introduction: Sexual health (SH) is compromised by cancer diagnosis and users. There was a significant disproportionality signal for sexual dysfunc-
treatment. Prevalence rates of sexual dysfunction are 90% in prostate/ tion (ROR 50.30, 95% CI 49.03–51.60) linked to finasteride use. All sensi-
gynecological, 73% in breast, 30% in colorectal, and 20% in non-breast/ tivity analyses met the threshold of signal significance (Table 1). Patients
non-pelvic cancers. SH clinics in oncology settings are the exception under the age of 45 (ROR 65.73, 95% CI 61.83–69.88) and alopecia
in Canada. As such, we formed the Canadian Oncology Sexual Health patients (ROR 33.62, 95% CI 25.22–44.82) had larger signals than older
Initiative (COSHI), which is comprised of a multidisciplinary group of SH patients (ROR 30.43, 95% CI 27.12–34.15) and those with BPH (ROR
experts with the following goals: 1.74, 95% CI 1.47–2.07). A signal was detected for minoxidil (ROR 1.92,
• Develop a SH virtual resource repository for participating cancer 95% CI 1.54–2.38).
centers Conclusions: We detected disproportional signals of sexual dysfunction
• Develop standardized treatment protocols and access for SH linked with finasteride use. Despite sexual dysfunction being more preva-
across Canada lent in older BPH patients, we detected larger signals of sexual dysfunc-
• Develop a series of cancer-type-specific guidelines for SH treatment tion in young alopecia patients. Sensitivity analyses suggest that reports
Establish a national SH database, inclusive of clinical and patient-reported of sexual dysfunction linked with finasteride use may be confounded by
outcomes (PROs) indication (young alopecia patients may be more likely to experience
Methods: The authors contacted selected Canadian clinicians to participate sexual dysfunction) and by stimulated reporting. However, confounding
in the development of COSHI. Purposeful effort was made to ensure regional alone does not account for the totality of the signal observed in young
and multidisciplinary representation. Every clinician contacted agreed to be patients with alopecia, considering the large difference in signal size
“site-champions” for COSHI. In June 2021, a meeting was held to define the between finasteride and minoxidil.
S58 CUAJ • June 2022 • Volume 16, Issue 6(Suppl1)