Real care beyond medical treatment, and impact on quality of life

A small, recent pilot study in Geneva, Switzerland, has shown that radiation therapy (RT) + androgen deprivation therapy (ADT) can be given safely to frail patients with non-metastatic, locally advanced or aggressive, intermediate prostate cancer, if and when a multidisciplinary care program is implemented to help such frail patients to limit risk for and manage predictable side effects.

The combination of RT + ADT, when the ADT is used over longer periods of time (e.g., 18 months to 3 years) is a standard form of treatment for men with non-metastatic, locally advanced or aggressive forms of prostate cancer. However, this form of treatment is known to be associated with significant risk for a spectrum of nutritional, physical, and psychological side effects. Such side effects can obviously have major impact on quality of life for patients who are already frail at time of diagnosis with their prostate cancer — because of such issues as cardiovascular and/or pulmonary comorbidities, age (e.g., ≥ 75 years), a variety of vulnerability ratings, or balance impairment.

Mareschal et al. carried out a small, pilot study known as the ADAPP trial in a total of 35 frail patients with non-metastatic, locally advanced or aggressive, intermediate prostate cancer. All patients were treated with ADT + RT, but they were also given: (a) nutritional counseling and coaching; (b) regular, supervised, 45-minute physical training sessions, and (c) psychological counseling for 2 years.

The patients’ responses to therapy were closely followed over the 2-year period, using a variety of means to measure not only their oncologic outcomes but more specifically things that are known to impact patients’ overall quality of life, such as their body mass index (BMI), fat mass index, the, Six-Minute Walk Test, Timed Up&Go (TUG) test, handgrip strength test, Hospital Anxiety and Depression scale (HADS), and Mini Mental State Examination, in addition to standard quality of life assessments. All measures associated with quality of life were carried out at baseline and then repeated at 3, 6, 9, 12, 18, and 24 months, and then again at 12 months after therapy had been completed.

Here are the basic study findings:

  • The average age of the 35 patients was 74 years (range 68 to 76 years).
  • There were no significant changes in the patients’ quality of life functions
    • During the 2 years of the trial
    • At the further 12-month post-trial follow-up evaluation
  • Average (mean) values of nutritional, physical, psychological, and overall quality of life measured were stable over the study period and the additional 12-month follow-up period.
  • Expected side effects of ADT + RT were not observed in these frail patients.

Now this was not a randomized clinical trial. It was, as stated, a small, pilot study. However, what it does seem to show, once again, is that even in older and less physically vigorous patients, ensuring that patients exercise, eat a healthy diet, and have access to psychological counseling on a regular basis can have major impact on their risk for the well-recognized side effects of treatment with RT + ADT (and maybe with ADT alone too). To that extent, this trial seems to validate what The “New” Prostate Cancer InfoLink has argued for years, which is that most patients will do best when they have organized and systematic follow-up care in addition to the necessary medical treatment. It is high time that the healthcare system here in the US (and probably in other countries around the world) started to make sure that this type of care is encouraged, available, and accessible to the majority of patients above and beyond the purely medical intervention to treat the immediate medical problem.

One is tempted to wonder whether a larger, randomized trial of ADT + coordinated systematic care vs. ADT + current standard care (i.e., benign neglect) might actually show a major impact not just on quality of life but actually on overall survival in a well-defined set of patients starting on ADT +RT — and not just in frail patients but in all patients receiving these types of treatment for prostate cancer.

One Response

  1. Absolutely, Sitemaster — exactly the same conclusion occurred to me as I read your review.

    So much of our patient navigation for men on RT + ADT involves implementation of exercise and nutrition!

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