Androgen Deprivation and Sleep Disturbance

Abstract

BackgroundMen receiving androgen deprivation therapy (ADT) for prostate cancer (PC) are at risk for cardiovascular comorbidities and cognitive changes. Interventional research involves in-person assessment of physical fitness/activity and cognitive function, which has been negatively affected by the COVID-19 pandemic. Androgen deprivation therapy–related hot flashes and nocturia increase risk for insomnia. Insomnia is associated with fatigue and may exacerbate ADT-related cognitive changes.ObjectivesThe purpose of this mixed-methods pilot was to (1) determine feasibility/acceptability of remotely assessing physical fitness/activity, cognitive function, and sleep; (2) deliver telehealth cognitive behavioral training for insomnia (teleCBT-I) to improve sleep; and (3) garner qualitative feedback to refine remote procedures and teleCBT-I content.MethodsFifteen men with PC receiving ADT completed a 4-week teleCBT-I intervention. Videoconferencing was used to complete study assessments and deliver the weekly teleCBT-I intervention.ResultsSelf-report of sleep quality improved (P < .001) as did hot flash frequency (P = .04) and bother (P = .025). Minimal clinically important differences were detected for changes in insomnia severity and sleep quality. All sleep logs indicated improvement in sleep efficiency. Remote assessment of fitness/cognitive function was demonstrated for 100% of participants. Sufficient actigraph wear time allowed physical activity/sleep assessment for 80%. Sleep actigraphy did not demonstrate significant changes.ConclusionsRemote monitoring and teleCBT-I are feasible/acceptable to men with PC on ADT. Further research to confirm teleCBT-I efficacy is warranted in this population.Implications for PracticePreliminary efficacy for teleCBT-I interventions was demonstrated. Remote assessments of physical fitness/activity, sleep, and cognitive function may enhance clinical trial access for rural or economically disadvantaged PC survivors.

Staying Strong and Healthy During Androgen Deprivation Therapy

“…This evidence is consistent with other research showing suppression of androgen has a negative impact on sleep quality that is further exacerbated by hot flashes and nocturia 45,46 . Subsequent work is in progress to add a cognitive behavioral therapy for insomnia component to the SS&H intervention 47 . Likewise, we are piloting a shift to virtual assessment methods designed to minimize barriers to participation because of the need to travel to the medical center 47 .…”

Prostate cancer patients' experiences and preferences for web‐based physical activity applications: A qualitative meta‐synthesis

“…Five studies contributed to this comprehensive finding (Evans et al, 2021; Lambert et al, 2020; Myers et al, 2022; Puszkiewicz et al, 2016; Roberts et al, 2019; Robertson et al, 2017; Wang et al, 2020). Prostate cancer patients expressed the benefits of tailored apps for achieving PA goals: “I think it is useful.…”

“…The studies were performed in the United States (Myers et al, 2022; Nabi et al, 2020; Robertson et al, 2017; Sangameswaran et al, 2021; Wang et al, 2020), UK (Puszkiewicz et al, 2016; Roberts et al, 2019), Australia (Evans et al, 2021) and Canada (Lambert et al, 2020), and all were published in English. The qualitative methods used included thematic analysis ( n = 5), grounded theory ( n = 1) and content analysis ( n = 1).…”

“…Prostate cancer patients may face a series of challenges due to individual differences in age, disease diagnosis, personal constitution and so on. Many prostate cancer patients in different studies expressed a desire for flexibility and tailored design preferences for applications (Myers et al, 2022; Puszkiewicz et al, 2016; Robertson et al, 2017; Wang et al, 2020). Patients mentioned that their level of engagement would change if messaging or movement content was tailored: “If we were talking of goals based on my activities on the site or my preferences, I might say more”, “but I think his thought of being more flexible is good.…”

“…Five studies contributed to this comprehensive finding (Evans et al, 2021;Lambert et al, 2020;Myers et al, 2022;Puszkiewicz et al, 2016;Roberts et al, 2019;Robertson et al, 2017;Wang et al, 2020) (Roberts et al, 2019).…”