Individualized Decision-Making for Older Men With Prostate Cancer: Balancing Cancer Control With Treatment Consequences Across the Clinical Spectrum

Sajid, Saleha; Mohile, Supriya G.; Szmulewitz, Russell Z.; Posadas, Edwin M.; Dale, William

doi:10.1053/j.seminoncol.2011.01.011

Cited by 24 publications

(15 citation statements)

References 117 publications

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“…Going forward, it is essential that we create a much stronger evidence base for the use of such interventions to improve IDM across the clinical spectrum for PCa. 49 Funding Source: Support for this publication was provided by a grant from the Robert Wood Johnson Foundation's Finding Answers: Disparities Research for Change program.…”

Section: Discussionmentioning

confidence: 99%

Interventions to Improve Decision Making and Reduce Racial and Ethnic Disparities in the Management of Prostate Cancer: A Systematic Review

2012

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OBJECTIVES: Ethnic minorities are disproportionately impacted by prostate cancer (PCa) and are at risk for not receiving informed decision making (IDM). We conducted a systematic literature review on interventions to improve: (1) IDM about PCa in screeningeligible minority men, and (2) quality of life (QOL) in minority PCa survivors. DATA SOURCES: MeSH headings for PCa, ethnic minorities, and interventions were searched in MED-LINE, Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, CINAHL, and PsycINFO. SUBJECT ELIGIBILITY CRITERIA: We identified U.S.-based, English-language articles (1985-2010) on interventions to improve PCa IDM and QOL that included 50 % or more minority patients or analyses stratified by race/ethnicity. STUDY APPRAISAL AND SYNTHESIS METHODS:Articles (n=19) were evaluated and scored for quality using a Downs and Black (DB) system. Interventions were organized by those enhancing 1) IDM about PCa screening and 2) improving QOL and symptom among PCa survivors. Outcomes were reported by intervention type (educational seminar, printed material, telephonebased, video and web-based). RESULTS: Fourteen studies evaluated interventions for enhancing IDM about PCa screening and five evaluated programs to improve outcomes for PCa survivors. Knowledge scores were statistically significantly increased in 12 of 13 screening studies that measured knowledge, with ranges of effect varying across intervention types: educational programs (13 %-48 % increase), print (11 %-18 %), videotape/DVD (16 %), and web-based (7 %-20 %). In the final screening study, an intervention to improve decision-making about screening increased decisional self-efficacy by 9 %. Five cognitive-behavioral interventions improved QOL among minority men being treated for localized PCa through enhancing problem solving and coping skills. LIMITATIONS: Weak study designs, small sample sizes, selection biases, and variation in follow-up intervals across studies. CONCLUSIONS: Educational programs were the most effective intervention for improving knowledge among screening-eligible minority men. Cognitive behavioral strategies improved QOL for minority men treated for localized PCa.

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Section: Discussionmentioning

confidence: 99%

Interventions to Improve Decision Making and Reduce Racial and Ethnic Disparities in the Management of Prostate Cancer: A Systematic Review

2012

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“…76,77 The optimal timing for initiation of ADT is not well established and has to be individualized particularly in the elderly. 78 A review of randomized trials suggests that early ADT treatment decreases prostate cancer mortality without any improvement in overall survival. 79 Another treatment strategy for elderly patients with prostate cancer has been intermittent androgen ablation as opposed to continuous therapy, with the hope of delaying androgen resistance and thereby prolonging survival and improving quality of life.…”

Section: Radiotherapymentioning

confidence: 99%

Challenges of managing elderly men with prostate cancer

et al. 2014

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The incidence of prostate cancer increases with age. Current evidence suggests that prostate cancer is under treated in patients aged ≥70 years, despite evidence of efficacy and acceptable toxicity. Radical cystectomy and definitive radiotherapy are often denied owing to fears of post-operative complications and radiotherapy-associated gastrointestinal and genitourinary toxicity. However, modern radical prostatectomy techniques provide excellent clinical outcomes with low perioperative morbidity. Moreover, volume-restricted intensity-modulated radiation therapy is a significant improvement over previous 2D conformal radiotherapy with similar efficacy and lower toxicity. Androgen-deprivation therapy is also under-prescribed among the elderly, owing to concerns of increases in cardiac deaths and osteoporosis acceleration. However, prospective trials have not identified any increase in cardiovascular mortality among elderly men receiving androgen-deprivation therapy compared to age-matched controls. Most patients on androgen deprivation eventually progress to a castration-resistant state. At this stage, the disease still responds to newer agents that target the androgen pathway and to chemotherapy. Among the elderly, chemotherapy is under-prescribed even though it has been demonstrated to be palliative and improve survival. We describe the trends in prostate cancer management in the elderly and the importance of assessing comorbidity status, tumour characteristics, and health status, including a complete geriatric evaluation, before making treatment recommendations.

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“…44 In addition, he has a number of social limitations that threaten his independence and prevent him from making it to clinic, including the need to care for his cognitively impaired spouse. Prior to starting on this therapy, every effort should be made to “prehabilitate” him with physical therapy in the home, provide additional social support to help maintain his independence, a home safety evaluation should be conducted to prevent more falls, and transportation to and from the hospital should be initiated.…”

Section: Improving Infrastructure For Older Adults With Cancermentioning

confidence: 99%

Geriatric oncology research to improve clinical care

2012

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Summary The incidence of cancer increases with advanced age. The Cancer and Aging Research Group (CARG), in partnership with the National Institute on Aging and National Cancer Institute, held a conference in September of 2010 which summarized the gaps in knowledge in geriatric oncology and recommendations to close these gaps. One recommendation was that the comprehensive geriatric assessment (CGA) should be incorporated within geriatric oncology research. The information from the CGA can be used to stratify patients into risk categories to better predict their tolerance of cancer treatment. CGA can also be used to follow functional consequences from treatment. Other recommendations were to design trials for older adults with study endpoints that address the needs of the older and/or vulnerable adult with cancer and to build better infrastructure to accommodate the needs of older adults to improve their representation in trials. In this review, we utilize a case-based approach to highlight gaps in knowledge regarding the care of older adults with cancer, discuss our current state of knowledge regarding best practice patterns, and identify opportunities for research in geriatric oncology. More evidence regarding the treatment of older patients with cancer is urgently needed given the rapid aging of the population.

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Individualized Decision-Making for Older Men With Prostate Cancer: Balancing Cancer Control With Treatment Consequences Across the Clinical Spectrum

Cited by 24 publications

References 117 publications

Interventions to Improve Decision Making and Reduce Racial and Ethnic Disparities in the Management of Prostate Cancer: A Systematic Review

Interventions to Improve Decision Making and Reduce Racial and Ethnic Disparities in the Management of Prostate Cancer: A Systematic Review

Challenges of managing elderly men with prostate cancer

Geriatric oncology research to improve clinical care

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