Publications by authors named "Henriette Breunis"

31 Publications

Association of Chemotherapy, Enzalutamide, Abiraterone, and Radium 223 With Cognitive Function in Older Men With Metastatic Castration-Resistant Prostate Cancer.

JAMA Netw Open 2021 Jul 1;4(7):e2114694. Epub 2021 Jul 1.

Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.

Importance: Older adults are at greater risk of cognitive decline with various oncologic therapies. Some commonly used therapies for advanced prostate cancer, such as enzalutamide, have been linked to cognitive impairment, but published data are scarce, come from single-group studies, or focus on self-reported cognition.

Objective: To longitudinally examine the association between cognitive function and docetaxel (chemotherapy), abiraterone, enzalutamide, and radium Ra 223 dichloride (radium 223) in older men with metastatic castration-resistant prostate cancer.

Design, Setting, And Participants: A multicenter, prospective, observational cohort study was conducted across 4 academic cancer centers in Ontario, Canada. A consecutive sample of 155 men age 65 years or older with metastatic castration-resistant prostate cancer starting any treatment with docetaxel, abiraterone acetate, enzalutamide, or radium Ra 223 dichloride (radium 223) were enrolled between July 1, 2015, and December 31, 2019.

Exposures: First-line chemotherapy (docetaxel), abiraterone, enzalutamide, or radium 223.

Main Outcomes And Measures: Cognitive function was measured at baseline and end of treatment using the Montreal Cognitive Assessment, the Trail Making Test part A, and the Trail Making Test part B to assess global cognition, attention, and executive function, respectively. Absolute changes in scores over time were analyzed using univariate and multivariable linear regression, and the percentages of individuals with a decline of 1.5 SDs in each domain were calculated.

Results: A total of 155 men starting treatment with docetaxel (n = 51) (mean [SD] age, 73.5 [6.2] years; 34 [66.7%] with some postsecondary education), abiraterone (n = 29) (mean [SD] age, 76.2 [7.2] years; 18 [62.1%] with some postsecondary education), enzalutamide (n = 54) (mean [SD] age, 75.7 [7.4] years; 33 [61.1%] with some postsecondary education), and radium 223 (n = 21) (mean [SD] age, 76.4 [7.2] years; 17 [81.0%] with some postsecondary education) were included. Most patients had stable cognition or slight improvements during treatment. A cognitive decline of 1.5 SDs or more was observed in 0% to 6.5% of patients on each measure of cognitive function (eg, 3 of 46 patients [6.5%; 95% CI, 2.2%-17.5%] in the group receiving chemotherapy [docetaxel] had a decline of 1.5 SDs for Trails A and Trails B). Although patients taking enzalutamide had numerically larger declines than those taking abiraterone, differences were small and clinically unimportant.

Conclusions And Relevance: These findings suggest that most older men do not experience significant cognitive decline in attention, executive function, and global cognition while undergoing treatment for advanced prostate cancer regardless of the treatment used.
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http://dx.doi.org/10.1001/jamanetworkopen.2021.14694DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8254132PMC
July 2021

Examining the ability of the Cancer and Aging Research Group tool to predict toxicity in older men receiving chemotherapy or androgen-receptor-targeted therapy for metastatic castration-resistant prostate cancer.

Cancer 2021 Jul 2;127(14):2587-2594. Epub 2021 Apr 2.

Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada.

Background: Because multiple treatments are available for metastatic castrate-resistant prostate cancer (mCRPC) and most patients are elderly, the prediction of toxicity risk is important. The Cancer and Aging Research Group (CARG) tool predicts chemotherapy toxicity in older adults with mixed solid tumors, but has not been validated in mCRPC. In this study, its ability to predict toxicity risk with docetaxel chemotherapy (CHEMO) was validated, and its utility was examined in predicting toxicity risk with abiraterone or enzalutamide (A/E) among older adults with mCRPC.

Methods: Men aged 65+ years were enrolled in a prospective observational study at 4 Canadian academic cancer centers. All clinically relevant grade 2 to 5 toxicities over the course of treatment were documented via structured interviews and chart review. Logistic regression was used to identify predictors of toxicity.

Results: Seventy-one men starting CHEMO (mean age, 73 years) and 104 men starting A/E (mean age, 76 years) were included. Clinically relevant grade 3+ toxicities occurred in 56% and 37% of CHEMO and A/E patients, respectively. The CARG tool was predictive of grade 3+ toxicities with CHEMO, which occurred in 36%, 67%, and 91% of low, moderate, and high-risk groups (P = .003). Similarly, grade 3+ toxicities occurred among A/E users in 23%, 48%, and 86% with low, moderate, and high CARG risk (P < .001). However, it was not predictive of grade 2 toxicities with either treatment.

Conclusions: There is external validation of the CARG tool in predicting grade 3+ toxicity in older men with mCRPC undergoing CHEMO and demonstrated utility during A/E therapy. This may aid with treatment decision-making.
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http://dx.doi.org/10.1002/cncr.33523DOI Listing
July 2021

Age-related cytokine effects on cancer-related fatigue and quality of life in acute myeloid leukemia.

J Geriatr Oncol 2020 04 10;11(3):402-409. Epub 2019 May 10.

Department of Psychiatry, University Health Network, Toronto, Canada.

Objectives: We determined whether cytokines are a potential target to improve cancer-related fatigue (CRF) and quality of life (QOL) in acute myeloid leukemia (AML).

Methods: 219 patients age 18+ undergoing intensive chemotherapy for AML were assessed at up to 4 time points (pre-treatment, 1 month, 6 months, 12 months). CRF and QOL were assessed with validated patient-reported outcome measures with minimum clinically important differences (MCID) of 4 and 10 points, respectively. A panel of 31 plasma cytokines was measured. CRF and QOL were regressed against scaled cytokine values, adjusting for age, gender, time, remission status, and hemoglobin in linear models.

Results: 498 cytokine samples were available. For CRF, the model R was 25.3%, with cytokines explaining 6.9% of the variance. For QOL, corresponding values were 27.9% and 7.4%, respectively. A shift from the 30th to 70th centile distribution of all cytokines was associated with an improvement in CRF by 5.2 points and a 10.2-point improvement in QOL. A shift from 5th to 95th centile in TNF-α but no other single cytokine was associated with a change of >MCID in CRF, but there was no similar association with QOL. Cytokines had greater explanatory power for CRF in older versus younger adults and the most influential cytokines differed by age, particularly TNF-α.

Conclusion: Cytokines explain a relatively small amount of CRF and QOL scores in patients with AML and effects differ by age group. For cytokine-targeted therapies to improve either outcome, multiple cytokines may need to be substantially altered and therapeutic targets may vary with age.
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http://dx.doi.org/10.1016/j.jgo.2019.04.009DOI Listing
April 2020

Clinical and Cost-effectiveness of a Comprehensive geriatric assessment and management for Canadian elders with Cancer-the 5C study: a study protocol for a randomised controlled phase III trial.

BMJ Open 2019 05 10;9(5):e024485. Epub 2019 May 10.

Department of Medicine and Institute of Health Policy, Management, and Evaluation, University Health Network and University of Toronto, Toronto, Ontario, Canada.

Introduction: Geriatric assessment and management is recommended for older adults with cancer referred for chemotherapy but no randomised controlled trial has been completed of this intervention in the oncology setting.

Trial Design: A two-group parallel single blind multi-centre randomised trial with a companion trial-based economic evaluation from both payer and societal perspectives with process evaluation.

Participants: A total of 350 participants aged 70+, diagnosed with a solid tumour, lymphoma or myeloma, referred for first/second line chemotherapy, who speak English/French, have an Eastern Collaborative Oncology Group Performance Status 0-2 will be recruited. All participants will be followed for 12 months.

Intervention: Geriatric assessment and management for 6 months. The control group will receive usual oncologic care. All participants will receive a monthly healthy ageing booklet for 6 months.

Objective: To study the clinical and cost-effectiveness of geriatric assessment and management in optimising outcomes compared with usual oncology care.

Randomisation: Participants will be allocated to one of the two arms in a 1:1 ratio. The randomisation will be stratified by centre and treatment intent (palliative vs other).

Outcome: Quality of life.

Secondary Outcomes: (1) Cost-effectiveness, (2) functional status, (3) number of geriatric issues successfully addressed, (4) grades3-5 treatment toxicity, (5) healthcare use, (6) satisfaction, (7) cancer treatment plan modification and (8) overall survival.

Planned Analysis: For the primary outcome we will use a pattern mixture model using an intent-to-treat approach (at 3, 6 and12 months). We will conduct a cost-utility analysis alongside this clinical trial. For secondary outcomes 2-4, we will use a variety of methods.

Ethics And Dissemination: Our study has been approved by all required REBs. We will disseminate our findings to stakeholders locally, nationally and internationally and by publishing the findings.

Trial Registration Number: NCT03154671.
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http://dx.doi.org/10.1136/bmjopen-2018-024485DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6530407PMC
May 2019

Performance of the Vulnerable Elders Survey 13 screening tool in identifying cancer treatment modification after geriatric assessment in pre-treatment patients: A retrospective analysis.

J Geriatr Oncol 2019 03 9;10(2):229-234. Epub 2018 Nov 9.

Toronto General Hospital, 200 Elizabeth St Room EN14-214, Toronto, Ontario M5G 2C4, Canada. Electronic address:

Purpose: Geriatric assessment (GA) is recommended for older adults ≥ 70 years with cancer to guide treatment selection. Screening tools such as the Vulnerable Elders Survey (VES-13) and G6 have been used to identify patients at highest need of GA. Whether either tool predicts a change in oncologic treatment following GA is unclear.

Methods: Patients attending a geriatric oncology clinic between July 2015 and June 2017 who completed a VES-13 and underwent subsequent GA were included. Clinical information was extracted from a prospectively maintained database. G6 scores were assigned retrospectively. Patients were stratified into those who were "VES-13 positive" (score ≥ 3) and "VES-13 negative" (score < 3). Logistic regression was used to explore the relationship between VES-13 score, G6 score, and treatment modification.

Results: Ninety-nine patients were seen prior to initiating cancer treatment. The median VES-13 score was 7; with 81.8% of patients scoring ≥3. The treatment plan was modified in 47.5% of patients after GA. VES-13 score was predictive of treatment plan modification (63.0% among VES-13 positive versus 16.7% among VES-13 negative patients; p = 0.001). G6 performed similarly to the VES-13. The only statistically significant predictor of treatment change in multivariable analysis was performance status.

Conclusion: VES-13 positive patients are more likely to undergo treatment modification to reduce treatment intensity or supportive care only. The VES-13 may provide oncologists with a rapid, reliable way of identifying vulnerability in older adults with cancer who may need further GA prior to commencing cancer treatment.
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http://dx.doi.org/10.1016/j.jgo.2018.10.018DOI Listing
March 2019

Healthy Bones Study: can a prescription coupled with education improve bone health for patients receiving androgen deprivation therapy?-a before/after study.

Support Care Cancer 2018 Aug 12;26(8):2861-2869. Epub 2018 Mar 12.

Department of Medicine, University Health Network and University of Toronto, 200 Elizabeth St., Toronto, Ontario, M5G 2C4, Canada.

Purpose: To evaluate the ability of a multimodal patient education initiative to improve adherence to healthy bone behaviors (HBBs) in men with prostate cancer receiving androgen deprivation therapy (ADT).

Methods: This was a pilot prospective, single-site, before-and-after clinical trial. The control arm (n = 51) received routine care. The intervention arm (n = 52) received multimodal HBB education which included a healthy bones prescription (BoneRx), focused face-to-face education with an oncology nurse or physician, and customized educational materials. The primary endpoints were feasibility of study methods and self-reported adherence to HBBs (vitamin D intake ≥ 1000 IU/day, calcium intake 1000-1500 mg/day, and exercise ≥ 150 min/week) at 3-month follow-up. Secondary endpoints included receipt of bone mineral density (BMD) testing.

Results: Patients were satisfied with the study intervention, found educational materials easy to understand, and felt that it increased their knowledge about osteoporosis. Although the intervention appeared to be associated with trends toward improved levels of vitamin D intake (adjusted odds ratio [OR] 1.8, 95% confidence interval [CI] 0.74-4.5), calcium intake (OR 1.5, 95% CI 0.63-3.4), and exercise (OR 1.7, 0.75-3.9) as compared to the control arm, none of these were statistically significant. Patients who received the study intervention were more likely to receive BMD testing (OR 3.3, 95% CI 1.3-8.8).

Conclusions: Although a brief, tailored educational intervention was feasible to implement and improve BMD test utilization, it did not increase HBB participation. Larger, well-designed trials are needed to clarify the effect of patient education interventions on HBB adherence.

Trial Registration: ClinicalTrials.gov ( NCT01973673 ).
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http://dx.doi.org/10.1007/s00520-018-4150-0DOI Listing
August 2018

Impact of Androgen Deprivation Therapy on Self-Reported Cognitive Function in Men with Prostate Cancer.

J Urol 2018 08 1;200(2):327-334. Epub 2018 Mar 1.

Department of Medicine, University Health Network, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada. Electronic address:

Purpose: Although androgen deprivation therapy is widely used to treat prostate cancer, its effects on cognitive function are unclear. To our knowledge no prior report has examined the impact of androgen deprivation therapy on self-reported cognitive function.

Materials And Methods: Three groups of men 50 years old or older who were matched on age and education were enrolled in the study, including 81 with prostate cancer starting on continuous androgen deprivation therapy, 84 controls with prostate cancer not receiving androgen deprivation therapy and 85 healthy controls. Two scales from the FACT-Cog (Functional Assessment of Cancer Therapy-Cognitive subscale) version 3 were used to assess self-reported cognitive function. Changes in cognitive scores with time were analyzed by 2 approaches, including 1) multivariable regression and 2) calculation of the proportion of subjects per group with a decrease of 1 SD or more. Multivariable regression was applied to assess predictors of a decline in self-reported cognitive function. We also examined relationships between the FACT-Cog and a neuropsychological battery of 15 tests.

Results: Mean participant age was 69 years (range 50 to 87). The mean educational level was 15 years (range 8 to 24). FACT-Cog scores were similar at baseline across the cohorts. Neither analytical approach revealed that androgen deprivation therapy was associated with changes in self-reported cognitive function on either FACT-Cog scale. Mood and fatigue correlated with changes in self-reported cognitive function. The relationship between self-reported and objective cognitive measures was weak (maximum Spearman correlation coefficient 0.14) and only 2 of 30 correlations were statistically significant.

Conclusions: A total of 12 months of androgen deprivation therapy were not associated with self-reported cognitive function changes in older men with nonmetastatic prostate cancer.
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http://dx.doi.org/10.1016/j.juro.2018.02.073DOI Listing
August 2018

Improving bone health in men with prostate cancer receiving androgen deprivation therapy: Results of a randomized phase 2 trial.

Cancer 2018 03 6;124(6):1132-1140. Epub 2017 Dec 6.

Department of Psychosocial Oncology, University Health Network, Toronto, Ontario, Canada.

Background: Strategies to improve bone health care in men receiving androgen deprivation therapy (ADT) are not consistently implemented. The authors conducted a phase 2 randomized controlled trial of 2 education-based models-of-care interventions to determine their feasibility and ability to improve bone health care.

Methods: A single-center parallel-group randomized controlled trial of men with prostate cancer who were receiving ADT was performed. Participants were randomized 1:1:1 to 1) a patient bone health pamphlet and brief recommendations for their family physician (BHP+FP); 2) a BHP and support from a bone health care coordinator (BHP+BHCC); or 3) usual care. The primary efficacy outcome was receipt of a bone mineral density (BMD) test within 6 months. Secondary efficacy outcomes included guideline-appropriate calcium and vitamin D use and bisphosphonate prescriptions for men at high fracture risk. Feasibility endpoints included recruitment, retention, satisfaction, contamination, and outcome capture. The main analysis used logistic regression with a 1-sided P of .10. The trial is registered at ClinicalTrials.gov (identifier NCT02043236).

Results: A total of 119 men were recruited. The BHP+BHCC strategy was associated with a greater percentage of men undergoing a BMD test compared with the usual-care group (78% vs 36%; P<.001). BMD ordering also was found to be increased with the BHP+FP strategy (58% vs 36%; P = .047). Both strategies were associated with higher percentages of patients using calcium and vitamin D, but only the BHP+FP arm was statistically significant (P = .039). No men were detected to be at high fracture risk. All but one feasibility endpoint was met.

Conclusions: Educational strategies to improve bone health care appear feasible and are associated with improved BMD ordering in men receiving ADT. Cancer 2018;124:1132-40. © 2017 American Cancer Society.
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http://dx.doi.org/10.1002/cncr.31171DOI Listing
March 2018

Return to work and work-related disability among AML survivors.

Ann Hematol 2017 Oct 14;96(10):1625-1633. Epub 2017 Aug 14.

Department of Medicine, University Health Network, Room EN14-214, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada.

Acute myeloid leukemia (AML) is an aggressive, acute-onset hematological malignancy. Greater use of intensive chemotherapy (IC), supportive care, and stem cell transplantation have led to an increasing number of long-term survivors. Few studies have examined employment issues among AML survivors and to our knowledge, no study has examined the long-term effects of treatment on return to work. This study is the first to utilize a validated measure of work-related limitation and productivity (WLQ-16) to assess the long-term effects of AML treatment on employment rates, work-related limitations, and overall productivity. We examined RTW issues in 111 adult AML 1-year survivors after conventional IC. We found that, over time, the number of employed survivors increased (to 54% by 36 months) while the number of unemployed, retired, and sick leave patients decreased. Among those employed, the majority were employed full time. Employed individuals reported few work-related limitations and productivity loss scores were low, ranging from 3.47% at 18 months to 2.34% at 36 months. These data suggest that, over time, over half of AML survivors who underwent IC regain social, emotional, cognitive, and physical function sufficient to RTW with few limitations.
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http://dx.doi.org/10.1007/s00277-017-3097-4DOI Listing
October 2017

Perceptions of Study Newsletters for Older Cancer Patients in Longitudinal Studies.

J Cancer Educ 2018 04;33(2):463-469

Department of Medicine, University Health Network, 200 Elizabeth Street Room EN14-214, Toronto, ON, M5G 2C4, Canada.

To date, no study has examined the value of providing study newsletters in educating and motivating participants taking part in longitudinal intervention studies and reducing attrition in studies. The study team examined perceptions and satisfaction towards study newsletters, and their potential benefits, in a population of older men with prostate cancer participating in two ongoing longitudinal trials. Two study newsletters issues were mailed out 4 months apart to prostate cancer patients participating in a bone health and/or exercise intervention trial. Participants (n = 133) were invited to complete an 18-item custom-designed survey examining perceptions towards and satisfaction with the newsletter, and provide feedback about what makes an ideal study newsletter. Analyses were primarily descriptive. Resources required to produce a study newsletter were also calculated. Of 133 participants, 83 usable surveys were returned (response rate 62.4%). The mean satisfaction rating for the newsletter was 8.5/10 (SD 1.9) (10 = highly satisfied). Seventy eight percent said the newsletter encouraged them to continue to participate in the study, and 93% indicated that providing such study newsletters should be optional (64%) or mandatory (29%). Each newsletter required 31 h of study personnel time (mostly research student) to produce. Study participants were very satisfied with the newsletter and the majority indicated that study newsletters should be a regular practice in all long-term studies and may improve participant retention. Producing a newsletter is a low-cost method of educating participants in longitudinal studies. Its impact on recruitment and retention should be examined in clinical trials.
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http://dx.doi.org/10.1007/s13187-016-1143-xDOI Listing
April 2018

A comparison of the CARG tool, the VES-13, and oncologist judgment in predicting grade 3+ toxicities in men undergoing chemotherapy for metastatic prostate cancer.

J Geriatr Oncol 2017 01 15;8(1):31-36. Epub 2016 Oct 15.

Princess Margaret Cancer Centre, University of Toronto, Toronto, ON, Canada.

Objective: Since the benefits of chemotherapy in treating older men with metastatic castration-resistant prostate cancer (mCRPC) are modest, validated tools that predict the risk of treatment toxicity may aid clinical decision-making. Whether these tools are better than oncologist judgment remains unclear. We compared the Cancer and Aging Research Group (CARG) tool, the Vulnerable Elders Survey-13 (VES-13), and oncologist judgment in predicting toxicity in men with mCRPC undergoing chemotherapy.

Materials And Methods: Men aged 65+ with mCRPC starting first-line or second-line chemotherapy were enrolled in this prospective observational study. At baseline, VES-13 and CARG risk scores were calculated and treating oncologists were asked to rate toxicity risk on a 10-point scale. Toxicity was captured using the Common Terminology Criteria for Adverse Events version 4. Logistic regression was performed to examine relationships between risk prediction tools and the development of grade 3+ toxicity.

Results: 46 patients (mean age 75) were accrued, with most receiving Docetaxel 75mg/m q3weekly. A total of 9 patients (20%, 95% confidence interval (CI) 9-34%) developed grade 3+ toxicity. Using the CARG tool, 0% (95% CI 0-84%), 17% (95% CI 6-36%), and 27% (95% CI 18-55%) of patients in the low, intermediate, and high risk groups developed grade 3+ toxicity, respectively (p=0.65). Although the CARG tool, the VES-13, and oncologist judgment appeared to perform similarly, comparisons were limited by the small sample size.

Conclusion: Chemotherapy for mCRPC was associated with lower than predicted rates of severe toxicity across all predicted risk groups. Further disease-specific validation studies are warranted.
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http://dx.doi.org/10.1016/j.jgo.2016.09.005DOI Listing
January 2017

Effects of long-term androgen deprivation therapy on cognitive function over 36 months in men with prostate cancer.

Cancer 2017 01 1;123(2):237-244. Epub 2016 Sep 1.

Department of Medicine, University Health Network, University of Toronto, Toronto, Ontario, Canada.

Background: Many men with prostate cancer (PC) require long-term androgen deprivation therapy (ADT), but to the authors' knowledge, its effects on cognitive function beyond 1 year are not described.

Methods: Three groups of men aged ≥50 years who were matched based on age and education were enrolled: 77 patients with nonmetastatic PC who initiated continuous ADT, 82 patients with PC who were not receiving ADT (PC controls), and 82 healthy controls. A battery of 14 neuropsychological tests, examining 8 cognitive domains, was administered on 5 occasions over 36 months. Changes in cognitive scores over time were analyzed using 3 approaches: linear mixed effects regression, the percentage of participants per group with declines in ≥1/2 cognitive tests, and a global summary of cognitive change.

Results: The mean age of the study subjects was 68.9 years, with a median of 16 years of education. In mixed effects models adjusted for age and education, ADT use was not found to be associated with significant changes over time in any cognitive test compared with healthy controls. The percentage of participants declining by ≥1.5 standard deviations in ≥2 tests or ≥2 standard deviations in ≥1 tests was similar across groups. A global summary of cognitive change found no statistically significant worsening of cognitive function among ADT users compared with controls. Sensitivity analyses adjusting for duration of ADT and using multiple imputation for missing data did not materially alter the study findings.

Conclusions: The ongoing use of ADT for up to 36 months does not appear to be associated with cognitive decline. Cancer 2017;123:237-244. © 2016 American Cancer Society.
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http://dx.doi.org/10.1002/cncr.30320DOI Listing
January 2017

Quality of care provided to prostate cancer (PC) patients for prevention and treatment of osteoporosis induced by androgen deprivation therapy (ADT).

Support Care Cancer 2016 11 2;24(11):4713-20. Epub 2016 Jul 2.

Department of Medicine, University Health Network, Toronto, ON, Canada.

Objectives: This study aims to evaluate the quality of care (QOC) and use of validated risk algorithms provided in a specialized osteoporosis clinic to men with prostate cancer on androgen deprivation therapy (ADT) who are at risk of bone loss and fragility fractures.

Patients And Methods: Charts for 100 consecutive men (mean age 73.0 years) on ADT referred to a tertiary osteoporosis clinic in Toronto, Canada between 2010 and 2014 were reviewed. The following QOC issues were examined: (a) bone health services provided, i.e., screening, preventing, and treating osteoporosis; and (b) use of national guidelines and fracture risk assessment tools for targeting appropriate therapy.

Results: The median (IQR) duration of ADT was 21.4 (26.9) months at the baseline visit. Nineteen patients had their first bone mineral density test before starting ADT and 34 during the first year of use. At initial consultation, 83 and 30 patients were taking inadequate amounts of calcium and vitamin D, respectively. A validated fracture risk assessment tool was used in all patients; 42 had a moderate 10-year fracture risk and 12 were high risk. Sixteen (72.7 %) of sedentary patients were advised to increase physical activity. Sixty-four (77.1 %) and 28 (93.3 %) of patients not taking appropriate amounts of calcium and vitamin D, respectively, were recommended to adjust their intake to guideline levels. All patients at high fracture risk were recommended a bisphosphonate.

Conclusions: The majority of referred patients had moderate to high fracture risk. The osteoporosis clinic recommended guideline-based bone health care for the vast majority of men on ADT.
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http://dx.doi.org/10.1007/s00520-016-3320-1DOI Listing
November 2016

Do quality of life, physical function, or the Wheatley index at diagnosis predict 1-year mortality with intensive chemotherapy in older acute myeloid leukemia patients?

Leuk Res 2016 08 3;47:142-8. Epub 2016 Jun 3.

Department of Medicine, University Health Network, Toronto, ON, Canada; Department of Medicine, University of Toronto, Toronto, ON, Canada; Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada. Electronic address:

Treatment decision-making is complicated in older adults with acute myeloid leukemia (AML) because of poor prognosis and significant treatment toxicities. Improved prognostication at the time of diagnosis, such as with the Wheatley Index, may aid clinical decision-making. Pre-treatment quality of life (QOL) or objective physical performance measures (PPMs) may also predict outcomes such as mortality in oncology. We investigated the predictive value of the Wheatley Index, QOL and PPMs at diagnosis on one-year mortality in older (60+ years) AML patients undergoing intensive chemotherapy (IC) in a large AML referral center. AML patients undergoing IC were enrolled in a single-center prospective study. The Wheatley prognostic risk category (good, standard and poor) was determined. Predictors of one-year mortality were assessed with logistic regression. Overall one-year mortality was 37.1%. QOL and PPMs at diagnosis were not good predictors of one-year mortality. Poor Wheatley risk category was the strongest predictor in both univariate and multivariable mortality models (adjusted odds ratio 7.1, 95% confidence interval 1.95-25.5, p<0.001). The Wheatley index may be useful to clinicians and patients by providing an integrated prognostic tool to guide up-front therapy in AML.
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http://dx.doi.org/10.1016/j.leukres.2016.06.001DOI Listing
August 2016

A prospective study examining elder-relevant outcomes in older adults with prostate cancer undergoing treatment with chemotherapy or abiraterone.

J Geriatr Oncol 2016 Mar 4;7(2):81-9. Epub 2016 Feb 4.

Princess Margaret Cancer Centre, University Health Network, Department of Medicine, University of Toronto, Toronto, ON, Canada. Electronic address:

Background: Treatment of metastatic castration-resistant prostate cancer (mCRPC) with chemotherapy improves disease control and survival in fit older men (age 65+) but its impact on function is not clear. We hypothesized that chemotherapy would impair daily function in older men with mCRPC.

Methods: Men aged 65+ with mCRPC starting chemotherapy or abiraterone were enrolled in this prospective observational pilot study. Daily function was evaluated with the OARS Instrumental Activities of Daily Living (IADL) scale. Three objective measures were used to assess physical function. Patients completed Functional Assessment of Cancer Therapy questionnaires measuring prostate-specific and general quality-of-life (QOL). Vulnerability was evaluated using the Vulnerable Elders Survey (VES-13). Assessments were completed before each cycle of chemotherapy or every 2-3 months for those receiving abiraterone. We compared outcomes pre- and post-treatment and with published minimal clinically important differences.

Results: We evaluated 29 and 7 men on 1st-line and 2nd-line chemotherapy (median 6 and 7 cycles, respectively) and 11 men receiving abiraterone for a median 7 months. IADL scores declined slightly after 1st-line chemotherapy (mean -0.31 points, 95% confidence interval 0.39, -1.02). Physical performance remained stable over time. Both general and prostate-specific QOL improved with 1st-line chemotherapy. For all but one outcome (Timed Chair Stands), vulnerable men had similar changes over time compared to non-vulnerable men. Second-line chemotherapy and abiraterone were generally well-tolerated.

Conclusion: IADL function declined slightly whereas physical function remained stable and QOL improved during chemotherapy. Vulnerable and non-vulnerable older men with mCRPC appear to tolerate 1st-line chemotherapy fairly well.
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http://dx.doi.org/10.1016/j.jgo.2016.01.003DOI Listing
March 2016

Keep your mind off negative things: coping with long-term effects of acute myeloid leukemia (AML).

Support Care Cancer 2016 May 5;24(5):2035-2045. Epub 2015 Nov 5.

Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street Suite 130, Toronto, ON, M5T 1P8, Canada.

Purpose Of Study: Acute myeloid leukemia (AML) is characterized by sudden onset, intensive treatment, a poor prognosis, and significant relapse risk. Quality of life (QOL) and well-being among AML survivors have been extensively studied during the 6 months of active treatment. However, it is not clear what survivors experience after active treatment. The purpose of our study was to explore how AML survivors describe their longer-term physical and psychosocial well-being and how they cope with these challenges.

Methods: We conducted a prospective qualitative study and interviewed 19 adult participants (11 had completed treatment, 8 were receiving maintenance chemotherapy). Data were collected using semi-structured interviews that were audio-recorded and transcribed verbatim. The grounded theory approach was used for data analysis.

Results: A marked improvement in physical health was reported; however, psychosocial well-being was compromised by enduring emotional distress. A range of emotion- and problem-focused coping strategies were reported. Keeping one's mind off negative things through engaging in formal work or informal activities and seeking control were the two most commonly used coping strategies. Seeking social support for reassurance was also common. Problem-focused strategies were frequently described by the ongoing treatment group to manage treatment side effects.

Conclusion: Although physical symptoms improved after completion of treatment, psychosocial distress persisted over longer period of time. In addition, essential needs of AML survivors shifted across survivorship as psychological burden gradually displaced physical concerns. The integral role of coping mechanisms in the adaptation process suggests a need for effective and ongoing psychological interventions.
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http://dx.doi.org/10.1007/s00520-015-3002-4DOI Listing
May 2016

Quality of life and physical function in adults treated with intensive chemotherapy for acute myeloid leukemia improve over time independent of age.

J Geriatr Oncol 2015 Jul 2;6(4):262-71. Epub 2015 May 2.

Department of Medicine, University of Alberta, 11350-83 Avenue, Edmonton, Alberta T6G 2G3, Canada.

Objectives: Intensive chemotherapy (IC) is the primary treatment of acute myeloid leukemia (AML) but is associated with significant toxicity, particularly in older adults. We characterized the impact of AML and its treatment on quality of life (QOL) and physical function in younger (age 18-59) and older (age 60+) patients with AML over 1year from diagnosis.

Materials And Methods: AML patients undergoing IC without stem-cell transplant at two tertiary care centers were enrolled in a prospective, longitudinal study. Assessments were done pre-IC and at 7 time points over the next year. QOL, fatigue, and physical performance (grip strength, 2-minute walk test (2MWT), timed chair stands) were measured in all patients whereas daily function was measured only in older patients. Data were analyzed using mixed effects regression models.

Results: 237 patients were recruited (140 younger and 97 older, 56% male). One-year survival was 79% and 60% among younger and older patients, respectively. For patients in remission, global QOL and fatigue improved significantly over time (p<0.001 for both); trends were similar between older and younger patients. Grip strength did not change over time (p=0.58) whereas both the 2MWT (p<0.001) and timed chair stands (p<0.001) improved significantly. Daily function improved significantly over time (p=0.003).

Conclusions: Survivors of AML in remission after IC achieve significant improvements in QOL, fatigue, and physical function over time with similar trajectories for older and younger patients. These data suggest that appropriately selected older patients do well following IC.
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http://dx.doi.org/10.1016/j.jgo.2015.04.002DOI Listing
July 2015

Long-term impact of androgen-deprivation therapy on physical function and quality of life.

Cancer 2015 Jul 24;121(14):2350-7. Epub 2015 Mar 24.

Department of Medicine, University Health Network, Toronto, Canada.

Background: This study examined the impact of androgen-deprivation therapy (ADT) on physical function and quality of life (QOL) over 36 months.

Methods: Eighty-seven men with nonmetastatic prostate cancer (PC) who were starting continuous ADT and 2 control groups (86 PC controls without ADT and 86 healthy controls), matched by age and education, were enrolled. Physical function was assessed with the 6-minute walk test (6MWT), grip strength, and Timed Up and Go (TUG) test. QOL was measured with the 36-Item Short Form Health Survey of the Medical Outcomes Study. Subjects were assessed at the baseline and at 3, 6, 12, 18, 24, 30, and 36 months. Mixed effects regression models were fitted with adjustments for baseline covariates.

Results: The 6MWT distance improved initially and then stabilized in both control groups but remained unchanged for ADT users (P = .0030). Grip strength remained stable in control groups but declined sharply in the ADT group by 3 months and then remained stable to 36 months (P = .0041). TUG scores declined gradually in the ADT group over 36 months but were unchanged in control groups (P = .0008). Aggregate physical QOL declined in ADT users over time but remained stable in control groups (P = .0001). Aggregate mental QOL was stable in all groups. Declines seen in the first year of ADT use generally persisted over 36 months and were independent of age.

Conclusions: Previously noted physical side effects over the first 12 months of ADT persisted or continued to worsen over an additional 2 years with no evidence of recovery. Exercise interventions to counteract these declines may be warranted.
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http://dx.doi.org/10.1002/cncr.29355DOI Listing
July 2015

One day at a time: improving the patient experience during and after intensive chemotherapy for younger and older AML patients.

Leuk Res 2015 Feb 8;39(2):192-7. Epub 2014 Dec 8.

Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada. Electronic address:

Few studies have focused on survivorship issues in AML patients that have successfully completed treatment, and no study examined age-related differences in survivorship. Therefore, our purpose was to explore the survivorship issues encountered by AML survivors, and explore if these survivorship issues are different for younger and older survivors. Lastly, we explored advice for future patients provided by younger and older AML survivors on how to survive the period of intensive chemotherapy (IC). We conducted a prospective qualitative study with 26 participants (14 younger (age 18-59), 12 older (age 60 or older)) who underwent IC. Data were analyzed using Grounded Theory. Both younger and older survivors reported persistent health issues and functional limitations; however, older participants were more satisfied with their post-treatment function and quality of life. Face-to-face communication, phase-specific information, step-by-step education, and home nursing care were important factors to cope with treatment. Provision of written educational material was highlighted by younger participants. Frequent travel to hospital and long waiting times were identified as undesirable. In conclusion, although we observed that many survivorship issues during and shortly after a diagnosis are similar among younger and older survivors, some issues differ by age, pointing out the need for customized approaches.
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http://dx.doi.org/10.1016/j.leukres.2014.11.028DOI Listing
February 2015

A pilot phase II RCT of a home-based exercise intervention for survivors of AML.

Support Care Cancer 2014 Apr 16;22(4):881-9. Epub 2013 Nov 16.

Department of Medicine, University Health Network, Toronto, ON, Canada,

Background: Fatigue is the most common and disabling symptom affecting quality of life (QOL) and daily function in patients who have completed treatment for acute myeloid leukemia (AML). Although trials in patients with various solid tumors have reported improved fatigue and QOL following exercise interventions, there have been no studies in AML patients post treatment.

Methods: Forty patients aged ≥ 40 years who had completed treatment for AML were enrolled in a 12-week randomized phase II exercise intervention to determine feasibility (recruitment, retention, and adherence), efficacy, and safety of the intervention. Patients assigned to the exercise group received an individualized, moderate-intensity, 12-week home-based exercise program with weekly telephone support from a certified exercise physiologist. QOL, fatigue, and fitness outcomes were measured at baseline, 6 weeks, and 12 weeks. Between-group differences in 12-week change scores were calculated using linear regression adjusting for age and baseline function.

Results: Recruitment and retention rates were 38% and 91%, respectively. Adherence was low at 28%. Analyses did not suggest statistically significant or clinically important benefits in QOL, fatigue, or physical fitness with the intervention. The level of adherence did not appear to impact outcomes. There were no adverse events.

Conclusion: A home-based exercise program for post-treatment AML patients age 40 years or older can be safely delivered with reasonable recruitment and high retention. However, feasibility was hampered by low adherence. Further research and program modification are needed to better understand and overcome barriers to exercise delivery and adherence in AML survivors.
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http://dx.doi.org/10.1007/s00520-013-2044-8DOI Listing
April 2014

Correlation between cytokine levels and changes in fatigue and quality of life in patients with acute myeloid leukemia.

Leuk Res 2013 Mar 20;37(3):274-9. Epub 2012 Dec 20.

University Health Network, Toronto, ON, Canada.

Cancer-related fatigue (CRF) is a major problem in patients with acute myeloid leukemia (AML) and may be mediated by circulating cytokines. We examined this relationship in 74 adult AML patients before and after the first cycle of induction chemotherapy. Plasma levels of 13 cytokines were measured via electrochemiluminescence. At baseline, potentially clinically important (r>0.30) correlations were seen between tumor necrosis factor (TNF)-α and fatigue (r=-0.336, p=0.017). Over time, correlations with fatigue were noted with TNF-α (r=-0.341, p=0.006) and interferon-inducible protein (IP)-10 (r=0.353, p=0.005). The link between IP-10 and fatigue is novel, implicating CXC chemokine pathways for CRF in hematologic malignancies.
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http://dx.doi.org/10.1016/j.leukres.2012.11.013DOI Listing
March 2013

Impact of androgen deprivation therapy on weight gain differs by age in men with nonmetastatic prostate cancer.

J Urol 2012 Dec 18;188(6):2183-8. Epub 2012 Oct 18.

Department of Medicine, University Health Network, Toronto, Ontario, Canada.

Purpose: Although androgen deprivation therapy leads to weight gain within the first year in men with prostate cancer, longer term changes and the relationship to patient age are not well characterized. We examined long-term weight gain by age group in men on androgen deprivation therapy for up to 36 months.

Materials And Methods: Three cohorts matched by age and education were recruited in this prospective study, including men in whom continuous androgen deprivation therapy was initiated, controls with prostate cancer and healthy controls. All patients with prostate cancer had nonmetastatic disease. We performed age stratified (less than 65 vs 65 years or greater) comparisons. Univariate and multivariable associations with weight change with time were evaluated using linear regression.

Results: We included 257 men with a mean age of 69.1 years. At baseline the cohorts were similar in age, education, body mass index, weight and comorbidity. Androgen deprivation therapy was associated with weight gain from baseline at 6, 12, 18, 24, 30 and 36 months compared to controls with prostate cancer and healthy controls (p = 0.006, 0.015, 0.028, 0.003, 0.014 and 0.0004, respectively). The proportion of men who gained weight was higher among androgen deprivation therapy users than controls with prostate cancer and healthy controls at most time points. Age stratified analyses showed that younger patients (age less than 65 years) on androgen deprivation therapy had significantly greater weight gain with time than older patients (4.7 vs 1.4 kg, p = 0.005). However, age did not appear to affect weight change with time in men not on androgen deprivation therapy (p = 0.37).

Conclusions: Androgen deprivation therapy was associated with an increase in weight during 36 months and weight gain was significantly higher in patients younger than 65 years.
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http://dx.doi.org/10.1016/j.juro.2012.08.018DOI Listing
December 2012

A clinical trial of supervised exercise for adult inpatients with acute myeloid leukemia (AML) undergoing induction chemotherapy.

Leuk Res 2012 Oct 21;36(10):1255-61. Epub 2012 Jun 21.

Department of Medicine, University Health Network, Toronto, ON, Canada.

Patients with acute myeloid leukemia (AML) receiving induction chemotherapy (IC) were enrolled in a supervised exercise intervention to determine safety, feasibility, and efficacy. Physical fitness measures, quality of life (QOL) and fatigue were assessed using standardized measures at baseline, post-induction, and post first consolidation. Retention was excellent, the intervention was safe, and efficacy estimates suggested benefits in physical fitness and QOL outcomes. Exercise is a safe, promising intervention for improving fitness and QOL in this patient population. These results provide a foundation for a randomized trial to better understand the impact of exercise during IC on clinically important outcomes.
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http://dx.doi.org/10.1016/j.leukres.2012.05.016DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3767429PMC
October 2012

Impact of androgen deprivation therapy on depressive symptoms in men with nonmetastatic prostate cancer.

Cancer 2012 Apr 25;118(7):1940-5. Epub 2011 Aug 25.

Department of Medicine, University Health Network, Toronto, Ontario, Canada.

Background: Up to 50% of prostate cancer (PC) patients receive androgen deprivation therapy (ADT), often for several years. Although depression has been reported after a diagnosis of PC, whether ADT leads to or worsens depression is not clear.

Methods: Three groups were assembled: ADT users (men initiating continuous ADT), PC controls (PC patients who were not on ADT), and healthy controls. All 3 cohorts were matched on age, education, and physical function, and none had metastases. Depression was measured at study entry and again at 3, 6, and 12 months using the 15-item Geriatric Depression Scale (GDS). Our primary outcomes were worsening depressive symptoms and incident depression (defined as a GDS score ≥5), analyzed using adjusted linear regression and logistic regression, respectively.

Results: Of the 257 participants (mean age, 69.1 years), baseline characteristics including GDS score and prior depression were similar across cohorts. In adjusted analyses of initially nondepressed patients, ADT use was not a significant predictor of change in GDS score at 3 months (P = .42), 6 months (P = .25), or 12 months (P = 0.19). Among ADT users, 8%-9% of participants developed incident depression compared with 0%-4% among PC controls and 4%-6% among healthy controls over 3-12 months (P>.05 at all time points). In a separate analysis of patients with depression at baseline, there was no effect of ADT on depressive symptoms at 3, 6, or 12 months (P = .11, .74, and .12, respectively).

Conclusion: Twelve months of ADT use were not associated with worsening depressive symptoms among nondepressed or depressed patients with nonmetastatic PC.
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http://dx.doi.org/10.1002/cncr.26477DOI Listing
April 2012

Changes in blood glucose and cholesterol levels due to androgen deprivation therapy in men with non-metastatic prostate cancer.

Can Urol Assoc J 2011 Feb;5(1):28-32

Division of General Internal Medicine & Clinical Epidemiology, University Health Network, University of Toronto, Toronto, ON.

Objective: To investigate the effects of androgen deprivation therapy (ADT) on blood glucose and cholesterol over 12 months in a prospective matched cohort study.

Methods: English-speaking patients with non-metastatic prostate cancer attending the Princess Margaret Hospital were invited to participate in this study. Patients were divided into two cohorts: ADT users and controls. Androgen deprivation therapy users were frequency matched to controls on age, education and body mass index (BMI). The study consisted of two visits. Sociodemographic and clinical information, medication use, physical fitness, height and weight were collected before initiation of ADT. Twelve months later, fasting morning blood work was obtained to measure plasma glucose, total cholesterol, high-density lipoprotein (HDL), low-density lipoprotein (LDL) and triglycerides. Statistical analyses included univariate and multivariable linear regression.

Results: We recruited 75 patients (mean age 68.9), 38 of whom were undergoing ADT. Twelve patients with prior diabetes and 29 patients taking cholesterol-lowering medication at baseline were excluded from the glucose and cholesterol analysis, respectively. In adjusted analyses, ADT users had a significantly higher glucose level compared to controls (5.88 vs. 5.52 mmol/L, p = 0.024). Overall, ADT users had higher levels of total cholesterol, HDL, LDL, and triglycerides than controls, although none of the differences reached statistical significance.

Conclusion: One year of ADT use is associated with elevated fasting glucose levels and may increase all lipid fractions in men with prostate cancer.
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http://dx.doi.org/10.5489/cuaj.09172DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3036752PMC
February 2011

Impact of androgen-deprivation therapy on physical function and quality of life in men with nonmetastatic prostate cancer.

J Clin Oncol 2010 Dec 1;28(34):5038-45. Epub 2010 Nov 1.

University Health Network, Toronto, Ontario, Canada.

Purpose: This prospective longitudinal study evaluated the effect of androgen deprivation therapy (ADT) on objective and self-reported physical function.

Patients And Methods: Men with nonmetastatic prostate cancer (PC) starting continuous ADT were enrolled in this matched cohort study. Physical function was assessed with the 6-minute walk test (6MWT), grip strength, and the timed-up-and-go (TUG) test, representing endurance and upper and lower extremity strength, respectively. Quality of life (QOL) was measured with the Medical Outcomes Study Short-Form 36 (SF-36) questionnaire. Subjects were assessed at baseline, 3, 6, and 12 months. Two control groups (PC without ADT; no PC), matched on age, education, and baseline function were enrolled. Mixed effects regression models were fitted, adjusting for baseline covariates.

Results: We enrolled 87 patients on ADT, 86 PC controls, and 86 healthy controls; groups were similar in age (mean, 69.1 years; range, 50 to 87) and physical function. The 6MWT distance remained stable in the ADT group (P = .96) but improved in both control groups (P < .05). Grip strength declined in the ADT group (P = .04), remained stable in PC controls (P = .31), and improved in healthy controls (P = .008). TUG scores remained stable over time and across groups (P > .10). The SF-36 physical function summary score declined in the ADT group (P < .001), but increased in both control groups (P < .001). Negative effects on outcomes were observed within 3 months of starting ADT and were generally independent of age.

Conclusion: Endurance, upper extremity strength, and physical components of QOL are affected within 3 months of starting ADT. Up-front exercise interventions to counteract these losses are warranted.
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http://dx.doi.org/10.1200/JCO.2010.29.8091DOI Listing
December 2010

Impact of androgen-deprivation therapy on cognitive function in men with nonmetastatic prostate cancer.

J Clin Oncol 2010 Dec 1;28(34):5030-7. Epub 2010 Nov 1.

University Health Network, Toronto, Ontario, Canada.

Purpose: To evaluate the effects of androgen-deprivation therapy (ADT) on cognitive function in men with nonmetastatic prostate cancer (PC).

Patients And Methods: The following three groups of men age 50 years or older and matched on age and education were enrolled: patients with PC starting continuous ADT (n = 77), patients with PC not receiving ADT (PC controls, n = 82), and healthy controls (n = 82). A battery of 14 neuropsychological tests, examining eight cognitive domains, was administered at baseline, 6 months, and 12 months. Changes in cognitive scores over time were analyzed using the following three approaches: multivariable linear regression; the proportion of participants per group with 1 standard deviation (SD) or greater declines, and the proportion of participants who declined by at least 1.5 SD on two or more tests.

Results: The mean age and education level of participants were 68.9 years (range, 50 to 87 years) and 15.4 years of education (range, 8 to 24 years), respectively. Adjusted for age and education, all three cohorts had similar cognitive scores at baseline other than in one test of working memory. In adjusted regressions, ADT use was not associated with significant changes in the domains of attention/processing speed, verbal fluency, verbal memory, visual memory, or cognitive flexibility at either 6 months (all P > .05) or 12 months (all P > .05). One test each of immediate memory (P = .029), working memory (P = .031), and visuospatial ability (P = .034) were worse among ADT users than controls at 12 months, but these findings were not confirmed using other analytic approaches.

Conclusion: There is no consistent evidence that 12 months of ADT use has an adverse effect on cognitive function in elderly men with PC.
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http://dx.doi.org/10.1200/JCO.2010.30.8742DOI Listing
December 2010

Predictors of hemoglobin decline in non-metastatic prostate cancer patients on androgen deprivation therapy: a matched cohort study.

Support Care Cancer 2011 Nov 16;19(11):1815-21. Epub 2010 Oct 16.

Division of General Internal Medicine & Clinical Epidemiology, University Health Network, Toronto, ON, Canada.

Purpose: The extent and severity of hemoglobin decline after the initiation of androgen deprivation therapy (ADT) is unclear, and predictors of hemoglobin decline in older men with prostate cancer (PC) are not well-characterized.

Methods: Three cohorts were recruited in this prospective study to evaluate the impact of ADT and other factors on hemoglobin decline. Cohorts included ADT users initiating continuous ADT, PC controls, and healthy controls, matched on age and education. All patients with PC had non-metastatic disease. Univariate and multivariable associations between changes in hemoglobin over 12 months and baseline characteristics were evaluated using linear regression models.

Results: We included 250 men (mean age 69 years). The baseline mean hemoglobin was 141 g/L in ADT users, 144 g/L in PC controls, and 149 g/L in healthy controls (p < 0.001). Over 12 months, the mean hemoglobin level declined in ADT users by 8.9 g/L, compared to 0.56 and 2.03 g/L among PC controls and healthy controls, respectively (p < 0.001). Statistically significant predictors of greater hemoglobin decline included ADT use (p < 0.001), lower activities of daily living score (p < 0.001), higher Charlson comorbidity score (p = 0.02), higher baseline hemoglobin level (p < 0.001), and non-White race (p = 0.04) but not age (p = 0.50).

Conclusions: In men with non-metastatic prostate cancer, ADT was independently associated with a decline in hemoglobin level over 12 months. Other predictors of declining hemoglobin included comorbidity, functional status, baseline hemoglobin level, and race. These findings may help clinicians identify patients starting ADT who would benefit from closer hemoglobin monitoring.
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http://dx.doi.org/10.1007/s00520-010-1023-6DOI Listing
November 2011

WITHDRAWN: Falls in men on androgen deprivation therapy for prostate cancer.

Crit Rev Oncol Hematol 2010 Jul 8. Epub 2010 Jul 8.

Department of Medicine, University Health Network, Toronto, Canada.

This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.
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http://dx.doi.org/10.1016/j.critrevonc.2010.03.004DOI Listing
July 2010

Management of decreased bone mineral density in men starting androgen-deprivation therapy for prostate cancer.

BJU Int 2009 Mar 24;103(6):753-7. Epub 2008 Oct 24.

Department of Medicine, University Health Network, Toronto, Ontario, Canada.

Objective: To determine whether clinicians discuss bone-specific side-effects with patients on androgen-deprivation therapy (ADT) for prostate cancer, or prescribe lifestyle and pharmacological interventions for low bone mineral density (BMD), as decreased BMD is a common side-effect of ADT, leading to increased risk of fracture.

Patients And Methods: Sixty-six men (mean age 70.6 years) with non-metastatic prostate cancer and starting continuous ADT were enrolled in a prospective longitudinal study. BMD was determined by dual X-ray absorptiometry (DXA) at baseline. Patients were interviewed to obtain their medical histories, and charts were reviewed to determine whether clinicians documented potential bone side-effects in clinic notes, and made lifestyle and/or medication recommendations. Both were done at the start of ADT, and 3 and 6 months later. Patients were classified based on DXA T-score as having normal BMD, as osteopenic, or osteoporotic.

Results: At baseline, 53% of patients had osteopenia and 5% had osteoporosis. Within 6 months of starting ADT, general side-effects and bone-specific side-effects of ADT were documented as being discussed with 26% and 15%, respectively. Clinicians recommended lifestyle interventions to 11% of patients. Pharmacological interventions (calcium, vitamin D, and/or bisphosphonates) were recommended to 18% of all patients within 6 months of starting ADT, and to 26% and 67% of osteopenic and osteoporotic patients, respectively.

Conclusions: A minority of patients is being informed of bone-specific side-effects of ADT. Lifestyle and drug interventions to prevent declines in BMD were recommended uncommonly. Practices around bone health for men starting ADT are suboptimal.
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http://dx.doi.org/10.1111/j.1464-410X.2008.08156.xDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5233446PMC
March 2009
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