Prostate cancer survivors who receive androgen deprivation therapy (ADT) are at increased risk of cardiovascular disease. They require coordinated care between cancer specialist and primary care physicians (PCPs) to monitor for cancer control and manage cardiovascular risk factors.
We prospectively enrolled 103 men receiving ADT with radiotherapy from 7 institutions to assess cardiovascular risk factors and survivorship care. Medical records, fasting labs, and patient-reported outcomes using a validated instrument were assessed at baseline (pre-treatment) and 1 year post-RT.
Cardiovascular disease (39%) and risk factors (diabetes 22%, hypertension 63%, hyperlipidemia 31%) were prevalent at baseline. During the first year after RT completion, 63% received cardiovascular monitoring concordant with American Heart Association guidelines. Fasting labs at 1 year showed 24% with inadequately controlled blood sugar, and 22% elevated cholesterol. Patient perceptions about care coordination were relatively low. At 1 year, 57% reported that their PCP "always know about the care I receive at other places," 67% reported that their cancer physician "communicated with other providers I see," and 65% reported the cancer physician "knows the results of my visits with other doctors."
Prostate cancer patients who receive ADT and RT are a vulnerable population with prevalent baseline cardiovascular disease and risk factors, and suboptimal survivorship care specifically related to coordinated care and cardiovascular monitoring. Clinical trials examining ways to improve the care and outcomes of these survivors are needed.
International journal of radiation oncology, biology, physics. 2018 Aug 09 [Epub ahead of print]
Jordan A Holmes, Roger F Anderson, Leroy G Hoffman, Timothy N Showalter, Mohit Kasibhatla, Sean P Collins, Michael A Papagikos, Brittany D Barbosa, Lori J Stravers, Zahra Mahbooba, Andrew Z Wang, Ronald C Chen
Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC., Rex Hospital Raleigh Radiation Oncology, Raleigh, NC., UNC Health Care Clayton Radiation Oncology, Clayton, NC., Department of Radiation Oncology, University of Virginia, Charlottesville, VA., High Point Regional Radiation Oncology, High Point, NC., Department of Radiation Oncology, Georgetown University School of Medicine, Washington, DC., New Hanover Regional Medical Center Radiation Oncology, Wilmington, NC., Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC; University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill, NC., Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC; University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, NC. Electronic address: .