Jordan A Holmes1, Roger F Anderson2, Leroy G Hoffman3, Timothy N Showalter4, Mohit Kasibhatla5, Sean P Collins6, Michael A Papagikos7, Brittany D Barbosa1, Kristy Alligood8, Lori J Stravers1, Zahra Mahbooba1, Andrew Z Wang9, Ronald C Chen10. 1. Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. 2. Radiation Oncology, Rex Hospital Raleigh, Raleigh, North Carolina. 3. Radiation Oncology, UNC Health Care Clayton, Clayton, North Carolina. 4. Department of Radiation Oncology, University of Virginia, Charlottesville, Virgina. 5. High Point Regional Radiation Oncology, High Point, North Carolina. 6. Department of Radiation Oncology, Georgetown University School of Medicine, Washington, DC. 7. Radiation Oncology, New Hanover Regional Medical Center, Wilmington, North Carolina. 8. Marion Shepard Cancer Center, Washington, NC. 9. Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina. 10. Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; University of North Carolina-Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina; Sheps Center for Health Services Research, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina. Electronic address: ronald_chen@med.unc.edu.
Abstract
PURPOSE: Prostate cancer survivors who receive androgen deprivation therapy (ADT) are at increased risk of cardiovascular disease. They require coordinated care between cancer specialists and primary care physicians to monitor for cancer control and manage cardiovascular risk factors. METHODS AND MATERIALS: We prospectively enrolled 103 men receiving ADT with radiation therapy (RT) from 7 institutions to assess cardiovascular risk factors and survivorship care. Medical records, fasting laboratory test values, and patient-reported outcomes using a validated instrument were assessed at baseline (pretreatment) and 1 year post-RT. RESULTS: 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 laboratory test values 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 primary care physicians "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 that the cancer care physician "knows the results of my visits with other doctors." CONCLUSIONS: Patients with prostate cancer 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.
PURPOSE:Prostate cancer survivors who receive androgen deprivation therapy (ADT) are at increased risk of cardiovascular disease. They require coordinated care between cancer specialists and primary care physicians to monitor for cancer control and manage cardiovascular risk factors. METHODS AND MATERIALS: We prospectively enrolled 103 men receiving ADT with radiation therapy (RT) from 7 institutions to assess cardiovascular risk factors and survivorship care. Medical records, fasting laboratory test values, and patient-reported outcomes using a validated instrument were assessed at baseline (pretreatment) and 1 year post-RT. RESULTS: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 laboratory test values 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 primary care physicians "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 that the cancer care physician "knows the results of my visits with other doctors." CONCLUSIONS:Patients with prostate cancer 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.
Authors: Lova Sun; Ravi B Parikh; Rebecca A Hubbard; John Cashy; Samuel U Takvorian; David J Vaughn; Kyle W Robinson; Vivek Narayan; Bonnie Ky Journal: JAMA Netw Open Date: 2021-02-01