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Treating the patient and not just the cancer: therapeutic burden in prostate cancer

BACKGROUND: Prostate cancer (PC) is a leading cause of death in older men. Androgen deprivation therapy (ADT) is considered the standard-of-care for men with locally advanced disease. However, continuous androgen ablation is associated with acute and long-term adverse effects and most patients will...

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Autores principales: Spratt, Daniel E., Shore, Neal, Sartor, Oliver, Rathkopf, Dana, Olivier, Kara
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Nature Publishing Group UK 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8384628/
https://www.ncbi.nlm.nih.gov/pubmed/33603236
http://dx.doi.org/10.1038/s41391-021-00328-1
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author Spratt, Daniel E.
Shore, Neal
Sartor, Oliver
Rathkopf, Dana
Olivier, Kara
author_facet Spratt, Daniel E.
Shore, Neal
Sartor, Oliver
Rathkopf, Dana
Olivier, Kara
author_sort Spratt, Daniel E.
collection PubMed
description BACKGROUND: Prostate cancer (PC) is a leading cause of death in older men. Androgen deprivation therapy (ADT) is considered the standard-of-care for men with locally advanced disease. However, continuous androgen ablation is associated with acute and long-term adverse effects and most patients will eventually develop castration-resistant PC (CRPC). The recent approval of three, second-generation androgen receptor inhibitors (ARIs), apalutamide, enzalutamide, and darolutamide, has transformed the treatment landscape of PC. Treatment with these second-generation ARIs have produced positive trends in metastasis-free survival, progression-free survival, and overall survival. For patients with non-metastatic CRPC, who are mainly asymptomatic from their disease, maintaining quality of life is a major objective when prescribing therapy. Polypharmacy for age-related comorbidities also is common in this population and may increase the potential for drug–drug interactions (DDIs). METHOD: This review summarizes the multiple factors that may contribute to the therapeutic burden of patients with CRPC, including the interplay between age, comorbidities, concomitant medications, the use of ARIs, and financial distress. CONCLUSIONS: As the treatment landscape in PC continues to rapidly evolve, consideration must be given to the balance between therapeutic benefits and potential treatment-emergent adverse events that may be further complicated by DDIs with concomitant medications. Patient-centered communication is a crucial aspect of alleviating this burden, and healthcare professionals (HCPs) may benefit from training in effective patient communication. HCPs should closely and frequently monitor patient treatment responses, in order to better understand symptom onset and exacerbation. Patients also should be encouraged to participate in exercise programs, and health information and support groups, which may assist them in preventing or mitigating certain determinants of the therapeutic burden associated with PC and its management.
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spelling pubmed-83846282021-09-09 Treating the patient and not just the cancer: therapeutic burden in prostate cancer Spratt, Daniel E. Shore, Neal Sartor, Oliver Rathkopf, Dana Olivier, Kara Prostate Cancer Prostatic Dis Review Article BACKGROUND: Prostate cancer (PC) is a leading cause of death in older men. Androgen deprivation therapy (ADT) is considered the standard-of-care for men with locally advanced disease. However, continuous androgen ablation is associated with acute and long-term adverse effects and most patients will eventually develop castration-resistant PC (CRPC). The recent approval of three, second-generation androgen receptor inhibitors (ARIs), apalutamide, enzalutamide, and darolutamide, has transformed the treatment landscape of PC. Treatment with these second-generation ARIs have produced positive trends in metastasis-free survival, progression-free survival, and overall survival. For patients with non-metastatic CRPC, who are mainly asymptomatic from their disease, maintaining quality of life is a major objective when prescribing therapy. Polypharmacy for age-related comorbidities also is common in this population and may increase the potential for drug–drug interactions (DDIs). METHOD: This review summarizes the multiple factors that may contribute to the therapeutic burden of patients with CRPC, including the interplay between age, comorbidities, concomitant medications, the use of ARIs, and financial distress. CONCLUSIONS: As the treatment landscape in PC continues to rapidly evolve, consideration must be given to the balance between therapeutic benefits and potential treatment-emergent adverse events that may be further complicated by DDIs with concomitant medications. Patient-centered communication is a crucial aspect of alleviating this burden, and healthcare professionals (HCPs) may benefit from training in effective patient communication. HCPs should closely and frequently monitor patient treatment responses, in order to better understand symptom onset and exacerbation. Patients also should be encouraged to participate in exercise programs, and health information and support groups, which may assist them in preventing or mitigating certain determinants of the therapeutic burden associated with PC and its management. Nature Publishing Group UK 2021-02-18 2021 /pmc/articles/PMC8384628/ /pubmed/33603236 http://dx.doi.org/10.1038/s41391-021-00328-1 Text en © The Author(s) 2021, corrected publication 2021 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons license, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons license and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this license, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) .
spellingShingle Review Article
Spratt, Daniel E.
Shore, Neal
Sartor, Oliver
Rathkopf, Dana
Olivier, Kara
Treating the patient and not just the cancer: therapeutic burden in prostate cancer
title Treating the patient and not just the cancer: therapeutic burden in prostate cancer
title_full Treating the patient and not just the cancer: therapeutic burden in prostate cancer
title_fullStr Treating the patient and not just the cancer: therapeutic burden in prostate cancer
title_full_unstemmed Treating the patient and not just the cancer: therapeutic burden in prostate cancer
title_short Treating the patient and not just the cancer: therapeutic burden in prostate cancer
title_sort treating the patient and not just the cancer: therapeutic burden in prostate cancer
topic Review Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8384628/
https://www.ncbi.nlm.nih.gov/pubmed/33603236
http://dx.doi.org/10.1038/s41391-021-00328-1
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