Prostate cancer is one of the most common cancers in Canada and a leading cause of morbidity and mortality in older men.2 Although treatment options for metastatic prostate cancer (mPC) are advancing, the non-curative nature of these treatments can translate into poor quality of life and decreased function. For instance, treatments such as chemotherapy and androgen receptor axis targeted therapies (ARAT) are known to produce side effects such as nausea, vomiting, and fatigue.3 In addition, the psychological stress of living with advanced disease can be detrimental to quality of life and treatment outcomes.4 However, these issues are typically not explored well in randomized trials. As a result, through detailed/in-depth semi-structured interviewing, we explored symptom experiences and supportive care needs of older men undergoing treatment for mPC.
In our study, participants (mean age: 76 years, chemotherapy (n=11), ARAT (n=19), and radium-223 (n=6)) commonly reported symptoms were fatigue, pain, sleep disturbances, mood disturbances, and gastrointestinal symptoms. Interestingly, clusters of fatigue-pain-sleep disturbances and mood issues were also reported. Therefore, recognition of the ways in which symptoms can co-occur and synergize is important for restructuring our approach to symptom elicitation, designing intervention activities and providing patient education.
In terms of impact on daily life, participants reported resting more than usual, decreased mobility, inability to maintain activities of daily living, and not feeling up to most things. These can lead to a vicious cycle of functional decline, resulting in further health deterioration. Recognizing and addressing the impact of treatment-related side effects on daily life is important as older adults with advanced disease tend to prioritize quality of life over long- term gains in survival.5 Therefore, Finding ways to enable older adults living with mPC to maintain their quality of life must be prioritized.
Symptom management strategies used by participants in our study mainly involved support systems (e.g., spouses, friends, healthcare providers, support groups), seeking help (e.g., through self-directed research and discussions with friends and healthcare providers), interventions by healthcare providers (e.g., pharmaceuticals), and self-management (e.g., having confidence in one’s treatment plan and making lifestyle modifications related to diet and physical activity). Understanding how older adults respond to their symptoms can help to determine when and how to provide supportive care interventions. For instance, interventions to address physical and psychological health and maintain social connections could be strategically embedded within healthcare visits or other points of interaction with the healthcare system.
Finally, participants in our study proposed numerous external support suggestions. These included building social support networks, improving health literacy, improving continuity of care, receiving support from healthcare providers, and engaging in health-seeking behaviours. Taken together, a combination of both individual and systems-level support is recommended. We believe these results will further stimulate discussion around meaningful ways to improve the level of care provided to older adults.
Written by: Gregory Feng, MPH(c); Milothy Parthipan, MScPT(c); Henriette Breunis, CCRP, Shabbir M. H. Alibhai, MD, MSc; Martine Puts, RN, PhD
References:
- Parthipan M, Feng G, Toledano N, et al. Symptom experiences of older adults during treatment for metastatic prostate cancer: A qualitative investigation. J Geriatr Oncol. 2023;14(1). doi:10.1016/j.jgo.2022.10.012
- Cancer statistics at a glance | Canadian Cancer Society.
- Mohler JL, Antonarakis ES, Armstrong AJ, et al. Prostate Cancer, Version 2.2019,
- NCCN Clinical Practice Guidelines in Oncology. Journal of the National Comprehensive Cancer Network. 2019;17(5):479-505.
- De Sousa A, Sonavane S, Mehta J. Psychological aspects of prostate cancer: a clinical review. Prostate Cancer and Prostatic Diseases 2012 15:2. 2012;15(2):120- 127.
- Shrestha A, Martin C, Burton M, Walters S, Collins K, Wyld L. Quality of life versus length of life considerations in cancer patients: A systematic literature review. Psychooncology. 2019;28(7):1367-1380. doi:10.1002/PON.5054