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What do urologists think patients need to know when starting on androgen deprivation therapy? The perspective from Canada versus countries with lower gross domestic product.

Rot I, Wassersug RJ, Walker LM - Transl Androl Urol (2016)

Bottom Line: No differences were found between responses from Canadian urologists and high GDP countries.Infertility was the only side effect more often disclosed by urologists in low GDP counties.Factors that could contribute to differences include economics (e.g., ADT drug costs), differences in side effect presentation due to different ADT drugs used, racial differences in perceived side effect burden, disease status at ADT commencement, and cultural differences in patient-physician shared-decision making.

View Article: PubMed Central - PubMed

Affiliation: 1 Department of Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada ; 2 Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada ; 3 Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia ; 4 Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Alberta, Canada.

ABSTRACT

Background: Androgen deprivation therapy (ADT) side effects are numerous and negatively impact prostate cancer patients' quality of life. There is considerable discrepancy though among Canadian urologists regarding what ADT side effects and side effect management strategies. Little is known about global differences in ADT patient education.

Methods: International respondents were recruited via online posting and at an international urology conference. Hypotheses suggest that economic and cultural differences influence patient education practices; therefore, international respondents were divided into 3 categories (high, medium, and low gross domestic product).

Results: No differences were found between responses from Canadian urologists and high GDP countries. Compared to responses from low GDP countries, Canadian urologists are more likely to endorse informing patients about: osteoporosis, loss of muscle mass, weight gain, fatigue/sleep disturbance, relationship changes, cognitive changes, and loss of body hair. Infertility was the only side effect more often disclosed by urologists in low GDP counties. Recommended management strategies for hot flashes are more likely to be pharmaceutical in Canada, and behavioral in low GDP countries. Management strategies for gynecomastia are emphasized more in low GDP countries. Physical exercise is endorsed consistently more often by Canadian urologists.

Conclusions: ADT educational practices vary greatly between Canada and lower GDP countries. Factors that could contribute to differences include economics (e.g., ADT drug costs), differences in side effect presentation due to different ADT drugs used, racial differences in perceived side effect burden, disease status at ADT commencement, and cultural differences in patient-physician shared-decision making.

No MeSH data available.


Related in: MedlinePlus

Comparison of the perceived importance of informing patients of specific ADT side effects between a sample of Canadian urologists (n=42) and a sample of urologists from lower GDP countries (n=31). The side effects are arranged left to right in order from those that Canadian urologists consider most important to least important to discuss with patients starting on ADT. Side effects rated as essential or important are depicted above zero on the x-axis and those rated as not important, or a topic to be avoided, are depicted below the x-axis. The biggest differences between the two populations are found for weight gain, loss of muscle mass, relationship changes, cognitive changes, fatigue/sleep disturbances and osteoporosis (all P<0.001). ADT, androgen deprivation therapy.
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f1: Comparison of the perceived importance of informing patients of specific ADT side effects between a sample of Canadian urologists (n=42) and a sample of urologists from lower GDP countries (n=31). The side effects are arranged left to right in order from those that Canadian urologists consider most important to least important to discuss with patients starting on ADT. Side effects rated as essential or important are depicted above zero on the x-axis and those rated as not important, or a topic to be avoided, are depicted below the x-axis. The biggest differences between the two populations are found for weight gain, loss of muscle mass, relationship changes, cognitive changes, fatigue/sleep disturbances and osteoporosis (all P<0.001). ADT, androgen deprivation therapy.

Mentions: The side effects that urologists in Canada considered most important to inform their patients about, in decreasing order, were: osteoporosis (100% ranked it essential or important), hot flashes (97.6%), erectile dysfunction (97.6%), loss of libido (94.9%) and gynecomastia (90.2%). Less than 50% of Canadian urologists thought it was important to inform their patients about 5 (out of 19) side effects: elevated cholesterol (46.2%), genital shrinkage (45.9%), delayed orgasm (39.5%), loss of body hair (23.7%) and infertility (10%). These and all other side effects examined are plotted in Figure 1.


What do urologists think patients need to know when starting on androgen deprivation therapy? The perspective from Canada versus countries with lower gross domestic product.

Rot I, Wassersug RJ, Walker LM - Transl Androl Urol (2016)

Comparison of the perceived importance of informing patients of specific ADT side effects between a sample of Canadian urologists (n=42) and a sample of urologists from lower GDP countries (n=31). The side effects are arranged left to right in order from those that Canadian urologists consider most important to least important to discuss with patients starting on ADT. Side effects rated as essential or important are depicted above zero on the x-axis and those rated as not important, or a topic to be avoided, are depicted below the x-axis. The biggest differences between the two populations are found for weight gain, loss of muscle mass, relationship changes, cognitive changes, fatigue/sleep disturbances and osteoporosis (all P<0.001). ADT, androgen deprivation therapy.
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4837317&req=5

f1: Comparison of the perceived importance of informing patients of specific ADT side effects between a sample of Canadian urologists (n=42) and a sample of urologists from lower GDP countries (n=31). The side effects are arranged left to right in order from those that Canadian urologists consider most important to least important to discuss with patients starting on ADT. Side effects rated as essential or important are depicted above zero on the x-axis and those rated as not important, or a topic to be avoided, are depicted below the x-axis. The biggest differences between the two populations are found for weight gain, loss of muscle mass, relationship changes, cognitive changes, fatigue/sleep disturbances and osteoporosis (all P<0.001). ADT, androgen deprivation therapy.
Mentions: The side effects that urologists in Canada considered most important to inform their patients about, in decreasing order, were: osteoporosis (100% ranked it essential or important), hot flashes (97.6%), erectile dysfunction (97.6%), loss of libido (94.9%) and gynecomastia (90.2%). Less than 50% of Canadian urologists thought it was important to inform their patients about 5 (out of 19) side effects: elevated cholesterol (46.2%), genital shrinkage (45.9%), delayed orgasm (39.5%), loss of body hair (23.7%) and infertility (10%). These and all other side effects examined are plotted in Figure 1.

Bottom Line: No differences were found between responses from Canadian urologists and high GDP countries.Infertility was the only side effect more often disclosed by urologists in low GDP counties.Factors that could contribute to differences include economics (e.g., ADT drug costs), differences in side effect presentation due to different ADT drugs used, racial differences in perceived side effect burden, disease status at ADT commencement, and cultural differences in patient-physician shared-decision making.

View Article: PubMed Central - PubMed

Affiliation: 1 Department of Medical Neuroscience, Dalhousie University, Halifax, Nova Scotia, Canada ; 2 Department of Urologic Sciences, University of British Columbia, Vancouver, British Columbia, Canada ; 3 Australian Research Centre in Sex, Health and Society, La Trobe University, Melbourne, Victoria, Australia ; 4 Department of Oncology, Division of Psychosocial Oncology, Cumming School of Medicine, University of Calgary, Alberta, Canada.

ABSTRACT

Background: Androgen deprivation therapy (ADT) side effects are numerous and negatively impact prostate cancer patients' quality of life. There is considerable discrepancy though among Canadian urologists regarding what ADT side effects and side effect management strategies. Little is known about global differences in ADT patient education.

Methods: International respondents were recruited via online posting and at an international urology conference. Hypotheses suggest that economic and cultural differences influence patient education practices; therefore, international respondents were divided into 3 categories (high, medium, and low gross domestic product).

Results: No differences were found between responses from Canadian urologists and high GDP countries. Compared to responses from low GDP countries, Canadian urologists are more likely to endorse informing patients about: osteoporosis, loss of muscle mass, weight gain, fatigue/sleep disturbance, relationship changes, cognitive changes, and loss of body hair. Infertility was the only side effect more often disclosed by urologists in low GDP counties. Recommended management strategies for hot flashes are more likely to be pharmaceutical in Canada, and behavioral in low GDP countries. Management strategies for gynecomastia are emphasized more in low GDP countries. Physical exercise is endorsed consistently more often by Canadian urologists.

Conclusions: ADT educational practices vary greatly between Canada and lower GDP countries. Factors that could contribute to differences include economics (e.g., ADT drug costs), differences in side effect presentation due to different ADT drugs used, racial differences in perceived side effect burden, disease status at ADT commencement, and cultural differences in patient-physician shared-decision making.

No MeSH data available.


Related in: MedlinePlus