Androgen-deprivation therapy (ADT) has been suggested to increase the risk for cardiovascular diseases, including myocardial infarction (MI) and stroke, but data are inconsistent.
To investigate the association between ADT and risk for MI and stroke in Danish men with prostate cancer.
A national cohort study of all patients with incident prostate cancer registered in the Danish Cancer Registry from January 1, 2002, through 2010 was conducted.
We used Cox regression analysis to estimate hazard ratios (HR) of MI and stroke for ADT users versus nonusers, adjusting for age, prostate cancer stage, comorbidity, and calendar period. Additionally, we stratified the analysis on preexisting MI/stroke status.
Of 31,571 prostate cancer patients, 9204 (29%) received medical endocrine therapy and 2060 (7%) were orchidectomized. Patients treated with medical endocrine therapy had an increased risk for MI and stroke with adjusted HRs of 1.31 (95% confidence interval [CI], 1.16-1.49) and 1.19 (95% CI, 1.06-1.35), respectively, compared with nonusers of ADT. We found no increased risk for MI (HR: 0.90; 95% CI, 0.83-1.29) or stroke (HR: 1.11; 95% CI, 0.90-1.36) after orchiectomy. One limitation of the study is that information on prognostic lifestyle factors was not included and might have further informed our estimates.
In this nationwide cohort study of >30 000 prostate cancer patients, we found that endocrine hormonal therapy was associated with increased risk for MI and stroke. In contrast, we did not find this association after orchiectomy.
(a) To determine which of two values clarification exercises (VCE), based on theoretical decision rules used naturally by people, would be more helpful to patients making a treatment decision and (b) to evaluate the convergent validity of the most helpful VCE when part of a decision aid for the treatment of early-stage prostate cancer.
Two studies were completed. Study 1: Ninety community volunteers were assigned at random to one of three groups and all made a hypothetical treatment decision. Two groups received VCEs, one with a summary and one without, and the third was a control group. Study 2: In a multi-centre phase II trial, 69 patients used the decision aid that included the exercise ranked most helpful in Study 1. Decision aid assessments included the decisional conflict scale, treatment valuation assessment and regret.
Study 1: Most participants in each group ranked the VCE with the summary as most helpful. Study 2: VCE outputs, such as the size of the summary, were associated in predictable ways with the decision aid assessments.
The VCE ranked most helpful in Study 1 showed convergent validity with decision aid assessments.
With the interpretation of the VCE outputs now validated, a randomized controlled trial is required to determine if the exercise helps patients more than the aid without the exercise.
GOALS OF WORK: The goal of this study was to explore living conditions among disease-free cancer survivors participating in the labour force after successful primary treatment. Their living conditions were compared with the conditions of matched controls from the general Norwegian population. PATIENTS AND METHODS: Living conditions are social indicators that stimulate social inclusion and reduce exclusion such as economy, employment, health, housing and social participation. A questionnaire covering living conditions with established questions from population surveys was mailed to 852 cancer survivors and 1,548 controls. Valid responses were obtained from 51% cancer survivors (216 women with breast cancer, 49 men with prostate cancer, and 165 with testicular cancer) and 39% controls (317 women and 279 men). MAIN RESULTS: Compared to their controls cancer survivors showed no difference in work hours or full-time jobs, but reported significantly poorer physical and mental work capacity. This was associated with significantly more somatic diseases among survivors and poorer general health status in male survivors. The survivors had significantly smaller households and more living space than controls. No significant differences were observed concerning economy or social participation, except that significantly more female survivors than controls stated that they had enough friends. CONCLUSIONS: In spite of poorer health, tumour-free survivors after breast, testicular, and prostate cancer report mostly equal living conditions compared to matched controls. The protection hypothesis of holding jobs as a precondition for normal living condition was confirmed in our study of a sample of cancer survivors with good outcome.
151 patients with locally advanced prostatic cancer (T3-4 M0), representing 38% of the 404 cancer patients in a Finnish multicenter study, were randomly assigned to one of three treatment arms: orchiectomy, estrogens or radiotherapy. During the 4-year follow-up period there were no significant differences in the progression rates (appearance of metastases in bone scan) between the therapy groups. The frequency of thromboembolic and other cardiovascular complications was highest in the estrogen group (13/50 patients). In the radiotherapy group, 19 of 45 patients had bowel or bladder complications. On the other hand, orchiectomy has few, if any, complications. The high risk of complications associated with estrogens and radiotherapy has to be taken into consideration in the selection of treatment.
This consensus statement emerged from the 2nd Canadian Uro-Oncology Congress, held January 16-20, 2002. The attendees at this meeting comprised approximately 125 urologists from across Canada, representing both community and academic perspectives. The group heard presentations by experts in the field addressing the spectrum of controversies in prostate cancer. After each session, the meeting broke into workshop sessions where attendees discussed the controversies raised by the speakers. Present in each workshop was a reporter who summarized the consensus of the group. These summaries were collected and integrated into a set of questions. At the end of the congress, the attendees voted on the questions and controversies identified through the workshop process.
This paper describes the development and a preliminary usage analysis of a novel Internet-based support system that assists cancer patients in symptom monitoring and disease management. The system, called WebChoice, allows patients to monitor symptoms over time, and provides access to evidence-based self-management options tailored to their reported symptoms as well as a communication area where patients can ask questions to a clinical nurse specialist and exchange experiences with other cancer patients. A currently ongoing randomized clinical trial evaluates effects of WebChoice on patient outcomes. This paper describes essential features of WebChoice, steps we used to design it as user-friendly as possible; and preliminary findings on patients use.
The Prostate Centre, a hypermedia program integrating CD-ROM and Internet technology, was developed to help patients with localized prostate cancer access detailed and current information about available treatment options. Personal interviews with ten patients confirmed the need for more specific information examining the diagnosis and treatment of prostate cancer, as well as the suitability of computers for conveying this information. Sample screen designs effectively determined patients' visual preferences and were a useful springboard for conversation about a number of other relevant topics. Pilot testing of the resulting prototype elicited a positive response about the program from this sample audience. Patients regarded the program as useful, relevant to their needs, and navigable. Although the small sample size limited the study's generalizability, the method of involving patients in the design process successfully guided the program's development toward a greater fit with the users' needs.
Indigenous traditional healing is an ancient, deeply rooted, complex holistic health care system practiced by indigenous people worldwide. However, scant information exists to explain the phenomenon of indigenous medicine and indigenous health. Even less is known about how indigenous healing takes place. The purpose of this study is to describe the meaning and essence of the lived experience of 4 indigenous people who have been diagnosed with cancer and have used indigenous traditional healing during their healing journey. The researcher used a qualitative phenomenological methodology to collect and analyze interview data. Interviews were conducted with 4 self-identified indigenous people, ages 49 to 61, from diverse tribes. Time since cancer diagnosis varied from 2 to 20 years; types of cancer included lung, prostate, sarcoma of the leg, and breast. Four themes and 2 subthemes emerged (1) receiving the cancer diagnosis (with subthemes of knowing something was wrong and hearing something was wrong), (2) seeking healing, (3) connecting to indigenous culture, and (4) contemplating life's future. This study demonstrates that 4 individuals with cancer integrated Western medicine and traditional healing to treat their cancer. This knowledge provides necessary data about the phenomena of being healed by indigenous healers. Such data may serve as an initial guide for health care professionals while interacting with indigenous people diagnosed with cancer. Accordingly, traditional healing may be used to decrease health disparities.