A multidisciplinary clinic to mitigate the impact of androgen deprivation therapy in prostate cancer: A pilot study.

Abstract

218 Background: Androgen deprivation therapy (ADT) increases the risk of numerous metabolic toxicities, including weight and body fat gain, insulin resistance, and osteoporosis. Many of these toxicities can be mitigated with lifestyle changes and monitoring of cardiovascular and diabetes risk factors, however, these are not routinely implemented in clinical practice. We designed a pilot study to evaluate whether a structured multidisciplinary (multi-D) clinic can lessen the metabolic impact of ADT. Methods: Patients who started ADT within the past 6 months were enrolled in the year-long multi-D clinic consisting of monthly face-to-face visits and individualized counseling from registered dietitian, certified exercise physiologist, and symptom management specialist, and assessment of weight, body mass index, percent body fat, fasting glucose, lipids, and hemoglobin A1c on an every 3 month schedule. The primary endpoint for this pilot study was the patient adherence rate to the clinic visit schedule, with a targeted goal of greater than 80%. Secondary endpoints included maximal percent change from baseline in metabolic parameters as outlined above. Results: 22 patients were enrolled between November 2013 and May 2014. Participation in the multi-D clinic was high, with a 95% adherence rate to the clinic schedule. The mean maximal percent change from baseline in metabolic parameters is shown below in the Table. Conclusions: Conducting a multi-D clinic for men receiving ADT was feasible, with an adherence rate of over 90%. The metabolic impact of ADT during the 12-month clinic participation was minimal and compares favorably to historical controls, but may be due to selection bias. A randomized phase 2 study comparing multi-D clinic to usual standard of care is ongoing to validate these findings. [Table: see text]