UCSF Oncology Connection
SPRING / SUMMER 2014
Taking a STAND: Preventing and Treating the Adverse Effects of Androgen Deprivation Therapy Screening and intervention to address treatment-related side effects of hormone therapy can greatly improve quality of life for men with prostate cancer.
Through screening and intervention, many side effects of ADT can be effectively addressed, prevented and treated Many of these side effects are experienced over time, and men treated for fewer than eight months are less likely to experience many of these issues. Some problems, like hot flashes and sexual side effects, usually manifest within the first four to six weeks of treatment. Fortunately, many adverse effects are modifiable with appropriate intervention. It is also important to note that not all men will experience all side effects and that their severity varies widely from patient to patient.
This approach represents an important and, until recently, unmet need for patients. Through screening and intervention aimed at preventing treatment-related morbidity, many side effects of ADT can be effectively addressed, prevented and treated. For example, hot flashes can be helped by treatment with certain antidepressants. There are several different drugs available to prevent and treat osteoporosis. Depression can be addressed through medication and counseling. Exercise and nutrition counseling can also help reduce many side effects, including fatigue, weight gain, loss of bone and muscle mass and insulin resistance. “The key to success is a team approach,” adds Aggarwal. We take a multidisciplinary, holistic approach to screening and treating side effects with the goal of improving patients’ quality of life.”
To refer a patient, call our nurse navigator at (415) 885-7795. For more information, visit www.ucsfhealth.org/stand.
Rahul Aggarwal, MD, medical director of the STAND Clinic.
One-Stop-Shop for Symptom Management The STAND Clinic provides a “one-stop-shop” for multidisciplinary management of the many issues that can affect men undergoing hormone therapy. Within two weeks of beginning androgen deprivation treatment, the patient is scheduled for an appointment at the clinic. Prior to the appointment, a variety of surveys, fasting labs and bone-density tests are performed. On the day of the visit, survey and lab results are reviewed with the patient’s health care provider. Patients will have one-on-one sessions with an exercise trainer, nutritionist and symptom manag- ment expert trained in managing side effects of hormone therapy. Patients have the opportunity to complete a series of educational modules designed to increase awareness of hormone therapy and provide strategies to prevent and treat their side effects.
Additional Services:
UCSF Osher Center for Cancer Risk Program Symptom Management Service Integrative Medicine Phone: (415) 885-7779 Phone: (415) 885-7671 [885-SMS1] Phone: (415) 353-7700 Website: www.ucsfhealth.org/ Website: cancer.ucsf.edu/sms Website: www.ucsfhealth.org/ocim cancerriskprogram
cancer.ucsf.edu
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Though effective – more than 90 percent of patients who undergo ADT experience a decrease in prostate-specific antigen (PSA) levels – the mostly older men who undergo this treatment are vulnerable to a variety of treatment-associated side effects. In addition to loss of libido, erectile dysfunction, flushing, anemia and fatigue, ADT also has been shown to accelerate bone loss, increase fat mass, increase cholesterol and triglycerides and increase the risk of diabetes.
“The Supportive Therapy in Androgen Deprivation (STAND) Clinic at UCSF Medical Center is focused on a team-based approach to addressing the potential adverse effects of hormone therapy,” says Rahul Aggarwal, MD, medical director of the STAND clinic, among the first resources of its kind in the country. “Our approach is to take a comprehensive assessment of a patient’s health profile and use a multidisciplinary approach to both prevent and treat the side effects associated with androgen deprivation.”
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ore than one-third of the estimated two million prostate cancer survivors in the United States receive androgen deprivation therapy (ADT). The goal of this treatment: To reduce the levels of testosterone and dihydrotesterone in the body, causing the cancer to shrink or grow more slowly. In many patients, ADT also improves the effectiveness of radiation therapy.