Climacteric-Like Disorders in Prostate Cancer Patients Treated With LHRH Agonists

Treatment-Related Symptom Clusters

OBJECTIVES

To provide a clinical overview of treatment-related symptom clusters.

DATA SOURCES

Journal articles, research reports, state of the science papers, and clinical practice experience.

CONCLUSION

Although understanding the etiology and interaction of symptoms may lead to targeted interventions, the nurse must often manage symptoms in which the cause or causes cannot be changed or in which there are multiple overlapping etiologies that lead to complex and challenging clinical presentations. Systematic and ongoing evaluation of symptoms, their treatment-related trajectory, and their response to interventions is essential.

IMPLICATIONS FOR NURSING PRACTICE

Systematic assessment of symptoms and symptom cluster presence, severity, and distress can guide the practitioner to intervene using evidence-based practice. Individualized care and evaluation of response is needed.

Role of Quality of Life in Men with Metastatic Hormone-Refractory Prostate Cancer: How Does Atrasentan Influence Quality of Life?

OBJECTIVE

Progression of hormone-refractory prostate cancer (HRPC) is associated with skeletal complications and bone pain, which contribute to deterioration in quality of life (QOL). The effects of new HRPC therapies on patients' QOL need to be studied. Patient-based assessments that help quantify the risk-benefit profile of HRPC therapies are warranted. This review summarizes the known QOL literature and estimates the potential effect of atrasentan, a novel, selective endothelin A receptor antagonist (SERA), on the QOL of HRPC patients.

METHODS

Published studies were identified through a structured, detailed literature review. Clinical studies that report QOL data were reviewed, along with recent QOL data from atrasentan studies.

RESULTS

HRPC studies have begun to use QOL assessments as primary endpoints, but different assessments and therapies are not comparable. Very few data integrate QOL with clinical endpoints. Atrasentan clinical trials demonstrated a statistically significant difference in the prostate cancer-specific QOL in favor of atrasentan (p=.032) and an increased quality-adjusted time to progression in men with HRPC.

CONCLUSIONS

Atrasentan provides QOL benefits relevant to HRPC. The quality-adjusted analyses applied in the atrasentan studies have begun to lay the foundation for interpreting clinical endpoints in conjunction with QOL. These analyses will facilitate better QOL comparisons within studies and across trials. Further evaluation of atrasentan in HRPC is warranted.