mHSPC: Importance of Quality of Life and Multidisciplinary Care


After nuancing quality of life data with chemotherapy in metastatic hormone-sensitive prostate cancer, panelists consider the value of multidisciplinary care.


Alan H. Bryce, MD: Dr Zhang, let’s talk about the way patients often react to the conversation around docetaxel. They’ll say, “Doctor, I prefer quality of life over quantity. I really don’t want chemotherapy; I hear terrible things about it.” But for that patient for whom you feel that chemotherapy is appropriate, how do you talk through those concerns?

Tian Zhang, MD, MHS: It’s a great question because there’s sometimes a bad reputation for chemotherapy out there. What I generally say is, we know these chemotherapies, when given together, get people to live longer, and it’s somewhat finite. We’re giving 6 cycles, once every 3 weeks, and we’re seeing them every time they’re getting chemotherapy, so we can titrate doses if they run into toxicities that are hard to manage. Ultimately, from a quality-of-life perspective, if we’re controlling disease and helping with symptoms that are related to the cancer itself, like pain and immobility, those things can improve on chemotherapy and early disease control.

Alan H. Bryce, MD: Every now and then, I like to show the patients the data. We have the quality-of-life data, the patient-reported outcomes from the ARASENS trial, we saw that at ESMO [European Society for Medical Oncology annual meeting]. From the CHAARTED trial, we’ve seen that years ago now. I think it’s critically important that the patients who received chemotherapy on those studies, because both of those studies were chemotherapy randomized versus no chemotherapy. But in both of those studies, the patients who received chemotherapy reported higher quality of life. What you see, as we understand as treating physicians, for a few months during the chemotherapy, quality of life is lower on the chemotherapy arm. But within about 2 months after, the chemotherapy-treated patients report a higher quality of life than the control arm. I think the message there is very clear, that superior disease control ends up leading to higher quality of life. And inferior disease control means more symptoms from cancer, more suffering, and imbalance in the patient-reported outcomes. The patients who receive better disease control ultimately enjoy not only longer life, but higher quality of life. Every now and then I’ll pull out those slides and show the patients who are very data-driven, because there are those, we get those engineers in our clinic who plot out their PSAs [prostate-specific antigen levels].

Let’s talk about some of the other factors here. What about the role of the multidisciplinary team? Let’s go back to Dr Petrylak here. RAD-ONC [radiation oncology], urology, MED-ONC [medical oncology], how does that work at your institution? What do you think is optimal for the patients with mHSPC [metastatic hormone-sensitive prostate cancer]?

Daniel P. Petrylak, MD: I think communication is optimal. I don’t think you have to be in a multidisciplinary setting, a physical clinic, to achieve the goals you’d like to achieve. My office is in the urology department, and if a urologist has a question about a patient, or I have a question about one of the patients they refer to me, we’re right there physically, and we talk to each other and the communication is excellent. That’s more the exception rather than the rule. Some places feel that a more formal multidisciplinary clinic would be appropriate, particularly if you have RAD-ONC, if a patient has low-volume disease and you want to administer radiation therapy to the prostate. If there are studies that are involved in terms of prostatectomy in a metastatic patient, those are ongoing. I think it is dependent upon the institution and how well people interact, but the important thing is communication, whether it be physical, face-to-face, or over the telephone. I think those are the best ways to go about it.

Transcript edited for clarity.

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