Improving Outcomes in Lethal Prostate Cancer Through Guideline-Concordant Use of Bone-Modifying Agents
Abstract
The drugs known as “bone modifying agents,” or BMAs, are an important part of prostate cancer care. BMAs do not directly attack cancer cells, but they do strengthen bones. This is important because the skeleton is the most common place for prostate cancer to spread, which weakens bones and results in painful, debilitating fractures. By strengthening bones, BMAs have been proven effective in preventing fractures among men with metastatic prostate cancer. Preventing fractures leads to improved quality of life and may even increase survival. However, the side effects of BMAs can be severe, including destruction of the jawbone, kidney failure, and calcium levels so low that some patients need to be hospitalized. Despite these side effects, the benefits outweigh the risks for many patients. However, not all men with prostate cancer need BMAs. We know that BMAs help men whose cancer has become castrate-resistant. At the same time, BMAs do not appear to help men whose prostate cancer is still castrate-sensitive, although these patients still experience the harmful side effects. Prostate cancer guidelines therefore recommend BMAs for men with castrate-resistant disease, but not for men with castrate-sensitive disease. Despite these guidelines, research suggests that one-half of patients with castrate-resistant disease do not receive BMAs, and one quarter of those with castrate-sensitive disease receive BMAs unnecessarily. The first goal of this project is to understand the reasons why this happens. For example, BMAs may be too expensive for some patients. In other cases, physicians may not be aware that BMAs are not recommended for castrate-sensitive disease. We plan to evaluate these possibilities and many others by (1) studying a population-based registry of prostate cancer patients and (2) interviewing physicians about the factors affecting their usage of BMAs. The second goal of this project is to develop strategies to fix the problem. We will apply our new understanding of the causes of BMA usage to develop an intervention strategy aimed at improving appropriate BMA use. This intervention will include components such as educating physicians on guideline recommendations and computerized reminders to order BMAs when indicated. Finally, we will conduct a trial of this new intervention to test its effectiveness. We anticipate that the results of this research will benefit patients with metastatic prostate cancer. This research will have direct clinical applications, given that the goal of the project is to improve the clinical care that patients receive. If we are successful in increasing appropriate BMA use, then fewer patients will experience bone fractures. If we are successful in decreasing unnecessary BMA use, then fewer patients will experience unnecessary side effects. In both cases, this would result in improved quality of life for patients surviving with metastatic prostate cancer. Improved quality of life is a critically important clinical outcome for patients. In addition, the financial burden of cancer treatment can be devastating for many patients and their families. If we are successful in reducing unnecessary BMA use, then this project may also help prostate cancer patients by lessening avoidable costs of treatment. The projected time needed to produce clinical benefits is short; some patients may benefit during the 4-year grant period itself. The principal investigator on this project, Dr. Aaron Mitchell, is a medical oncologist at Memorial Sloan Kettering Cancer Center. He specializes in prostate cancer. He has prior training in epidemiology and population science and has conducted many observational studies of cancer patients. His career goal is to both identify problems in cancer care through observational studies and actively work to fix them. This work will involve designing and leading interventions to improve care delivery, such as the one proposed in this grant. Dr. Mi
Document Details
- Document Type
- DoD Grant Award
- Publication Date
- Dec 05, 2021
- Source ID
- W81XWH2110087
Entities
People
- Aaron Mitchell
Organizations
- Sloan-Kettering Institute
- United States Army