Patient experience in the treatment of metastatic castration-resistant prostate cancer: state of the science.

BACKGROUND: Contemporary therapies for metastatic castration-resistant prostate cancer (mCRPC) have shown survival improvements, which do not account for patient experience and health-related quality of life (HRQoL). METHODS: This literature review included a search of MEDLINE for randomized clinical trials enrolling ⩾50 patients with mCRPC and reporting on patient-reported outcomes (PROs) since 2010. RESULTS: Nineteen of 25 publications describing seven treatment regimens (10 clinical trials and nine associated secondary analyses) met the inclusion criteria and were critically appraised. The most commonly used measures were the Functional Assessment of Cancer Therapy-Prostate (n=5 trials) and Brief Pain Inventory Short Form (n=4 trials) questionnaires. The published data indicated that HRQoL and pain status augmented the clinical efficacy data by providing a better understanding of treatment impact in mCRPC. Abiraterone acetate and prednisone, enzalutamide, radium-223 dichloride and sipuleucel-T offered varying levels of HRQoL benefit and/or pain mitigation versus their respective comparators, whereas three treatments (mitoxantrone, estramustine phosphate and docetaxel, and cabazitaxel) had no meaningful impact on HRQoL or pain. The main limitation of the data were that the PROs utilized were not developed for use in mCRPC patients and hence may not have comprehensively captured symptoms important to this population. CONCLUSIONS: Recently published randomized clinical trials of new agents for mCRPC have captured elements of the patient experience while on treatment. Further research is required to standardize methods for measuring, quantifying and reporting on HRQoL and pain in patients with mCRPC in the clinical practice setting.

Strength training in a cardiac rehabilitation program: a six-month follow-up.

The effect of circuit training on blood pressure (BP) and strength were evaluated for six months in 16 middle-aged (means = 55.8 years) men in a metropolitan cardiac rehabilitation program. Circuit training consisted of 12 to 20 repetitions at 30% to 40% of one repetition maximum on 12 Nautilus exercises with one-minute rests between exercises. This strength conditioning was supplemental to the patients' aerobic exercise. Five of the patients had myocardial infarctions, six had coronary artery bypass grafts, two had ventricular arrhythmias, one had angioplasty, and two had a complex of other cardiac conditions. Average height, weight, and body fat for the 16 patients were 179.3 cm, 82.4 kg, and 24.6%, respectively. Blood pressure (BP) data indicated no change in mean systolic or diastolic values during actual circuit training sessions (initial = 122/77 mmHg, mid = 124/78 mmHg, end = 122/76 mmHg). These data were compared with corresponding sets of BP at three and six months of training and no significant differences were seen. In no instance did circuit training appear to elevate a patient's BP above clinically acceptable levels for controlled hypertension. In the six months, significant increases in strength were observed with a mean increment of 8.2 kg or 22% for all 12 exercises. No changes occurred in body weight or percentage of fat. For selected patients in cardiac rehabilitation programs, a carefully supervised, long-term program of low-resistance strength training appears to be safe with regard to BP response, and beneficial in terms of strength gain.