1: Cognitive behaviour therapy can reduce fear of recurrence in cancer patients

Fear of cancer recurrence (FCR) is one of the most common concerns for cancer patients and affects up to a third of men with prostate cancer. Despite this, there have been few controlled trials that test strategies to meet this unmet need. While there is evidence that cognitive behaviour therapy (CBT) may be a promising strategy, it is a resource and time-intensive intervention. To address these challenges the Dutch SWORD trial randomised 88 cancer survivors (breast (41%), prostate (34%) and colorectal (25%)) to blended CBT (bCBT), composed of a mixture of face to face and web-based consultations, or no intervention for the control group (care as usual). All participants had completed treatment between 6 months to 5 years previously and had FCR, defined as a score ≥14 on the Cancer Worry Scale. FCR and other measures of distress were collected at baseline and at 3 months.

At baseline, FCR was similar for both groups (Cancer Worry Scale mean score 19.6) but after 3 months was significantly reduced for the bCBT compared to the control group (15.2 vs 18.7). Secondary measures such as severity, distress, global quality of life and emotional functioning were also significantly improved in the bCBT compared to the control group. These results are particularly impressive when considering the fact that a third of bCBT participants did not complete all sessions. Overall, almost one third (29%) of bCBT participants demonstrated clinically significant improvement, while no participants in the control group did.

This was a small study and results may vary in larger or different population settings or if the therapy is led by more diverse/less experienced counsellors. However, this study represents an important first step in providing evidence for treatments that could be used to support patients with FCR.

2: Comorbidity does not increase prostate cancer-specific mortality

Comorbidities are very common in men diagnosed with prostate cancer and can impact on decision to treat as well as the treatment modality chosen. However, evidence is mixed over the impact that comorbidity plays in prostate cancer mortality. A Swedish population-based observational study examined outcomes in 118,543 men diagnosed with prostate cancer between 1998 to 2012, stratified by their level of comorbidity using the Charlson Comorbidity Index.

Men who had more comorbidities were also more likely to be older and have higher grade tumours. However, after adjusting for patient and tumour characteristics, there was only a small association between comorbidities and prostate cancer mortality which disappeared with additional adjustment for treatment type. In contrast, comorbidities were significantly associated with increased all-cause mortality in both adjusted and unadjusted analyses.

Recent studies have suggested that radical prostatectomy (RP) may have better outcomes compared to radiotherapy (RT) for men with localised disease. A criticism of these publications has been that men with comorbidites may be more likely to receive RT and that this may account for the higher RT mortality. However, as comorbidity was not associated with prostate cancer specific mortality in either the RP or the RT treatment groups, this work suggests that outcomes seen in these effectiveness studies are likely not affected by this source of bias. 

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3: A new study does not find any association between ADT and Alzheimer’s Disease

We have previously written about research that links androgen deprivation therapy (ADT) to an enhanced risk of Alzheimer’s disease and dementia. However, the evidence has been conflicting and the effects seen were small, demonstrating the need for more research on this subject. A new American study examined 1.2 million men on Medicare who were diagnosed with prostate cancer between 2001 to 2014. While rates of dementia were higher in men on ADT, once this was adjusted for treatment type and other characteristics such as age, ethnicity and comorbidity, the authors found no increased risk of Alzheimer’s disease and only a very small increase (1%) in the risk of dementia (subdistribution hazard ratio (SHR) 1.01 [95% CI, 1.01 to 1.02]). Overall, this study is consistent with current practice that suggests that the risks and benefits of ADT should be weighed for each man taking into consideration their disease, comorbidities, risk factors and overall health in order to try and achieve good outcomes.  

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