3605 - "Big Jolts Like an Electric Shock:" Patient Perspectives on the Expectations, Experiences and Quality-of-Life Impact of Androgen Deprivation Therapy (ADT) for Prostate Cancer

M. A. Ansari¹, P. P. Carriere¹, L. M. Lowenstein², S. Cantor², S. Choi¹, B. De¹, D. A. Kuban¹, R. Volk², and K. E. Hoffman³; ¹Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, ²Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX, ³Department of Genitourinary Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX

Purpose/Objective(s): ADT in combination with external beam radiation therapy (EBRT) is a well-established treatment for prostate cancer, though ADT is known to cause significant side effects impacting patients quality of life. This study focuses on the lived experiences of prostate cancer patients on ADT, seeking to better understand how these treatment-related side effects impact their overall well-being. By exploring patient perspectives, we aim to provide valuable insights that can inform patient-centered care. Materials/

Methods: Semi-structured qualitative interviews were conducted with patients diagnosed with intermediate-risk prostate cancer and treated with 6 months of ADT and EBRT, and who were enrolled on a larger protocol aiming to develop tailored treatment guidelines for men with intermediate-risk prostate cancer. The interviews explored nuanced experiences with six treatment-related side effects: hot flashes, fatigue, weight gain, loss of libido, erectile dysfunction, and changes in body image. Interviews were audio-recorded and analyzed for themes. Saturation was achieved after interviews with 8 participants; 3 additional interviews were performed for validation.
Results: The duration of the interview was a median of 37 minutes [IQR 32-42]. All 11 participants experienced hot flashes, with descriptions ranging from “feeling increases in body temperature” and “heavy sweating" to “big jolts like an electric shock.” Notably, men reported the predominance of severe nighttime hot flashes, causing loss of sleep and changes in their daily routines. Most participants did not expect the hot flashes to be as frequent and intense. Fatigue was pervasive, making day-to-day tasks more difficult, with some patients resorting to frequent naps to cope. Strategies to mitigate weight gain included dietary changes including “eating more greens and less sugar” and increased physical activity. Loss of libido and erectile dysfunction were universally reported, with varying emotional responses based on importance of sexual activity in personal relationships prior to diagnosis of prostate cancer. Sexually active men found medication "like Cialis” helpful, stating “it doesn’t clear the problem or the issue, but it helps.” There were 5 participants who reported changes in body image, including loss of muscle mass and feelings of weakness.
Conclusion: While most patients managed ADT side effects, hot flashes were notably burdensome yet accepted as a tradeoff for treatment efficacy. Loss of libido and erectile dysfunction posed significant distress, particularly for sexually active men anticipating full recovery post-treatment. This study provides valuable insights into the nuanced experiences of patients undergoing ADT, emphasizing the need for tailored support in managing treatment-related challenges.