The role of endocrinologist led androgen depravation therapy clinic in metastatic prostate cancer-a retrospective evaluation.

Abstract

Background and objectives This audit investigates the utility of a Monash Health endocrinology directed androgen depravation therapy (ADT) clinic and the role it plays in supporting the urology service with ADT adverse effects management. Materials and methods A 5-year retrospective chart analysis compared the workload of Monash Health's urology and ADT clinics, including breadth of counselling and the adherence to the Medical Journal of Australia (MJA) 2011 ADT management recommendations. Results 87 patients (mean age 72), initiated on ADT by a urologist, were seen in ADT clinic over a 5-year period. 46% had pre-existing diabetes, 80% hypertension, 68% dyslipidaemia, 63% cardiovascular disease and 55% osteopenia or osteoporosis. In urology clinic, adequate ADT counselling was limited to adverse effects (bone mineral density > cardiovascular disease > hot flushes/ gynaecomastia/sexual dysfunction). Employment of patient directed risk mitigation was inadequately utilised; only 21% of patients were educated regarding the use of vitamin D and calcium supplementation. Medical examination (blood pressure, etc.) was never performed and baseline metabolic workup was only initiated in 1/44 patients. The endocrinologist-led ADT clinic established by Monash Health provided superior medical care. All patients underwent thorough medical examination (100% blood pressure checks, 45% breast exam), all patients had a baseline metabolic workup (100% DEXA scan, 96% fasting lipids), and the counselling was more comprehensive compared to urology counterparts. A significant imbalance in workload was demonstrated between clinics. The urology clinics averaged 15-20 min per patient compared to 45- min appointments in ADT clinic. A mean of 239 patients were reviewed in a 12-month period in ADT clinic, while between 926 and 2064 patients were reviewed per annum in urology clinics. Conclusion ADT clinic relieves the urologist of the unfair expectation to provide adequate counselling in an inadequate (time) span. It introduces elderly men to specialist physicians, apt at managing a complex physiology and pharmacotherapy and its broad effect on pre-existing comorbidities. Monash Health's ADT clinic facilitates superior outcomes in bone health, cardiovascular health and other symptom control. It serves as a model for other hospital networks.