Androgen deprivation therapy and quality of life: A concept map analysis.

Abstract

12067 Background: Androgen deprivation therapy (ADT) is the backbone of systemic treatments for prostate cancer (PC), but is associated with side effects that decrease quality of life (QOL). There lacks a robust qualitative exploration of the nuanced entirety of physical, mental, and social changes men experience during ADT. While interventions typically focus on metabolic and cardiovascular effects, it is unclear if these are the most impactful contributors to QOL as experienced by men themselves. Methods: We conducted concept mapping, a participatory mixed-methods research approach, involving item generation, pile sorting, and rating to identify and categorize side effects of ADT. Thirty men who started ADT for PC in the past 3-12 months and reported undesirable changes from ADT participated. Men on oral androgen axis inhibitors were included, but those receiving other systemic therapies or with comorbidities that could confound results were excluded. Men who had surgery or radiation for PC were enrolled after ≥3 months post-treatment. We conducted semi-structured brainstorming interviews to generate lists of undesirable changes participants experienced. Study team members reviewed each list for completeness, then combined all 676 items into 79 unique items. Fifteen participants sorted these items into named groups and rated each item on a 1-5 Likert scale for the following questions (5 representing maximal response): “After starting ADT, how much did this change negatively affect your life?” and “After starting ADT, how much additional support would you have liked to receive for the following change?” GroupWisdom Concept Mapping software generated a cluster map and calculated mean Likert scale ratings for each cluster. Results: Based on participant sorting, items were grouped into four main clusters: Physical Manifestations; Sexual Changes; Mental Health Changes & Concerns of Stigma; and Motivational Changes (13 iterations, stress value 0.29). The Table presents sample items and mean Likert scale cluster ratings. Conclusions: While men on ADT reported expected physical and sexual changes, qualitative interviews uncovered changes in motivation, mental health, and concerns of stigma. Men reported sexual changes as having the largest negative impact on QOL. The concept mapping can be utilized to provide anticipatory guidance to men starting ADT, as well as guide the development of supportive interventions. Cluster Example Items Negative Affect on Life Rating (1-5; 5=Most Negative) Additional Support Wanted Rating (1-5; 5=Most Support Wanted) Physical Manifestations - Physical Strength Decreased 2.6 2.1 Sexual Changes - Sex Drive/Libido Diminished 2.9 2.0 Motivational Changes - Wanting to Sit and Do Nothing/Watch TV; Being Less Active; Feeling "Lazy" 2.2 1.7 Mental Health Changes & Concerns of Stigma - Not Wanting to Share Information About Diagnosis/Treatment with Others-More Pessimistic/Less Optimistic 1.8 1.5