title: A prospective study examining elder-relevant outcomes in older adults with prostate cancer undergoing treatment with chemotherapy or abiraterone.
abstract: BACKGROUND
  Treatment of metastatic castration-resistant prostate cancer (mCRPC) with chemotherapy improves disease control and survival in fit older men (age 65+) but its impact on function is not clear. We hypothesized that chemotherapy would impair daily function in older men with mCRPC.
  
  
  METHODS
  Men aged 65+ with mCRPC starting chemotherapy or abiraterone were enrolled in this prospective observational pilot study. Daily function was evaluated with the OARS Instrumental Activities of Daily Living (IADL) scale. Three objective measures were used to assess physical function. Patients completed Functional Assessment of Cancer Therapy questionnaires measuring prostate-specific and general quality-of-life (QOL). Vulnerability was evaluated using the Vulnerable Elders Survey (VES-13). Assessments were completed before each cycle of chemotherapy or every 2-3 months for those receiving abiraterone. We compared outcomes pre- and post-treatment and with published minimal clinically important differences.
  
  
  RESULTS
  We evaluated 29 and 7 men on 1st-line and 2nd-line chemotherapy (median 6 and 7 cycles, respectively) and 11 men receiving abiraterone for a median 7 months. IADL scores declined slightly after 1st-line chemotherapy (mean -0.31 points, 95% confidence interval 0.39, -1.02). Physical performance remained stable over time. Both general and prostate-specific QOL improved with 1st-line chemotherapy. For all but one outcome (Timed Chair Stands), vulnerable men had similar changes over time compared to non-vulnerable men. Second-line chemotherapy and abiraterone were generally well-tolerated.
  
  
  CONCLUSIONS
  IADL function declined slightly whereas physical function remained stable and QOL improved during chemotherapy. Vulnerable and non-vulnerable older men with mCRPC appear to tolerate 1st-line chemotherapy fairly well.
authors: Princess Margaret Cancer Centre, University Health Network, Department of Medicine, University of Toronto, Toronto, ON, Canada.
authors: Tharsika
authors: T
authors: Manokumar
authors: Princess Margaret Cancer Centre, University Health Network, Department of Medicine, University of Toronto, Toronto, ON, Canada.
authors: Salman
authors: S
authors: Aziz
authors: Princess Margaret Cancer Centre, University Health Network, Department of Medicine, University of Toronto, Toronto, ON, Canada.
authors: Henriette
authors: H
authors: Breunis
authors: Princess Margaret Cancer Centre, University Health Network, Department of Medicine, University of Toronto, Toronto, ON, Canada.
authors: S Faraz
authors: SF
authors: Rizvi
authors: Princess Margaret Cancer Centre, University Health Network, Department of Medicine, University of Toronto, Toronto, ON, Canada.
authors: Anthony M
authors: AM
authors: Joshua
authors: Princess Margaret Cancer Centre, University Health Network, Department of Medicine, University of Toronto, Toronto, ON, Canada.
authors: Ian F
authors: IF
authors: Tannock
authors: Princess Margaret Cancer Centre, University Health Network, Department of Medicine, University of Toronto, Toronto, ON, Canada. Electronic address: shabbir.alibhai@uhn.on.ca.
authors: Shabbir M H
authors: SM
authors: Alibhai
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D000369:Aged, 80 and over; D000736:Androstenes / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D065607:Cytochrome P-450 Enzyme Inhibitors / Q000627:therapeutic use*; D018737:Hand Strength; D006801:Humans; D008297:Male; D010865:Pilot Projects; D011446:Prospective Studies; D064129:Prostatic Neoplasms, Castration-Resistant / Q000188:drug therapy*; D011795:Surveys and Questionnaires
chemical_list: D000736:Androstenes; D065607:Cytochrome P-450 Enzyme Inhibitors; C089740:abiraterone
keywords: Abiraterone; Activities of daily living; Castration-resistant; Chemotherapy; Elderly; Falls; Frailty; Metastatic prostate cancer; Physical performance; Quality of life