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Development of comorbidities in men with prostate cancer treated with androgen deprivation therapy: an Australian population-based cohort study

Prostate Cancer and Prostatic Diseasesvolume 21pages403410 (2018) | Download Citation

Background

The increasing use of androgen deprivation therapy has prompted further evaluation of its potential adverse effects as the treatment may exacerbate or increase the risk of developing new comorbid diseases. This study aims to assess the patterns of comorbidities among Australian men with prostate cancer treated with androgen deprivation therapy.

Methods

Pharmaceutical Benefits Scheme (PBS) 10% data between 1 January 2003 and 31 December 2014 was utilised in this retrospective cohort study. Men who had received their first androgen deprivation therapy between 2004 and 2010 were selected as the prostate cancer cohort. Comorbidities were identified using the dispensing claims data and classified with the Rx-Risk-V model. Comparisons were made between the prostate cancer cohort and specific control groups (age-matched and sex-matched without any dispensing of anti-neoplastic agents during the study period and without the individual comorbidity of interest evaluated at baseline at 1:10 ratio) for the development of nine individual comorbidities over time using Cox regression models.

Results

The prostate cancer cohort had a significant higher risk of developing cardiovascular conditions (hazard ratio 1.37, 95% CI: 1.26–1.48), depression (1.86, 95% CI: 1.73–2.01), diabetes (1.30, 95% CI: 1.15–1.47), gastric acid disorders (1.48, 95% CI: 1.39–1.57), hyperlipidaemia (1.18, 95% CI: 1.09–1.29), osteoporosis (1.65, 95% CI: 1.48–1.85) and pain/pain-inflammation (1.47, 95% CI: 1.39–1.55) compared to the control groups. The hazard ratios for cardiovascular conditions and depression were highest in the first year and declined over time. There were no significant differences between the two groups for reactive airway diseases and Alzheimer’s disease.

Conclusion

Men with prostate cancer treated with androgen deprivation therapy had a higher likelihood of developing new comorbidities than men who did not receive androgen deprivation therapy. Our results support the need for developing coordinated care models that effectively address multiple chronic diseases experienced by prostate cancer survivors.

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Acknowledgements

Huah Shin Ng is supported by an Australian Government Research Training Programme Scholarship.

Author information

Affiliations

  1. School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, SA, Australia

    • Huah Shin Ng
    •  & Agnes Vitry
  2. Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, SA, Australia

    • Bogda Koczwara
  3. Cancer Epidemiology and Population Health, Centre of Population Health Research, School of Health Sciences, University of South Australia, Adelaide, SA, Australia

    • David Roder

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Conflict of interest

The authors declare that they have no conflict of interest.

Corresponding author

Correspondence to Huah Shin Ng.

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DOI

https://doi.org/10.1038/s41391-018-0036-y