Congress Abstracts 2003

92

HORMONAL MANIPULATIONS FOR PROSTATE CANCER: THE AMBULATORY NURSE PRACTITIONER’S ROLE. Christine Liebertz, RN, CS, MSN, AOCN^®, Memorial Sloan-Kettering Cancer Center, New York, NY.

Multiple hormones and combinations of hormones, with a diversity of side effects and various mechanisms of action, are used for the treatment of prostate cancer. Oncology nurse practitioners are instrumental in educating, monitoring, and providing symptom management to patients while on therapy. Hormonal manipulation occurs through the disruption of the hypothalamic-pituitary gonadal axis by surgical or medical castration, adrenal suppression, and/or testosterone blockage by nonsteroidal and steroidal antiandrogens. No other therapies surpass hormonal manipulations for controlling growth, decreasing tumor burden, or stabilizing or promoting disease regression; however, eventually, most men will become refractory to their first line hormones. Historically, this progression of disease was considered to be the hormone refractory stage. Studies now show that many individuals have continued responses to further hormonal manipulations such as ketoconazole, steroids, alternate anti-androgens, and hormonal withdrawal.

Non-conventional approaches to standard castrating regimens include intermittent hormones (cycling on and off) or non-castrating regimens (high dose anti-androgens). These treatments are used to decrease potential side effects and may also prolong the hormonal response. For a population of patients who may live many years and may have multiple hormonal interventions, it is essential that the nurse be aware of all treatment options in order to help optimize the patient’s quality of life as well as to help in decision-making, side effect management, and overall understanding of the disease process. At this NCI-designated cancer center, treatment decisions are based on disease state and hormonal sensitivity, co-morbidities, patient preference, performance status, and age.

This presentation will provide an overview of hormonal manipulations and educate NP’s and nurses about the expert nursing management that has been developed at this center that can be used to provide comprehensive care to men with prostate cancer. It will provide information that the NP and nurse can use to educate patients about disease states of prostate cancer, effects of hormones on prostate cancer growth, hormonal sensitivities, mechanisms of action, standard and alternative hormonal combinations, along with the rationale for the use of therapies at various stages of the prostate cancer disease continuum.