The older a man with prostate cancer, and the less able he is to cope with treatment – the more likely his treatments will be scaled back, or not given.

Dr. Shabbir Alibhai at University of Toronto is working with these men, frequently overlooked in research: “I’m looking at how older, frailer men tolerate treatments like hormone therapy, radiation or chemotherapy – what sorts of side effects are they having? How is it affecting their day-to-day living? And more importantly, how might healthcare professionals help men cope better?” he says. “It’s fair to say that if we can monitor symptoms better, intervene earlier, and reduce side effects of treatment, we can help men live better and longer.”

He’s focusing specifically on men whose bodies don’t cope well with the stress of treatment, who are likely to have complications or decline generally in their daily functioning.

“We’re looking at these men because they are more vulnerable to the side effects of treatment,” he says. “They tend to be studied less because they’re more complicated. Much of the information we get from clinical trials are from younger, healthier men, so there is a gap in knowledge.”
 
Building on an initial grant from Prostate Cancer Canada funded by Movember, Dr. Alibhai’s team is now following men through a cycle of treatment, about three to four weeks, to track how they are feeling. Each day, participants rate symptoms such as pain, difficulties sleeping and nausea. This shows the team patterns of side effects for various treatments, which will help determine what supports they might need and when to improve their quality of life.

Integrating technology

 

The study integrates internet-enabled devices, along with telephone and paper surveys in order to track this daily information, allowing doctors to respond more quickly to health issues before they get more serious.

“We’re using smartphone apps that monitor step counts,” he says. “When people get sick, they start to spend more time sitting or in bed. If we see there is a sudden drop in step count, we’ll call the patient and ask what’s going on. If we find this is an efficient way to pick up symptoms early, it means we can s
imply monitor their step counts.”

Many study participants are over the age of 75 and are embracing the new technology. “Older men often need a little more time to learn and more support along the way, and we’re happy to offer that. In fact, most men are quite eager to try the technology.”

Moving research to practice

“The ultimate hope is to find better ways of identifying men who are high risk of having side effects sooner when they’re on treatment, and ways we can act quickly to reduce them,” says Dr. Alibhai. “Ultimately, men may be able to survive longer and better – with less suffering, less fatigue and less reduction in quality of life.”

Dr. Alibhai hopes the lessons learned in his study can be widely implemented in two years, for prostate cancer and other types of cancers. 
 

“More of these men might be able to safely go on therapy if we can find these new ways to monitor them safely that would allow them to tolerate therapies.”

A patient perspective

Tony Embleton turns 90 in 2019. Since being diagnosed with cancer in 2013, including prostate and bladder, he has been treated with surgery, radiation, hormone therapy and multiple rounds of chemotherapy.

Nearly a year ago, he enrolled in Dr. Alibhai’s initial research project, filling in paper questionnaires and undergoing cognitive and physical tests each time he attended the clinic.
“It did help me keep track of how I was feeling,” says Tony. “I’ve been lucky in terms of feeling pain. On the scale, it’s always been down in the 0-1-2-3 range.”

Tony understands how Dr. Ali bhai’s work will benefit others who are not so lucky as him. “Quality of life would play a big part, but I think the biggest aspect would mainly be to achieve the same treatment results, with less pain. The more knowledge the doctors have, or the closer they can monitor things, there’s bound to be a benefit.”

This project is proudly funded by Movember and awarded by Prostate Cancer Canada as part of the Discovery Grant program. In 2019, this was one of ten projects awarded through the program to save and improve more lives of those affected by prostate cancer.