ideasIdea
Cardiometabolic screening and treatment for survivors on long-term hormone therapy
Hormone-blocking treatments for prostate and breast cancer, taken for years, raise the risk of diabetes, heart disease and bone fractures. Survivors on these drugs should get the same preventive care as diabetics.
Androgen deprivation therapy increases diabetes, cardiovascular events, and fractures; aromatase inhibitors affect bone and lipids. Millions of survivors take these drugs for years, but cardiometabolic risk management is rarely owned by anyone. A protocolised pathway with baseline and annual metabolic and bone assessment, and treatment to targets, delivered by nurses or pharmacists, would prevent a substantial burden of non-cancer morbidity.
Hypothesis
Protocolised cardiometabolic management for survivors on long-term hormone therapy will reduce major cardiovascular events and fragility fractures by at least 20% over five years compared with usual care.
Rationale
The risks are well quantified and the preventive treatments are cheap and proven in other populations; the failure is one of ownership between oncology and primary care.
What would test it
A cluster-randomised trial across 30 practices or clinics with cardiovascular events, fractures, and treatment-to-target rates as endpoints.
Maturity
early clinical
Who has to act
clinic
Cost to try
Small (under $1M)
Years to first evidence
3
Bottlenecks it attacks
- Survivorship and late effects are neglected · Tens of millions of people live after cancer with heart damage, infertility, second cancers and fear, and few services.
- Older and multimorbid patients are excluded and undertreated · Most people with cancer are over 65 but most trial patients are younger and fitter. We guess how to treat the majority.