2014 PCRP Investigator Vignette

Title: An Intervention to Control Vasomotor Symptoms for Advanced PC Patients on Hormone Therapy

Investigator: Michael Diefenbach, PhD; Icahn School of Medicine at Mount Sinai, NY

The most recent grant that we've received from the PCRP deals with symptom control among patients who have had definite treatment for prostate cancer but then had a recurrence of prostate cancer that is being treated with hormones or androgen deprivation therapy. Those hormones in some men cause side effects such as hot flashes. Just like among women who go through menopause; these hot flashes can be quite bothersome, and there is no really good pharmaceutical control available.

So we decided that we are looking for a non-pharmacological intervention that is a slow-breathing exercise just as you find it in yoga exercises, for example, or that also has been found to be successful among women who have menopausal hot flashes. And so, because hot flashes can occur any time during the day or at night, the patient would be required to engage in a slow breathing exercise right at the spot. If they're not as familiar with what to do, we developed a software in the form of an app for the i-Touch that the patient can immediately fire up and then start the slow-breathing mechanism. The app has the advantage that it is graphics-based, and so we have not only music but also graphics that show the correct rhythm with which the patient should breathe. So it's a six-second breathing in and a six-second breathing out, and the other nice thing about this app is that we can track how often the software was used, and the software then, at the end of the episode, asks the patient to indicate how severe it was. So, we have also this little research study built in that we can immediately tell whether this program is actually successful in reducing the frequency and the severity of this-of those hot flash episodes among prostate cancer patients who have these hot flashes.

The breathing techniques have been found to reduce the hot flash intensity and the frequency among women who have these kinds of problems when they go through menopause. We've decided that we should apply this to men who have these artificially induced, almost menopausal, symptoms.

We haven't really quite figured out why the breathing exercises work. We just know that it works in certain populations. Some researchers have suggested a physiological mechanism, an overall slowing down.

It is certainly possible that it is a distraction phenomenon, and we are taking that into account because we are randomizing patients to either do the slow breathing or to concentrate on something else. So if they are in the comparison condition, then they also get the i-Touch, they go through the motions-but not through the breathing motions-but they are then asked to play a game, and that's a distracting game-not too challenging, not too exciting, but something to just take their mind off from the hot flash.

And so we have a way then to figure out whether it's just a distraction, for example, or whether it's the deep breathing with the hypothesized physiological mechanism that really is responsible for a hopefully reduced hot flash experience.

We're right now in the field. We are actively collecting data, and our main partner in that is the VA in the Bronx in New York.

I think the impact of the DoD Prostate Cancer Research Program has been tremendous. One has to consider that they're not only supporting behavioral research, but they're also supporting basic science research and clinical research; and all together, this additional funding that is provided by the DoD has made a tremendous impact and has generated many, many thousands of publications, and has, I would estimate, changed the lives of quite a number of prostate cancer patients.