Opportunities to maximize value with integrated palliative care

Figures & data

Table 1 Treatment options to be considered by men with castrate-resistant prostate cancer

Treatment	Side effects	Quality of life benefit	Average survival benefit	Yearly cost (USD)	Logistic burden
Abiraterone	Fluid retention, hypertension, hypokalemia	Delays progression of pain and QOL deterioration if taken with prednisone	4 months	$60,000	Daily oral
Sipuleucel-T	Dizziness, arthralgia	None	4 months	$93,000	Biweekly infusion after leukopheresis
Enzalutamide	Seizures, hallucinations	Improved QOL when administered after docetaxel	2–5 months	$90,000	Daily oral
Radium 223	Myelosuppression, diarrhea	None	3–4 months	$70,000	Monthly infusion
Docetaxel (first-line chemo)	Hair loss, neuropathy	Improved QOL, reduced pain	3–4 months	$15,000	Every 3-week hourly infusion
Cabazitaxel (second-line chemo)	Neutropenia, hypersensitivity	Unknown	3 months	$45,000	Every 3-week hourly infusion
Cabozantinib	Fatigue, hypertension, hand-foot-mouth disease	Decreased bone pain	Unknown	$120,000	Daily oral
Palliative care	None	Unstudied in this population	Unstudied in this population; 3 months in individuals with metastatic lung cancer	Variable	Variable

Abbreviation: QOL, quality of life.

Table 2 Androgen deprivation options for men with castrate-resistant prostate cancer

Method of androgen deprivation	Unique benefits	Unique side effects	Yearly cost	Logistic burden
Surgical castration	Avoidance of ongoing interventions	Surgical morbidity	$4,000 (once)	One-time surgical procedure
Leuprolide	Lowest cost of injectables	Injection site pain	$2,400	Every 3 months subcutaneous
Leuprolide long acting	Least frequent dosing	Injection site pain, irreversible for 6 months	$6,000	Every 6 months subcutaneous
Bicalutamide	Reversible if side effects not tolerated	Less effective as monotherapy than other castration options	$365	Daily oral
Degarelix	Castration achieved by day 3 (7–14 days with leuprolide)	Cardiac arrhythmias	$6,000	Monthly subcutaneous