{"entity":{"id":"idea-acc-cardiometabolic-clinic-hormone-therapy","kind":"idea","name":"Cardiometabolic screening and treatment for survivors on long-term hormone therapy","aka":[],"tldr":"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.","summary":"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.","asOf":"2026-09-08","links":[{"label":"Bottleneck evidence (Survivorship and late effects are neglected): NCI Office of Cancer Survivorship statistics","url":"https://cancercontrol.cancer.gov/ocs/statistics"}],"tags":[],"related":["prostate-roadmap","idea-prostate-other-cause-mortality-as-a-reported-service-outcome"],"cancers":["prostate","breast-hr-positive"],"sections":[],"technologies":["androgen-deprivation","endocrine-therapy"],"targets":[],"drugs":[],"companies":[],"institutions":[],"pathways":[],"terms":[],"trials":[],"people":[],"bottlenecks":["b-survivorship","b-aging-comorbidity"],"keyPapers":[],"journals":[],"dependsOn":[],"notes":[],"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.","test":"A cluster-randomised trial across 30 practices or clinics with cardiovascular events, fractures, and treatment-to-target rates as endpoints.","maturity":"early-clinical","actor":"clinic","cost":"small","horizonYears":3},"route":"/ideas/idea-acc-cardiometabolic-clinic-hormone-therapy/","neighbours":{"roadmap":[{"id":"hormonal-therapy-roadmap","kind":"roadmap","name":"Hormonal therapy roadmap: removing the ovaries → tamoxifen → oral degraders switched by a blood test","route":"/roadmaps/hormonal-therapy-roadmap/"},{"id":"prostate-roadmap","kind":"roadmap","name":"Prostate cancer roadmap: from Huggins and the discovery that a cancer can depend on a hormone, through the PSA epidemic and what it cost, the androgen receptor drugs, the DNA repair subset and PSMA, to a 2032 registry watch","route":"/roadmaps/prostate-roadmap/"}],"idea":[{"id":"idea-prostate-other-cause-mortality-as-a-reported-service-outcome","kind":"idea","name":"Report death from other causes as an outcome of the prostate cancer service, split by deprivation and ethnicity","route":"/ideas/idea-prostate-other-cause-mortality-as-a-reported-service-outcome/"}],"cancer":[{"id":"breast-hr-positive","kind":"cancer","name":"HR-positive / HER2-negative breast cancer","route":"/cancers/breast-hr-positive/"},{"id":"prostate","kind":"cancer","name":"Prostate cancer","route":"/cancers/prostate/"}],"technology":[{"id":"androgen-deprivation","kind":"technology","name":"Androgen deprivation & AR pathway inhibitors","route":"/technologies/androgen-deprivation/"},{"id":"endocrine-therapy","kind":"technology","name":"Endocrine therapy (SERMs, AIs, SERDs)","route":"/technologies/endocrine-therapy/"}],"bottleneck":[{"id":"b-aging-comorbidity","kind":"bottleneck","name":"Older and multimorbid patients are excluded and undertreated","route":"/bottlenecks/b-aging-comorbidity/"},{"id":"b-survivorship","kind":"bottleneck","name":"Survivorship and late effects are neglected","route":"/bottlenecks/b-survivorship/"}],"paper":[{"id":"paper-dess-black-race-prostate-mortality-jama-oncol-2019","kind":"paper","name":"Association of Black race with prostate cancer-specific and other-cause mortality","route":"/key-papers/paper-dess-black-race-prostate-mortality-jama-oncol-2019/"}]}}