Pain and health-related quality of life in a geographically defined population of men with prostate cancer

In order to provide baseline data on pain and health-related quality of life, to explore factors predicting pain and reduced quality of life, and to find potentially undertreated cases in men with prostate cancer, we undertook a population-based questionnaire study. The questionnaire, which included the EuroQo1 instrument, the Brief Pain Inventory form and 8 specially designed questions, was sent to all men with prostate cancer in the county of Östergötland, Sweden. Of the 1442 men included in the study, 1243 responded to the questionnaire. Altogether 42% had perceived pain during the previous week and 26% stated their quality of life to be 50% or lower on a visual analogue scale. A high rating of health care availability and short time since diagnosis were found to significantly predict lower ratings of pain (P< 0.05). Pain was found to be a significant predictive factor for decreased quality of life together with high age, low rating of health care availability and palliative treatment (P< 0.05). In conclusion, assessment and treatment of pain is essential for a good quality of life in men with prostate cancer. The monitoring of prostate cancer patients should be individualized to fit the demands of the groups with the greatest need for support. © 2001 Cancer Research Campaign http://www.bjcancer.com     

Health-related quality of life in Dutch men with prostate cancer

Prostate cancer is the most prevalent solid malignancy in men in the Netherlands. With regard to treatment, the focus of attention has shifted in the last decade from pure survival rates to health-related quality of life. HRQOL is affected differently by different treatments. The objective of this study is to assess the HRQOL related to treatment regime and time since diagnosis in Dutch men with prostate cancer. We conducted a cross-sectional study among 238 men with prostate cancer in a heterogeneous sample who filled in a general health-related quality-of-life measure (EORTC-QLQ-C30) and a prostate cancer specific quality-of-life instrument (the EORTC-QLQ-PR25) and a Joy-of-Life questionnaire. Men on hormonal treatment are doing worse compared with other treatments with respect to physical functioning, role functioning, fatigue, pain and sexual functioning. No differences were found between radical prostatectomy and radiation therapy on any of the HRQOL dimensions nor for time since diagnosis. In hormonal therapy, men who are diagnosed longer than two years ago report a worse cognitive functioning and more burdens from urinary problems.     

Spirituality influences health related quality of life in men with prostate cancer

Spirituality is interdependent with the biological, psychological, and interpersonal aspects of life. Although spirituality has been studied in breast cancer survivors, little work has been done in men with prostate cancer. We sought to determine whether lower spirituality in men with early stage prostate cancer is associated with worse general health-related quality of life (HRQOL), disease-specific HRQOL, or psychosocial health. Two hundred and twenty-two subjects were drawn from a state-funded program providing free prostate cancer treatment to indigent men. Validated instruments captured spirituality, general and disease-specific HRQOL, anxiety, symptom distress, and emotional well-being. We found a consistent relationship between spirituality and the outcomes assessed. Low spirituality was associated with significantly worse physical and mental health, sexual function and more urinary bother after controlling for covariates. All of the psychosocial variables studied reflected worse adjustment in the men with low spirituality. Because the likelihood of prostate cancer survivorship is high, interventions targeting spirituality could impact the physical and psychosocial health of many men.     

Patient satisfaction with health-related quality of life: implications for prognosis in prostate cancer

PURPOSE: The goal of this study was to evaluate the association between patient satisfaction with health-related quality of life (HRQOL), as measured by the Ferrans and Powers Quality of Life Index (QLI), and survival in patients with prostate cancer treated in an integrative cancer treatment setting. MATERIALS AND METHODS: This is a case series of 230 histologically confirmed stage I-IV prostate cancers treated at Cancer Treatment Centers of America. Quality of Life Index measures overall HRQOL and HRQOL in 4 major subscales: health and physical, social and economic, psychological and spiritual, and family. Study patients were dichotomized into 2 groups based on the median scores for all QLI subscales. Kaplan- Meier and log-rank tests were used to evaluate survival. Multivariate Cox regression analyses were then performed to evaluate the joint prognostic significance of HRQOL and clinical factors. RESULTS: Patient satisfaction with health and physical (P = .0001), psychological and spiritual (P = .03), family (P = .02), and overall HRQOL (P = .0001) were statistically significantly associated with survival upon univariate analysis. Upon multivariate analysis, patient satisfaction with the health and physical subscale was found to be predictive of survival (P = .04), independent of the effects of previous treatment history and Gleason score. CONCLUSION: This study suggests that baseline patient satisfaction with health and physical function, as measured by the QLI, provides useful prognostic information in patients with prostate cancer, independent of previous treatment history and Gleason score. The QLI Index can be used as a stratification variable in the oncology clinic to aid in medical decision-making.     

Health-related quality of life in men with metastatic prostate cancer treated with prednisone alone or mitoxantrone and prednisone.

PURPOSE: A combination of mitoxantrone plus prednisone is preferable to prednisone alone for reduction of pain in men with metastatic, hormone-resistant, prostate cancer. The purpose of this study was to assess the effects of these treatments on health-related quality of life (HQL). PATIENTS AND METHODS: Men with metastatic prostate cancer (n = 161) were randomized to receive either daily prednisone alone or mitoxantrone (every 3 weeks) plus prednisone. Those who received prednisone alone could have mitoxantrone added after 6 weeks if there was no improvement in pain. HQL was assessed before treatment initiation and then every 3 weeks using the European Organization for Research and Treatment of Cancer Quality-of-Life Questionnaire C30 (EORTC QLQ-C30) and the Quality of Life Module-Prostate 14 (QOLM-P14), a trial-specific module developed for this study. An intent-to-treat analysis was used to determine the mean duration of HQL improvement and differences in improvement duration between groups of patients. RESULTS: At 6 weeks, both groups showed improvement in several HQL domains, and only physical functioning and pain were better in the mitoxantrone-plus-prednisone group than in the prednisone-alone group. After 6 weeks, patients taking prednisone showed no improvement in HQL scores, whereas those taking mitoxantrone plus prednisone showed significant improvements in global quality of life (P =.009), four functioning domains, and nine symptoms (.001 < P <. 01), and the improvement (> 10 units on a scale of 0 to100) lasted longer than in the prednisone-alone group (.004 < P <.05). The addition of mitoxantrone to prednisone after failure of prednisone alone was associated with improvements in pain, pain impact, pain relief, insomnia, and global quality of life (.001 < P <.003). CONCLUSION: Treatment with mitoxantrone plus prednisone was associated with greater and longer-lasting improvement in several HQL domains and symptoms than treatment with prednisone alone.     

Differences in health-related quality of life of prostate cancer patients based on stage of cancer

BACKGROUND: Understanding medical factors that influence quality of life for men with prostate cancer is an important goal. This study analysed the relationship between cancer stage and quality of life, including measures of physical and psychological well-being. METHOD: A secondary analysis of data from 341 ambulatory men with prostate cancer. The Functional Assessment of Cancer Therapy (FACT)-Prostate version, Urinary Function Subscale of UCLA Prostate Cancer Index, and Hospital Anxiety and Depression Scale (HADS), were administered during their clinic visit. Stage of disease and treatment history was obtained from clinic records. Patients were categorized into localised (T1-T2, N0, M0, n=186), locally advanced (T3-T4, N0, M0, n=92), and metastatic (T3-T4, N1-3 or Ma-c, n=63) disease. Differences in quality of life based on stage were examined using multivariate analyses controlling for age, treatment type, time since diagnosis, co-morbidities, and urinary function. RESULTS: Stage of prostate cancer was significantly associated with most FACT scales (Physical, Functioning, Social) and summary scores (Treatment Outcomes Index, FACT total score). However, no significant associations were observed between stage of cancer and psychological symptoms of depression or anxiety. This association remained significant even after controlling for the influence of illness co-morbidity, urinary functioning, time since diagnosis, age, and type of treatment. CONCLUSIONS: Higher cancer stage appears to be associated with poorer quality of life in prostate cancer and this association does not appear to be simply a function of the symptoms and disability that accompany advanced disease. These results have implications for understanding the impact of progression of prostate cancer on patients' health-related quality of life.     

Partnership status influences quality of life in low-income, uninsured men with prostate cancer

BACKGROUND: Being partnered confers significant benefits in survival for patients with prostate cancer, yet little is known of the impact of relationship status on health-related quality of life (HRQOL). The authors evaluated the influence of partnership on measures of HRQOL. METHODS: The authors studied 291 patients who were enrolled in a program that provided free treatment to impoverished, uninsured men with prostate cancer. The associations between relationship status and measures of general and disease-specific HRQOL were evaluated. Results from multivariate models determined the independent effect of partnership on HRQOL. RESULTS: Partnered patients were more likely than unpartnered patients to be Hispanic (58% vs. 34%) and were more likely to have elected surgical therapy (49% vs. 34%). Multivariate analyses, controlling for age, ethnicity, disease stage, and treatment type, revealed that partnered patients had better mental health (P = 0.009), less urinary bother (P = 0.011), higher spirituality (P = 0.037), and lower symptom distress (P = 0.005) than unpartnered participants. CONCLUSIONS: Relationship status had a positive effect on the quality of life of low-income, uninsured men with prostate cancer.     

Spirituality and quality of life in low‐income men with metastatic prostate cancer

Objective: To determine how spirituality is associated with health‐related quality of life (HRQOL) in an ethnically diverse cohort of low‐income men with metastatic prostate cancer. Methods: Eighty‐six participants in a state‐funded program that provides free prostate cancer treatment to uninsured, low‐income men completed written surveys and telephone interviews containing validated measures of spirituality, and general and disease‐specific HRQOL. Assessments were made following diagnosis of metastatic disease. We used multivariate analyses to assess the effect of spirituality and its two subscales, faith and meaning/peace, on HRQOL. Results: African American and Latino men, and men with less than a high‐school education had the highest spirituality scores. Spirituality was significantly associated with general and disease‐specific HRQOL. We also found a significant interaction between faith and meaning/peace in the physical and pain domains. Conclusion: Greater spirituality was associated with better HRQOL and psychosocial function. Meaning/peace closely tracks with HRQOL. Higher faith scores, in the absence of high meaning/peace scores, are negatively associated with HRQOL. Copyright © 2008 John Wiley & Sons, Ltd.     

Measuring health-related quality of life consequences from primary treatment for early-stage prostate cancer

Radical prostatectomy, external radiation therapy, and brachytherapy are all mainstay treatment options for clinically localized prostate cancer. Over time, each of these treatments has been modified so as to maximize percent cancer-free survival while minimizing health-related risks such as urinary incontinence, bowel incontinence, and sexual dysfunction. With these efforts, there is still not one superior single treatment that is devoid of side effects. Concurrently, efforts have been made to generate validated health-related quality of life (HRQOL) measurement scales to aid in the decision making by both physician and patient. HRQOL measurement scales enable physicians to have informed discussions with patients about potential likelihood of a given set of side effects with the various prostate cancer treatment options. This review will highlight prostate cancer HRQOL outcomes and delineate further areas of study necessary to optimize evidence-based decision making for prostate cancer patients.     

Self-assessed health-related quality of life in men who have completed radiotherapy for prostate cancer: instrument validation and its relation to patient-assessed bother of symptoms

The purpose of this study was to develop a psychometrically reliable and valid questionnaire to assess the disease-specific dimensions of health-related quality of life (HRQOL) in the urinary function (UF), bowel function (BF), and sexual function (SF) domains of prostate cancer (PCa) patients treated with radiation therapy. Patients were given a six-page questionnaire using Likert-type questions assessing three HRQOL dimensions during their follow-up visits after completing radiotherapy. Scales created from an earlier study were utilized and tested for reliability and validity. In addition, we assessed the relationship between these dimensions and the degree to which a decreased HRQOL increases the degree to which patients feel bothered about their symptoms. There are two scales within each dimension: BF, Urgency and Daily Living; UF, Urgency and Weakness of Stream; SF, Interest/Satisfaction and Impotence. Internal-consistency reliability coefficients (Cronbach's alpha) for the proposed scales range from 0.48 to 0.92, and all item-scale correlations and divergence correlations validate the use of the scales, ranging from 0.49 to 0.89. The validity of these scales is also confirmed by the rising median scores with rising reported levels of patient-perceived "bother." The different dimensions have differing quantitative influences on patients. We have developed a prostate-specific HRQOL instrument that is an adequate and suitable tool for measuring HRQOL along three distinct dimensions for patients who have completed radiotherapy for PCa. Psychometric standards for reliability and validity were met for the proposed scales. Moreover, positive correlations were found between these dimensions and how bothered patients were by their symptoms, suggesting important relationships that should be followed in PCa patients after radiotherapy. Certain scales have strong influences on patient-perceived "bothersomeness" of symptoms, such as loss of control of BF, urgency of BF, urgency of urination, and level of interest/satisfaction in sex. Compared to our earlier study on patients being treated with radiotherapy for PCa, this study produced very similar results. With some modification, the same questionnaire could be used for both groups of patients. Int. J. Cancer (Radiat. Oncol. Invest.) 90, 163-172 (2000).     

Antidepressant medication use and prostate cancer recurrence in men with depressive disorders

Cancer Causes & Control - Whether treating prostate cancer survivors with a depressive disorder with antidepressants can affect their cancer outcomes is unknown. We evaluated the association...     

Five-year follow-up of health-related quality of life after primary treatment of localized prostate cancer

Although with earlier detection of prostate cancer more men face the long-term consequences of primary treatment, studies on the impact of treatment on long-term health-related quality of life (HRQoL) are scarce. We followed 314 men with newly diagnosed localized prostate cancer from 1 month before until 5 years after radical prostatectomy (n = 127) or external beam radiotherapy (n = 187; median follow-up = 52 months). Questionnaires addressing disease-specific (UCLA PCI) and generic (SF-36, EQ-5D) HRQoL were sent 1 month before and 6, 12 and 52 months after treatment. Repeated-measures modeling was used to study HRQoL over time. Regular urinary leakage was reported by 12% of prostatectomy patients before treatment and by 31% at the 52-month assessment. Erectile dysfunction before treatment was reported by 31% of prostatectomy patients and by 40% of radiotherapy patients; at the 52-month assessment, these percentages were 88% and 64%, respectively. Erectile dysfunction present at 1 year posttreatment can be considered permanent. Prostatectomy patients reported better generic functioning both before and after treatment than radiotherapy patients, who were on average 5.9 years older and had more comorbid conditions. General physical functioning of prostatectomy patients slightly improved over time, but declined in radiotherapy patients. The relation between age and physical scores was found to be nonlinear. The long-term physical decline in radiotherapy patients partly resulted from aging and its nonlinear impact on health, although treatment effects cannot be excluded. Scores of both patient groups remained above those of norm populations. Innovative graphs describing disease-specific and generic functions after treatment can help patients and physicians in their treatment choices.     

Promising long-term health-related quality of life after high-dose-rate brachytherapy boost for localized prostate cancer

PURPOSE: To explore the long-term general and disease-specific health-related quality of life (HRQOL) >5 years after combined radiotherapy for localized prostate cancer, including a high-dose-rate brachytherapy boost and hormonal deprivation therapy. METHODS AND MATERIALS: Of 196 eligible patients with localized prostate cancer (Stage T1-T3a) consecutively treated with curative radiotherapy at our institution between June 1998 and August 2000, 182 (93%) completed the European Organization for Research and Treatment of Cancer Quality of Life questionnaires QLQ-C30 and QLQ-PR25, including specific questions on fecal incontinence >5 years after treatment in September 2005. A comparison with age-matched normative data was done, as well as a longitudinal analysis using HRQOL data from a previous study. RESULTS: The analysis included 158 nonrecurrent patients. Comparisons made with normative data showed that physical and role functioning were significantly better statistically and social functioning was significantly worse. Diarrhea and sleep disturbances were more pronounced and pain less pronounced than in a normal male population. The longitudinal analysis of disease-specific HRQOL showed that urinary urgency and erectile problems persisted 5 years after treatment, and nocturia and hormonally dependent symptoms had declined significantly, with a statistically significant difference. Fecal incontinence was recognized by 25% of patients, of whom 80% considered it a minor problem. CONCLUSION: More than 5 years after combined radiotherapy, irritative urinary problems and erectile dysfunction remain concerns, although severe bowel disturbance and fecal incontinence seem to be minor problems. Longitudinally, a decline mainly in hormonally dependent symptoms was seen. Minor differences in general HRQOL compared with normative data were observed, possibly including "response shift" effects.     

Profile of men randomized to the prostate cancer prevention trial: baseline health-related quality of life, urinary and sexual functioning, and health behaviors.

PURPOSE: To describe men who agreed to be randomized to the Prostate Cancer Prevention Trial (PCPT), a 7-year, double-blind placebo-controlled study of the efficacy of finasteride in preventing prostate cancer. METHODS: Comprehensive health-related quality-of-life data are presented for 18,882 randomized PCPT participants. RESULTS: PCPT participants are highly educated, middle to upper income, and primarily white (92%). Participants reported healthy lifestyles. The mean American Urological Association Symptom Index score was well below the maximum entry score of less than 19; existing urinary symptoms were generally not bothersome. The scores for two sexual functioning scales could range from 0 to 100, with higher scores reflecting worse sexual functioning. The mean score for the Sexual Problem Scale was 19.2 out of 100, and the mean Sexual Activities Scale was 44.1 out of 100. Scores for seven of the eight Medical Outcomes Study 36-item Short-Form Health Survey scales (higher scores are better) were 10 to 20 points higher than those reported by a general population sample and differed minimally by race but not by age. Previously reported associations between sexual dysfunction and hypertension, diabetes, and depression were also observed. Men who never smoked reported less sexual dysfunction than did those who either had quit or still smoked. CONCLUSION: Individuals who are likely to enroll in primary prevention trials have a high socioeconomic status, healthy lifestyle behaviors, and better health than the general population. These data help oncologists design chemoprevention trials with respect to the selection of health-related quality-of-life assessments and recruitment strategies.     

同期放疗联合内分泌治疗对中晚期前列腺癌患者生存质量的影响

目的 探讨同期放疗联合内分泌治疗对中晚期前列腺癌患者生存质量的影响.方法 选取中晚期前列腺癌患者82例,依据治疗方式的不同分为对照组(n=41)和研究组(n=41).对照组行三维适形放射治疗,研究组行同期放射治疗联合内分泌治疗(口服比卡鲁胺50 mg,每天1次,皮下注射戈舍瑞林3.6 mg,每28 d 1次,持续3年).比较两组患者放疗前和放疗后3年的最大尿流率、前列腺癌症状评分表(EPIC)评分及并发症发生情况.结果 放疗后3年,研究组和对照组患者的最大尿流率分别为(13.67±1.68)ml/s和(11.03±0.98)ml/s,差异有统计学意义(P﹤0.05);研究组患者的EPIC评分高于对照组(P﹤0.05);研究组和对照组患者在治疗期间的并发症总发生率分别为41.5%和70.7%,差异有统计学意义(P﹤0.05).结论 同期放疗联合内分泌治疗能够改善中晚期前列腺癌患者的生理功能状况,减少不良反应,提高患者的生存质量,具有重要的临床应用价值.