Health related quality of life in prostate carcinoma patients: a systematic review of randomized controlled trials

Factors affecting health-related quality of life among prostate cancer patients: A systematic review

INTRODUCTION

Prostate cancer is recognized as the leading cause of malignancy-related incidence and mortality in the male population. The treatment regimens have long-term effects detrimental to the patient's quality of life. Hence, this review was aimed to determine the overall HRQOL and its associated among prostate cancer patients.

METHODS

The review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The databases searched were PubMed, Embase, Google Scholar and Cumulative Index to the Nursing and Allied Literature (CINAHL), which provided articles that were critically examined, yielding 52 studies that met the inclusion criteria for the systematic review.

RESULTS

Out of 52 studies, 30 studies reported poor overall HRQOL in various domains after prostate cancer treatment. Contrastingly, 15 studies reported good overall quality of life after treatment. Among the various domains, sexual function was the most grossly affected functional score by the treatment modalities of prostate cancer. Nonetheless, seven studies showed that the absence of a significant change in the overall quality of life after treatment. According to the studies, older age, comorbidities, higher clinical stage, higher Gleason score, greater cancer severity, African American race, impaired mental health, neoadjuvant hormonal therapy and lower level of education were the major poor predictors of HRQOL among prostate cancer patients.

CONCLUSION

The overall HRQOL in prostate cancer patients was generally poor in various functional domains after treatment. Among the various domains, sexual function was the most grossly affected functional score by the treatment modalities of prostate cancer.

Patient-Reported Outcomes in Sinonasal and Skull Base Malignancy: An Assessment of Study Quality and Clinical Relevance

BACKGROUND

Sinonasal and skull base malignancies can cause significant adverse effects on functional status and survival.

OBJECTIVE

The goal of this study was to systematically review the published literature of patient-reported outcomes pertaining to treatment of sinonasal and skull base malignancy.

METHODS

A systematic literature search of Medline was conducted with PubMed to identify studies that assessed patient-reported outcomes in patients with sinonasal or skull base malignancy. Patient-reported outcomes studies with at least 10 patients published in English from January 2000 to April 2017 were included. Criteria from International Society for Quality of Life guidelines and criteria unique to sinonasal and skull base malignancies were used to calculate a composite score for each article. Studies with the top 33% of scores were categorized as high quality articles.

RESULTS

Twenty-two articles met inclusion/exclusion criteria. Three studies (14%) reported a priori hypothesis. Eleven (50%) assessed specific quality of life domains and 10 studies (45%) performed statistical analysis on these domains. Specific symptoms were assessed in up to 32% of studies. Eight studies were characterized as high quality; these studies had higher sample sizes and more often assessed patient-reported outcomes prior to treatment compared to low quality studies.

CONCLUSIONS

The goal of the current study was to evaluate the quality of the current patient-reported outcomes literature on sinonasal and skull base malignancies. Areas of improvement for future studies include analysis of individual domains and disease-specific symptoms, reporting a priori hypotheses, and collecting preoperative and longitudinal patient-reported outcomes data.

Patient-Centered Outcomes From Multiparametric MRI and MRI-Guided Biopsy for Prostate Cancer: A Systematic Review

OBJECTIVE

To identify and characterize patient-centered outcomes (PCOs) relating to multiparametric MRI (mpMRI) and MRI-guided biopsy as diagnostic tests for possible prostate cancer.

METHODS

Medline via OVID, EMBASE, PsycInfo, and the Cochrane Central register of Controlled Trials (CENTRAL) were searched for relevant articles. Hand searching of reference lists and snowballing techniques were performed. Studies of mpMRI and MRI-guided biopsy that measured any PCO were included. There were no restrictions placed on year of publication, language, or country for study inclusion. All database search hits were screened independently by two reviewers, and data were extracted using a standardized form.

RESULTS

Overall, 2,762 database search hits were screened based on title and abstract. Of these, 222 full-text articles were assessed, and 10 studies met the inclusion criteria. There were 2,192 participants featured in the included studies, all of which were conducted in high-income countries. Nineteen different PCOs were measured, with a median of four PCOs per study (range 1-11). Urethral bleeding, pain, and urinary tract infection were the most common outcomes measured. In the four studies that compared mpMRI or MRI-guided biopsy to transrectal ultrasound biopsy, most adverse outcomes occurred less frequently in MRI-related tests. These four studies were assessed as having a low risk of bias.

DISCUSSION

PCOs measured in studies of mpMRI or MRI-guided biopsy thus far have mostly been physical outcomes, with some evidence that MRI tests are associated with less frequent adverse outcomes compared with transrectal ultrasound biopsy. There was very little evidence for the effect of mpMRI and MRI-guided biopsy on emotional, cognitive, social, or behavioral outcomes.

Patient Reported Outcomes Have Arrived: A Practical Overview for Clinicians in Using Patient Reported Outcomes in Oncology

Ensuring that the patient's voice is routinely incorporated in all aspects of health care in oncology is essential to provide quality care. Patient reported outcomes (PROs) are standardized measures that are used to obtain the patient's perspective and are increasingly used in all aspects of health care to ensure optimal delivery of patient-centered care. The US Food and Drug Administration encourages that PROs be used in studies for label indications. There are no uniform standardized methods to use PROs nor is there consensus on which PROs are best for regulatory approval, comparative effectiveness research, toxicity assessment, health-related quality of life, or symptom monitoring. For this review, we conducted a literature search using PubMed and Google Scholar, and herein summarize the evidence related to the use of PROs in clinic care and research. Using valid, reliable, and easily interpretable PROs developed in comparable populations will provide the most useful results. Various ways that PROs can be used successfully in oncology have been exemplified in this overview to provide clinicians and researchers practical guidance.

Quality of life in cancer patients-a comparison of inpatient, outpatient, and rehabilitation settings

PURPOSE

The aim of this study was to compare quality of life (QoL) data from cancer patients in different clinical settings with data from the general population.

METHODS

A sample of 4020 German cancer patients (1735 inpatients, 1324 outpatients, 961 participants in rehabilitation treatment) was tested with the EORTC QLQ-C30.

RESULTS

Compared with the general population, cancer patients reported markedly worse QoL. There were clinically significant differences on all 15 scales of the EORTC QLQ-C30 (except one). For the sum score, averaging across 13 scales, the effect size of the difference between cancer patients and the general population was d = 1.16. Inpatients reported the greatest detriments to QoL, followed by the rehabilitation patients and the outpatients (mean sum scores 68.6, 71.0, and 72.3, respectively, compared with 89.2 in the general population). Mean scores for different groups of cancer sites are given separately for the three settings.

CONCLUSION

The detriments to QoL were stronger than in comparable studies conducted on data from clinical trials. Since these detriments were found in all three settings to a similar degree, health care providers should offer their services not only to inpatients but to outpatients and patients treated in rehabilitation clinics as well. The data can be used for QoL comparisons of assessments from different settings.

'Trial Exegesis': Methods for Synthesizing Clinical and Patient Reported Outcome (PRO) Data in Trials to Inform Clinical Practice. A Systematic Review

Purpose

The CONSORT extension for patient reported outcomes (PROs) aims to improve reporting, but guidance on the optimal integration with clinical data is lacking. This study examines in detail the reporting of PROs and clinical data from randomized controlled trials (RCTs) in gastro-intestinal cancer to inform design and reporting of combined PRO and clinical data from trials to improve the ‘take home’ message for clinicians to use in practice.

Materials and Methods

The case study was undertaken in gastro-intestinal cancer trials. Well-conducted RCTs reporting PROs with validated instruments were identified and categorized into those combining PRO and clinical data in a single paper, or those separating data into linked primary and supplemental papers. Qualitative methods were developed to examine reporting of the critical interpretation of the trial results (trial exegesis) in the papers in relation of the PRO and clinical outcomes and applied to each publication category. Results were used to inform recommendations for practice.

Results

From 1917 screened abstracts, 49 high quality RCTs were identified reported in 36 combined and 15 linked primary and supplemental papers. In-depth analysis of manuscript text identified three categories for understanding trial exegesis: where authors reported a “detailed”, “general”, or absent PRO rationale and integrated interpretation of clinical and PRO results. A total of 11 (30%) and 6 (16%) combined papers reported “detailed” PRO rationale and integrated interpretation of results although only 2 (14%) and 1 (7%) primary papers achieved the same standard respectively. Supplemental papers provide better information with 11 (73%) and 3 (20%) achieving “detailed” rationale and integrated interpretation of results. Supplemental papers, however, were published a median of 20 months after the primary RCT data in lower impact factor journals (median 16.8 versus 5.2).

Conclusion

It is recommended that single papers, with detailed PRO rationale and integrated PRO and clinical data are published to optimize trial exegesis. Further work to examine whether this improves the use of PRO data to inform practice is needed.

Quality of life in penile carcinoma patients - post-total penectomy

INTRODUCTION

Total amputation, as a treatment for advanced penile cancer, significantly debilitates the patient's quality of life and sexual function. The aim of the study was to assess the quality of life in patients who had undergone total penectomy.

MATERIAL AND METHODS

The questionnaires EORTC QLQ C-30, SES, CMNI, and a modified IIEF-15 questionnaire, were sent to 11 patients.

RESULTS

A total of 10 patients returned the questionnaires completed. The results of the overall quality of life, the median result in individual domains, as assessed by the EORT QLQ C-30 questionnaire, were clearly lower than the reference results. There were statistically significant differences in the results of the QLQ C-30, concerning the role-functioning domain in relation to age (p = 0.008) and education (p = 0.032), in the domain of emotional functioning in relation to education (p = 0.008) and in the domains of physical functioning in relation to the partner relationship (p = 0.032). A significant number of patients were sexually inactive. Sexual activity as defined by touching the area of the pubic symphysis at the scars of the penis, touching and fondling perianal areas or the scrotum and watching things/people that cause excitement was observed in 2/10, 1/10 and 2/10 of patients respectively. In 5/6 of these patients, partnership relationships did not deteriorate, including one patient for whom the relationship actually improved.

CONCLUSIONS

The results obtained indicate that total amputation of the penis significantly affects one's sex life and overall quality of life. However, this does not have negative implications in terms of partnership relations, self-assessment or the evaluation of masculinity.

Graphical displays of patient-reported outcomes (PRO) for use in clinical practice: What makes a pro picture worth a thousand words?

Patient-reported outcomes (PROs) report patients' assessments of the impact of a health condition and its treatment, and can promote patient-centered care.

OBJECTIVES

To address the effectiveness of graphic display of PRO data in clinical practice by reviewing existing literature, and current recommendations, regarding graphic presentations of PROs.

METHODS

We performed an integrated literature review to identify themes and emerging principles guiding effective graphic display of PRO data. The findings were placed in the context of the literature informing graphical presentation of other clinical data.

RESULTS

Although a large body of literature informs graphical presentation of clinical data, only nine empirical studies addressed presentation of PROs. Four major themes emerged: many patients and most clinicians can accurately interpret some PRO graphs; interpretation accuracy, personal preference, and perceived level of understanding are sometimes discordant; patient age and education may predict PRO graph comprehension; patients tend to prefer simpler graphs than do clinicians.

CONCLUSIONS

Little empirical research specifically addresses graphic representation of PRO data. A single format may not work optimally for both clinicians and patients.

PRACTICE IMPLICATIONS

Patients and clinicians may or may not comprehend PRO data when graphically presented. Further research to determine best practices for presenting PROs optimally is needed.

USE OF PATIENT ASSESSED HEALTH-RELATED QUALITY OF LIFE INSTRUMENTS IN PROSTATE CANCER RESEARCH: A SYSTEMATIC REVIEW OF THE LITERATURE 2002-15

OBJECTIVES

The objectives of this study were to identify and qualitatively describe, in a systematic literature review, published studies that collected prostate cancer patients' health-related quality of life (HRQoL) estimates by using validated, generic instruments.

METHODS

Systematic searches of the literature were made using the Medline, Cochrane Library, PsycINFO, and CINAHL electronic databases from 2002 to 2015.

RESULTS

The search identified 2,171 references, of which 237 were obtained for full-text assessment; thirty-three of these articles were deemed relevant and included in the systematic review. An indirect valuation method was used in 73 percent (n = 24) of the studies. The most commonly used HRQoL instrument with an indirect valuation method was the EuroQol (EQ-5D; n = 21), and the second most common was the 15D (n = 5). A direct valuation method was used in 48 percent (n = 16) of the studies. Of these, the Visual Analogue Scale (VAS) was the most often used (n = 10), followed by the Time-Trade-Off (n = 6). HRQoL scores varied in localized and early stage disease between 0.63 and 0.91, and in advanced or metastatic disease stage between 0.50 and 0.87. There was also variance in the HRQoL instruments and study methods used, which explains the large variance in HRQoL scores between the various disease stages.

CONCLUSIONS

Although utility and quality-adjusted life-years gained are considered important measures of effectiveness in health care, the number of studies in which utilities of prostate cancer patients have been estimated using generic HRQoL instruments, based on either direct or indirect measurement of HRQoL, is fairly small.

Development of a Standardized Set of Patient-centered Outcomes for Advanced Prostate Cancer: An International Effort for a Unified Approach

BACKGROUND

There are no universally monitored outcomes relevant to men with advanced prostate cancer, making it challenging to compare health outcomes between populations.

OBJECTIVE

We sought to develop a standard set of outcomes relevant to men with advanced prostate cancer to follow during routine clinical care.

DESIGN, SETTING, AND PARTICIPANTS

The International Consortium for Health Outcomes Measurement assembled a multidisciplinary working group to develop the set.

OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS

We used a modified Delphi method to achieve consensus regarding the outcomes, measures, and case mix factors included.

RESULTS AND LIMITATIONS

The 25 members of the multidisciplinary international working group represented academic and nonacademic centers, registries, and patients. Recognizing the heterogeneity of men with advanced prostate cancer, the group defined the scope as men with all stages of incurable prostate cancer (metastatic and biochemical recurrence ineligible for further curative therapy). We defined outcomes important to all men, such as overall survival, and measures specific to subgroups, such as time to metastasis. Measures gathered from clinical data include measures of disease control. We also identified patient-reported outcome measures (PROMs), such as degree of urinary, bowel, and erectile dysfunction, mood symptoms, and pain control.

CONCLUSIONS

The international multidisciplinary group identified clinical data and PROMs that serve as a basis for international health outcome comparisons and quality-of-care assessments. The set will be revised annually.

PATIENT SUMMARY

Our international group has recommended a standardized set of patient-centered outcomes to be followed during routine care for all men with advanced prostate cancer.

Assessment of the relationship between resilience and quality of life in patients with digestive cancer

AIM: To study the relationship between resilience and quality of life (QOL) in patients with digestive cancer.

METHODS: The resilience of patients was measured prior to treatment, and their psychological distress, fatigue status, and treatment side effects were assessed 3 wk after. Their QOL was measured after their treatment ended. A relationship model of these variables was constructed using path analysis.

RESULTS: Resilience explained 33.2% of the variance in psychological distress, 16.1% of the variance in fatigue, and 1.23% of the variance in side effects. The relationship between resilience and QOL was statistically significant (β = 0.119, t = 4.499, P < 0.001) when psychological distress, fatigue, and side effects were absent from the regression model, whereas the adjusted regression coefficient of resilience was not statistically significant (t = 1.562, P > 0.05) when these variables were added. Psychological distress, together with fatigue and side effects, could explain 52.40% of the variance in QOL (P < 0.05). Physiological distress accounted for 28.94% of the total effect on QOL, fatigue accounted for 33.72%, side effects accounted for 22.53%, and resilience accounted for 14.80%.

CONCLUSION: Resilience is not an independent predictor of QOL in patients with digestive cancer, but it is a main factor influencing psychological distress and side effects.

Patient-reported outcomes in randomised controlled trials of prostate cancer: methodological quality and impact on clinical decision making

CONTEXT

Patient-reported outcomes (PRO) data from randomised controlled trials (RCTs) are increasingly used to inform patient-centred care as well as clinical and health policy decisions.

OBJECTIVE

The main objective of this study was to investigate the methodological quality of PRO assessment in RCTs of prostate cancer (PCa) and to estimate the likely impact of these studies on clinical decision making.

EVIDENCE ACQUISITION

A systematic literature search of studies was undertaken on main electronic databases to retrieve articles published between January 2004 and March 2012. RCTs were evaluated on a predetermined extraction form, including (1) basic trial demographics and clinical and PRO characteristics; (2) level of PRO reporting based on the recently published recommendations by the International Society for Quality of Life Research; and (3) bias, assessed using the Cochrane Risk of Bias tool. Studies were systematically analysed to evaluate their relevance for supporting clinical decision making.

EVIDENCE SYNTHESIS

Sixty-five RCTs enrolling a total of 22 071 patients were evaluated, with 31 (48%) in patients with nonmetastatic disease. When a PRO difference between treatments was found, it related in most cases to symptoms only (n=29, 58%). Although the extent of missing data was generally documented (72% of RCTs), few reported details on statistical handling of this data (18%) and reasons for dropout (35%). Improvements in key methodological aspects over time were found. Thirteen (20%) RCTs were judged as likely to be robust in informing clinical decision making. Higher-quality PRO studies were generally associated with those RCTs that had higher internal validity.

CONCLUSIONS

Including PRO in RCTs of PCa patients is critical for better evaluating the treatment effectiveness of new therapeutic approaches. Marked improvements in PRO quality reporting over time were found, and it is estimated that at least one-fifth of PRO RCTs have provided sufficient details to allow health policy makers and physicians to make critical appraisals of results.

PATIENT SUMMARY

In this report, we have investigated the methodological quality of PCa trials that have included a PRO assessment. We conclude that including PRO is critical to better evaluating the treatment effectiveness of new therapeutic approaches from the patient's perspective. Also, at least one-fifth of PRO RCTs in PCa have provided sufficient details to allow health policy makers and physicians to make a critical appraisal of results.

Overcoming barriers to the implementation of patient-reported outcomes in cancer clinical trials: the PROMOTION Registry

Every cancer treatment, irrespective of its clinical effectiveness, has an impact on patients’ quality of life (QoL). Even recently developed targeted therapies might have side effects and significantly impact patients’ QoL. Thus, understanding the advantages and disadvantages of different treatments from the patient’s standpoint has become a must in clinical research and is highly valued by major stakeholders. Thousands of cancer patients are enrolled into randomized controlled trials (RCTs) each year and many complete patient-reported outcome (PRO) instruments to obtain patient-centered information as part of the assessment of the overall effectiveness of the new therapy. Some of these RCTs have generated high quality PRO evidence forming the basis for approval (or support to approval) of drugs by the US Food and Drug Administration. However, a consistent strategy to determine the quality of patient centered evidence presented in RCTs has until recently been lacking. One of the fundamental questions when including PROs in clinical research revolves around methodological robustness and consistency of outcome reporting. Cancer patients, physicians and healthcare system stakeholders need to rely on solid information to make the best possible choice regarding treatment. Therefore generating high-quality findings from PRO assessment in cancer trials is of paramount importance. In an effort to improve quality of PRO assessment and reporting in the near future, the Patient-Reported Outcome Measurements Over Time In ONcology (PROMOTION) Registry was developed. The scope of this Registry is to identify, track, analyse, and store information on all cancer RCTs that have included PROs, and assess the quality of their PRO assessments.

Patient-reported outcomes in randomised controlled trials of gynaecological cancers: investigating methodological quality and impact on clinical decision-making

AIM

The aim for this study is to investigate the methodological quality and potential impact on clinical decision making of patient reported outcome (PRO) assessment in randomised controlled trials (RCTs) in the gynaecological cancer sites.

METHODS

A systematic review identified RCTs published between January 2004 and June 2012. Relevant studies were evaluated using a pre-determined extraction form which included: (1) Trial demographics and clinical and PRO characteristics; (2) level of PRO reporting and (3) bias, assessed using the Cochrane Risk of Bias tool. All studies were additionally analysed in relation to their relevance in supporting clinical decision making.

RESULTS

Fifty RCTs enrolling 24,991 patients were identified. In eight RCTs (16%) a PRO was the primary end-point. Twenty-one studies (42%) were carried out in a multi-national context. Where statistically significant PRO differences between treatments were found, it related in most cases to both symptoms and domains other than symptoms (n=17, 57%). The majority of studies (n=42, 84%) did not mention the mode of administration nor the methods of collecting PRO data. Statistical approaches for dealing with missing data were only explicitly mentioned in nine RCTs (18%). Sixteen RCTs (32%) were considered to be of high-quality and thus able to inform clinical decision making. Higher-quality PRO studies were generally associated with RCTs that were at a low risk of bias.

CONCLUSION

This study showed that RCTs with PROs were generally well designed and conducted. In a third the information was very informative to fully understand the pros and cons of PROs treatment decision-making.

Assessing quality of life in patients with prostate cancer: a systematic and standardized comparison of available instruments

Purpose

The objective was to obtain a standardized evaluation of available prostate cancer-specific quality of life instruments used in patients with early-stage disease.

Methods

We carried out systematic literature reviews in the PubMed database to identify manuscripts which contained information regarding either the development process or metric properties of prostate cancer-specific quality of life instruments. Each instrument was evaluated by two experts, independently, using the Evaluating Measures of Patient-Reported Outcomes (EMPRO) tool. An overall and seven attribute-specific EMPRO scores were calculated (range 0–100, worst to best): measurement model, reliability, validity, responsiveness, interpretability, burden and alternative forms.

Results

Eight instruments and 57 manuscripts (2–15 per instrument) were identified. The Expanded Prostate Cancer Index Composite (EPIC) was the best rated (overall EMPRO score 83.1 points). Good results were also obtained by University of California Los Angeles-Prostate Cancer Index (UCLA-PCI), Patient-Oriented Prostate Utility Scale (PORPUS) and Prostate Cancer Quality of Life Instrument (PC-QoL) with 77.3, 70.5 and 64.8 points, respectively. These four instruments passed with distinction the validity and responsiveness evaluation. Insufficient reliability results were observed for UCLA-PCI and PORPUS.

Conclusions

Current evidence supports the choice of EPIC, PORPUS or PC-QoL. Attribute-specific EMPRO results facilitate selecting the adequate instrument for every purpose. For longitudinal studies or clinical trials, where responsiveness is the priority, EPIC or PC-QoL should be considered. We recommend the PORPUS for economic evaluations because it allows cost-utility analysis, and EPIC short versions to minimize administration burden.

Electronic supplementary material

The online version of this article (doi:10.1007/s11136-014-0678-8) contains supplementary material, which is available to authorized users.

Health-related quality of life in small-cell lung cancer: a systematic review on reporting of methods and clinical issues in randomised controlled trials

Small-cell lung cancer represents about 15% of all lung cancers; increasingly, randomised controlled trials of this disease measure the health-related quality of life of patients. In this Systematic Review we assess the adequacy of reporting of health-related quality-of-life methods in randomised controlled trials of small-cell lung cancer, and the potential effect of this reporting on clinical decision making. Although overall reporting of health-related quality of life was acceptable, improvements are needed to optimise the use of health-related quality of life in randomised controlled trials.

The CONSORT Patient-Reported Outcome (PRO) extension: implications for clinical trials and practice

To inform clinical guidelines and patient care we need high quality evidence on the relative benefits and harms of intervention. Patient reported outcome (PRO) data from clinical trials can "empower patients to make decisions based on their values" and "level the playing field between physician and patient". While clinicians have a good understanding of the concept of health-related quality of life and other PROs, evidence suggests that many do not feel comfortable in using the data from trials to inform discussions with patients and clinical practice. This may in part reflect concerns over the integrity of the data and difficulties in interpreting the results arising from poor reporting.The new CONSORT PRO extension aims to improve the reporting of PROs in trials to facilitate the use of results to inform clinical practice and health policy. While the CONSORT PRO extension is an important first step in the process, we need broader engagement with the guidance to facilitate optimal reporting and maximize use of PRO data in a clinical setting. Endorsement by journal editors, authors and peer reviewers are crucial steps. Improved design, implementation and transparent reporting of PROs in clinical trials are necessary to provide high quality evidence to inform evidence synthesis and clinical practice guidelines.

Reporting of health-related quality of life (HRQOL) data in oncology trials: a comparison of the European Organization for Research and Treatment of Cancer Quality of Life (EORTC QLQ-C30) and the Functional Assessment of Cancer Therapy-General (FACT-G)

PURPOSE

The inclusion of patient-reported outcome (PRO) instruments to record patient health-related quality of life (HRQOL) data has virtually become the norm in oncology randomised controlled trials (RCTs). Despite this fact, recent concerns have focused on the quality of reporting of HRQOL. The primary aim of this study was to evaluate the quality of reporting of HRQOL data from two common instruments in oncology RCTs.

DESIGN

A meta-review was undertaken of systematic reviews reporting HRQOL data collected using PRO instruments in oncology randomised controlled trials (RCTs). English language articles published between 2000 and 2012 were included and evaluated against a methodology checklist.

RESULTS

Four hundred and thirty-five potential articles were identified. Six systematic reviews were included in the analysis. A total of 70,403 patients had completed PROs. The European Organization for Research and Treatment of Cancer QLQ-C30 and Functional Assessment of Cancer Therapy-General questionnaire accounted for 55 % of RCTs. Eighty per cent of RCTs had used psychometrically validated instruments; 70 % reported culturally valid instruments and almost all reported the assessment timing (96 %). Thirty per cent of RCTS reported clinical significance and missing data. In terms of methodological design, only 25 % of RCTs could be categorised as probably robust.

CONCLUSION

The majority of oncology RCTs has shortcomings in terms of reporting HRQOL data when assessed against regulatory and methodology guidelines. These limitations will need to be addressed if HRQOL data are to be used to successfully support clinical decision-making, treatment options and labelling claims in oncology.

Interdisciplinary decision making in prostate cancer therapy - 5-years' time trends at the Interdisciplinary Prostate Cancer Center (IPC) of the Charité Berlin

Background

Patients with prostate cancer face the difficult decision between a wide range of therapeutic options. These men require elaborate information about their individual risk profile and the therapeutic strategies´ risks and benefits to choose the best possible option. In order to detect time trends and quality improvements between an early patient population (2003/2004) and a later reference group (2007/2008) data was analysed with regards to epidemiologic parameters, differences in diagnostics and the type and ranking of the recommended therapies taking into account changes to Gleason Grading System and implementation of new therapeutic strategies, particularly Active surveillance, in 2005.

Methods

Data from all 496 consecutive patients who received consultation in 2003/2004 (n = 280) and 2007/2008 (n = 216) was retrospectively evaluated. Categorical variables were compared using the Chi-square test. Dependent variables were analysed using the unpaired Students´ t-test and the Mann–Whitney U-test.

Results

The cohorts were comparable concerning clinical stage, initial PSA, prostate volume, comorbidities and organ confined disease. Patients in Cohort I were younger (66.44 vs. 69.31y; p < .001) and had a longer life expectancy (17.22 vs. 14.75y; p < .001). 50.9%, 28.2% and 20.9% in Cohort I and 37.2%, 39.6% and 23.2% in Cohort II showed low-, intermediate- and high-risk disease (D´Amico) with a trend towards an increased risk profile in Cohort II (p = .066). The risk-adapted therapy recommended as first option was radical prostatectomy for 91.5% in Cohort I and 69.7% in Cohort II, radiation therapy for 83.7% in Cohort I and 50.7% in Cohort II, and other therapies (brachytherapy, Active surveillance, Watchful waiting, high-intensity focused ultrasound) for 6.5% in Cohort I and 6.9% in Cohort II (p < .001). Radiation therapy was predominant in both cohorts as second treatment option (p < .001). Time trends showing quality improvement involved an increase in biopsy cores (9.95 ± 2.38 vs. 8.43 ± 2.29; p < .001) and an increased recommendation for bilateral nerve sparing (p < .001).

Conclusion

In the earlier years, younger patients with a more favourable risk profile presented for interdisciplinary consultation. A unilateral recommendation for radical prostatectomy and radiation therapy was predominant. In the later years, the patient population was considerably older. However, this group may have benefitted from optimised diagnostic possibilities and a wider range of treatment options.

Validation of the Chinese version of the resilience scale and its cutoff score for detecting low resilience in Chinese cancer patients

PURPOSE

We aim to investigate the reliability and validity of the Chinese version of the Resilience Scale (RS-14) and to determine the cutoff score of the RS-14 for screening Chinese cancer patients with low resilience.

METHODS

The current study was divided into two studies. In the first study, we randomly selected 625 people and obtained their scores in the Chinese version of the RS-14 and SF-36 using cross-sectional survey. We then calculated the validity and reliability of the Chinese version of the RS-14. In the second study, we selected 970 hospital cancer patients diagnosed during 2010 to 2011 and assessed for their resilience once and for anxiety, depression, and quality of life on two occasions. We determined the cutoff score of the RS-14 based on the maximum Youden Index, with the scores of anxiety and depression as gold standards.

RESULTS

The correlation coefficients for inter-items were in the range of 0.23 to 0.68 (P < 0.001), whereas those for the item-scale were in the range of 0.62 to 0.82 (P < 0.001). Two factors represent the factor structure of the RS-14. The correlation coefficient between the RS-14 and SF-36 scores was 0.82 (P < 0.001). The split-half reliability and test-retest reliability of the RS-14 were both 0.82 (P < 0.001), and the internal consistency Cronbach's α was 0.93. The cutoff score of 64 was obtained for screening cancer patients with low resilience (sensitivity and specificity were 0.74 and 0.71, respectively).

CONCLUSION

The Chinese version of the RS-14 has good validity and reliability, and it can measure the resilience of Chinese people. The cutoff score of 64 for the RS-14 is appropriate for detecting cancer patients with low resilience in order to decrease psychological stress and improving quality of life. Health care nurses can screen and detect cancer patients with low resilience based on the said cutoff score to timely provide psychological care and interventions for the patients.

Integration of clinical and patient-reported outcomes in surgical oncology

BACKGROUND

Patient-reported outcomes (PROs) provide information about the patient perspective and experience of undergoing surgery for cancer, but evidence suggests that they are not used widely to influence practice. This review considers key challenges and opportunities for using PROs effectively in gastrointestinal surgical oncology, drawing on principles learnt from surgical oncology in general.

METHODS

Systematic reviews of randomized controlled trials (RCTs) in surgical oncology reporting PROs as primary or secondary outcomes, and studies examining methods to communicate PRO information, were identified. Common themes are summarized and the future of PRO studies considered.

RESULTS

Reviews highlighted the need for improved design, conduct and reporting of PROs in RCTs in surgical oncology. Main issues related to the multiplicity of PRO measures hindering data synthesis and clinical understanding, problems with missing data risking bias, and limited integration of clinical and PRO data undermining the role of PRO data in practice. Reviews indicated that patients want PRO data to meet information needs and early work shows that graphically displayed PROs are understood by patients.

CONCLUSION

PROs have a role in the evaluation of surgical oncology, but increased consensus and collaboration between surgeons and methodologists is needed to improve the design, conduct and reporting of PROs with clinical outcomes in trials. Possible solutions include investing more effort and systematic thought into the PRO rationale in RCTs, the development and use of 'core outcome sets' with PROs, and implementation of the extension to the Consolidated Standards of Reporting Trials (CONSORT) guidelines for reporting PROs in RCTs.

Patient-reported outcomes to evaluate surgery

The role of patient-reported outcomes (PROs) in surgery evaluation is increasing. PROs include measures of health-related quality of life (HRQL), patient satisfaction and utility. It is hypothesized that they add to traditional end points by providing detailed assessment of the impact of surgery on patient well-being as well as assessing patient preferences. In addition, qualitative observations from in-depth or semistructured interviews, or focus groups provide data about patient experiences and views of surgery that may supplement standard outcomes and quantitative PROs. This type of detail may contribute to clinical decision-making and informed consent. It is essential, however, that PROs are valid and reliable, and that robust methodology is used in trials and other research settings to incorporate PROs in a clinical context. Future work focusing upon the role of PROs in surgical decision-making is needed, and there is a need to develop methods for communicating PROs to patients. In addition, evaluating surgery with qualitative approaches will add useful insights into how patients experience surgery. This review article focuses on evaluating surgery with measures of HRQL and the qualitative methods that may supplement quantitative outcomes.

Methodological issues in designing and reporting health-related quality of life in cancer clinical trials: the challenge of brain cancer studies

Health-related quality of life (HRQOL) and other types of patient-reported outcomes (PROs) are now important outcome measures in cancer clinical trials. A number of potentially less toxic drugs are available, and newer treatments can potentially offer cancer patients the possibility to be treated with less aggressive approaches, making PROs more critical in evaluating treatment effectiveness. However, assessing PROs in clinical trials requires careful consideration of a number of methodological issues. Robust methodology and accurate reporting of results are crucial to provide the scientific community and health care providers with a transparent message about the impact of a given drug or a new medical approach on patients' health status. This paper provides basic guidance on methodological issues to be addressed when designing and reporting HRQOL in clinical trials and presents examples of relevant brain cancer studies.

Health-related quality of life and symptom assessment in patients with myelodysplastic syndromes

Health-related quality of life (HRQOL), symptom burden and other types of patient-reported outcomes have acquired an important role in clinical research, as they can provide precious information on the patient's perspective of disease symptoms and treatment-related effects. HRQOL in patients with myelodysplastic syndromes (MDSs) may be compromised for several reasons, including severe anemia, the frequent occurrence of infections and the need for blood transfusions. Many MDS patients are elderly patients who might present with comorbidities from the time of diagnosis. Our investigation started with a systematic search of the literature in which prospective studies were identified and evaluated according to a predefined coding scheme. Both HRQOL outcomes and traditional clinical reported outcomes were systematically analyzed. Overall, we found nine prospective studies, four of which evaluated HRQOL in a randomized controlled trial setting and, interestingly, all these studies were published after the year 2001, possibly reflecting a recent interest in HRQOL research in MDS patients. While methodological drawbacks were identified, mainly in terms of small sample size and amount of missing data, HROQL assessment has been shown to be feasible in MDS patients and there are excellent examples of how this approach can provide additional key outcomes. A good example is the important evidence emerging from two recent randomized controlled trials that HRQOL benefits are obtained with azacitidine and decitabine compared with supportive care. In view of the enormous potential of patient-reported outcome assessment in providing valuable outcomes in support of clinical decision-making, its implementation in future studies of MDS patients is strongly recommended.

Quality-of-life measurement in randomized clinical trials in breast cancer: an updated systematic review (2001-2009)

BACKGROUND

Quality-of-life (QOL) measurement is often incorporated into randomized clinical trials in breast cancer. The objectives of this systematic review were to assess the incremental effect of QOL measurement in addition to traditional endpoints (such as disease-free survival or toxic effects) on clinical decision making and to describe the extent of QOL reporting in randomized clinical trials of breast cancer.

METHODS

We conducted a search of MEDLINE for English-language articles published between May-June 2001 and October 2009 that reported: 1) a randomized clinical trial of breast cancer treatment (excluding prevention trials), including surgery, chemotherapy, hormone therapy, symptom control, follow-up, and psychosocial intervention; 2) the use of a patient self-report measure that examined general QOL, cancer-specific or breast cancer-specific QOL or psychosocial variables; and 3) documentation of QOL outcomes. All selected trials were evaluated by two reviewers, and data were extracted using a standardized form for each variable. Data are presented in descriptive table formats.

RESULTS

A total of 190 randomized clinical trials were included in this review. The two most commonly used questionnaires were the European Organization for Research and Treatment of Cancer QOL Questionnaire and the Functional Assessment of Cancer Therapy/Functional Assessment of Chronic Illness Therapy. More than 80% of the included trials reported the name(s) of the instrument(s), trial and QOL sample sizes, the timing of QOL assessment, and the statistical method. Statistical power for QOL was reported in 19.4% of the biomedical intervention trials and in 29.9% of the nonbiomedical intervention trials. The percentage of trials in which QOL findings influenced clinical decision making increased from 15.2% in the previous review to 30.1% in this updated review for trials of biomedical interventions but decreased from 95.0% to 63.2% for trials of nonbiomedical interventions. Discordance between reviewers ranged from 1.1% for description of the statistical method (yes vs no) to 19.9% for the sample size for QOL.

CONCLUSION

Reporting of QOL methodology could be improved.

Patterns of reporting health-related quality of life outcomes in randomized clinical trials: implications for clinicians and quality of life researchers

PURPOSE

To assess the patterns of, and trends over time in, health-related quality of life (HRQL) reporting in randomized controlled trials (RCTs).

METHODS

The English-language literature of RCTs published in 2002-2008 was identified using Medline, Embase, and Healthstar databases, in addition to the Cochrane Clinical Trials Registry. Eligible trials were phase III studies that included an HRQL outcome. Data were abstracted on eight outcomes derived from previously recommended quality standards for reporting HRQL, and on four outcomes describing how HRQL data are presented in RCT reports. Two readers examined each article; discrepancies were resolved through discussion and third review if required.

RESULTS

A sample of 794 RCTs was identified. HRQL was a primary outcome in 25.4% (200/794). One hundred and ten RCTs (14%) used "supplementary" reports (separate from the first publication) to report HRQL findings. The proportion of RCTs that met the eight quality indicators ranged from 15% (HRQL used in the calculation of sample size) to 81% (reporting instrument validity). RCTs with HRQL as a primary outcome or with a supplementary report had higher concordance on the quality measures. Reporting improved on many indicators over time. Substantive variation in how HRQL data are presented in RCTs was evident.

CONCLUSIONS

Current practice of reporting HRQL outcomes in RCTs remains highly variable, both with regard to quality of reporting and the patterns of data analysis and presentation. This variation presents challenges for clinicians to apply these data in clinical practice. Consistent reporting practices, which are interpretable by clinicians, are required, as are processes to achieve this consistency in future reports.

Development and validation of the korean version of expanded prostate cancer index composite: questionnaire assessing health-related quality of life after prostate cancer treatment

Purpose

Although the quality of life (QoL) of prostate cancer (PCa) patients is a major issue, there is no unified and useful methodology for assessing QoL. The Expanded Prostate Cancer Index Composite (EPIC) is a globally used tool to measure QoL after PCa treatment that comprises urinary, bowel, sexual, and hormonal domains. Acknowledging the need for such a tool applicable to Korean PCa patients, we translated EPIC into Korean and validated the new version.

Materials and Methods

The Korean version of EPIC was devised by translation, back-translation, and reconciliation. Subsequently, we randomly selected 153 patients with localized PCa treated with radical perineal prostatectomy (67, 43.8%), radical retropubic prostatectomy (19, 12.4%), laparoscopic radical prostatectomy (12, 7.8%), robot-assisted laparoscopic radical prostatectomy (36, 23.5%), and high-intensity focused ultrasound ablation of the prostate (19, 12.4%) and asked them to complete EPIC. Reliability was assessed by test-retest correlation and Cronbach's alpha. Validity was assessed by factor analysis, interscale correlation, and correlation with Functional Assessment of Cancer Therapy-Prostate (FACT-P).

Results

Test-retest correlation and Cronbach's alpha were high in each of the domains (0.92, 0.91, 0.76, 0.84 and 0.86, 0.84, 0.92, 0.83, p<0.0001). Interscale correlation among the domains was low (r<0.37), which indicated that EPIC is composed of proper domains. Interscale correlation between the function and bother subscales was high (0.94, 0.81, 0.84 and 0.80, p<0.0001). EPIC domains had low correlation with FACT-P, permitting complementary use.

Conclusions

The Korean version of EPIC was developed by a proper process, as evident by its high reliability and validity. Therefore, it is a reliable, comprehensive, systematic method that evaluates QoL in Korean patients after PCa treatment. Furthermore, it can be adapted as an objective methodology for research globally.

Reporting on quality of life in randomised controlled trials in gastrointestinal surgery

BACKGROUND

Although health-related quality of life (HRQOL) has become an important outcome measure in surgical trials, questions still remain about the quality of its reporting. The aim of this study was to evaluate HRQOL assessment methodology of randomised clinical trials concerning gastrointestinal surgery.

METHODS

All articles published in the calendar years 2006 and 2007 that purported to assess quality of life as end points or make some conclusion about quality of life were chosen for review from eight general surgical journals and four medical journals. Identified eligible studies were selected and then evaluated on a broad set of predetermined criteria.

RESULTS

Twenty-four published randomised controlled clinical trials (RCTs)s with an HRQOL component were identified. Although most trials exhibited good-quality research, some methodological limitations were identified: Only 21% of the studies gave a rationale for selecting a specific HRQOL measure, 46% of the studies failed to report information about the administration of the HRQOL measure, and 37% did not give details on missing data.

CONCLUSIONS

Although it is clear that HRQOL is an important end point in surgical RCTs because the information helps to influence treatment recommendations, a number of methodological shortcomings have to be further addressed in future studies.

A randomized trial of external beam radiotherapy versus cryoablation in patients with localized prostate cancer: quality of life outcomes

BACKGROUND

A recent randomized trial to compare external beam radiation therapy (EBRT) to cryoablation for localized disease showed cryoablation to be noninferior to external beam EBRT in disease progression and overall and disease-specific survival. We report on the quality of life (QOL) outcomes for this trial.

METHODS

From December 1997 through February 2003, 244 men with newly diagnosed localized prostate cancer were randomly assigned to cryoablation or EBRT (median dose 68 Gy). All patients received neoadjuvant antiandrogen therapy. Patients completed the EORTC QLQ C30 and the Prostate Cancer Index (PCI) before treatment and at 1.5, 3, 6, 12, 18, 24, and 36 months post-treatment.

RESULTS

Regardless of treatment arm, participants reported high levels of QOL with few exceptions. cryoablation was associated with more acute urinary dysfunction (mean PCI urinary function cryoablation=69.4; mean EBRT=90.7; P<.001), which resolved over time. No late arising QOL issues were observed. Both EBRT and cryoablation participants reported decreases in sexual function at 3 months with the cryoablation patients reporting poorer functioning (mean cryoablation=7.2: mean EBRT=32.9; P<.001). Mean sexual function score was 15 points lower at 3 years for the cryoablation group and 13% more of the cryoablation men said that sexuality was a moderate or big problem.

CONCLUSIONS

In this randomized trial, no long-term QOL advantage for either treatment was apparent with the exception of poorer sexual function reported by those treated with cryoablation. Men who wish to increase their odds of retaining sexual function might be counseled to choose EBRT over cryoablation.

Quality, interpretation and presentation of European Organisation for Research and Treatment of Cancer quality of life questionnaire core 30 data in randomised controlled trials

AIM

To review reporting standard, presentation and interpretation for quality of life (QOL) outcomes in randomised controlled trials (RCTs) using the European Organisation for Research and Treatment of Cancer quality of life questionnaire core 30 (EORTC QLQ-C30).

METHODS

Cancer RCTs reporting EORTC QLQ-C30 data were identified and reviewed against a reporting quality checklist. Interpretation/presentation methods for QOL data were also recorded.

RESULTS

Eighty-two papers were reviewed. Seventy percent met criteria for high quality reporting; 94% reported mean scores; 84% presented results in tables/graphs; 80% reported p-values or statistical significance. Clinical significance was addressed in 38%. Where clinical significance was not addressed, reliance was usually on statistical significance to interpret the results.

DISCUSSION

EORTC QLQ-C30 results are generally reported well, although it was common to rely on statistical significance alone for interpreting results. Whilst interpretation in terms of clinical significance has improved in recent years, there is still a lack of robust clinical interpretation of QOL results even in papers reported to a high standard.

Health-related quality of life assessment and reported outcomes in leukaemia randomised controlled trials - a systematic review to evaluate the added value in supporting clinical decision making

Health-related quality of life (HRQOL) is increasingly reported as an important outcome in cancer clinical trials. However, very little evidence exists on the impact of such evaluation in randomised controlled trials (RCTs) of leukaemia patients. A systematic search of the literature from 1980 to 2007 was undertaken and studies were identified and evaluated independently, according to a pre-defined coding scheme, by three reviewers. Both HRQOL outcomes and traditional clinical reported outcomes were systematically analysed to evaluate their consistency and their relevance for supporting clinical decision making. Nine RCTs were identified, involving 3838 patients overall. There were four RCTs involving acute myeloid leukaemia patients (AML), three with chronic myeloid leukaemia (CML) and two with chronic lymphocytic leukaemia (CLL). Six studies were published after 2000 and provided fairly robust methodological quality. Imatinib greatly improved HRQOL compared to interferon based treatments in CML patients and fludarabine plus cyclophosphamide does not seem to have a deleterious impact on patient's HRQOL when compared to fludarabine alone or chlorambucil in CLL patients. This study revealed the paucity of HRQOL research in leukaemia patients. Nonetheless, HRQOL assessment is feasible in RCTs and has the great potential of providing valuable outcomes to further support clinical decision making.

Evaluation of quality of life in patients with previously untreated advanced prostate cancer receiving maximum androgen blockade therapy or LHRHa monotherapy: a multicenter, randomized, double-blind, comparative study

PURPOSE

To assess quality of life (QOL) data from a double-blind Phase III study evaluating bicalutamide (Casodex) 80 mg as part of maximum androgen blockade (MAB) in patients with previously untreated advanced prostate cancer.

METHODS

Patients with untreated stage C/D prostate cancer were randomized to MAB with bicalutamide plus a luteinizing hormone-releasing hormone agonist (LHRHa) or LHRHa monotherapy. QOL was evaluated at baseline and at weeks 1, 5, and 24 using the Japanese version of the Functional Assessment of Cancer Therapy-Prostate (FACT-P) questionnaire.

RESULTS

A total of 203 patients were assessed for QOL. The MAB group had more rapid and greater improvements in "emotional well-being" and "prostate cancer-specific issues" domain scores than the monotherapy group. Further analysis of "prostate cancer-specific issues" revealed that, compared with monotherapy, MAB provided a greater improvement in "micturition disorder"-related QOL. Complete improvement rates for items related to "pain and micturition disorder" were also higher with MAB. Item scores of "pain and micturition disorder" did not correlate strongly with prostate-specific antigen levels or tumor size. Fewer patients who had deterioration in their "pain and micturition disorder" item scores at week 1 in the MAB group than the monotherapy group.

CONCLUSIONS

Maximum androgen blockade with bicalutamide plus LHRHa did not reduce the overall QOL of patients with previously untreated advanced prostate cancer. MAB was superior to monotherapy in achieving early improvement of QOL related to micturition disorder and pain.

Does androgen-deprivation therapy accelerate the development of frailty in older men with prostate cancer?: a conceptual review

The majority of men with prostate cancer are aged > or =65 years. Men, as they age, are more likely to suffer from impaired physical function. The standard treatment for recurrent prostate cancer is androgen-deprivation therapy (ADT). Well-established toxicities from ADT include lean weight loss or sarcopenia, muscle weakness, fatigue, and reduced activity levels. Frailty is a term from geriatrics that describes older individuals with limited physiologic reserve who are at significant risk for adverse outcomes, including falls, disability, hospitalization, and death. An increasingly accepted definition of frailty is a syndrome in which > or =3 of the following are present: unintentional (lean) weight loss > or =10 pounds in the past year, weakness (measured by grip strength), slow walking speed, self-reported exhaustion, and low physical activity. This clinical syndrome overlaps closely with the known toxicities of ADT. In addition, alterations in the inflammatory system, neuroendocrine system, and energy production are associated with this syndrome, as evidenced by biomarkers such as C-reactive protein, interleukin-6, and tumor necrosis factor-alpha. For this article, the authors reviewed the evidence for the effect of ADT on each of the 5 frailty components plus the identified biomarkers, and the evidence indicates that ADT may accelerate the development of frailty in vulnerable older men with prostate cancer. Given the association of frailty with important clinical outcomes such as hospitalization and death, this potential consequence of ADT should be considered carefully when initiating therapy in older patients with recurrent prostate cancer.

A systematic review of quality of life associated with standard chemotherapy regimens for advanced non-small cell lung cancer

PURPOSE

Systemic chemotherapy is accepted as a standard of care for patients with advanced non-small cell lung cancer (NSCLC). Although survival outcomes are equivalent among standard chemotherapy regimens, it is unknown whether the quality of life (QOL) outcomes are also comparable. We evaluated available literatures to summarize the state of current knowledge and provide suggestions for future studies.

METHODS

Using PUBMED/MEDLINE database, a systematic review of randomized controlled phase III trials of advanced NSCLC reporting QOL as one of the end points was conducted. Trials were included if standard chemotherapy regimens (as defined by The American Society of Clinical Oncology 2003 recommendations) were used in at least two arms of a trial. Two reviewers independently extracted data and evaluated the characteristics of QOL reporting, analyses, and results.

RESULTS

The search criteria identified 14 trials (6665 patients). Of these, 13 trials used validated QOL instruments and were included for review. The QOL reporting/analysis techniques were heterogeneous. We included nine trials, which reported the rate of completed baseline assessment and compliance survivors at analysis greater than 50%, for data synthesis. Of these, only one trial found a significant difference in QOL between the comparator arms: paclitaxel plus cisplatin was better than teniposide plus cisplatin.

CONCLUSION

Based on our review, it seems unlikely that a major difference exists in the global QOL associated with standard chemotherapy regimens for advanced NSCLC. Although QOL reporting format is largely acceptable, a lack of uniformity in analysis and a poor compliance to QOL assessment made between-trial comparisons difficult.

Health-Related Quality of Life Results in Pathologic Stage C Prostate Cancer From a Southwest Oncology Group Trial Comparing Radical Prostatectomy Alone With Radical Prostatectomy Plus Radiation Therapy

Purpose

To compare short- and long-term effects of adjuvant treatment versus observation after surgery on health-related quality of life (HRQL) of prostate cancer patients.

Patients and Methods

The Southwest Oncology Group (SWOG) intergroup trial compared radical prostatectomy (RP) plus observation versus RP plus adjuvant radiation therapy (RT). Two-hundred seventeen of 425 therapeutic trial patients were eligible and registered to the HRQL study. Patients completed the SWOG Quality of Life Questionnaire (emotional, physical, social, and role function; general symptom status; treatment/disease-specific symptoms; and global HRQL [GHRQL]) at baseline, 6 weeks, 6 months, and annually for 5 years. Prespecified outcomes were three genitourinary symptoms (bowel function tenderness, frequent urination, and erectile dysfunction [ED]) and measures of physical and emotional function. Adjustments were made for the baseline score.

Results

Patients receiving adjuvant RT reported worse bowel function (through approximately 2 years) and worse urinary function. There were no statistically significant differences for ED. GHRQL was initially worse for the RP+RT arm but improved over time and was better at the end of the period than the GHRQL reported for RP alone (treatment arm × time interaction, P = .0004). Symptom distress was significantly worse for the RP+RT arm compared with the RP alone arm, but the treatment arms did not differ with respect to other general measures of HRQL.

Conclusion

The addition of RT to surgery resulted in more frequent urination, as well as early report of more bowel dysfunction, although bowel function differences disappeared over the 5-year period. The addition of RT did not negatively impact ED.

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.

Has the quality of health-related quality of life reporting in cancer clinical trials improved over time? Towards bridging the gap with clinical decision making

BACKGROUND

Previous work highlighted a number of methodological constraints when reporting health-related quality of life (HRQOL) outcomes from randomized controlled trials (RCTs). Given this, the objective of this study was to investigate whether the quality of such HRQOL reports has improved over time.

MATERIALS AND METHODS

On the basis of a predefined set of criteria, 159 RCTs with a HRQOL end point, published between 1990 and 2004 were identified and analyzed. Each study was evaluated by a number of issues (e.g. sample size and industry sponsorship) and by the "minimum standard checklist for evaluating HRQOL outcomes in cancer clinical trials".

RESULTS

The quality of HRQOL reports, as measured by the overall checklist score, was independently related to more recently published studies (P < 0.0001). This relationship was independent of industry funded, HRQOL end point (primary versus secondary), cancer disease site, size of the study and HRQOL difference between treatment arms. While only 39.3% of studies published between 1990 and 2000 (89/159 RCTs) were identified as being probably robust, thus likely to support clinical decision making, this percentage was 64.3% for studies published after 2000 (70/159 RCTs).

CONCLUSION

Since we found a significant learning curve in HRQOL trial reporting since 1990, it can be expected that HRQOL data will increasingly impact on clinical decision making and treatment policies in the near future.

Methodological quality of patient-reported outcome research was low in complementary and alternative medicine in oncology

OBJECTIVE

To evaluate the methodological robustness of patient-reported outcomes (PROs) evaluation in complementary and alternative medicine (CAM) randomized controlled trials (RCTs) in oncology.

STUDY DESIGN AND SETTING

CAM RCTs with a PRO endpoint were retrieved from a number of electronic databases. CAM interventions were defined according to the five major categories of the National Center for Complementary and Alternative Medicine. The "Minimum Standard Checklist for Evaluating HRQOL Outcomes in Cancer Clinical Trials" was used to assess the quality of the PRO reporting in these trials.

RESULTS

Forty-four RCTs enrolling 4,912 patients were identified: six studies involved alternative medical systems, 14 involved mind body interventions, 15 dealt with biologically-based therapies, seven involved manipulative and body-based methods, and two energy therapies. Eighty-nine percent of studies used a PRO as a primary endpoint and 59% documented PRO missing data. Although 84% of the studies used a validated PRO questionnaire, only 37% stated an a priori hypothesis and 20% addressed clinical significance of the outcomes. Overall, 64% of the studies analyzed exhibited a number of methodological drawbacks.

CONCLUSIONS

To facilitate the interpretation of results from such CAM RCTs, investigators are encouraged to pay greater attention to key methodological issues as identified in this study.

The Functional Assessment of Cancer Therapy-Prostate (FACT-P) scales in men with prostate cancer: reliability and validity of the Korean version

The Functional Assessment of Cancer Therapy-Prostate (FACT-P) questionnaire is a relevant, worldwide tool used for assessing the health-related quality of life in men with prostate cancer. The purpose of this study was to translate the FACT-P into Korean, to assess its reliability and validity, and to test its discriminative ability between the cancer patients and normal controls. The Korean version was developed via the FACT multilingual translation project. The translated questionnaire was self-administered to 70 prostate cancer patients and 70 age-matched controls. In evaluating its psychometric properties for cancer patients, internal consistency and test-retest reliability were used. Validity was estimated by using inter-subscale correlations and discriminant validity between cancer patients and controls. Cronbach's alpha coefficient for the individual subscales were 0.7 or greater (range 0.73 to 0.89), except for emotional well-being (0.61). The test-retest reliability showed high correlations (intraclass coefficients ranged from 0.72 to 0.93). Inter-subscale correlations demonstrated each subscale was unrelated, but moderate correlation was observed between social/family well-being and functional well-being subscales (r=0.56). The FACT-P scale could discriminate reliably between the cancer patients and controls in most subscales. In conclusion, the Korean version of the FACT-P is a reliable and valid questionnaire in patients with prostate cancer.

Health-related quality of life in patients with idiopathic pulmonary fibrosis: a systematic review

BACKGROUND

Idiopathic pulmonary fibrosis (IPF) profoundly affects the quality of patients' lives. A systematic review was performed to evaluate critically the published literature and to examine what is known about health-related quality of life (HRQL) in patients with IPF.

METHODS

The MEDLINE, EMBASE, Health and Psychosocial Instruments, and Cochrane Library databases were searched to 1 April 2004. Abstracts and bibliographies of published articles were scanned and contact was made with investigators. Included studies analysed HRQL (or quality of life) in at least 10 patients with IPF. Two reviewers independently selected studies, evaluated their quality according to predetermined criteria, and abstracted data on study design, patients' demographic and clinical characteristics, and quality of life outcome measures.

RESULTS

Seven studies met the inclusion criteria. The studies enrolled 512 patients with IPF and used three different instruments to measure HRQL. All studies had important limitations in methodological quality; none measured longitudinal changes in HRQL over time. Patients reported substantially impaired HRQL, especially in domains that measured physical health and level of independence. Patients with IPF appear to have similar impairments in HRQL to those with chronic obstructive pulmonary disease. Measures of dyspnoea were moderately correlated with scores from domains that measured physical health (R2 = 0.03-0.66) and energy/fatigue/pep (R2 = 0.19-0.55), but measures of pulmonary function and gas exchange did not correlate as strongly with these and other domains.

CONCLUSION

Studies of HRQL in patients with IPF suggest that, in addition to the obvious effect on physical health, general health, energy level, respiratory symptoms, and level of independence are also impaired. Variability in HRQL among patients is not fully explained by measures of dyspnoea or pulmonary function, suggesting that HRQL measures provide unique information. More research is needed to identify or design appropriate measurement instruments for patients with IPF and to examine changes in HRQL over time or in response to specific treatments.

Comparison of quality of life between urban and rural gastric cancer patients and analysis of influencing factors

AIM: The conception of quality of life has been widely accepted by clinic doctors. Evaluations of the treatment effect of chronic diseases have been changed to depend not only on the survival time, but also on the quality of life of the patients. Fuzhou City and Changle County are high-incidence areas of the gastric cancer in Fujian Province. The aims of this research were to compare the quality of life of urban patients with that of rural patients and analyze the factors influencing quality of life of gastric cancer patients in Fujian Province.

METHODS: The samples were drawn with cluster sampling. The urban sample consisted of 162 patients aged 25 to 75 with 143 males and 19 females. The rural sample consisted of 200 patients aged 32 to 78 with 166 males and 34 females. The patients in both the urban and rural areas were investigated, and their scores on 21 items reflecting the quality of life were measured. The methods of t test and stepwise regression were used to analyze the data.

RESULTS: The average total scores of quality of life of the urban patients and rural patients were 64.11 and 68.69 respectively. There was a significant difference between the means of two samples (P = 0.0004). Seven variables in the regression model estimated by the urban sample and 4 variables in the model by the rural sample were at the level of significance α = 0.05. Family income, nutrition and rehabilitating exercise were selected into both the urban and rural regression models.

CONCLUSION: Most of the gastric cancer patients have poor quality of life in Fujian Province and the rural patients have lower quality of life than that of urban patients. The patients having more family income have better quality of life, and enhanced nutrition and doing rehabilitating exercise are helpful in improving the quality of life of the gastric cancer patients.

Methodological issues in assessing health-related quality of life of colorectal cancer patients in randomised controlled trials

Although health-related quality of life (HRQOL) is increasingly reported as an important endpoint in cancer clinical trials, questions still remain about the quality of its reporting. The aim of this study was to evaluate the level of reporting of HRQOL in randomised controlled trials (RCTs) of colorectal cancer (CRC). A systematic literature search from 1980 to March 2003 was undertaken on a number of databases. Identified eligible studies were selected and then evaluated on a broad set of HRQOL predetermined criteria by four reviewers. Thirty-one randomised controlled trials involving 9683 colorectal cancer patients were identified. Nearly all studies dealt with metastatic patients and principally compared different chemotherapy regimens. The HRQOL tool most often used was the European Organisation for Research and Treatment of Cancer, Quality of Life Questionnaire-Core 30 (EORTC QLQ-C30), which was used in 48% of the studies. Some methodological limitations were identified: 39% of the RCTs did not report HRQOL compliance at baseline and 52% did not give details on missing data. A rationale for using a specific HRQOL measure was given in only 10% of the studies. Whilst HRQOL assessment is a potential valuable source of information in understanding the impact of colorectal cancer, a number of methodological shortcomings have to be further addressed in future studies.

Sleep management training for cancer patients with insomnia

Insomnia is a common phenomenon in cancer patients; nevertheless, there are only a few intervention results published covering this topic. We examined the effects of a multi-modal psychological sleep management programme combining relaxation techniques, sleep hygiene, cognitive techniques and advice in stimulus control technique on various sleep and quality-of-life variables. We compared two intervention groups up to 6 months after treatment, one with progressive muscle relaxation (n=80), the other with autogenic training (n=71). A control group (n=78) received only a standard rehabilitation programme. It was a heterogeneous sample of adult patients (mean age 58 years) predominantly with breast, kidney or prostate cancer staying for 3 or 4 weeks in an oncological rehabilitation clinic. In comparison to the control group, the analysis of variance for repeated measures (R-MANOVA) showed significant improvements over time, indicating that intervention group participants benefited with moderate- or large-scale effects on sleep latency (p<0.001), sleep duration (p<0.001), sleep efficiency (p<0.001), sleep quality (p<0.001), sleep medication (p<0.05) and daytime dysfunction (p<0.05). In quality-of-life subscales, there was mainly improvement over time. This may indicate a benefit of the rehabilitation treatment in general. No evidence was found for any differences between the two intervention groups. The results suggest that the use of a multi-modal psychological sleep intervention could enhance various sleep parameters and well being of patients. The efficacy on quality of life is still under review.

Comparison of health-related quality of life and prostate-associated symptoms after primary and salvage cryotherapy for prostate cancer

PURPOSE

Recent advances in cryosurgery of the prostate have led to the ability to treat tumors successfully with decreased morbidity. The patients' perspectives of this relatively new technique, however, have not yet been addressed. The purpose of this study was to compare health related quality of life (QoL) as well as prostate-associated symptoms in patients after primary and salvage cryoablation for clinically localized prostate cancer using a self-administered questionnaire.

METHODS

A total of 131 consecutive patients who underwent cryoablation of the prostate between 1997 and 2001 were included in this confidential mailing study. The patients were either (a) patients with localized prostate cancer with contraindications for radical surgery, including patients refusing other forms of therapy, or (b) had locally recurrent prostate cancer after failure of radiation therapy. All patients received 3 months of neoadjuvant androgen deprivation therapy prior to cryosurgery and were surgically treated by the same surgeon using an argon-based system. We used the EORTC QLQ-C30, a commonly used, multidimensional instrument together with a supplementing, prostate-cancer-specific module.

RESULTS

Eighty-one of the 131 patients (response rate 62%) returned the questionnaires. The two groups were comparable regarding age (mean age 72.8 vs 70.1 for the primary and the salvage group, respectively; p=0.22). The overall QoL scores were high in both groups. Primary cryotherapy patients fared significantly better regarding physical (p=0.005) and social (p=0.024) functioning compared with salvage cryotherapy patients. The most prominent prostate-related symptom in both patient groups was sexual dysfunction, followed by urinary symptoms, which were significantly more severe in the salvage group (p=0.001). Incontinence rates were 5.9 and 10% in the primary and the salvage group, respectively. Severe erectile dysfunction was reported in 86 and 90% of the primary and the salvage group, respectively.

CONCLUSIONS

The present study demonstrates that, in selected patients, cryotherapy is a treatment option which has a functional outcome comparable to traditionally used prostate cancer treatments. More information regarding QoL is necessary for appropriate patient counseling and individual decision-making in the presence of various treatment alternatives.