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Luo YH, Yang YW, Wu CF, Wang C, Li WJ, Zhang HC. Fatigue prevalence in men treated for prostate cancer: A systematic review and meta-analysis. World J Clin Cases 2021; 9:5932-5942. [PMID: 34368311 PMCID: PMC8316927 DOI: 10.12998/wjcc.v9.i21.5932] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 05/08/2021] [Accepted: 05/27/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The side effects of prostate cancer (PCa) treatment are very prominent, with cancer-related fatigue (CRF) being the most common. Fatigue is a distressing symptom that interferes with daily functioning and seriously affects patient quality of life during, and for many years after, treatment. However, compared with other types of cancer, such as breast cancer, little is known about the prevalence of PCa-related fatigue.
AIM To determine the prevalence of CRF in patients with PCa.
METHODS A systematic search of EMBASE, PubMed, Web of Science, Cochrane Library, Chinese National Knowledge Infrastructure, WANFANG DATA, Technology Journal Database and the Chinese Biological Medical Database was conducted up to July 28, 2020. Included studies measured the incidence of PCa-related fatigue and differentiated fatigue outcomes (incidence) between treatment modalities and fatigue assessment times. In our meta-analysis, both fixed and random-effects models were used to estimate the pooled prevalence of PCa-related fatigue. Subgroup analyses were performed using treatment modalities and fatigue assessment times. Publication and sensitivity bias analyses were performed to test the robustness of the associations.
RESULTS Fourteen studies, involving 4736 patients, were eligible for the review. The pooled CRF prevalence was 40% in a total sample of 4736 PCa patients [95% confidence interval (CI): 29-52; P < 0.01; I2 = 98%]. The results of the subgroup analyses showed the prevalence of CRF after androgen deprivation therapy treatment, radical prostatectomy and radiotherapy to be 42% (95%CI: 20-67, P < 0.01, I2 = 91%), 21% (95%CI: 16-26, P = 0.87, I2 = 0%) and 40% (95%CI: 22-58, P < 0.01, I2 = 90%), respectively. The prevalence of acute and persistent fatigue was 44% (95%CI: 25-64; P < 0.01; I2 = 93%) and 29% (95%CI: 25-32; P = 0.30; I2 = 17%), respectively.
CONCLUSION Our meta-analysis showed that fatigue is a common symptom in men with PCa, especially those using hormone therapy.
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Affiliation(s)
- Yu-Hong Luo
- School of Nursing, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Yan-Wei Yang
- Department of Stomatology, The 940th Hospital of Joint Logistic Support Force of the Chinese People’s Liberation Army, Lanzhou 730050, Gansu Province, China
| | - Chang-Fu Wu
- The First Clinical Medical College, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Chao Wang
- School of Clinical Medicine, Gansu University of Chinese Medicine, Lanzhou 730000, Gansu Province, China
| | - Wen-Juan Li
- Department of Respiratory and Critical Care, Henan Provincial Hospital, Zhengzhou 450003, Henan Province, China
| | - Hong-Chen Zhang
- School of Nursing, Lanzhou University, Lanzhou 730000, Gansu Province, China
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Impact of Gastrointestinal Side Effects on Patients' Reported Quality of Life Trajectories after Radiotherapy for Prostate Cancer: Data from the Prospective, Observational Pros-IT CNR Study. Cancers (Basel) 2021; 13:cancers13061479. [PMID: 33806994 PMCID: PMC8004900 DOI: 10.3390/cancers13061479] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Revised: 03/06/2021] [Accepted: 03/19/2021] [Indexed: 11/17/2022] Open
Abstract
Radiotherapy (RT) represents an important therapeutic option for the treatment of localized prostate cancer. The aim of the current study is to examine trajectories in patients' reported quality of life (QoL) aspects related to bowel function and bother, considering data from the PROState cancer monitoring in ITaly from the National Research Council (Pros-IT CNR) study, analyzed with growth mixture models. Data for patients who underwent RT, either associated or not associated with androgen deprivation therapy, were considered. QoL outcomes were assessed over a 2-year period from the diagnosis, using the Italian version of the University of California Los Angeles-Prostate Cancer Index (Italian-UCLA-PCI). Three trajectories were identified for the bowel function; having three or more comorbidities and the use of 3D-CRT technique for RT were associated with the worst trajectory (OR = 3.80, 95% CI 2.04-7.08; OR = 2.17, 95% CI 1.22-3.87, respectively). Two trajectories were identified for the bowel bother scores; diabetes and the non-Image guided RT method were associated with being in the worst bowel bother trajectory group (OR = 1.69, 95% CI 1.06-2.67; OR = 2.57, 95% CI 1.70-3.86, respectively). The findings from this study suggest that the absence of comorbidities and the use of intensity modulated RT techniques with image guidance are related with a better tolerance to RT in terms of bowel side effects.
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Can Comprehensive Geriatric Assessment Predict Tolerance of Radiotherapy for Localized Prostate Cancer in Men Aged 75 Years or Older? Cancers (Basel) 2020; 12:cancers12030635. [PMID: 32182949 PMCID: PMC7139355 DOI: 10.3390/cancers12030635] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 02/07/2023] Open
Abstract
Curative radiotherapy for prostate cancer is common in the elderly. However, concerns about potential toxicity have inhibited access to radiotherapy for this population, for whom preserving quality of life (QoL) is crucial. The primary endpoint was to identify predictors of impaired QoL in men aged 75 years or older treated with curative intent radiotherapy with or without androgen deprivation therapy (ADT) for localized prostate cancer. We prospectively performed comprehensive geriatric assessment (CGA) and administered QoL questionnaires to 208 elderly (>75 years) patients prior to, plus two and six months after, radiotherapy (NCT 02876237). The median age of the patients was 77 years (range 75–89). At the start of the study, comorbidities were highlighted in 65% of patients: 23% were depressed, 23% had cognitive impairment, and 16% had reduced independence. At six months, 9% of patients had a consistently decreased QoL (>20 points), and a further 16% had a more moderate reduction (10 to 20 points) in QoL. None of the parameters studied (tumor characteristic, treatment, or oncogeriatric parameters) were predictive of a reduced QoL following radiotherapy. Though co-existing geriatric impairment was common, QoL was maintained for 75% of patients six months after radiotherapy. CGA was poorly predictive of tolerance of prostatic radiotherapy. Geriatric assessments dedicated to quality of life following radiotherapy need to be developed.
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Goineau A, Campion L, d’Aillières B, Vié B, Ghesquière A, Béra G, Jaffres D, de Laroche G, Magné N, Artignan X, Chamois J, Bergerot P, Martin E, Créhange G, Deniaud-Alexandre E, Buthaud X, Belkacémi Y, Doré M, de Decker L, Supiot S. Comprehensive Geriatric Assessment and quality of life after localized prostate cancer radiotherapy in elderly patients. PLoS One 2018; 13:e0194173. [PMID: 29630602 PMCID: PMC5890970 DOI: 10.1371/journal.pone.0194173] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 02/26/2018] [Indexed: 02/07/2023] Open
Abstract
Introduction Radiotherapy can diminish quality of life (QoL) for prostate cancer patients. Our objective was to evaluate the effect of radiotherapy on QoL in men aged 75 years or older treated with radiotherapy for a localized prostate cancer, and to identify predictors of reduced QoL. Patients and methods We prospectively administered a battery of geriatric (MNA, GDS, Get up and Go Test, CIRS-G, ADL, IADL, MMSE), toxicity (IPSS; IIEF 5), and QoL (QLQ C30) screening tests in 100 elderly patients before and two months after prostate cancer radiotherapy (NCT 02876237). Patients ≥ 75 years undergoing radiotherapy with a curative intent for localized prostate cancer with or without androgen deprivation therapy (ADL) were eligible for study inclusion. Correlations between patient-assessed QoL and tumor characteristics, radiotherapy treatment or CGA parameters were sought using the Fisher or the Mann and Whitney tests. Changes in QoL parameters over time were analyzed using the Wilcoxon signed-rank test. Results At study entry, scores for IADL impairments were present in 51%, reduced autonomy in activities of daily living in 16%, cognitive impairment found in 20%, depression-related symptoms in 31%, and 66% of patients had significant co-morbidities. Eight percent were judged to be at risk of fall and 2% were found to be undernourished. Severely impaired (IPSS ≥ 20) urinary function was observed in 11.2% and 13.5% of patients before and two months after completion of radiotherapy respectively. Significantly decreased QoL (> 20 points) at two months after treatment was found in 13% of patients and a moderate but clinically relevant reduction (10 to 20 points) in 17% of patients. No tumor characteristic, treatment, or oncogeriatric parameter was predictive of reduced QoL following prostate cancer radiotherapy. Conclusion Despite sometimes markedly diminished oncogeriatric parameters, prostate cancer radiotherapy was generally well tolerated in these elderly patients. We found no predictive factor to determine which patients would experience impaired quality of life following radiotherapy.
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Affiliation(s)
- Aurore Goineau
- Department of Radiation Oncology, Institut de Cancérologie de l’Ouest, Angers, France
- * E-mail:
| | - Loïc Campion
- Department of Statistics, Institut de Cancérologie de l’Ouest, Saint Herblain, France
| | - Bénédicte d’Aillières
- Department of Radiation Oncology, Institut de Cancérologie de l’Ouest, Angers, France
| | - Brigitte Vié
- Department of Radiation Oncology, Clinique Armoricaine de Radiologie, St Brieuc, France
| | - Agnès Ghesquière
- Department of Radiation Oncology, Clinique Armoricaine de Radiologie, St Brieuc, France
| | - Guillaume Béra
- Department of Radiation Oncology, Centre Hospitalier de Bretagne Sud, Lorient, France
| | - Didier Jaffres
- Department of Radiation Oncology, Centre Hospitalier de Bretagne Sud, Lorient, France
| | - Guy de Laroche
- Department of Radiation Oncology, Institut de Cancérologie de Loire, St Priest en Jarez, France
| | - Nicolas Magné
- Department of Radiation Oncology, Institut de Cancérologie de Loire, St Priest en Jarez, France
| | - Xavier Artignan
- Department of Radiation Oncology, CHP St Grégoire, St Grégoire, France
| | - Jérôme Chamois
- Department of Radiation Oncology, CHP St Grégoire, St Grégoire, France
| | - Philippe Bergerot
- Department of Radiation Oncology, Clinique Mutualiste de l’Estuaire, St Nazaire, France
| | - Etienne Martin
- Department of Radiation Oncology, Centre Georges François Leclerc, Dijon, France
| | - Gilles Créhange
- Department of Radiation Oncology, Centre Georges François Leclerc, Dijon, France
| | | | - Xavier Buthaud
- Department of Radiation Oncology, Centre Catherine de Sienne, Nantes, France
| | - Yazid Belkacémi
- Department of Radiation Oncology, CHU Henri Mondor, Créteil, France
| | - Mélanie Doré
- Department of Radiation Oncology, Institut de Cancérologie de l’Ouest, Saint Herblain, France
| | - Laure de Decker
- Department of Radiation Oncology, Institut de Cancérologie de l’Ouest, Saint Herblain, France
| | - Stéphane Supiot
- Department of Radiation Oncology, Institut de Cancérologie de l’Ouest, Saint Herblain, France
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Lilleby W, Stensvold A, Dahl AA. Fatigue and other adverse effects in men treated by pelvic radiation and long-term androgen deprivation for locally advanced prostate cancer. Acta Oncol 2016; 55:807-13. [PMID: 26959297 DOI: 10.3109/0284186x.2015.1127417] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background We compared the development of adverse effects and psychosocial measures from baseline to 36-month follow-up in patients with prostate cancer (T1-3 M0) referred to our department for definitive radiotherapy encompassing the prostate and pelvic lymph nodes (RAD + IMRT) or radiotherapy to the prostatic gland only (RAD), applied with standard adjuvant androgen deprivation (AD) in all patients. Few studies have explored the impact of fatigue on patients' reported quality of life (QoL) after combined therapy for prostate cancer. Material and methods The 206 consecutive eligible men (RAD + IMRT = 64 and RAD = 142) completed the UCLA-PCI questionnaire for adverse effects at baseline, 12, 24, and 36 months. QoL, anxiety and depression, and fatigue were rated at the same time points. Between-group and longitudinal within-group changes at different time points were reported. At 36 months variables associated with fatigue were analyzed with regression analyses. Results Our main novel finding is the long-term high level of fatigue and high prevalence of chronic fatigue, affecting patients receiving radiotherapy combined with long-term AD. Except for urinary bother in the RAD + IMRT group all functions and the other bothers mean scores were significantly worse at 36 months compared to baseline. In multivariable analyses only physical QoL remained significantly associated with fatigue at 36-months follow-up. Conclusions Fatigue and impaired QoL in patients considered to curative irradiation with long-term AD should be addressed when counseling men to combined treatment.
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Affiliation(s)
- Wolfgang Lilleby
- Department of Oncology, Oslo University Hospital, the Norwegian Radium Hospital, Oslo, Norway
| | | | - Alv A. Dahl
- Department of Oncology, Oslo University Hospital, the Norwegian Radium Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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Alexander KE, Cooper BA, Paul SM, Yates P, Aouizerat BE, Miaskowski C. Phenotypic and molecular characteristics associated with various domains of quality of life in oncology patients and their family caregivers. Qual Life Res 2016; 25:2853-2868. [PMID: 27160108 DOI: 10.1007/s11136-016-1310-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2016] [Indexed: 12/12/2022]
Abstract
PURPOSE Not all oncology patients and their family caregivers (FCs) experience the same quality of life (QOL). The purposes of this study were to identify latent classes of oncology patients (n = 168) and their FCs (n = 85) with distinct physical, psychological, social, and spiritual well-being trajectories from prior to through 4 months after the completion of radiation therapy and to evaluate for demographic, clinical, and genetic characteristics that distinguished between these latent classes. METHODS Using growth mixture modeling, two latent classes were found for three (i.e., physical, psychological, and social well-being) of the four QOL domains evaluated. RESULTS Across these three domains, the largest percentage of participants reported relatively high well-being scores across the 6 months of the study. Across these three QOL domains, patients and FCs who were younger, female, belonged to an ethnic minority group, had children at home, had multiple comorbid conditions, or had a lower functional status, were more likely to be classified in the lower QOL class. The social well-being domain was the only domain that had a polymorphism in nuclear factor kappa beta 2 (NFKB2) associated with latent class membership. Carrying one or two doses of the rare allele for rs7897947 was associated with a 54 % decrease in the odds of belonging to the lower social well-being class [OR (95 % CI) = .46 (.21, .99), p = .049]. CONCLUSIONS These findings suggest that a number of phenotypic and molecular characteristics contribute to differences in QOL in oncology patients and their FCs.
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Affiliation(s)
- Kimberly E Alexander
- School of Nursing, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Brisbane, Australia
| | - Bruce A Cooper
- Department of Physiological Nursing, School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA
| | - Steven M Paul
- Department of Physiological Nursing, School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA
| | - Patsy Yates
- School of Nursing, Queensland University of Technology, Victoria Park Road, Kelvin Grove, Brisbane, Australia
| | | | - Christine Miaskowski
- Department of Physiological Nursing, School of Nursing, University of California, 2 Koret Way - N631Y, San Francisco, CA, 94143-0610, USA.
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McDonald TL, Hung AY, Thomas CR, Wood LJ. Localized External Beam Radiation Therapy (EBRT) to the Pelvis Induces Systemic IL-1Beta and TNF-Alpha Production: Role of the TNF-Alpha Signaling in EBRT-Induced Fatigue. Radiat Res 2015; 185:4-12. [PMID: 26720802 DOI: 10.1667/rr14072.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Prostate cancer patients undergoing localized external beam radiation therapy (EBRT) can experience a progressive increase in fatigue, which can affect physical functioning and quality of life. The purpose of this study was to develop a mouse EBRT prostate cancer treatment model with which to determine the role of pro-inflammatory cytokines in the genesis of EBRT-related fatigue. We assessed voluntary wheel-running activity (VWRA) as a proxy for fatigue, food intake and body weight in male C57BL/6 mice undergoing EBRT to the pelvis. In the first experiment, anesthetized male C57BL/6 mice underwent fractionated EBRT to the pelvis for a total dose of 68.2 Gy, thereby mimicking a clinically relevant therapeutic dose and frequency. The day after the last treatment, levels of IL-1β and TNF-α in plasma along with mRNA levels in liver, colon and whole brain were measured. EBRT-induced fatigue resulted in reduced body weight, diminished food intake, and increased plasma and tissue levels of IL-1β and TNF-α. In a follow-up experiment, we used TNF-α-deficient mice to further delineate the role of TNF-α signaling in EBRT-induced sickness behavior. EBRT-induced changes in fatigue, food intake and body weight were no different between TNF-α deficient mice and their wild-type counterparts. Taken together our data demonstrate that a clinically relevant localized irradiation of the pelvis induces a systemic IL-1β and TNF-α response and sickness behavior in mice, but the TNF-α signaling pathway alone does not independently mediate these effects.
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Affiliation(s)
- Tasha L McDonald
- a Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon; and
| | - Arthur Y Hung
- a Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon; and
| | - Charles R Thomas
- a Department of Radiation Medicine, Oregon Health and Science University, Portland, Oregon; and
| | - Lisa J Wood
- b Amelia Peabody Professor for Nursing Research, MGH Institute of Health Professions, School of Nursing, Boston, Massachusetts
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Holliday EB, Dieckmann NF, McDonald TL, Hung AY, Thomas CR, Wood LJ. Relationship between fatigue, sleep quality and inflammatory cytokines during external beam radiation therapy for prostate cancer: A prospective study. Radiother Oncol 2015; 118:105-11. [PMID: 26743832 DOI: 10.1016/j.radonc.2015.12.015] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Revised: 10/22/2015] [Accepted: 12/18/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND AND PURPOSE Mechanisms of fatigue reported during radiotherapy are poorly defined but may include inflammatory cytokines and/or sleep disturbances. This prospective, longitudinal, phase II study assessed fatigue, sleep, and serum cytokine levels during radiotherapy for early-stage prostate cancer (PCa). MATERIAL AND METHODS Twenty-eight men undergoing radiotherapy for early-stage PCa wore an Actiwatch Score to record fatigue level, sleep time, onset latency, efficiency and wake after sleep onset. Serum levels of IL-1α, IL-1β, TNF-α, IL-6, IL-8, IL-10 and VEGF were measured weekly during radiotherapy. Patient reported quality of life (QOL) metrics were collected before and after treatment. Linear mixed effects models examined trajectories across treatment weeks. RESULTS Fatigue increased across treatment weeks (P<.01), and fatigue was associated with decreased patient-reported QOL. Sleep efficiency increased across treatment weeks (rate of change over time=.29, P=.03), and sleep onset latency decreased (rate of change over time=.86, P=.06). IL-6 tended to increase during treatment (P=0.09), but none of the cytokine levels or sleep variables were significantly related to fatigue trajectories. CONCLUSIONS Despite increased sleep efficiency across treatment weeks, fatigue significantly increased. Although IL-6 increased during the course of radiotherapy, cytokines levels were not associated with fatigue scores or sleep disturbance. Further studies are needed to define the mechanisms for fatigue during radiotherapy.
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Affiliation(s)
- Emma B Holliday
- The University of Texas MD Anderson Cancer Center Division of Radiation Oncology, Houston, United States
| | - Nathan F Dieckmann
- Oregon Health & Science University School of Nursing, Department of Public Health and Preventative Medicine & Department of Psychiatry, Portland, United States
| | - Tasha L McDonald
- Oregon Health & Science University Department of Radiation Medicine, Portland, United States
| | - Arthur Y Hung
- Oregon Health & Science University Department of Radiation Medicine, Portland, United States
| | - Charles R Thomas
- Oregon Health & Science University Department of Radiation Medicine, Portland, United States
| | - Lisa J Wood
- The University of Texas MD Anderson Cancer Center Division of Radiation Oncology, Houston, United States; Massachussettes General Hospital Institute of Health Professions, Boston, United States.
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9
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Chu D, Popovic M, Chow E, Cella D, Beaumont JL, Lam H, Nguyen J, Giovanni JD, Pulenzas N, Bedard G, Bottomley A. Development, characteristics and validity of the EORTC QLQ-PR25 and the FACT-P for assessment of quality of life in prostate cancer patients. J Comp Eff Res 2014; 3:523-31. [DOI: 10.2217/cer.14.41] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
This review aims to compare and contrast the development, characteristics and validity of two widely used quality of life assessment tools in patients with prostate cancers: the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-PR25) and Functional Assessment of Chronic Illness Therapy (FACT-P). Both questionnaires present several strengths as well as some limitations in measuring the quality of life of prostate cancer patients. Each tool may be selected accordingly based on study design and needs.
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Affiliation(s)
- Dominic Chu
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Marko Popovic
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Edward Chow
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - David Cella
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jennifer L Beaumont
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Henry Lam
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Jasmine Nguyen
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Julia Di Giovanni
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Natalie Pulenzas
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Gillian Bedard
- Rapid Response Radiotherapy Program, Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Bottomley
- European Organisation for Research & Treatment of Cancer Headquarters, Brussels, Belgium
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Jereczek-Fossa BA, Santoro L, Zerini D, Fodor C, Vischioni B, Dispinzieri M, Bossi-Zanetti I, Gherardi F, Bonora M, Caputo M, Vavassori A, Cambria R, Garibaldi C, Cattani F, Matei DV, Musi G, De Cobelli O, Orecchia R. Image Guided Hypofractionated Radiotherapy and Quality of Life for Localized Prostate Cancer: Prospective Longitudinal Study in 337 Patients. J Urol 2013; 189:2099-103. [DOI: 10.1016/j.juro.2013.01.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2013] [Accepted: 01/02/2013] [Indexed: 10/27/2022]
Affiliation(s)
- Barbara A. Jereczek-Fossa
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
- University of Milan, Milan, Italy
| | - Luigi Santoro
- Department of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
| | - Dario Zerini
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Cristiana Fodor
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | | | - Michela Dispinzieri
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
- University of Milan, Milan, Italy
| | - Isa Bossi-Zanetti
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
- University of Milan, Milan, Italy
| | - Federica Gherardi
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
- University of Milan, Milan, Italy
| | - Maria Bonora
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
- University of Milan, Milan, Italy
| | - Mariangela Caputo
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
- University of Milan, Milan, Italy
| | - Andrea Vavassori
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
| | - Raffaella Cambria
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Cristina Garibaldi
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Federica Cattani
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
| | - Deliu V. Matei
- Department of Urology, European Institute of Oncology, Milan, Italy
| | - Gennaro Musi
- Department of Urology, European Institute of Oncology, Milan, Italy
| | - Ottavio De Cobelli
- Department of Urology, European Institute of Oncology, Milan, Italy
- University of Milan, Milan, Italy
| | - Roberto Orecchia
- Department of Radiation Oncology, European Institute of Oncology, Milan, Italy
- University of Milan, Milan, Italy
- Centro Nazionale di Adroterapia Oncologica, Pavia, Italy
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11
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Trudel-Fitzgerald C, Savard J, Ivers H. Evolution of cancer-related symptoms over an 18-month period. J Pain Symptom Manage 2013; 45:1007-18. [PMID: 23017613 DOI: 10.1016/j.jpainsymman.2012.06.009] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2012] [Revised: 05/21/2012] [Accepted: 06/03/2012] [Indexed: 02/02/2023]
Abstract
CONTEXT Previous studies have revealed inconsistent findings about the longitudinal evolution of cancer-related symptoms. In addition, the contribution of medical factors (e.g., cancer site, and treatments) in explaining the changes in these symptoms is yet to be established. OBJECTIVES This prospective study investigated longitudinal changes of five symptoms (i.e., depression, anxiety, insomnia, fatigue, and pain) in patients scheduled to undergo surgery for cancer (N=828). METHODS The patients completed the Hospital Anxiety and Depression Scale, the Insomnia Severity Index, the Multidimensional Fatigue Inventory, and a pain questionnaire at baseline and after 2, 6, 10, 14 and 18 months. RESULTS Several time changes were statistically significant but effect sizes only revealed one change of a medium magnitude, that is, a reduction of anxiety from T1 to T2 (d=-0.58). Women with breast or gynecological cancer were the only subgroups to exhibit significant changes (i.e., reduction of a small magnitude of anxiety symptoms from T1 to T2; ds=-0.27 and -0.30, respectively). However, numerous differences were found across adjuvant treatments, including greater variations in depression and insomnia scores in the chemotherapy group (ds=-0.71 to 0.20) and a transient increase in fatigue symptoms in patients receiving "all" adjuvant treatments (ds=-0.24 to 0.37). CONCLUSION The severity of cancer-related symptoms varies during the cancer care trajectory, especially anxiety scores, which importantly decrease during the first few months after the surgery. This study also suggests that treatment regimens better account for individual differences than cancer site in the evolution of symptoms.
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Affiliation(s)
- Claudia Trudel-Fitzgerald
- School of Psychology, Université Laval and Laval University Cancer Research Center, Québec, Québec, Canada
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The prevalence and severity of fatigue in men with prostate cancer: a systematic review of the literature. Support Care Cancer 2013; 21:1761-71. [PMID: 23455492 DOI: 10.1007/s00520-013-1751-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2012] [Accepted: 02/04/2013] [Indexed: 01/27/2023]
Abstract
BACKGROUND Cancer-related fatigue is a significant clinical problem and is a symptom commonly experienced by patients with differing cancer types during and following treatment. It is a distressing symptom which interferes with functioning in daily life. However, much less is known about the prevalence and severity of fatigue in prostate cancer when compared to other cancer types, such as breast cancer. METHODS A systematic review was conducted to appraise the prevalence and severity of cancer-related fatigue in prostate cancer. Systematic searches of published quantitative research relating to the prevalence and severity of fatigue were conducted using databases, including Medline, PsychINFO, CINAHL and ISI Web of Knowledge (January 2012). Included papers measured the prevalence or severity of prostate-cancer-related fatigue and differentiated fatigue outcomes (prevalence, severity) between treatment modalities. RESULTS Nineteen studies were eligible for the review, of which 17 were cross-sectional and 2 longitudinal. Findings suggest that the prevalence of any fatigue is as high as 74%, whilst chronic fatigue prevalence was highest (39%) when hormone therapy was combined with radiotherapy. Fatigue severity is reported as worse in hormone therapy and treatment combining hormone therapy and radiotherapy. CONCLUSIONS Fatigue is a common symptom for men with prostate cancer, particularly those prescribed hormone therapy. A wide variety of tools were used to measure fatigue prevalence and severity, which made comparisons across studies difficult. The review is limited by methodological shortcomings in the studies included.
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van Gysen KL, Kneebone AB, Guo L, Vaux KJ, Lazzaro EM, Eade TN. Health-related quality of life using intensity-modulated radiation therapy for post-prostatectomy radiotherapy. J Med Imaging Radiat Oncol 2012; 57:89-96. [PMID: 23374560 DOI: 10.1111/j.1754-9485.2012.02464.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2012] [Accepted: 07/01/2012] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Post-prostatectomy radiotherapy (PPRT) with intensity-modulated radiation therapy (IMRT) has the potential to decrease toxicity by reducing dose to surrounding structures. We assessed its impact on health-related quality of life (HRQoL). METHODS PPRT patients were enrolled in a prospective HRQoL database. To be eligible, patients were required to be treated with IMRT and have a minimum of 15-month follow up. HRQoL was assessed at baseline, 3, 9 and 15-24 months using the Expanded Prostate Cancer Index Composite questionnaire. Higher scores reflected better HRQoL. Results were analysed as both population means and as individual scores where a moderate change was 10-20 points and a substantial change was >20 points. RESULTS There were 64 patients eligible and 83% of the cohort received salvage radiotherapy. Prescribed dose was 64 Gy in 32 fractions for adjuvant and 66 Gy in 33 fractions for salvage IMRT. Mean function scores for urinary, bowel and sexual domains were similar at baseline and 15 months (83.5, 94.2 and 16.9 vs. 82.2, 93.1 and 14.3, respectively). Mean global physical functioning (51.0 vs. 48.1) and mental functioning (51.6 vs. 54.2) showed no difference over time. Individual patient scores by 2 years showed a >20-point deterioration in urinary (12.5%), bowel (1.6%), sexual function (9.4%), physical functioning (3.1%) and mental functioning (1.6%). CONCLUSION This report on HRQoL following post-prostatectomy IMRT demonstrates no variation in mean scores in any domain and only 1.6% of patients reporting a greater than 20-point deterioration between baseline and 15-24 months in bowel function.
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Affiliation(s)
- Kirsten L van Gysen
- Northern Sydney Cancer Centre, Royal North Shore Hospital, Sydney, New South Wales, Australia
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Knapp K, Cooper B, Koetters T, Cataldo J, Dhruva A, Paul SM, West C, Aouizerat BE, Miaskowski C. Trajectories and predictors of symptom occurrence, severity, and distress in prostate cancer patients undergoing radiation therapy. J Pain Symptom Manage 2012; 44:486-507. [PMID: 22771128 PMCID: PMC3463773 DOI: 10.1016/j.jpainsymman.2011.10.020] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2011] [Revised: 10/09/2011] [Accepted: 10/12/2011] [Indexed: 10/28/2022]
Abstract
CONTEXT Radiation therapy (RT) is a common treatment for prostate cancer. Despite available research, prostate cancer patients report that information about side effects is their most important unmet need. Additional research is needed that focuses on specific dimensions of the patient's symptom experience. OBJECTIVES The study's purposes were to evaluate the trajectories of occurrence, severity, and distress of the six most prevalent symptoms reported by patients undergoing RT for prostate cancer and the effects of selected demographic and clinical characteristics on these trajectories. METHODS Patients completed the Memorial Symptom Assessment Scale 11 times before, during, and after RT. For problems with urination, pain, lack of energy, feeling drowsy, difficulty sleeping, and diarrhea, the trajectories of occurrence, severity, and distress were evaluated using multilevel generalized linear models. RESULTS Across all three dimensions, pain, lack of energy, feeling drowsy, and difficulty sleeping followed a decreasing linear trend. Problems with urination and diarrhea demonstrated more complex patterns of change over time. CONCLUSION Although longitudinal data on pain, lack of energy, feeling drowsy, and difficulty sleeping are limited, they are highly prevalent symptoms in these patients. In addition, diarrhea becomes a significant problem for these patients over the course of RT. A number of demographic and clinical characteristics affect the trajectories of these common symptoms differentially.
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Affiliation(s)
- Katie Knapp
- School of Nursing, University of California at San Francisco, CA 94143, USA
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Chen RC, Zhang Y, Chen MH, McMahon E, Loffredo M, McPherson CP, Nguyen AU, Nguyen PL, D'Amico AV. Patient-reported quality of life during radiation treatment for localized prostate cancer: results from a prospective phase II trial. BJU Int 2012; 110:1690-5. [DOI: 10.1111/j.1464-410x.2012.11117.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Mc Caughan E, Mc Sorley O, Prue G, Parahoo K, Bunting B, Sullivan JO, McKenna H. Quality of life in men receiving radiotherapy and neo-adjuvant androgen deprivation for prostate cancer: results from a prospective longitudinal study. J Adv Nurs 2012; 69:53-65. [PMID: 22458267 DOI: 10.1111/j.1365-2648.2012.05987.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
AIM To report a study measuring the quality of life and side effects in men receiving radiotherapy and hormone ablation for prostate cancer up to 1 year after treatment. BACKGROUND Prostate cancer incidence is increasing with the result that more men are living longer with the disease and the side effects of treatment. It is important to know the effects this has on their quality of life. DESIGN Survey. METHOD Between September 2006-September 2007, all men who were about to undergo radical conformal radiotherapy ± neo-adjuvant androgen deprivation for localized prostate cancer were invited to participate in the study; 149 men were recruited. They completed the European Organization on Research and Treatment of Cancer quality of life questionnaire C-30 and Prostate Cancer module PR25 at four time-points. RESULTS At 4-6 weeks after radiotherapy, participants experienced the biggest relative decline in global quality of life, social, physical, and role functioning and an increase in treatment side effects. At 6 months postradiotherapy the majority of men experienced an improvement in their side effects. However, a minority of men were experiencing severe side effects of radiotherapy at 1 year post-treatment. Single men and men who had a low quality of life prior to radiotherapy, reported a lower quality of life at 1 year after treatment in comparison to married men. CONCLUSION Men with prostate cancer suffer limitations due to the symptoms they experience and disruption to their quality of life. It is essential that nurses develop and deliver follow-up care which is flexible and appropriate to the individual needs of these men.
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Bauml J, Xie SX, Penn C, Desai K, Dong KW, Bruner DW, Vapiwala N, Mao JJ. A Pragmatic Evaluation of the National Cancer Institute Physician Data Query (PDQ)®-Based Brief Counseling on Cancer-Related Fatigue among Patients Undergoing Radiation Therapy. ACTA ACUST UNITED AC 2012; 2. [PMID: 29479490 PMCID: PMC5824725 DOI: 10.4172/2165-7386.1000125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Purpose Cancer-Related Fatigue (CRF) negatively affects quality of life among cancer patients. This study seeks to evaluate the outcome and patient receptiveness of a brief counseling program based on National Cancer Institute (NCI) PDQ® information to manage CRF when integrated into Radiation Therapy (RT). Methods We conducted a prospective cohort study among patients undergoing non-palliative RT. Patients with stage I–III tumors and with Karnofsky score 60 or better were given a ten-minute behavioral counseling session during the first two weeks of RT. The Brief Fatigue Inventory (BFI) was administered at baseline/end of RT. Results Of 93 patients enrolled, 89% found the counseling useful and practical. By the end of RT, 59% reported increased exercise, 41.6% sought nutrition counseling, 72.7% prioritized daily activities, 74.4% took daytime naps, and 70.5% talked with other cancer patients. Regarding counseling, patients who had received chemotherapy prior to RT had no change in fatigue (−0.2), those who received RT alone had mild increase in fatigue (0.7, p=0.02), and those who received concurrent chemotherapy experienced a substantial increase in fatigue (3.0 to 5.2, p=0.05). Higher baseline fatigue and receipt of chemotherapy were predictive of worsened fatigue in a multivariate model (both p<0.01). Conclusion Our data suggests that brief behavioral counseling based on NCI guidelines is well accepted by patients showing an uptake in many activities to cope with CRF. Those who receive concurrent chemotherapy and with higher baseline fatigue are at risk for worsening fatigue despite of guideline-based therapy.
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Affiliation(s)
- Joshua Bauml
- Abramson Cancer Center, University of Pennsylvania, 3400 Spruce Street/2 Gates, Philadelphia, Pennsylvania 19104, USA
| | - Sharon X Xie
- Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, 3400 Spruce Street/2 Gates, Philadelphia, Pennsylvania 19104, USA
| | - Courtney Penn
- Department of Family Medicine and Community Health, University of Pennsylvania, 3400 Spruce Street/2 Gates, Philadelphia, Pennsylvania 19104, USA
| | - Krupali Desai
- Department of Family Medicine and Community Health, University of Pennsylvania, 3400 Spruce Street/2 Gates, Philadelphia, Pennsylvania 19104, USA
| | - Kimberly W Dong
- Department of Family Medicine and Community Health, University of Pennsylvania, 3400 Spruce Street/2 Gates, Philadelphia, Pennsylvania 19104, USA
| | - Deborah Watkins Bruner
- Abramson Cancer Center, University of Pennsylvania, 3400 Spruce Street/2 Gates, Philadelphia, Pennsylvania 19104, USA.,Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street/2 Gates, Philadelphia, Pennsylvania 19104, USA.,Woodruff School of Nursing, University of Emory, Georgia 30322, USA
| | - Neha Vapiwala
- Abramson Cancer Center, University of Pennsylvania, 3400 Spruce Street/2 Gates, Philadelphia, Pennsylvania 19104, USA.,Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street/2 Gates, Philadelphia, Pennsylvania 19104, USA
| | - Jun James Mao
- Abramson Cancer Center, University of Pennsylvania, 3400 Spruce Street/2 Gates, Philadelphia, Pennsylvania 19104, USA.,Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, 3400 Spruce Street/2 Gates, Philadelphia, Pennsylvania 19104, USA.,Department of Family Medicine and Community Health, University of Pennsylvania, 3400 Spruce Street/2 Gates, Philadelphia, Pennsylvania 19104, USA
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Storey DJ, McLaren DB, Atkinson MA, Butcher I, Liggatt S, O'Dea R, Smyth JF, Sharpe M. Clinically relevant fatigue in recurrence-free prostate cancer survivors. Ann Oncol 2012; 23:65-72. [PMID: 21436185 DOI: 10.1093/annonc/mdr034] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Little is known about the prevalence and associations of clinically relevant fatigue (CRF) in recurrence-free prostate cancer survivors. PATIENTS AND METHODS Four hundred and sixteen recurrence-free prostate cancer survivors who were >1 year post-radiotherapy or radical prostatectomy were surveyed. The prevalence of CRF (defined as Brief Fatigue Inventory >3) was determined and compared with a noncancer control group. Other measures included the Hospital Anxiety and Depression Scale, International Prostate Symptom Score, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire. Relationships between these factors and CRF were explored in univariate and multivariate analyses. RESULTS Analyzable data were obtained from 91% (377/416) of patients. The prevalence of CRF was 29% (108/377) versus 16% (10/63) in the controls (P=0.031). CRF was more common in post-radiotherapy than in post-prostatectomy 33% (79/240) versus 22% (29/133), P=0.024. However, when other factors (current depression, anxiety, urinary symptoms, medical comorbidities, pain and insomnia) were controlled for, previous treatment did not predict CRF. Current depression [Hospital Anxiety and Depression Scale≥8 was by far the strongest association [odds ratio 9.9, 95% confidence interval 4.2-23.5)]. CONCLUSIONS Almost one-third of recurrence-free prostate cancer survivors report CRF. Depression, anxiety, urinary symptoms, pain and insomnia measured at outcome are more strongly associated than type of cancer treatment previously received.
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Affiliation(s)
- D J Storey
- Edinburgh Cancer Research UK Centre, University of Edinburgh, Edinburgh; Edinburgh Cancer Centre, Western General Hospital, Edinburgh.
| | - D B McLaren
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh
| | - M A Atkinson
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh
| | - I Butcher
- Centre for Population Health Sciences, Edinburgh
| | - S Liggatt
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh
| | - R O'Dea
- Edinburgh Cancer Centre, Western General Hospital, Edinburgh
| | - J F Smyth
- Edinburgh Cancer Research UK Centre, University of Edinburgh, Edinburgh
| | - M Sharpe
- Edinburgh Cancer Research UK Centre, University of Edinburgh, Edinburgh; Psychological Medicine Research, University of Edinburgh, Edinburgh, UK
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Neu B, Sautter V, Momm F, Melcher U, Seegenschmiedt H, Micke O, Sautter-Bihl ML. Radiotherapy for Prevention and Therapy of Gynecomastia Due to Antiandrogen Treatment in Prostate Cancer Patients. Strahlenther Onkol 2011; 187:771-7. [DOI: 10.1007/s00066-011-2283-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2011] [Accepted: 06/16/2011] [Indexed: 10/15/2022]
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Momm F, Jooss D, Xander CJ, Adebahr S, Duncker-Rohr V, Heinemann F, Kirste S, Messmer MB, Grosu AL, Becker G. [Survey of potential improvements during the course of the radiotherapy treatment--a patient questionnaire]. Strahlenther Onkol 2011; 187:750-6. [PMID: 22037653 DOI: 10.1007/s00066-011-2264-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2011] [Accepted: 06/16/2011] [Indexed: 11/28/2022]
Abstract
INTRODUCTION AND BACKGROUND In the context of quality assurance, increasing demands are placed on the whole radiotherapy treatment process. The patients directly concerned generally do not realize most aspects of the quality assurance program (e.g., additional safety checks) during their daily therapy. It was the aim of this study to systematically ask patients about potential improvements during the course of radiotherapy treatment from their own perspective. PATIENTS AND METHODS In the defined time span (1 month), 624 radiotherapy patients (600 questionnaires were returned, 96.2%) were interviewed using a questionnaire newly developed to inquire about several aspects of their treatment. Furthermore, they were asked for their specific needs and suggestions for improvements that could be made during the course of radiotherapy treatment. RESULTS Overall, the patients were satisfied with the course of their radiotherapy treatment and with patient care. As an example, about 90% agreed with the statement: "My first contact with the radiation oncology unit proceeded with kindness and competence so that I was given the impression that I will be well cared for in this clinic." Considering the organization of the course of radiotherapy, a large majority of patients attached great value to set appointments for the therapy fractions. A main point of criticism was waiting times or delays caused by servicing or machine failures. Small, low cost improvements as music in the therapy room were considered as important as expensive measures (e.g., daylight in the therapy room). The patients emphasized the importance of staff friendliness. CONCLUSION The situation of radiotherapy patients was, in general, satisfactory. Future improvements can be mainly expected from smooth organisation of both planning and treatment which can be achieved by electronic scheduling systems. Many results of the survey could be easily implemented in daily practice. In matters of organization radiation oncology with its complex procedures can be used as a model for other clinical departments.
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Affiliation(s)
- Felix Momm
- Klinik für Strahlenheilkunde, Universitätsklinikum Freiburg, Freiburg i. Br., Germany.
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Welzel G, Hägele V, Wenz F, Mai SK. Quality of life outcomes in patients with anal cancer after combined radiochemotherapy. Strahlenther Onkol 2011; 187:175-82. [PMID: 21347639 DOI: 10.1007/s00066-010-2175-5] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2010] [Accepted: 12/01/2010] [Indexed: 01/04/2023]
Abstract
PURPOSE To assess self-reported quality of life (QoL) experienced by anal cancer patients after radiochemotherapy, and to identify patient- and disease-related factors associated with QoL. PATIENTS AND METHODS A total of 88 patients treated for anal cancer at our institution between 1990 and 2006 were identified from our database. Of these, 15 patients had died, and 4 were lost to follow-up. QoL was assessed using the EORTC QLQ-C30 questionnaire (cancer-specific QoL) and the colorectal cancer module QLQ-CR38 (site-specific QoL); 52 responses were received. The median follow-up was 36 months (range, 5-137 months). RESULTS As for cancer-specific QoL, global health QoL score (mean 60.4) was similar to the general German population, whereas most of the function and symptom scale scores were considerably lower/higher in anal cancer patients. The most prominent mean score differences were observed in role functioning (-21.8 points), emotional functioning (-20.7 points), social functioning (-28.9 points), diarrhea (+34.6 points), and financial difficulties (+26.9 points; p < 0.001). As for site-specific QoL, the mean function scale scores ranged from 22.1 (sexual function) to 63.2 (body image), and the mean symptom scale scores from 14.7 (weight loss) to 69.0 (stoma-related problems, 4 patients) and 67.9 (male sexual dysfunction), respectively. Most of the QoL scores were not affected by late toxicity, patient- or disease-related factors. Fatigue (+18.2 points) emerged as the strongest predictor of impaired QoL. CONCLUSION The global health QoL of anal cancer patients is comparable with that of the general German population, but there are specific limitations, e.g., sexual dysfunction, urological/gastrointestinal complaints, financial difficulties, fatigue, and a reduction in emotional and social well-being.
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Affiliation(s)
- Grit Welzel
- Department of Radiation Oncology, University Medical Center Mannheim, University of Heidelberg, Germany.
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Pinkawa M, Holy R, Piroth MD, Fischedick K, Schaar S, Székely-Orbán D, Eble MJ. Consequential late effects after radiotherapy for prostate cancer - a prospective longitudinal quality of life study. Radiat Oncol 2010; 5:27. [PMID: 20377874 PMCID: PMC2857853 DOI: 10.1186/1748-717x-5-27] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2010] [Accepted: 04/08/2010] [Indexed: 11/24/2022] Open
Abstract
Background To answer the question if and to which extent acute symptoms at the end and/or several weeks after radiotherapy can predict adverse urinary and gastrointestinal long-term quality of life (QoL). Methods A group of 298 patients has been surveyed prospectively before (time A), at the last day (B), two months after (C) and >one year after (D) radiotherapy using a validated questionnaire (Expanded Prostate Cancer Index Composite). A subgroup of 10% with the greatest urinary/bowel bother score decrease at time D was defined as patients with adverse long-term QoL. Results Subgroup and correlation analyses could demonstrate a strong dependence of urinary/bowel QoL after radiotherapy on urinary/bowel QoL before radiotherapy. In contrast to absolute scores, QoL score changes (relative to baseline scores) did not correlate with pretreatment scores. Long-term changes could be well predicted by acute changes. Patients reporting great/moderate bother with urinary/bowel problems at time C reported to have great/moderate bother at time D in ≥ 50%, respectively. In a multivariate analysis of factors for adverse long-term urinary and bowel QoL, score changes at time C were found to be independent predictors, respectively. Additionally, QoL changes at time B were independently predictive for adverse long-term bowel QoL. Conclusions Consequential late effects play a major role after radiotherapy for prostate cancer. Patients with greater and particularly longer non-healing acute toxicity are candidates for closer follow-up and possible prophylactic actions to reduce a high probability of long-term problems.
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Affiliation(s)
- Michael Pinkawa
- Department of Radiation Oncology, RWTH Aachen University, Pauwelsstrasse 30, 52072 Aachen, Germany.
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