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Chu JN, Canchola AJ, Keegan THM, Nickell A, Oakley-Girvan I, Hamilton AS, Yu RL, Gomez SL, Shariff-Marco S. Evaluating the Impact of Social and Built Environments on Health-Related Quality of Life among Cancer Survivors. Cancer Epidemiol Biomarkers Prev 2022; 31:161-174. [PMID: 34728471 PMCID: PMC8755614 DOI: 10.1158/1055-9965.epi-21-0129] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/07/2021] [Accepted: 10/26/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND With almost 17 million U.S. cancer survivors, understanding multilevel factors impacting health-related quality of life (HRQOL) is critical to improving survivorship outcomes. Few studies have evaluated neighborhood impact on HRQOL among cancer survivors. METHODS We combined sociodemographic, clinical, and behavioral data from three registry-based studies in California. Using a three-level mixed linear regression model (participants nested within block groups and study/regions), we examined associations of both independent neighborhood attributes and neighborhood archetypes, which capture interactions inherent among neighborhood attributes, with two HRQOL outcomes, physical (PCS) and mental (MCS) composite scores. RESULTS For the 2,477 survivors, 46% were 70+ years, 52% were non-Hispanic White, and 53% had localized disease. In models minimally adjusted for age, stage, and cancer recurrence, HRQOL was associated with neighborhood socioeconomic status (nSES), racial/ethnic composition, population density, street connectivity, restaurant environment index, traffic density, urbanicity, crowding, rental properties, and non-single family units. In fully adjusted models, higher nSES remained associated with better PCS, and restaurant environment index, specifically more unhealthy restaurants, associated with worse MCS. In multivariable-adjusted models of neighborhood archetype, compared with upper middle-class suburb, Hispanic small town and inner city had lower PCS, and high status had higher MCS. CONCLUSIONS Among survivors, higher nSES was associated with better HRQOL; more unhealthy restaurants were associated with worse HQROL. As some neighborhood archetypes were associated with HRQOL, they provide an approach to capture how neighborhood attributes interact to impact HRQOL. IMPACT Elucidating the pathways through which neighborhood attributes influence HRQOL is important in improving survivorship outcomes.
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Affiliation(s)
- Janet N Chu
- Department of Medicine, University of California San Francisco, San Francisco, California
| | - Alison J Canchola
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
| | - Theresa H M Keegan
- Department of Internal Medicine, University of California Davis, Davis, California
| | | | | | - Ann S Hamilton
- Department of Preventive Medicine, Keck School of Medicine, Los Angeles, California
| | - Rosa L Yu
- Department of Medicine, Beth Israel Deaconess Medical Center, New York, New York
| | - Scarlett Lin Gomez
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
| | - Salma Shariff-Marco
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.
- Helen Diller Family Comprehensive Cancer Center, University of California San Francisco, San Francisco, California
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Magnus A, Isaranuwatchai W, Mihalopoulos C, Brown V, Carter R. A Systematic Review and Meta-Analysis of Prostate Cancer Utility Values of Patients and Partners Between 2007 and 2016. MDM Policy Pract 2019; 4:2381468319852332. [PMID: 31192309 PMCID: PMC6540514 DOI: 10.1177/2381468319852332] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2017] [Accepted: 03/03/2019] [Indexed: 11/24/2022] Open
Abstract
Background. There is widespread agreement that both the length and
quality of life matter when assessing new technologies and/or models of care in
the treatment for cancer patients. Quality of life for partners/carers also
matters, particularly for prostate cancer. Purpose. This systematic
review aims to provide up-to-date utility values along the prostate cancer care
continuum (i.e., from prescreening through to palliative care) for use where
future trial-based or modelled economic evaluations cannot collect primary data
from men and/or partners. Data Sources. A protocol was developed
and registered on the international register of systematic reviews—PROSPERO.
Databases searched included EBSCO Information Services (CINAHL, EconLit, Global
Health, HEED, MEDLINE Complete, PsycINFO), Cochrane Database of Systematic
Reviews, Web of Science, and Embase. Study Selection. Study
selection terms included health-related quality of life, prostate cancer, and
partners or carers. Data Extraction. The authors identified
articles published between 2007 and 2016 that provided health state utility
values, with statistical uncertainty, for men with or at risk of prostate cancer
and/or their partner/carers. Data Synthesis and Results. Study
quality and generalizability of utilities was evaluated and meta-analysis
conducted against prespecified criteria. From 906 original articles, 29 recent
primary studies met the inclusion/exclusion criteria. We tabulate all the
utility values with uncertainty, along with considerable methodological detail
and patient population characteristics. Limitations. Utility values
pertaining to carers/partners were limited to one study.
Conclusions. Studies varied in design, measurement instruments
utilized, quality, and generalizability. There is sufficient qualitative and
quantitative detail for the reported utility values to be readily incorporated
into economic evaluations. More research is needed with carers/partners and with
newly developing prostate cancer-specific quality of life tools.
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Affiliation(s)
- Anne Magnus
- Deakin Health Economics, Centre for Population Health Research, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Wanrudee Isaranuwatchai
- Centre for Excellence in Economic Analysis Research, St. Michael's Hospital; Institute for Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Cathrine Mihalopoulos
- Deakin Health Economics, Centre for Population Health Research, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Victoria Brown
- Deakin Health Economics, Centre for Population Health Research, Faculty of Health, Deakin University, Geelong, Victoria, Australia
| | - Rob Carter
- Deakin Health Economics, Centre for Population Health Research, Faculty of Health, Deakin University, Geelong, Victoria, Australia
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Lorent M, Maalmi H, Tessier P, Supiot S, Dantan E, Foucher Y. Meta-analysis of predictive models to assess the clinical validity and utility for patient-centered medical decision making: application to the CAncer of the Prostate Risk Assessment (CAPRA). BMC Med Inform Decis Mak 2019; 19:2. [PMID: 30616621 PMCID: PMC6323757 DOI: 10.1186/s12911-018-0727-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 12/21/2018] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND The Cancer of the Prostate Risk Assessment (CAPRA) score was designed and validated several times to predict the biochemical recurrence-free survival after a radical prostatectomy. Our objectives were, first, to study the clinical validity of the CAPRA score, and, second, to assess its clinical utility for stratified medicine from an original patient-centered approach. METHODS We proposed a meta-analysis based on a literature search using MEDLINE. Observed and predicted biochemical-recurrence-free survivals were compared to assess the calibration of the CAPRA score. Discriminative capacities were evaluated by estimating the summary time-dependent ROC curve. The clinical utility of the CAPRA score was evaluated according to the following stratified decisions: active monitoring for low-risk patients, prostatectomy for intermediate-risk patients, or radio-hormonal therapy for high risk patients. For this purpose, we assessed CAPRA's clinical utility in terms of its ability to maximize time-dependent utility functions (i.e. Quality-Adjusted Life-Years - QALYs). RESULTS We identified 683 manuscripts and finally retained 9 studies. We reported good discriminative capacities with an area under the SROCt curve at 0.73 [95%CI from 0.67 to 0.79], while graphical calibration seemed acceptable. Nevertheless, we also described that the CAPRA score was unable to discriminate between the three medical alternatives, i.e. it did not allow an increase in the number of life years in perfect health (QALYs) of patients with prostate cancer. CONCLUSIONS We confirmed the prognostic capacities of the CAPRA score. In contrast, we were not able to demonstrate its clinical usefulness for stratified medicine from a patient-centered perspective. Our results also highlighted the confusion between clinical validity and utility. This distinction should be better considered in order to develop predictive tools useful in practice.
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Affiliation(s)
- Marine Lorent
- SPHERE (methodS in Patient-centered outcomes & HEalth ResEarch) U1246, INSERM, Nantes University, Tours University, Nantes, France
| | - Haïfa Maalmi
- Division of Clinical Epidemiology and Aging Research, Heidelberg University, Heidelberg, Germany
| | - Philippe Tessier
- SPHERE (methodS in Patient-centered outcomes & HEalth ResEarch) U1246, INSERM, Nantes University, Tours University, Nantes, France
| | - Stéphane Supiot
- Department of Radiotherapy, Institut de Cancérologie de l’Ouest René Gauducheau, Saint Herblain, France
- INSERM UMR892, Nantes University, Nantes, France
| | - Etienne Dantan
- SPHERE (methodS in Patient-centered outcomes & HEalth ResEarch) U1246, INSERM, Nantes University, Tours University, Nantes, France
| | - Yohann Foucher
- SPHERE (methodS in Patient-centered outcomes & HEalth ResEarch) U1246, INSERM, Nantes University, Tours University, Nantes, France
- Nantes University Hospital, Nantes, France
- IRS2, SPHERE U1246, 22 boulevard Bénoni Goullin, 44200 Nantes, France
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Ávila M, Becerra V, Guedea F, Suárez JF, Fernandez P, Macías V, Mariño A, Hervás A, Herruzo I, Ortiz MJ, Ponce de León J, Sancho G, Cunillera O, Pardo Y, Cots F, Ferrer M. Estimating preferences for treatments in patients with localized prostate cancer. Int J Radiat Oncol Biol Phys 2014; 91:277-87. [PMID: 25491504 DOI: 10.1016/j.ijrobp.2014.09.044] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 09/25/2014] [Accepted: 09/30/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE Studies of patients' preferences for localized prostate cancer treatments have assessed radical prostatectomy and external radiation therapy, but none of them has evaluated brachytherapy. The aim of our study was to assess the preferences and willingness to pay of patients with localized prostate cancer who had been treated with radical prostatectomy, external radiation therapy, or brachytherapy, and their related urinary, sexual, and bowel side effects. METHODS AND MATERIALS This was an observational, prospective cohort study with follow-up until 5 years after treatment. A total of 704 patients with low or intermediate risk localized prostate cancer were consecutively recruited from 2003 to 2005. The estimation of preferences was conducted using time trade-off, standard gamble, and willingness-to-pay methods. Side effects were measured with the Expanded Prostate Index Composite (EPIC), a prostate cancer-specific questionnaire. Tobit models were constructed to assess the impact of treatment and side effects on patients' preferences. Propensity score was applied to adjust for treatment selection bias. RESULTS Of the 580 patients reporting preferences, 165 were treated with radical prostatectomy, 152 with external radiation therapy, and 263 with brachytherapy. Both time trade-off and standard gamble results indicated that the preferences of patients treated with brachytherapy were 0.06 utilities higher than those treated with radical prostatectomy (P=.01). Similarly, willingness-to-pay responses showed a difference of €57/month (P=.004) between these 2 treatments. Severe urinary incontinence presented an independent impact on the preferences elicited (P<.05), whereas no significant differences were found by bowel and sexual side effects. CONCLUSIONS Our findings indicate that urinary incontinence is the side effect with the highest impact on preferences and that brachytherapy and external radiation therapy are more valued than radical prostatectomy. These time trade-off and standard gamble preference assessments as well as the willingness-to-pay estimation could be useful to perform respectively cost-utility or cost-benefit analyses, which can guide health policy decisions.
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Affiliation(s)
- Mónica Ávila
- Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain; Universitat Pompeu Fabra, Barcelona, Spain
| | - Virginia Becerra
- Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Ferran Guedea
- Servicio de Oncología Radioterápica, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Spain
| | - José Francisco Suárez
- Servicio de Urología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Pablo Fernandez
- Servicio de Oncología Radioterápica, Instituto Oncológico de Guipúzcoa, San Sebastián, Spain
| | - Víctor Macías
- Servicio de Oncología Radioterápica, Hospital Clínico Universitario de Salamanca, Salamanca, Spain; Servicio de Oncología Radioterápica, Institut Oncologic del Valles-Hospital General de Catalunya, Sant Cugat del Vallès, Spain
| | - Alfonso Mariño
- Servicio de Oncología Radioterápica, Centro Oncológico de Galicia, A Coruña, Spain
| | - Asunción Hervás
- Servicio de Oncología Radioterápica, Hospital Ramón y Cajal, Madrid, Spain
| | - Ismael Herruzo
- Servicio de Oncología Radioterápica, Hospital Regional Carlos Haya, Málaga, Spain
| | - María José Ortiz
- Servicio de Oncología Radioterápica, Hospital Virgen del Rocío, Sevilla, Spain
| | | | - Gemma Sancho
- Servicio de Oncología Radioterápica, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Oriol Cunillera
- Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Yolanda Pardo
- Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
| | - Francesc Cots
- Epidemiology and Evaluation Research Group, Epidemiology and Evaluation Department, Hospital del Mar, Barcelona, Spain
| | - Montse Ferrer
- Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain; Universitat Autònoma de Barcelona, Bellaterra, Spain.
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A reference set of health utilities for long-term survivors of prostate cancer: population-based data from Ontario, Canada. Qual Life Res 2013; 22:2951-62. [PMID: 23564620 DOI: 10.1007/s11136-013-0401-1] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/25/2013] [Indexed: 12/29/2022]
Abstract
PURPOSE To measure quality of life (QOL) and utilities for prostate cancer (PC) patients and determine their predictors. METHODS A population-based, community-dwelling, geographically diverse sample of long-term PC survivors in Ontario, Canada, was identified from the Ontario Cancer Registry and contacted through their referring physician. Consenting patients completed questionnaires by mail: Health Utilities Index (HUI 2/3), Patient Oriented Prostate Utility Scale PORPUS-U (utility), PORPUS-P (health profile), Functional Assessment of Cancer Therapy-Prostate (FACT-P), and Prostate Cancer Index (PCI). Clinical data were obtained from chart reviews. Regression models determined the effects of a series of variables on QOL and utility. RESULTS We received questionnaires and reviewed charts for 585 patients (mean age 72.6, 2-13 years postdiagnosis). Mean utility scores were as follows: PORPUS-U = 0.92, HUI2 = 0.85, and HUI3 = 0.78. Mean health profile scores were as follows: PORPUS-P = 71.7, PCI sexual, urinary, and bowel function = 23.7, 79.1, and 84.6, respectively (0 = worst, 100 = best), and FACT-P = 125.1 (0 = worst, 156 = best). In multiple regression analyses, comorbidity and PCI urinary, sexual, and bowel function were significant predictors of other QOL measures. With all variables, 32-50 % of the variance in utilities was explained. CONCLUSIONS Many variables affect global QOL of PC survivors; only prostate symptoms and comorbidity have independent effects. Our model allows estimation of the effects of multiple factors on utilities. These utilities for long-term outcomes of PC and its treatment are valuable for decision/cost-effectiveness models of PC treatment.
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Mickevičienė A, Vanagas G, Ulys A, Jievaltas M, Smailytė G, Padaiga Ž. Factors affecting health-related quality of life in prostate cancer patients. ACTA ACUST UNITED AC 2012; 46:180-7. [PMID: 22375530 DOI: 10.3109/00365599.2012.661765] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Prostate cancer is the most common cancer among men in Lithuania. Quality of life (QoL) assessment plays a key role in the evaluation and treatment of cancer patients. The aim of this study was to evaluate factors affecting the QoL of patients with prostate cancer in Lithuania. MATERIAL AND METHODS A cross-sectional national-level study was performed. QoL was investigated with the EORTC QLQ-C30 questionnaire. Statistical analysis included descriptive statistics, interrelationship analysis between characteristics and multivariate logistic regression to estimate predictors and odds ratios (ORs) for each of the independent variables in the model. RESULTS The response rate was 74.8% (N = 486). One-quarter of respondents with prostate cancer indicated high QoL scores. Higher QoL scores were given for prostate cancer patients with lower education level [OR = 3.092, 95% confidence interval (CI) 1.007-9.491, p = 0.049], having lower monthly expenses for treatment (OR = 3.653, CI 1.318-10.128, p = 0.013), disease stage II (by patient conveyance) (OR = 10.053, CI 1.015-99.534, p = 0.048), disease stage I (by medical record) (OR = 2.19E + 08, CI 218514200.17-218514200.17, p < 0.001) and in those with undisclosed disease stage (OR = 9.220, CI 1.251-67.965, p = 0.029). CONCLUSIONS Significant predictors for higher QoL scores were education level, own monthly expenses for treatment and disease stage. Patients with undisclosed disease stage more often had higher QoL scores.
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Affiliation(s)
- Aušra Mickevičienė
- Department of Preventive Medicine, Academy of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania.
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Gandhi P, Spooner J, Huang IC. In reply to: association between utility and treatment among patients with prostate cancer. Qual Life Res 2010; 19:1393-4. [DOI: 10.1007/s11136-010-9698-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2010] [Indexed: 11/30/2022]
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