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Westerhoff JM, Lalmahomed TA, Meijers LTC, Henke L, Teunissen FR, Bruynzeel AME, Alongi F, Hall WA, Kishan AU, Intven MPW, Verkooijen HM, van der Voort van Zyp JRN, Daamen LA. Patient-Reported Outcomes Following Magnetic Resonance-Guided Radiation Therapy for Prostate Cancer: A Systematic Review and Meta-Analysis. Int J Radiat Oncol Biol Phys 2024; 120:38-48. [PMID: 38838994 DOI: 10.1016/j.ijrobp.2024.05.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 05/24/2024] [Accepted: 05/29/2024] [Indexed: 06/07/2024]
Abstract
PURPOSE This systematic review provides an overview of literature on the impact of magnetic resonance-guided radiation therapy (MRgRT) on patient-reported outcomes (PROs) in patients with prostate cancer (PC). METHODS AND MATERIALS A systematic search was performed in October 2023 in PubMed, EMBASE, and Cochrane Library. The Patient, Intervention, Comparison, Outcomes, and Study design (PICOS) framework was used to determine eligibility criteria. Included were studies assessing PROs following MRgRT for PC with a sample size >10. Methodological quality was assessed using the Cochrane's Risk of Bias in Nonrandomized Studies - of Interventions and Cochrane's risk of bias tool for randomized trials. Relevant mean differences (MDs) compared with pre-RT were interpreted using minimal important differences. Meta-analyses were performed using random-effects models. Between-study heterogeneity was assessed using the I2 statistic. RESULTS Eleven observational studies and 1 randomized controlled trial (n = 897) were included. Nine studies included patients with primary PC with MRgRT as first-line treatment (n = 813) and 3 with MRgRT as second-line treatment (n = 84). Substantial risk of bias was found in 5 studies. European Organization for Research and Treatment Quality of Life Questionnaire (EORTC QLQ) core 30 (C30) and EORTC QLQ prostate cancer module (PR25) scores were pooled from 3 studies, and Expanded Prostate Cancer Index Composite (EPIC)-26 scores were pooled from 4 studies. Relevant MDs for the urinary domain were found with the EPIC-26 (MD, -10.0; 95% CI, -12.0 to -8.1; I2 = 0%) and the EORTC QLQ-PR25 (MD, 8.6; 95% CI, -4.7 to 22.0; I2 = 97%), both at end-RT to 1-month follow-up. Relevant MDs for the bowel domain were found with the EPIC-26 (MD, -4.7; 95% CI, -9.2 to -0.2; I2 = 82%) at end-RT or 1-month follow-up, but not with the EORTC QLQ-PR25. For both domains, no relevant MDs were found after 3 months of follow-up. No relevant MDs were found in the general quality of life domains of the EORTC QLQ C30. CONCLUSIONS MRgRT for PC results in a temporary worsening of patient-reported urinary and bowel symptoms during the first month after treatment compared with pre-RT, resolving at 3 months. No clinically relevant changes were found for general quality of life domains. These results provide important information for patient counseling and can serve as a benchmark for future studies.
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Affiliation(s)
- Jasmijn M Westerhoff
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Tariq A Lalmahomed
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lieke T C Meijers
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Lauren Henke
- Department of Radiation Oncology, University Hospitals, Case Western Reserve University, Cleveland, Ohio, USA
| | - Frederik R Teunissen
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands; Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Anna M E Bruynzeel
- Department of Radiation Oncology, Amsterdam UMC (location VUmc), Amsterdam, the Netherlands
| | - Filippo Alongi
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Negrar di Valpolicella, Italy; University of Brescia, Brescia, Italy
| | - William A Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Amar U Kishan
- Department of Radiation Oncology, University of California, Los Angeles, California, USA
| | - Martijn P W Intven
- Department of Radiation Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Helena M Verkooijen
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Lois A Daamen
- Division of Imaging and Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
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Arcangeli S, Chissotti C, Ferrario F, Lucchini R, Belmonte M, Purrello G, Colciago RR, De Ponti E, Faccenda V, Panizza D. Ablative Radiation Therapy for Unfavorable Prostate Tumors (ABRUPT): Preliminary Analysis of Toxicity and Quality of Life from a Prospective Study. Int J Radiat Oncol Biol Phys 2024:S0360-3016(24)02539-2. [PMID: 38971384 DOI: 10.1016/j.ijrobp.2024.06.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 06/04/2024] [Accepted: 06/24/2024] [Indexed: 07/08/2024]
Abstract
PURPOSE To assess late gastrointestinal (GI) and genitourinary (GU) side effects in patients with organ-confined unfavorable prostate cancer (PCa) treated with single-dose ablative radiation therapy (SDRT). METHODS AND MATERIALS Thirty patients enrolled in a single-arm prospective trial received 24 Gy SDRT to the whole prostate with urethra-sparing and organ motion control delivered on a Linac platform with a 10 MV flattening filter-free single partial arc. Androgen deprivation therapy was prescribed as per standard of care. Treatment-related acute and late GU and GI toxicities (Common Terminology Criteria for Adverse Events_v5 scale) and quality of life (QoL) outcomes (European Organisation for Research and Treatment of Cancer [EORTC] QLQ-PR25/C30, International Prostate Symptom Score [IPSS]) were assessed at different time points. Minimal important difference (MID) was established as a change of >0.5 pooled standard deviations from baseline. Statistical analysis included analysis of variance and logistic regression. RESULTS Median follow-up was 18 months (range, 6-31 months), with no ≥G3 late side effects observed. G2 late GI and G2 late GU toxicities occurred in 1 and 2 patients, respectively. GI toxicity of any grade correlated with maximum rectal dose (P = .021). Lower baseline QoL score (P = .025), higher baseline IPSS score (P = .049), acute GU toxicity (P = .029), and acute urinary domain MID (P = .045) predicted GU toxicity of any grade. In multivariate analysis (MVA), only baseline QoL score (odds ratio [OR], 0.95, P = .031) and acute GU toxicity (OR, 8.4, P = .041) remained significant. Significant QoL change was observed only in the urinary domain (P = .005), with a median increase from 8 to 17. Late urinary MID correlated with acute urinary MID (P = .003), acute QoL MID (P = .029), acute GU toxicity (P = .030), and lower baseline urinary score (P = .033). In MVA, only acute urinary MID predicted late urinary MID (OR, 9.7, P = .035). CONCLUSIONS Our findings provide promising data on the feasibility and safety of 24 Gy whole-gland SDRT with urethra-sparing and organ motion control, in association with androgen deprivation therapy and an adequate prophylactic medication, in organ-confined unfavorable PCa. Long-term follow-up is needed to confirm these results.
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Affiliation(s)
- Stefano Arcangeli
- Radiation Oncology Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy; School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | - Chiara Chissotti
- School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | - Federica Ferrario
- School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | - Raffaella Lucchini
- School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | - Maria Belmonte
- School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | - Giorgio Purrello
- School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy
| | | | - Elena De Ponti
- School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy; Medical Physics Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Valeria Faccenda
- Medical Physics Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy.
| | - Denis Panizza
- School of Medicine and Surgery, University of Milan Bicocca, Milan, Italy; Medical Physics Department, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
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Juravle IB, Hiriscau EI, Coroi T, Feciche BO, Crisan N, Coman I, Pop CD. The Romanian translation and validation of the Extended Prostate Cancer Index Composite in patients undergoing radical prostatectomy. Med Pharm Rep 2024; 97:330-337. [PMID: 39234449 PMCID: PMC11370850 DOI: 10.15386/mpr-2757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2024] [Revised: 06/24/2024] [Accepted: 07/15/2024] [Indexed: 09/06/2024] Open
Abstract
Background and aims To evaluate the quality of life in patients treated for prostate cancer in detail, an accessible, extensive, and easy-to-administer questionnaire is needed. The self-administered 50-item "Expanded Prostate Cancer Index Composite" (EPIC) is an instrument used for this purpose, but it is not officially translated into Romanian. The aim of the study was to translate and validate the Romanian version of the EPIC. Methods We translated and culturally adapted the EPIC into Romanian. For validation, we included a retrospective analysis of 112 patients who underwent robotic radical prostatectomy and a prospective study including 120 consecutive patients hospitalized before surgical treatment. Baseline and follow-up assessments took place before and at six months, two, and five years post-surgery, between January 2014 and December 2015. We performed cross-sectional correlations between the EPIC, AUASI, and SF-12 at baseline, factor analysis, and calculated the internal consistency. Results For most EPIC domains and subscales, our a priori-defined criteria for reliability were fulfilled (Cronbach's alpha 0.7-0.9). Cross-sectional correlations between EPIC scales and AUASI domain ranged from 0.23-0.69, and SF-12 domains ranged from 0.21-0.53 and 0.22-0.61, respectively. The retrospective analysis showed a medium acceptability and understanding of the EPIC questionnaire. In the prospective study, the revised EPIC draft showed an overall higher acceptability with a responding rate of 66% at a 5-year follow-up. All domains exhibited good internal consistency except for the hormonal section (Cronbach's α = 0.67) at the 6-month follow-up. Conclusion The Romanian version of the EPIC is reliable, responsive and valid for measuring HRQL in prostate cancer patients. The EPIC questionnaire proved to be an exhaustive and reproducible instrument for evaluating the quality of life in Romanian prostate cancer patients.
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Affiliation(s)
- Ioan-Bogdan Juravle
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Urology Department, Emergency County Hospital, Zalau, Romania
| | - Elisabeta Ioana Hiriscau
- Nursing Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Intensive Care Unit, University Clinical Municipal Hospital, Cluj-Napoca, Romania
| | - Tudor Coroi
- Urology Department, CH de Valence, Valence, France
| | - Bogdan-Ovidiu Feciche
- Surgery Department, University of Medicine and Pharmacy, Oradea, Romania
- Urology Department, Clinical Emergency County Hospital Bihor, Oradea, Romania
| | - Nicolae Crisan
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- Urology Department, University Clinical Municipal Hospital, Cluj-Napoca, Romania
| | - Ioan Coman
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Cristian-Doru Pop
- Clinique de Villeneuve-Saint-Georges, Villeneuve-Saint-Georges, France
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Zamora V, Garin O, Suárez JF, Jové J, Castells M, Ferrer F, Gutiérrez C, Guedea F, Boladeras A, Fumadó L, Roselló A, Pastor J, Samper P, Pont À, Ferrer M. Psychometric validation of the Spanish version of the Expanded Prostate Cancer Index Composite-26. World J Urol 2023; 41:3511-3518. [PMID: 37947846 PMCID: PMC10693511 DOI: 10.1007/s00345-023-04691-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/10/2023] [Indexed: 11/12/2023] Open
Abstract
PURPOSE To assess the validity, reliability, and responsiveness of the Spanish version of the Expanded Prostate cancer Index Composite (EPIC) with 26 items. METHODS Multicentric longitudinal study of patients diagnosed with localized or locally advanced prostate cancer (any T, any N, M0) treated with active surveillance, surgery, external radiotherapy, or brachytherapy. The EPIC-50 was administered initially to the cohort (n = 324 patients), until it was replaced in November 2019 by the EPIC-26 (n = 543), in both groups before treatment and 12 months after. We assessed confirmatory factor analysis (CFA), reliability with Cronbach's alpha coefficient, criterion validity with the intraclass correlation coefficient (ICC), and responsiveness by testing a priori hypotheses on deterioration effect size (ES). RESULTS The CFA confirmed the five-domain structure of the EPIC-26 proposed by the original instrument (comparative fit index = 0.95). The agreement between EPIC-50 (gold standard) and EPIC-26 domains was excellent (ICC > 0.90). Cronbach's alpha was > 0.7 in almost all domains, and the floor effect was near zero, although ceiling effect was higher than 50% in urinary incontinence and bowel domains. Hypothesized changes between before and 12 months after treatment were confirmed: ES > 0.8 in both urinary incontinence and sexual domains among patients who underwent surgery; and ES ranging 0.44-0.48 for bowel and sexual domains in patients treated with external radiotherapy. CONCLUSION The Spanish version of the EPIC-26 has demonstrated adequate metric properties, similar to those of the original version, with acceptable goodness-of-fit indices, good criterion validity, reliability, and responsiveness to detect changes after radical prostatectomy or external radiotherapy.
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Affiliation(s)
- Víctor Zamora
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona Biomedical Research Park, Office 144. Doctor Aiguader, 88, 08003, Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
- CIBER en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | - Olatz Garin
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona Biomedical Research Park, Office 144. Doctor Aiguader, 88, 08003, Barcelona, Spain.
- CIBER en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.
- Universitat Pompeu Fabra, Barcelona, Spain.
| | - José Francisco Suárez
- Urology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Josep Jové
- Radiation Oncology Department, Institut Català d'Oncologia, Badalona, Spain
| | - Manuel Castells
- Urology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Ferran Ferrer
- Radiation Oncology Department, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Spain
| | - Cristina Gutiérrez
- Radiation Oncology Department, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Spain
| | - Ferran Guedea
- Radiation Oncology Department, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Spain
| | - Ana Boladeras
- Radiation Oncology Department, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Spain
| | - Lluis Fumadó
- Urology Department, Hospital del Mar, Barcelona, Spain
| | - Alvar Roselló
- Radiation Oncology Department, Institut Català d'Oncologia, Girona, Spain
| | - Jorge Pastor
- Radiation Oncology Department, ASCIRES GRUPO BIOMÉDICO, Valencia, Spain
| | - Pilar Samper
- Radiation Oncology Department, Hospital Universitario Rey Juan Carlos, Móstoles, Spain
| | - Àngels Pont
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona Biomedical Research Park, Office 144. Doctor Aiguader, 88, 08003, Barcelona, Spain
- CIBER en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | - Montse Ferrer
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona Biomedical Research Park, Office 144. Doctor Aiguader, 88, 08003, Barcelona, Spain.
- CIBER en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.
- Universitat Pompeu Fabra, Barcelona, Spain.
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Lozano-Hernández CM, Cladellas YP, Gil Conesa M, Garin O, Forés MF, del Cura-González I. Functional social support: A systematic review and standardized comparison of different versions of the DUFSS questionnaire using the EMPRO tool. PLoS One 2023; 18:e0291635. [PMID: 37713437 PMCID: PMC10503721 DOI: 10.1371/journal.pone.0291635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 09/03/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND Functional social support is one of the most established predictors of health, and the Duke-UNC Functional Social Support Questionnaire (DUFSS) is one of the most commonly used instruments to measure this parameter. The objective of this study is to systematically review the available evidence on the psychometric and administration characteristics of the different versions of the DUFSS and perform a standardized assessment though to a specifically designed tool. METHODS A systematic review was performed in the PubMed/MEDLINE, SCOPUS, WOS and SCIELO databases. All articles that contained information on the development process of the instrument, the psychometric properties and aspects related to its administration were included, without restrictions based on publication date, language, or the version of the questionnaire that was studied. The selection and extraction procedure were carried out by two researchers. The articles finally included were peer-reviewed through a standardised assessment using the Evaluating the Measurement of Patient-Reported Outcomes (EMPRO) tool. PROSPERO registration number: CRD42022342977. RESULTS A total of 54 articles were identified. After eliminating duplicates and screening articles based on the selection criteria, 15 studies that examined the DUFSS questionnaire resulting in 4 different versions: 3 articles obtained the 8-item version; 11 the 11-item version; and a single article obtained two versions, the 14-item version and the 5-item version. At least 60% of them did so in a young adult population, predominantly female and with a medium-low socio-economic level or with characteristics of social vulnerability. The EMPRO evaluation showed that the 11-item version (54.01 total score) was the only one that had been studied on all recommended attributes and had higher total scores than the other versions: 8 items (36.31 total score), 14 items (27.48 total score) and 5 items (23.81 total score). This difference appears in all attributes studied, with the highest scores in "reliability (internal consistency)" and "validity". CONCLUSIONS Of the 4 versions identified in the DUFSS questionnaire, the 11-item version was found to be optimal based on the EMPRO standardized tool. Although, a priori, we could prioritise its use in epidemiological studies over the other versions, it should be noted that this version should also be used with caution because there are attributes that have not been studied.
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Affiliation(s)
- Cristina M. Lozano-Hernández
- Interuniversity Doctoral Program in Epidemiology and Public Health, Rey Juan Carlos University, Alcorcon (Madrid), Spain
- Research Unit, Primary Health Care Management Madrid, Madrid, Spain
- Research Network on Chronicity, Primary Care and Health Promotion -RICAPPS- (RICORS), Spain
- Biosanitary Research and Innovation Foundation of Primary Care (FIIBAP), Spain
| | - Yolanda Pardo Cladellas
- Networking Group of the Centre for Biomedical Research, Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Health Services Research Unit, Institut Mar d’Investigacion Mèdiques (IMIM-Hospital del Mar), Barcelona, Spain
- Autonomous University of Barcelona, Spain
| | - Mario Gil Conesa
- Preventive Medicine and Public Health Physician, Castellón General Hospital, Castellón, Valencian Community, Castellón, Spain
| | - Olatz Garin
- Networking Group of the Centre for Biomedical Research, Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Pompeu Fabra University, Barcelona, Spain
| | - Montserrat Ferrer Forés
- Networking Group of the Centre for Biomedical Research, Epidemiology and Public Health (CIBERESP), Instituto de Salud Carlos III, Madrid, Spain
- Health Services Research Unit, Institut Mar d’Investigacion Mèdiques (IMIM-Hospital del Mar), Barcelona, Spain
- Pompeu Fabra University, Barcelona, Spain
| | - Isabel del Cura-González
- Research Unit, Primary Health Care Management Madrid, Madrid, Spain
- Research Network on Chronicity, Primary Care and Health Promotion -RICAPPS- (RICORS), Spain
- Department of Medical Specialties and Public Health. Faculty of Health Sciences Rey Juan Carlos University, Madrid, Spain
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Valli J, Haapiainen H, Murtola TJ, Huhtala H, Kaipia A, Raitanen M. Visual Analogue Scale and Expanded Prostate Cancer Index Composite-26 in the Evaluation of Urinary Continence Recovery After Three-Dimensional Laparoscopic Radical Prostatectomy, a Single-Center Prospective Registered Study. Urology 2023; 177:103-108. [PMID: 37146729 DOI: 10.1016/j.urology.2023.04.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2023] [Revised: 04/17/2023] [Accepted: 04/27/2023] [Indexed: 05/07/2023]
Abstract
OBJECTIVE To assess the correlation between the Visual Analogue Scale (VAS) and the Expanded Prostate Cancer Index Composite (EPIC)-26 in the evaluation of urinary continence (UC) recovery after 3-dimensional laparoscopic radical prostatectomy (3D-LRP). METHODS 105 men underwent 3D-LRP in Seinäjoki Central Hospital Finland between November 2018 and February 2021. VAS forms and EPIC-26 questionnaires were used to assess UC preoperatively and at 6 weeks, 3-, 6-, 9-, 12-, 15-, 18-, 21-, and 24 months postoperatively. On the VAS form, the patient put a mark on the 10 cm long horizontal line in place, which described his experienced degree of UC (0 cm; fully incontinent-10 cm; fully continent). The scores for the urinary incontinence domain of EPIC-26 (UI-EPIC-26) were calculated and transformed to a scale of 0-100. Spearman´s rank correlation coefficient was used to evaluate the correlation between the VAS and UI-EPIC-26. RESULTS A total of 915 VAS forms and 909 EPIC-26 questionnaires were evaluable. UC improved significantly during the first year but not after that. The medians for UI-EPIC-26 and VAS were 50.8 (0-100) and 7.2 cm (0-10 cm) at 3 months, 76.8 (14.5-100) and 8.7 cm (1.7-10 cm) at 12 months and 79.6 (8.25-100) and 9.0 cm (2.7-10 cm) at 24 months. The correlation coefficient (95% confidence interval) between VAS and UI-EPIC-26 preoperatively, at 12 months and at 24 months was 0.639 (0.505-0.743), 0.807 (0.716-0.871), and 0.831 (0.735-0.894), respectively (P < 0.001). CONCLUSION The VAS can be utilized as an easy-to-use alternative to the EPIC-26 when evaluating UC recovery after 3D-LRP.
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Affiliation(s)
- Jaakko Valli
- Seinäjoki Central Hospital, Department of Urology, Seinäjoki, Finland; TAYS Cancer Center, Department of Urology, Tampere, Finland.
| | - Henry Haapiainen
- Seinäjoki Central Hospital, Department of Urology, Seinäjoki, Finland
| | - Teemu J Murtola
- TAYS Cancer Center, Department of Urology, Tampere, Finland; Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
| | - Heini Huhtala
- Faculty of Social Sciences, Biostatistics Group, Tampere University, Tampere, Finland
| | - Antti Kaipia
- TAYS Cancer Center, Department of Urology, Tampere, Finland
| | - Mika Raitanen
- Seinäjoki Central Hospital, Department of Urology, Seinäjoki, Finland; TAYS Cancer Center, Department of Urology, Tampere, Finland; Tampere University, Faculty of Medicine and Health Technology, Tampere, Finland
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Bulamu NB, Mpundu-Kaambwa C, O'Callaghan M, Kaambwa B. Responsiveness and construct validity of EPIC-26, AQoL-6D and SF-6D following treatment in prostate cancer. BMC Cancer 2023; 23:297. [PMID: 37005587 PMCID: PMC10067207 DOI: 10.1186/s12885-023-10732-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 03/13/2023] [Indexed: 04/04/2023] Open
Abstract
PURPOSE To assess construct validity and responsiveness of the Expanded Prostate Cancer Index Composite Instrument (EPIC-26) relative to the Short-Form Six-Dimension (SF-6D) and Assessment of Quality of Life 6-Dimension (AQoL-6D) in patients following treatment for prostate cancer. METHODS Retrospective prostate cancer registry data were used. The SF-6D, AQoL-6D, and EPIC-26 were collected at baseline and one year post treatment. Analyses were based on Spearman's correlation coefficient, Bland-Altman plots and intra-class correlation coefficient, Kruskal Wallis, and Effect Size and the Standardised Response Mean for responsiveness. RESULTS The study sample was comprised of 1915 patients. Complete case analysis of 3,697 observations showed moderate evidence of convergent validity between EPIC-26 vitality/hormonal domain and AQoL-6D (r = 0.45 and 0.54) and SF-6D (r = 0.52 and 0.56) at both timepoints. Vitality/hormonal domain also showed moderate convergent validity with coping domain of AQoL-6D (r = 0.45 and 0.54) and with role (r = 0.41 and 0.49) and social function (r = 0.47 and 0.50) domains of SF-6D at both timepoints, and with independent living (r = 0.40) and mental health (r = 0.43) of AQoL-6D at one year. EPIC-26 sexual domain had moderate convergent validity with relationship domain (r = 0.42 and 0.41) of AQoL-6D at both timepoints. Both AQoL-6D and SF-6D did not discriminate between age groups and tumour stage at both timepoints but AQoL-6D discriminated between outcomes for different treatments at one year. All EPIC-26 domains discriminated between age groups and treatment at both timepoints. The EPIC-26 was more responsive than AQoL-6D and SF-6D between baseline and one year following treatment. CONCLUSIONS AQoL-6D can be used in combination with EPIC-26 in place of SF-12. Although EPIC-26 is not utility based, its popularity amongst clinicians and ability to discriminate between disease-specific characteristics and post-treatment outcomes in clinical trials makes it a candidate for use within cost-effectiveness analyses. The generic measure provides a holistic assessment of quality of life and is suitable for generating quality adjusted life years (QALYs).
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Affiliation(s)
- Norma B Bulamu
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia.
| | - Christine Mpundu-Kaambwa
- Health and Social Care Economics Group, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Michael O'Callaghan
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
- SA-PCCOC: South Australian Prostate Cancer Clinical Outcomes Collaborative, Flinders Medical Centre, Urology Unit, Adelaide, Australia
- Discipline of Medicine, University of Adelaide, Adelaide, Australia
| | - Billingsley Kaambwa
- Flinders Health and Medical Research Institute, College of Medicine and Public Health, Flinders University, Adelaide, Australia
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Evaluating Self-Concept Measurements in Adolescents: A Systematic Review. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10020399. [PMID: 36832528 PMCID: PMC9954829 DOI: 10.3390/children10020399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Revised: 02/16/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023]
Abstract
(1) Background: To evaluate the self-concept of adolescents, a proper evaluation of several existing self-concept measurements is needed. The objectives of this study are to conduct a systematic review of the available measures used to assess self-concept in adolescents, to evaluate the psychometric properties of each measurement, and to assess the attributes of patient-reported outcome measurements (PROMs) of self-concept in adolescents. (2) Methods: The systematic review was conducted on six databases: EMBASE, MEDLINE, Cochrane, PubMed, CINAHL, and Web of Science, from inception to 2021. A standardized evaluation of psychometric properties was carried out using the Evaluating the Measurement of Patient-Reported Outcomes (EMPRO). The review was conducted independently by two reviewers. Each attribute in EMPRO was assessed and analyzed to obtain an overall score. Only scores that exceeded 50 were considered acceptable. (3) Results: From 22,388 articles, we reviewed 35 articles with five self-concept measurements. Four measurements were obtained that had values above the threshold (SPPC, SPPA, SDQ-II, and SDQII-S). However, there is not enough evidence to support the interpretability attribute in self-concept measurement. (4) Conclusions: There are various measurements of self-concept in adolescents accompanied by their psychometric properties. Each measurement of adolescent self-concept has a characteristic of psychometric properties and measurement attributes.
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Haapiainen H, Valli J, Murtola T, Huhtala H, Kaipia A, Raitanen M. Visual Analogue Scale (VAS) in the Evaluation of Functional Outcomes After Three-dimensional Laparoscopic Prostatectomy. Urology 2023; 172:121-125. [PMID: 36549575 DOI: 10.1016/j.urology.2022.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 11/22/2022] [Accepted: 12/04/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE To assess suitability of visual analog scale (VAS) in the evaluation of functional outcomes after 3D laparoscopic prostatectomy (3D LRP) METHODS: Two hundred men underwent 3D LRP for localised prostate cancer at Seinäjoki Central Hospital in Finland between December 2013 and September 2018. In October 2019, an EPIC-26 survey along with VAS scales enquiring urinary (VAS-incontinence) and sexual (VAS-sexual) symptoms was mailed to the patients, and the correlations between these 2 methods were evaluated. In the EPIC-26 survey, scores for incontinence-(EPIC-26 UI) and sexual (EPIC-26-sexual) domains were calculated using the University of Michigan scoring system. In the VAS questionnaires, patient put a mark on the 10 cm long horizontal line in place, which described his experience of continence and potency. The Spearman rank correlation coefficient was used to evaluate the correlation between methods. RESULTS The median scores were as follows: EPIC-26-UI, 79.25 (14.5-100); EPIC-26-sexual, 36.17 (0.0-100); VAS-incontinence, 8.8 cm (1.4-10.0); and VAS-sexual, 3.2 cm (0.0-10). The correlation coefficient between EPIC-26 UI and VAS-incontinence was 0.722 (95% confidence interval [CI], 0.63-0.79; p <.0001) and 0.883 (95% CI, 0.84-0.91; p <.0001) between EPIC-26-sexual and VAS-sexual. CONCLUSION Our study shows a strong correlation between VAS and EPIC-26 urinary incontinence and sexual domains. In daily clinical practice VAS-scale may serve as a simple tool to evaluate the key functional outcomes of radical prostatectomy.
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Affiliation(s)
- Henry Haapiainen
- Department of Urology, Seinäjoki Central Hospital, Seinäjoki, Finland.
| | - Jaakko Valli
- Department of Urology, Seinäjoki Central Hospital, Seinäjoki, Finland; Department of Urology, TAYS Cancer Center, Tampere, Finland
| | - Teemu Murtola
- Department of Urology, TAYS Cancer Center, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Heini Huhtala
- Biostatistics Group, Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Antti Kaipia
- Department of Urology, TAYS Cancer Center, Tampere, Finland
| | - Mika Raitanen
- Department of Urology, Seinäjoki Central Hospital, Seinäjoki, Finland; Department of Urology, TAYS Cancer Center, Tampere, Finland; Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
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de Held PA, Matheus WE, Naccarato AMEP, Rodrigues RCM, Ferruccio AA, Ferreira U. Validation of the Brazilian Version of Functional Assessment of Cancer Therapy-Prostate-FACT-P (Version 4) in Prostate Cancer Patients. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1760-1767. [PMID: 34250581 DOI: 10.1007/s13187-021-02024-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/02/2021] [Indexed: 06/13/2023]
Abstract
The purpose of this study is to validate the Brazilian version of Functional Assessment of Cancer Therapy-Prostate FACT-P (version 4) in nonmetastatic prostate cancer (PC) patients. Patients with histopathological diagnosis of PC were submitted to health-related quality of life (HRQOL) questionnaires - SF-36 (Medical Outcomes Study 36 - Item Short-Form Health Survey) and FACT-P (version 4). After 7 to 15 days, FACT-P (version 4) was reapplied in the sample's percentage that participated the first evaluation. Cronbach alpha coefficient was used to determine internal consistency and intraclass correlation coefficient (ICC) certified stability. Correlations between FACT-P (version 4) and SF-36 tested convergent validity. Regarding known groups validity, the hypothesis tested was that FACT-P (version 4) is capable of discriminating HRQOL in patients with different PC risk classifications. A total of 112 patients with nonmetastatic PC were evaluated. Cronbach alpha coefficients (0.64-0.88) and ICC (0.75-0.93) obtained satisfactory results of reliability. Verified correlations (r 0.3-0.72) between FACT-P (version 4) and SF-36 suggest convergent validity. In the studied sample, FACT-P (version 4) was unable to discriminate HRQOL in nonmetastatic patients. The Brazilian version of FACT-P questionnaire (version 4) showed evidences of reliability and validity on evaluating HRQOL in Brazilian men with nonmetastatic PC.
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Affiliation(s)
| | - Wagner Eduardo Matheus
- Department of Urology, School of Medical Sciences, State University of Campinas (Unicamp), Campinas, Brazil
| | | | | | - Aline Akel Ferruccio
- Department of Urology, School of Medical Sciences, State University of Campinas (Unicamp), Campinas, Brazil
| | - Ubirajara Ferreira
- Department of Urology, School of Medical Sciences, State University of Campinas (Unicamp), Campinas, Brazil
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Snyder LE, Phan DF, Williams KC, Piqueiras E, Connor SE, George S, Kwan L, Villatoro Chavez J, Tandel MD, Frencher SK, Litwin MS, Gore JL, Hartzler AL. Comprehension, utility, and preferences of prostate cancer survivors for visual timelines of patient-reported outcomes co-designed for limited graph literacy: meters and emojis over comics. J Am Med Inform Assoc 2022; 29:1838-1846. [PMID: 36040190 PMCID: PMC9552288 DOI: 10.1093/jamia/ocac148] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 08/10/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Visual timelines of patient-reported outcomes (PRO) can help prostate cancer survivors manage longitudinal data, compare with population averages, and consider future trajectories. PRO visualizations are most effective when designed with deliberate consideration of users. Yet, graph literacy is often overlooked as a design constraint, particularly when users with limited graph literacy are not engaged in their development. We conducted user testing to assess comprehension, utility, and preference of longitudinal PRO visualizations designed for prostate cancer survivors with limited literacy. MATERIALS AND METHODS Building upon our prior work co-designing longitudinal PRO visualizations with survivors, we engaged 18 prostate cancer survivors in a user study to assess 4 prototypes: Meter, Words, Comic, and Emoji. During remote sessions, we collected data on prototype comprehension (gist and verbatim), utility, and preference. RESULTS Participants were aged 61-77 (M = 69), of whom half were African American. The majority of participants had less than a college degree (95%), had inadequate health literacy (78%), and low graph literacy (89%). Among the 4 prototypes, Meter had the best gist comprehension and was preferred. Emoji was also preferred, had the highest verbatim comprehension, and highest rated utility, including helpfulness, confidence, and satisfaction. Meter and Words both rated mid-range for utility, and Words scored lower than Emoji and Meter for comprehension. Comic had the poorest comprehension, lowest utility, and was least preferred. DISCUSSION Findings identify design considerations for PRO visualizations, contributing to the knowledge base for visualization best practices. We describe our process to meaningfully engage patients from diverse and hard-to-reach groups for remote user testing, an important endeavor for health equity in biomedical informatics. CONCLUSION Graph literacy is an important design consideration for PRO visualizations. Biomedical informatics researchers should be intentional in understanding user needs by involving diverse and representative individuals during development.
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Affiliation(s)
- Lauren E Snyder
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
| | - Daniel F Phan
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
- Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, Washington, USA
| | - Kristen C Williams
- Department of Urology, University of California, Los Angeles, California, USA
| | - Eduardo Piqueiras
- Department of Urology, University of California, Los Angeles, California, USA
| | - Sarah E Connor
- Department of Urology, University of California, Los Angeles, California, USA
| | - Sheba George
- Department of Community Health Sciences, The Fielding School of Public Health, University of California, Los Angeles, California, USA
- Department of Preventive & Social Medicine and the Center for Biomedical Informatics, Charles R. Drew University of Medicine & Science, Los Angeles, California, USA
| | - Lorna Kwan
- Department of Urology, University of California, Los Angeles, California, USA
| | | | - Megha D Tandel
- Department of Urology, University of California, Los Angeles, California, USA
| | - Stanley K Frencher
- Department of Urology, University of California, Los Angeles, California, USA
| | - Mark S Litwin
- Department of Urology, University of California, Los Angeles, California, USA
- Department of Community Health Sciences, The Fielding School of Public Health, University of California, Los Angeles, California, USA
- School of Nursing, University of California, Los Angeles, California, USA
- Department of Health Policy & Management, The Fielding School of Public Health, University of California, Los Angeles, California, USA
| | - John L Gore
- Department of Urology, University of Washington, Seattle, Washington, USA
| | - Andrea L Hartzler
- Department of Biomedical Informatics and Medical Education, University of Washington, Seattle, Washington, USA
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Sinclair S, Kondejewski J, Hack TF, Boss HCD, MacInnis CC. What is the Most Valid and Reliable Compassion Measure in Healthcare? An Updated Comprehensive and Critical Review. THE PATIENT - PATIENT-CENTERED OUTCOMES RESEARCH 2022; 15:399-421. [PMID: 35107822 PMCID: PMC9197914 DOI: 10.1007/s40271-022-00571-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/10/2022] [Indexed: 11/26/2022]
Abstract
Our previous review of compassion measures in healthcare between 1985 and 2016 concluded that no available measure assessed compassion in healthcare in a comprehensive or methodologically rigorous fashion. The present study provided a comparative review of the design and psychometric properties of recently updated or newly published compassion measures. The search strategy of our previous review was replicated. PubMed, MEDLINE, CINAHL, and PsycINFO databases and grey literature were searched to identify studies that reported information on instruments that measure compassion or compassionate care in clinicians, physicians, nurses, healthcare students, and patients. Textual qualitative descriptions of included studies were prepared. Instruments were evaluated using the Evaluating Measures of Patient-Reported Outcomes (EMPRO) tool. Measures that underwent additional testing since our last review included the Compassion Competence Scale (CCS), the Compassionate Care Assessment Tool (CCAT)©, and the Schwartz Center Compassionate Care Scale (SCCCS)™. New compassion measures included the Sussex-Oxford Compassion for Others Scale (SOCS-O), a self-report measure of compassion for others; the Bolton Compassion Strengths Indicators (BSCI), a self-report measure of the characteristics (strengths) associated with a compassionate nurse; a five-item Tool to Measure Patient Assessment of Clinician Compassion (TMPACC); and the Sinclair Compassion Questionnaire (SCQ). The SCQ was the only measure that adhered to measure development guidelines, established initial construct validity by first defining the concept of interest, and included the patient perspective across all stages of development. The SCQ had the highest EMPRO overall score at 58.1, almost 9 points higher than any other compassion measure, and achieved perfect EMPRO subscale scores for internal consistency, reliability, validity, and respondent burden, which were up to 43 points higher than any other compassion measure. These findings establish the SCQ as the ‘gold standard’ compassion measure, providing an empirical basis for evaluations of compassion in routine care.
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Affiliation(s)
- Shane Sinclair
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.
- Division of Palliative Medicine, Department of Oncology, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.
- Compassion Research Lab, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada.
| | - Jane Kondejewski
- Faculty of Nursing, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
- Compassion Research Lab, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Thomas F Hack
- College of Nursing, Rady Faculty of Health Sciences, University of Manitoba, 99 Curry Place, Winnipeg, MB, R3T 2M6, Canada
- Psychosocial Oncology & Cancer Nursing Research, St. Boniface Hospital Research Centre, Room CR3018, 369 Taché Ave, Winnipeg, MB, R2H 2A6, Canada
| | - Harrison C D Boss
- Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
| | - Cara C MacInnis
- Department of Psychology, University of Calgary, 2500 University Drive NW, Calgary, AB, T2N 1N4, Canada
- Department of Psychology, Acadia University, 15 University Ave, Wolfville, NS, B4P 2R6, Canada
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Patient reported outcomes and health related quality of life in localized prostate cancer: A review of current evidence. Urol Oncol 2022; 40:304-314. [DOI: 10.1016/j.urolonc.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 03/30/2022] [Accepted: 04/13/2022] [Indexed: 11/21/2022]
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Jalili S, Ghasemi Shayan R. A Comprehensive Evaluation of Health-Related Life Quality Assessment Through Head and Neck, Prostate, Breast, Lung, and Skin Cancer in Adults. Front Public Health 2022; 10:789456. [PMID: 35493355 PMCID: PMC9051448 DOI: 10.3389/fpubh.2022.789456] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 03/07/2022] [Indexed: 11/13/2022] Open
Abstract
Health assessment data assists the well-being and patient care teams' process in drawing up a care and assistance plan and comprehending the requirements of the patient. Comprehensive and precise data about the Quality of Life of cancer patients play a significant part in the development and organization of cancer patient care. Quality of Life has been used to mean a variety of various things, such as health situation, physical function, symptoms, psychosocial modification, well-being, enjoyment of life, and happiness. Chronic diseases such as cancer are among the disorders that severely affect people's health and consequently their Quality of Life. Cancer patients experience a range of symptoms, including pain and various physical and mental conditions that negatively affect their Quality of Life. In this article, we examined cancer and the impact that this disease can have on the Quality of Life of cancer patients. The cancers examined in this article include head and neck, prostate, breast, lung, and skin cancers. We also discussed health assessment and the importance and purpose of studying patients' Quality of Life, especially cancer patients. The various signs and symptoms of the disease that affect the Quality of Life of patients were also reviewed.
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Affiliation(s)
- Shirin Jalili
- Department of Surgical Technology, Islamic Azad University of Sarab, Sarab, Iran
| | - Ramin Ghasemi Shayan
- Department of Radiology, Paramedical Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
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Implementation of patient-reported outcome measures into health care for men with localized prostate cancer. Nat Rev Urol 2022; 19:263-279. [PMID: 35260844 DOI: 10.1038/s41585-022-00575-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2022] [Indexed: 11/12/2022]
Abstract
Measuring treatment-related quality of life (QOL) has become an increasingly requisite component of delivering high-quality care for patients with prostate cancer. Patient-reported outcome measures (PROMs) have, therefore, become an important tool for understanding the adverse effects of radical prostate cancer treatment and have been widely integrated into clinical practice. By providing real-time symptom monitoring and improved clinical feedback to patients and providers, PRO assessment has led to meaningful gains in prostate cancer care delivery and quality improvement worldwide. By providing an avenue for benchmarking, collaboration and population health monitoring, PROMs have delivered substantial improvements beyond providing individual symptom feedback. However, multilevel barriers exist that need to be addressed before the routine implementation of PROMs is achieved. Improvements in collection, interpretation, standardization and reporting will be crucial for the continued implementation of PROM instruments in prostate cancer pathways.
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Ratti MM, Gandaglia G, Alleva E, Leardini L, Sisca ES, Derevianko A, Furnari F, Mazzoleni Ferracini S, Beyer K, Moss C, Pellegrino F, Sorce G, Barletta F, Scuderi S, Omar MI, MacLennan S, Williamson PR, Zong J, MacLennan SJ, Mottet N, Cornford P, Aiyegbusi OL, Van Hemelrijck M, N'Dow J, Briganti A. Standardising the Assessment of Patient-reported Outcome Measures in Localised Prostate Cancer. A Systematic Review. Eur Urol Oncol 2021; 5:153-163. [PMID: 34785188 DOI: 10.1016/j.euo.2021.10.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 09/30/2021] [Accepted: 10/15/2021] [Indexed: 01/27/2023]
Abstract
CONTEXT Prostate cancer (PCa) is the second most common cancer among men worldwide. Urinary, bowel, and sexual function, as well as hormonal symptoms and health-related quality of life (HRQoL), were prioritised by patients and professionals as part of a core outcome set for localised PCa regardless of treatment type. OBJECTIVE To systematically review the measurement properties of patient-reported outcome measures (PROMs) used in localised PCa and recommend PROMs for use in routine practice and research settings. EVIDENCE ACQUISITION The psychometric properties of PROMs measuring functional and HRQoL domains used in randomised controlled trials including patients with localised PCa were assessed according to the Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) methodology. MEDLINE and Embase were searched to identify publications evaluating psychometric properties of the PROMs. The characteristics and methodological quality of the studies included were extracted, tabulated, and assessed according to the COSMIN criteria. EVIDENCE SYNTHESIS Overall, 27 studies evaluating psychometric properties of the Expanded Prostate Cancer Index Composite (EPIC), University of California-Los Angeles Prostate Cancer Index (UCLA-PCI), European Organisation for Research and Treatment of Cancer (EORTC) quality of life core 30 (QLQ-C30) and prostate cancer 25 (QLQ-PR25) modules, International Index of Erectile Function (IIEF), and the 36-item (SF-36) and 12-item Short-Form health survey (SF-12) PROMs were identified and included in the systematic review. EPIC and EORTC QLQ-C30, a general module that assesses patients' physical, psychological, and social functions, were characterised by high internal consistency (Cronbach's α 0.46-0.96 and 0.68-0.94 respectively) but low content validity. EORTC QLQ-PR25, which is primarily designed to assess PCa-specific HRQoL, had moderate content validity and internal consistency (Cronbach's α 0.39-0.87). UCLA-PCI was characterised by moderate content validity and high internal consistency (Cronbach's α 0.21-0.94). However, it does not directly assess hormonal symptoms, whereas EORTC QLQ-PR25 does. CONCLUSION The tools with the best evidence for psychometric properties and feasibility for use in routine practice and research settings to assess PROMs in patients with localised PCa were EORTC QLQ-C30 and QLQ-PR25. Since EORTC QLQ-C30 is a general module that does not directly assess PCa-specific issues, it should be adopted in conjunction with the QLQ-PR25 module. PATIENT SUMMARY We reviewed and appraised the measurement properties of patient-reported outcome measure questionnaires used for patients with localised prostate cancer. We found good evidence to suggest that two questionnaires (EORTC QLQ-C30 and QLQ-PR25) can be used to measure urinary, bowel, and sexual functions and health-related quality of life.
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Affiliation(s)
- Maria Monica Ratti
- Department of Medicine and Surgery, Vita Salute San Raffaele University, Milan, Italy; Department of Clinical and Health Psychology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Giorgio Gandaglia
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy.
| | - Eugenia Alleva
- Department of Medicine and Surgery, Vita Salute San Raffaele University, Milan, Italy
| | - Luca Leardini
- Department of Clinical and Health Psychology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Elena Silvia Sisca
- Department of Clinical and Health Psychology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Alexandra Derevianko
- Department of Clinical and Health Psychology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Federica Furnari
- Department of Clinical and Health Psychology, IRCCS San Raffaele Hospital, Milan, Italy
| | | | - Katharina Beyer
- Translational and Oncology Research, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Charlotte Moss
- Translational and Oncology Research, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Francesco Pellegrino
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Gabriele Sorce
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Francesco Barletta
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | - Simone Scuderi
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
| | | | | | - Paula R Williamson
- MRC North West Hub for Trials Methodology Research, University of Liverpool, Liverpool Health Partners, Liverpool, UK
| | - Jihong Zong
- Global Epidemiology, Bayer HealthCare Pharmaceuticals Inc., Whippany, NJ, USA
| | | | - Nicolas Mottet
- Department of Urology, University Hospital, St. Etienne, France
| | | | - Olalekan Lee Aiyegbusi
- Centre for Patient-Reported Outcomes Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
| | - Mieke Van Hemelrijck
- Translational and Oncology Research, Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - James N'Dow
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK
| | - Alberto Briganti
- Unit of Urology/Division of Oncology, Urological Research Institute, IRCCS San Raffaele Hospital, Milan, Italy
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Bradley C, Ilie G, MacDonald C, Massoeurs L, Jasmine Dang Cam-Tu V, Rutledge RDH. Treatment Regret, Mental and Physical Health Indicators of Psychosocial Well-Being among Prostate Cancer Survivors. Curr Oncol 2021; 28:3900-3917. [PMID: 34677251 PMCID: PMC8535109 DOI: 10.3390/curroncol28050333] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 09/13/2021] [Accepted: 09/14/2021] [Indexed: 01/04/2023] Open
Abstract
Prostate cancer (PCa) patients and survivors are at high risk of mental health illness. Here, we examined the contribution of treatment regret, mental and physical health indicators to the social/family, emotional, functional and spiritual well-being of PCa survivors. The study assessed 367 men with a history of PCa residing in the Maritimes Canada who were surveyed between 2017 and 2021. The outcomes were social/family, emotional, functional and spiritual well-being (FACT-P,FACIT-Sp). Predictor variables included urinary, bowel and sexual function (UCLA-PCI), physical and mental health (SF-12), and treatment regret. Logistic regression analyses were controlled for age, income, and survivorship time. Poor social/family, emotional, functional and spiritual well-being was identified among 54.4%, 26.5%, 49.9% and 63.8% of the men in the sample. Men who reported treatment regret had 3.62, 5.58, or 4.63 higher odds of poor social/family, emotional, and functional well-being, respectively. Men with low household income had 3.77 times higher odds for poor social/well-being. Good mental health was a protective factor for poor social/family, emotional, functional, or spiritual well-being. Better physical and sexual health were protective factors for poor functional well-being. Seeking to promote PCa patients' autonomy in treatment decisions and recognizing this process' vulnerability in health care contexts is warranted.
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Affiliation(s)
- Cassidy Bradley
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS B3H 1V7, Canada; (C.B.); (C.M.); (L.M.)
| | - Gabriela Ilie
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS B3H 1V7, Canada; (C.B.); (C.M.); (L.M.)
- Department of Urology, Dalhousie University, Halifax, NS B3H 4R2, Canada;
- Department of Psychology and Neuroscience, Dalhousie University, Halifax, NS B3H 4R2, Canada
- Department of Radiation Oncology, Dalhousie University, Halifax, NS B3H 4R2, Canada;
- Faculty of Medicine, Dalhousie University, Halifax, NS B3H 1V7, Canada
| | - Cody MacDonald
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS B3H 1V7, Canada; (C.B.); (C.M.); (L.M.)
| | - Lia Massoeurs
- Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS B3H 1V7, Canada; (C.B.); (C.M.); (L.M.)
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Sevier-Guy LJ, Ferreira N, Somerville C, Gillanders D. Psychological flexibility and fear of recurrence in prostate cancer. Eur J Cancer Care (Engl) 2021; 30:e13483. [PMID: 34191379 DOI: 10.1111/ecc.13483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/29/2021] [Accepted: 05/06/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Psychological flexibility and fear of cancer recurrence are important variables that influence psychosocial outcomes in individuals diagnosed with a range of different types of cancer. Their role and how they impact on psychological distress and quality of life in men with prostate cancer specifically have not been established. METHODS A cross-sectional sample of 144 men with prostate cancer was recruited. Multiple regression and conditional process analysis were used to assess whether psychological flexibility moderates the relationship between fear of recurrence and distress and quality of life. RESULTS Psychological flexibility significantly predicted psychological distress (β = -0.56, p < 0.0001) and quality of life (β = 0.21, p < 0.0001), appearing a stronger predictor of psychological distress than fear of recurrence (β = 0.25, p < 0.0001). Fear of recurrence was a stronger predictor of quality of life (β = -0.41, p < 0.0001) than psychological flexibility. Psychological flexibility moderated the relationship between fear of recurrence and psychological distress (β = -0.01, p < 0.001). At low and average levels of psychological flexibility, psychological distress mediated the relationship between fear of recurrence and quality of life (β = -0.33 to -0.16, p < 0.05). At high levels of psychological flexibility, distress no longer mediated this relationship (β = 0.01, ns), supporting the role of psychological flexibility as a moderator. CONCLUSIONS These findings suggest that psychological flexibility might be a useful treatment target, through interventions such as Acceptance and Commitment Therapy, to buffer the effects of fear of recurrence and distress and improve psychosocial outcomes in this population.
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Affiliation(s)
- Lindsay-Jo Sevier-Guy
- School of Health and Social Science, University of Edinburgh, Edinburgh, UK.,Psychology Department, NHS Fife, Kirkcaldy, UK.,Psychology Department, NHS Tayside, Dundee, UK
| | - Nuno Ferreira
- School of Health and Social Science, University of Edinburgh, Edinburgh, UK.,School of Humanities and Social Sciences, University of Nicosia, Nicosia, Cyprus
| | | | - David Gillanders
- School of Health and Social Science, University of Edinburgh, Edinburgh, UK
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19
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El-Haouly A, Lacasse A, El-Rami H, Liandier F, Dragomir A. Out-of-Pocket Costs and Perceived Financial Burden Associated with Prostate Cancer Treatment in a Quebec Remote Area: A Cross-Sectional Study. Curr Oncol 2020; 28:26-39. [PMID: 33704114 PMCID: PMC7816191 DOI: 10.3390/curroncol28010005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 11/10/2020] [Accepted: 11/10/2020] [Indexed: 11/16/2022] Open
Abstract
Background: In publicly funded healthcare systems, patients do not pay for medical visits but can experience costs stemming from travel or over-the-counter drugs. We lack information about the extent of this burden in Canadian remote regions. This study aimed to: (1) describe prostate cancer-related out-of-pocket costs and perceived financial burden, and (2) identify factors associated with such a perceived burden among prostate cancer patients living in a remote region of the province of Quebec (Canada). Methods: A cross-sectional study was conducted among 171 prostate cancer patients who consulted at the outpatient clinic of the Centre Hospitalier de Rouyn-Noranda. Results: The majority of patients (83%) had incurred out-of-pocket costs for their cancer care. The mean total cost incurred in the last three months was $517 and 22.3% reported a moderate, considerable or unsustainable burden. Multivariable analysis revealed that having incurred higher cancer-related out-of-pocket costs (OR: 1.001; 95%CI: 1.001-1.002) private drug insurance (vs. public, OR: 5.23; 95%CI: 1.13-24.17) was associated with a greater perceived financial burden. Having better physical health-related quality of life (OR: 0.95; 95%CI: 0.913-0.997), a university education (vs. elementary/high school level, OR: 0.03; 95%CI: 0.00-0.79), and an income between $40,000 and $79,999 (vs. ≤ $39,999, OR: 0.15; 95%CI: 0.03-0.69) were associated with a lower perceived burden. Conclusion: Prostate cancer patients incur out-of-pocket costs even if they were diagnosed many years ago and the perceived burden is significant. Greater attention should be paid to the development of services to help patients manage this burden.
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Affiliation(s)
- Abir El-Haouly
- Département des Sciences de la Santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, QC J9X 5E4, Canada; (A.E.-H.); (A.L.)
| | - Anais Lacasse
- Département des Sciences de la Santé, Université du Québec en Abitibi-Témiscamingue (UQAT), Rouyn-Noranda, QC J9X 5E4, Canada; (A.E.-H.); (A.L.)
| | - Hares El-Rami
- Centre Hospitalier de Rouyn-Noranda, Centre Intégré de Santé et de Services Sociaux de l’Abitibi-Témiscamingue (CISSS-AT), Rouyn-Noranda, QC J9X 2A9, Canada; (H.E.-R.); (F.L.)
| | - Frederic Liandier
- Centre Hospitalier de Rouyn-Noranda, Centre Intégré de Santé et de Services Sociaux de l’Abitibi-Témiscamingue (CISSS-AT), Rouyn-Noranda, QC J9X 2A9, Canada; (H.E.-R.); (F.L.)
| | - Alice Dragomir
- Department of Surgery, Division of Urology, Faculty of Medicine, McGill University, Montreal, QC H3G 1A4, Canada
- Research Institute, McGill University Health Centre, Montreal, QC H3G 1A4, Canada
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20
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Wong RL, Morgans AK. Integration of Patient Reported Outcomes in Drug Development in Genitourinary Cancers. Curr Oncol Rep 2020; 22:21. [PMID: 32036478 DOI: 10.1007/s11912-020-0890-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Patient reported outcomes (PROs) are increasingly utilized in cancer drug development, and are of particular importance in genitourinary cancers due to symptom burden, multiple treatment options with similar efficacy, and often prolonged duration of disease. Here we review current data and perspectives related to use of PROs in drug development for genitourinary cancers, including insights on the regulatory process for drug approval. RECENT FINDINGS The FDA is committed to incorporating PRO data into the regulatory process for development and approval of new cancer drugs, but challenges exist due to lack of standardization of PRO instrument choice and analytic approach, missing data, and difficulty isolating treatment effect from disease-related effects. We review guidance for standardization of PRO methodology that is nonetheless tailored to disease state and anticipated effects of treatment. PRO and efficacy data should be simultaneously analyzed and reported for best clinical practice. Multiple disease-specific PRO instruments exist for genitourinary cancers. While clinicians, researchers, and regulatory bodies alike recognize the importance of PROs in cancer drug development, challenges remain regarding implementation of best practices.
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Affiliation(s)
- Risa L Wong
- Department of Medicine, Division of Oncology, University of Washington, Seattle, WA, USA.,Clinical Research Division, Fred Hutchinson Cancer Research Center, Seattle, WA, USA
| | - Alicia K Morgans
- Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, IL, USA.
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21
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Sibert NT, Dieng S, Oesterle A, Feick G, Carl G, Steiner T, Minner J, Roghmann F, Kaftan B, Zengerling F, Hinkel A, Beyer B, Heidenreich A, Harke N, Brehmer B, Pfitzenmaier J, Fichtner J, Neisius A, Hammerer P, Wesselmann S, Kowalski C. Psychometric validation of the German version of the EPIC-26 questionnaire for patients with localized and locally advanced prostate cancer. World J Urol 2019; 39:11-25. [PMID: 31552467 DOI: 10.1007/s00345-019-02949-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 09/04/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE For patients with prostate cancer, validated and reliable instruments are essential for measuring patient-reported outcomes. The aim of this study was to validate the German version of the widely established Expanded Prostate Cancer Index Composite with 26 items (EPIC-26). METHODS A German translation of the original questionnaire was tested in 3094 patients with localized or locally advanced (any T, any N and M0) prostate cancer with treatment intent (including radical prostatectomy, brachytherapy, active surveillance, watchful waiting). They completed the EPIC-26 questionnaire before treatment. A total of 521 of them also completed a questionnaire 12 months afterward. Internal consistency, sensitivity to change, and construct validity were assessed. RESULTS The internal consistency of all domains was sufficient (Cronbach's alpha between 0.64 and 0.93). Item-to-scale correlation coefficients showed acceptable associations between items and their domain score (all > 0.30), with the lowest scores for "bloody stools" (r = 0.37) and "breast problems" (r = 0.32). Confirmatory and exploratory factor analysis confirmed the five-dimension structure of the EPIC-26 (comparative fit index 0.95). CONCLUSIONS Psychometric evaluation suggests that the German version of the EPIC-26 is a well-constructed instrument for measuring patient-reported health-related symptoms in patients with prostate cancer.
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Affiliation(s)
- Nora Tabea Sibert
- German Cancer Society, Kuno-Fischer-Strasse 8, Berlin, 14057, Germany.
| | | | | | - Günter Feick
- Federal Association of German Prostate Cancer Patient Support Groups, Bonn, Germany
| | - Günther Carl
- Help for Prostate Cancer Patients (Förderverein Hilfe bei Prostatakrebs e.V.-FHbP), Tornesch, Germany
| | | | - Jörg Minner
- Hegau-Bodensee-Klinikum Singen, Singen, Germany
| | | | - Björn Kaftan
- Städtisches Klinikum Lüneburg, Lüneburg, Germany
| | | | | | - Burkhard Beyer
- Martini-Klinik Prostate Cancer Center Hamburg, Hamburg, Germany
| | | | - Nina Harke
- University Hospital Essen, Essen, Germany
| | | | | | - Jan Fichtner
- Johanniter Krankenhaus Oberhausen, Oberhausen, Germany
| | | | | | - Simone Wesselmann
- German Cancer Society, Kuno-Fischer-Strasse 8, Berlin, 14057, Germany
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22
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Marzorati C, Monzani D, Mazzocco K, Masiero M, Pavan F, Monturano M, Pravettoni G. Validation of the Italian version of the abbreviated expanded prostate Cancer index composite (EPIC-26) in men with prostate Cancer. Health Qual Life Outcomes 2019; 17:147. [PMID: 31464649 PMCID: PMC6716830 DOI: 10.1186/s12955-019-1214-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 08/16/2019] [Indexed: 12/18/2022] Open
Abstract
Background This study aims to validate and evaluate the psychometric properties and reliability of the Italian version of the Expanded Prostate Cancer Index Composite – Short Form (EPIC-26), a measure of quality of life (QoL) for prostate cancer patients. Methods Two hundred and eighty-four prostate cancer patients completed the Italian version of the EPIC-26 questionnaire at 45 days (T1) and 3 months (T2) after robot-assisted radical prostatectomy (RARP). Psychometric properties were evaluated using structural equation modeling: the goodness of fit of the correlated five-factor model (CFFM) for the EPIC-26 was assessed using the confirmatory factor analysis (CFA), while longitudinal invariance was conducted to assess the ability of the EPIC-26 to measure QoL construct over time. Test-retest reliability was assessed as well by considering intraclass correlations. Results At T1, the CFFM model displayed a good fit to data. Similarly, the model showed an adequate fit also at T2. Results of the reliability analysis attested the acceptable internal consistency and test-retest reliability of each dimension: all Cronbach’s alphas could be classified as acceptable (i.e., above .65) except for low Cronbach’s alpha for hormonal dysfunction at T1 (i.e., .638) and urinary irritation at both waves. (i.e., respectively .585 and .518). Finally, psychometric properties were invariant over time and each of the five dimensions of QoL displayed from moderate (all ICCs above .500) to good test-retest reliability (i.e. ICC for urinary incontinence = .764). Conclusions Results of the CFA and the measurement invariance analysis demonstrated the validity of the Italian version of the EPIC-26 to assess QoL in prostate cancer patients. Its reliability and good psychometric qualities are well-supported, thus providing a valid tool to assess health-related quality of life and its change over time in prostate cancer patients.
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Affiliation(s)
- Chiara Marzorati
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy. .,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy.
| | - Dario Monzani
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Ketti Mazzocco
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Marianna Masiero
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy.,Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Francesca Pavan
- Patient Safety & Risk Management Service, European Institute of Oncology IRCCS, Milan, Italy
| | - Massimo Monturano
- Patient Safety & Risk Management Service, European Institute of Oncology IRCCS, Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
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23
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Hathout L, Mahmoud O, Wang Y, Vergalasova I, Barkati M, Després P, Martin AG, Foster W, Lacroix F, Delouya G, Taussky D, Morton G, Vigneault E. A Phase 2 Randomized Pilot Study Comparing High-Dose-Rate Brachytherapy and Low-Dose-Rate Brachytherapy as Monotherapy in Localized Prostate Cancer. Adv Radiat Oncol 2019; 4:631-640. [PMID: 31673656 PMCID: PMC6817536 DOI: 10.1016/j.adro.2019.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/08/2019] [Accepted: 04/09/2019] [Indexed: 01/30/2023] Open
Abstract
Purpose To compare health-related quality of life (HRQOL) of high-dose-rate brachytherapy (HDRB) versus low dose-rate brachytherapy (LDRB) for localized prostate cancer in a multi-institutional phase 2 randomized trial. Methods and Materials Men with favorable-risk prostate cancer were randomized between monotherapy brachytherapy with either Iodine-125 LDRB to 144 Gy or single-fraction Iridium-192 HDRB to 19 Gy. HRQOL and urinary toxicity were recorded at baseline and at 1, 3, 6, and 12 months using the Expanded Prostate Cancer Index Composite (EPIC)-26 scoring and the International Prostate Symptom Score (IPSS). Independent samples t test and mixed effects modeling were performed for continuous variables. Time to IPSS resolution, defined as return to its baseline score ±5 points, was calculated using Kaplan-Meier estimator curves with the log-rank test. A multiple-comparison adjusted P value of ≤.05 was considered significant. Results LDRB and HDRB were performed in 15 and 16 patients, respectively, for a total of 31 patients. At 3 months, patients treated with LDRB had a higher IPSS score (mean, 15.5 vs 6.0, respectively; P = .003) and lower EPIC urinary irritative score (mean, 69.2 vs 85.3, respectively; P = .037) compared with those who received HDRB. On repeated measures at 1, 3, 6, and 12 months, the IPSS (P = .003) and EPIC urinary irritative scores (P = .019) were significantly better in the HDR arm, translating into a lower urinary toxicity profile. There were no significant differences in the EPIC urinary incontinence, sexual, or bowel habit scores between the 2 groups at any measured time point. Time to IPSS resolution was significantly shorter in the HDRB group (mean, 2.0 months) compared with the LDRB group (mean, 6.0 months; P = .028). Conclusions HDRB monotherapy is a promising modality associated with a lower urinary toxicity profile and higher HRQOL in the first 12 months compared with LDRB.
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Affiliation(s)
- Lara Hathout
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey
| | - Omar Mahmoud
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey
| | - Yaqun Wang
- Department of Biostatistics, School of Public Health, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey
| | - Irina Vergalasova
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey
| | - Maroie Barkati
- Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Philippe Després
- Department of Radiation Oncology and Research Centre CHU de Québec-Université Laval, Québec City, QC, Canada
| | - André-Guy Martin
- Department of Radiation Oncology and Research Centre CHU de Québec-Université Laval, Québec City, QC, Canada
| | - William Foster
- Department of Radiation Oncology and Research Centre CHU de Québec-Université Laval, Québec City, QC, Canada
| | - Frédéric Lacroix
- Department of Radiation Oncology and Research Centre CHU de Québec-Université Laval, Québec City, QC, Canada
| | - Guila Delouya
- Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Daniel Taussky
- Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Gerard Morton
- Department of Radiation Oncology, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Eric Vigneault
- Department of Radiation Oncology and Research Centre CHU de Québec-Université Laval, Québec City, QC, Canada
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24
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Talvitie AM, Ojala H, Tammela T, Koivisto AM, Pietilä I. Factors related to self-rated health and life satisfaction one year after radical prostatectomy for localised prostate cancer: a cross-sectional survey. Scand J Caring Sci 2019; 33:688-697. [PMID: 30866074 DOI: 10.1111/scs.12664] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 01/07/2019] [Indexed: 11/27/2022]
Abstract
BACKGROUND Localised prostate cancer affects patient's quality of life in many ways. The aim of this study was to explore factors related to self-rated health and life satisfaction for patients treated for prostate cancer, and to compare the results of these generic quality-of-life measures to the prostate cancer-specific quality-of-life measure (UCLA Prostate Cancer Index), which focuses on physical functioning. MATERIAL AND METHODS This cross-sectional survey was carried out among 183 men who underwent radical prostatectomy in 2012-2015 at a university hospital in Finland and were seen 1 year postsurgery. Approval from an ethics committee and written consents from participants were received. A questionnaire was used to evaluate patients' perceived quality of life. Logistic regression model, Spearman's correlation, Kruskal-Wallis test and Mann-Whitney U-test were used to analyse factors related to quality of life. RESULTS Of the 183 men in the study, 63% rated their health status as good, and 70% were satisfied with their lives after prostatectomy. Older age and better urinary function were the only factors that explained both better self-rated health and better satisfaction with life. The patients seemed not to interpret problems with sexual function as health-related problems. In our sample, sexual dysfunction was relatively severe, but patients considered them to be less harmful than urinary or bowel symptoms. Interestingly, 24% of the men with low sexual function did not find that dysfunction bothersome. CONCLUSIONS Objectively measured physical functioning is not necessarily in line with patients' experienced satisfaction with life and their self-ratings of health. More longitudinal and qualitative research is needed about the meanings that patients attach to physical treatment side effects and the extent to which they can adapt to them over time. With a bigger sample and longer follow-up time, it would be possible to identify men who particularly benefited from pretreatment counselling.
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Affiliation(s)
| | - Hanna Ojala
- Faculty of Social Sciences, Tampere University, Tampere, Finland
| | - Teuvo Tammela
- Faculty of Medicine and Health Technology, Tampere University Hospital and Tampere University, Tampere, Finland
| | | | - Ilkka Pietilä
- Faculty of Social Sciences, University of Helsinki, Helsinki, Finland
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25
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Mukherjee AA, Kandhare AD, Bodhankar SL. Evaluation of health-related quality of life in hemolytic uraemic syndrome patients treated with eculizumab: a systematic evaluation on basis of EMPRO. Ren Fail 2018; 40:107-118. [PMID: 29363392 PMCID: PMC6014301 DOI: 10.1080/0886022x.2018.1427110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2017] [Revised: 10/07/2017] [Accepted: 12/14/2017] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Hemolytic uraemic syndrome (HUS) is progressive renal failure disease and determination of their quality of life (QoL) on the basis of patient-reported outcomes (PROs) are becoming increasingly important in the economic evaluations for its treatment with eculizumab (ECU). AIM To perform the systematic evaluation of QoL in HUS patients treated with ECU on the basis of Evaluating Measures of Patient Reported Outcomes (EMPRO) tool. MATERIALS AND METHODS A systematic review was conducted in PubMed, EMBASE, the Cochrane Library, CINAHL and Google Scholar till September 2016 by two independent researchers. Each identified instrument was evaluated for its quality of performance by using the EMPRO tool for its overall score and seven attribute specific scores (range 0-100, worst to best). RESULTS Five different PROs instruments were identified from 10 articles (n = 112) which showed eculizumab significantly improves health-related quality of life (HRQOL) in atypical HUS (aHUS) patients. Amongst five instruments viz. EuroQol five dimensions questionnaire (EQ-5 D), Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F), Headache Impact Test-6 (HIT-6), 36-Item Short Form Health Survey (SF-36) and Visual Analogue Scale (VAS), the overall EMPRO score was higher for VAS (73.83) and EQ-5 D (73.81). Whereas, FACIT-F and HIT- 6 were just able to meet the minimal threshold of EMPRO scoring (50.24 and 59.09, respectively). CONCLUSIONS Evidence from present investigation support that eculizumab significantly improves HRQoL in patients with aHUS furthermore, EQ-5 D and VAS instrument should be recommended for assessing HRQoL in them. However, selection of PRO instrument for determination of QoL in HUS entirely depend upon the study requirements.
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Affiliation(s)
| | - Amit D. Kandhare
- Department of Pharmacology, Poona College of Pharmacy, Pune, India
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26
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Assessing health-related quality of life in patients with breast cancer: a reply to Ribi et al. Qual Life Res 2018; 27:2757-2758. [DOI: 10.1007/s11136-018-1927-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/26/2018] [Indexed: 11/26/2022]
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27
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Vrotsou K, Ávila M, Machón M, Mateo-Abad M, Pardo Y, Garin O, Zaror C, González N, Escobar A, Cuéllar R. Constant-Murley Score: systematic review and standardized evaluation in different shoulder pathologies. Qual Life Res 2018; 27:2217-2226. [PMID: 29748823 PMCID: PMC6132990 DOI: 10.1007/s11136-018-1875-7] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/03/2018] [Indexed: 02/07/2023]
Abstract
PURPOSE The objective of this study was to evaluate the psychometric properties of the Constant-Murley Score (CMS) in various shoulder pathologies, based on a systematic review and expert standardized evaluations. METHODS A systematic review was performed in MEDLINE and EMBASE databases. Titles and abstracts were reviewed and finally the included articles were grouped according to patients' pathologies. Two expert evaluators independently assessed the CMS properties of reliability, validity, responsiveness to change, interpretability and burden score in each group, using the EMPRO (Evaluating Measures of Patient Reported Outcomes) tool. The CMS properties were assessed per attribute and overall for each considered group. Only the concept and measurement model was assessed globally. RESULTS Five individual pathologies (i.e. subacromial, fractures, arthritis, instability and frozen shoulder) and two additional groups (i.e. various pathologies and healthy subjects) were considered. Overall EMPRO scores ranged from 58.6 for subacromial to 30.6 points for instability. Responsiveness to change was the only quality to obtain at least 50 points across all groups, but for frozen shoulder. Insufficient information was obtained in relation to the concept and measurement model and great variability was seen in the other evaluated attributes. CONCLUSIONS The current evidence does not support the CMS as a gold standard in shoulder evaluation. Its use is advisable for subacromial pathology; but data are inconclusive for other shoulder conditions. Prospective studies exploring the psychometric properties of the scale, particularly for fractures, arthritis, instability and frozen shoulder are needed. LEVEL OF EVIDENCE Systematic review.
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Affiliation(s)
- Kalliopi Vrotsou
- Unidad de Investigación de Atención Primaria-OSIS Gipuzkoa, Instituto Biodonostia, Paseo Dr. Beguiristain s/n, 20014 San Sebastián, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Spain
- Centro de Investigación en Cronicidad Kronikgune, Barakaldo, Spain
| | - Mónica Ávila
- Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Mónica Machón
- Unidad de Investigación de Atención Primaria-OSIS Gipuzkoa, Instituto Biodonostia, Paseo Dr. Beguiristain s/n, 20014 San Sebastián, Spain
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Spain
| | - Maider Mateo-Abad
- Unidad de Investigación de Atención Primaria-OSIS Gipuzkoa, Instituto Biodonostia, Paseo Dr. Beguiristain s/n, 20014 San Sebastián, Spain
- Centro de Investigación en Cronicidad Kronikgune, Barakaldo, Spain
| | - Yolanda Pardo
- Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Barcelona, Spain
| | - Olatz Garin
- Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Carlos Zaror
- Department of Paediatric Dentistry and Orthodontics, Faculty of Dentistry, Universidad de La Frontera, Temuco, Chile
- Faculty of Dentistry, Universidad San Sebastian, Puerto Montt, Chile
| | - Nerea González
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Spain
- Unidad de Investigación, Hospital Galdakao-Usansolo, Galdakao, Spain
| | - Antonio Escobar
- Red de Investigación en Servicios de Salud en Enfermedades Crónicas (REDISSEC), Bilbao, Spain
- Unidad de investigación, Hospital Universitario Basurto, Bilbao, Spain
| | - Ricardo Cuéllar
- Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario Donostia, San Sebastián, Spain
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Measuring a new facet of post traumatic growth: Development of a scale of physical post traumatic growth in men with prostate cancer. PLoS One 2018; 13:e0195992. [PMID: 29702656 PMCID: PMC5922578 DOI: 10.1371/journal.pone.0195992] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2016] [Accepted: 04/04/2018] [Indexed: 11/19/2022] Open
Abstract
PURPOSE This study developed a measure of physical post traumatic growth (physical post traumatic growth inventory; P-PTGI) in men with prostate cancer. METHODS A pool of items was created from themes identified in a qualitative study. A quantitative study was then conducted to assess the psychometric properties of the P-PTGI in a sample of 693 prostate cancer survivors. RESULTS Tests of dimensionality revealed that the 20-item P-PTGI contained two factors: Health Autonomy and Health Awareness. Results demonstrated that scale score reliability for the P-PTGI and its subscales was excellent. In support of the scale's convergent validity, scores on the P-PTGI correlated positively with mindfulness and quality of life, and correlated negatively with depression and anxiety. A statistically significant correlation between the P-PTGI and another robust indicator of post traumatic growth attests to its concurrent validity. CONCLUSIONS While further investigation of the P-PTGI's psychometric properties is required, preliminary findings are promising.
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Ávila M, Patel L, López S, Cortés-Sanabria L, Garin O, Pont À, Ferrer F, Boladeras A, Zamora V, Fosså S, Storås AH, Sanda M, Serra-Sutton V, Ferrer M. Patient-reported outcomes after treatment for clinically localized prostate cancer: A systematic review and meta-analysis. Cancer Treat Rev 2018; 66:23-44. [PMID: 29673922 DOI: 10.1016/j.ctrv.2018.03.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 02/23/2018] [Accepted: 03/23/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND The aim of this systematic review is to assess the impact of primary treatments with curative intention in patients with localized prostate cancer, measured with Patient-Reported Outcomes (PROs), and to examine differences among modalities within treatments. METHODS We conducted a systematic literature search for January 2005-March 2017 following PRISMA guidelines, including longitudinal studies measuring disease-specific PROs in localized prostate cancer patients with a follow-up from pre- to post-treatment (≥1 year). Two reviewers independently extracted data and assessed risk of bias. The study is registered in PROSPERO: CRD42015019747. RESULTS Of 148 identified studies, 60 were included in the meta-analyses. At the 1st year, radical prostatectomy patients showed small urinary irritative-obstructive improvement (0.37SD 95%CI 0.30, 0.45), but large deterioration for sexual function and incontinence with high heterogeneity (I2 = 77% and 93%). Moderate worsening in external radiotherapy patients for sexual function (-0.46SD 95%CI -0.55, -0.36), small urinary incontinence (-0.16SD 95%CI -0.23, -0.09) and bowel impairment (-0.31SD 95%CI -0.39, -0.23). Brachytherapy patients presented small deterioration in urinary incontinence (-0.29SD 95%CI -0.39, -0.19), irritative obstructive symptoms (-0.35SD 95%CI -0.47, -0.23), sexual function (-0.12SD 95%CI -0.24, -0.002), and bowel bother (-0.27SD 95%CI -0.42, -0.11). These patterns persisted up to the 5th year. High-intensity focused ultrasound and active surveillance only have results at 1st year, showing no statistically significant worsening. CONCLUSIONS No remarkable differences in PRO appeared between modalities within each treatment. Nowadays, available evidence supports brachytherapy as possible alternative to radical prostatectomy for patients seeking an attempted curative treatment limiting the risk for urinary incontinence and sexual dysfunction.
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Affiliation(s)
- Mónica Ávila
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain; Universitat Pompeu Fabra, Barcelona, Spain
| | | | - Silvia López
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Laura Cortés-Sanabria
- Unidad de Investigación Médica en Enfermedades Renales, Hospital de Especialidades, CMNO, IMSS, Guadalajara, Mexico
| | - Olatz Garin
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain; Universitat Pompeu Fabra, Barcelona, Spain.
| | - Àngels Pont
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
| | | | | | - Victor Zamora
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; Barcelona University UB, Barcelona, Spain
| | - Sophie Fosså
- Oslo University Hospital, University of Oslo, Norway
| | - Anne H Storås
- Oslo University Hospital, University of Oslo, Norway
| | - Martin Sanda
- Department of Urology, Emory University School of Medicine, United States
| | - Vicky Serra-Sutton
- Agency for Health Quality and Assessment of Catalonia (AQuAS), Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
| | - Montse Ferrer
- Health Services Research Group, 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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Zaror C, Pardo Y, Espinoza-Espinoza G, Pont À, Muñoz-Millán P, Martínez-Zapata MJ, Vilagut G, Forero CG, Garin O, Alonso J, Ferrer M. Assessing oral health-related quality of life in children and adolescents: a systematic review and standardized comparison of available instruments. Clin Oral Investig 2018; 23:65-79. [DOI: 10.1007/s00784-018-2406-1] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 02/28/2018] [Indexed: 01/14/2023]
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Echevarría-Guanilo ME, Gonçalves N, Romanoski PJ. PROPRIEDADES PSICOMÉTRICAS DE INSTRUMENTOS DE MEDIDAS: BASES CONCEITUAIS E MÉTODOS DE AVALIAÇÃO - PARTE I. TEXTO & CONTEXTO ENFERMAGEM 2018. [DOI: 10.1590/0104-07072017001600017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
RESUMO Objetivo: apresentar e discutir bases conceituais e métodos de avaliações que fundamentam importantes propriedades de instrumentos de medidas. Método: estudo teórico embasado na literatura internacional e nacional e nos instrumentos Consensus-based Standards for the selection of health Measurement Instruments e Evaluating the Measurement of Patient-Reported Outcomes que contemplam conceitos de avaliação de instrumentos para apreciação de resultados relatados pelo paciente. Inicialmente são apresentados e discutidos os conceitos de confiabilidade, responsividade e interpretabilidade, citados exemplos das principais formas de avaliação dessas propriedades. Resultados: pode-se perceber que ainda há divergências em algumas descrições conceituais. Entretanto, os autores ressaltam a importância da confiabilidade para avaliar o instrumento de medida. Destaca-se a importância do conhecimento do Modelo Conceitual, das propriedades de medidas e dos diferentes métodos de avaliação para garantir, principalmente em estudo de validação de instrumentos, resultados confiáveis e válidos. Conclusões: a discussão apresentada sobre a confiabilidade, responsividade e interpretabilidade contribui para os profissionais de saúde no conhecimento teórico e senso crítico na escolha de instrumentos e na condução de análises sobre essas propriedades de medida.
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Assessing Features of Psychometric Assessment Instruments: A Comparison of the COSMIN Checklist with Other Critical Appraisal Tools. BRAIN IMPAIR 2017. [DOI: 10.1017/brimp.2017.29] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
The past 20 years have seen the development of instruments designed to specify standards and evaluate the adequacy of published studies with respect to the quality of study design, the quality of findings, as well as the quality of their reporting. In the field of psychometrics, the first minimum set of standards for the review of psychometric instruments was published in 1996 by the Scientific Advisory Committee of the Medical Outcomes Trust. Since then, a number of tools have been developed with similar aims. The present paper reviews basic psychometric properties (reliability, validity and responsiveness), compares six tools developed for the critical appraisal of psychometric studies and provides a worked example of using the COSMIN checklist, Terwee-m statistical quality criteria, and the levels of evidence synthesis using the method of Schellingerhout and colleagues (2012). This paper will aid users and reviewers of questionnaires in the quality appraisal and selection of appropriate instruments by presenting available assessment tools, their characteristics and utility.
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Axcrona K, Nilsson R, Brennhovd B, Sørebø Ø, Fosså SD, Dahl AA. Psychometric properties of the expanded prostate cancer index composite - 26 instrument in a cohort of radical prostatectomy patients: theoretical and practical examinations. BMC Urol 2017; 17:111. [PMID: 29197360 PMCID: PMC5712157 DOI: 10.1186/s12894-017-0302-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2016] [Accepted: 11/17/2017] [Indexed: 03/21/2023] Open
Abstract
Background Recently, the Expanded Prostate Cancer Index Composite 26-item version (EPIC-26) was recommended for the assessment of adverse effects after the treatment of prostate cancer without clear reasons. This decision encouraged us to review the questionnaire development from the UCLA Prostate Cancer Index (UCLA-PCI) to the EPIC-16 CP with a focus on psychometric properties. We also reviewed PubMed for papers concerning such properties of the EPIC-26 since 2012 (latest review in 2011). Finally, we examined the psychometric properties of the EPIC-26 in a sample of Norwegian males treated with robot-assisted laparoscopic prostatectomy (RALP). Methods This study used three methods: (1) Comparison of the content of the UCLA-PCI, EPIC-50, EPIC-26, and EPIC-16 CP; (2) Review of EPIC-26 and EPIC-16 CP papers in PubMed from 2012 to 2016, identifying papers reporting on the psychometric properties of these questionnaires; and (3) Psychometric examination of the EPIC-26 rating in 651 Norwegian men treated with RALP at a mean of 3.2 years post-surgery. Results The questionnaire development showed a significant increase in bother versus function items, and the EPIC-26 contains eight function and 18 bother items. Twelve papers concerning the EPIC-26 available on PubMed since 2012 support the psychometric properties of the EPIC-26. The Norwegian EPIC-26 findings supported the psychometric properties of the EPIC-26, but suggested six subdomains both by exploratory and confirmatory factor analyses. Conclusions In general our examinations supported the adequate psychometric properties of the EPIC-26, although the factor structure, construct and predictive validity of the instrument should be examined further.
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Affiliation(s)
- Karol Axcrona
- Department of Urology, Akershus University Hospital, Lørenskog, Norway
| | | | - Bjørn Brennhovd
- Department of Urology, Oslo University Hospital, The Norwegian Radium Hospital, Oslo, Norway
| | - Øystein Sørebø
- School of Business and Social Sciences, University College of Southeast Norway, Hønefoss, Norway
| | - Sophie D Fosså
- National Resource Center for Late Effects after Cancer Treatment, Oslo University Hospital, The Norwegian Radium Hospital, P.O. Box 4453, Nydalen, 0424, Oslo, Norway.,Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Alv A Dahl
- National Resource Center for Late Effects after Cancer Treatment, Oslo University Hospital, The Norwegian Radium Hospital, P.O. Box 4453, Nydalen, 0424, Oslo, Norway. .,Faculty of Medicine, University of Oslo, Oslo, Norway.
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Vigneault É, Savard J, Savard MH, Ivers H, Després P, Foster W, Martin AG, Fradet V. Validation of the French-Canadian version of the Expanded Prostate Cancer Index Composite (EPIC) in a French-Canadian population. Can Urol Assoc J 2017; 11:404-410. [PMID: 29106365 DOI: 10.5489/cuaj.4428] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study aims to empirically validate the French-Canadian version of the Expanded Prostate Cancer Index Composite (EPIC), a measure of health-related quality of life for prostate cancer patients. METHODS Two hundred fifty-one participants completed a battery of self-report scales, including the French-Canadian version of the EPIC, after having received radiation therapy or radical prostatectomy for prostate cancer. RESULTS The internal consistency for the urinary incontinence, bowel, and sexual domains of the EPIC-26 was high (Cronbach's alpha coefficients from 0.80-0.92), while coefficients for the urinary irritation/obstruction (0.59) and hormonal (0.67) domains were lower. Item-total correlations (rs=0.15-0.85), and temporal stability (rs=0.72-0.93) generally supported the reliability of the instrument. The five-factor structure of the EPIC-26 was confirmed for the most part. The construct validity of the instrument was also supported by high correlations obtained between each domain and measures assessing similar constructs (rs=-0.56-0.83). The EPIC also showed an excellent sensitivity to change with significant differences obtained on EPIC scores (all p<0.05) between pre- and post-prostate cancer treatment. CONCLUSIONS The psychometric qualities of the French-Canadian version of the EPIC are well-supported, thus providing a valid tool to assess health-related quality of life in prostate cancer patients.
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Affiliation(s)
- Éric Vigneault
- CHU de Québec-Université Laval Research Centre; Quebec City, QC, Canada.,Department of Radiation Oncology, CHU de Québec-Université Laval; Quebec City, QC, Canada
| | - Josée Savard
- CHU de Québec-Université Laval Research Centre; Quebec City, QC, Canada.,Université Laval Cancer Research Centre; Quebec City, QC, Canada.,School of Psychology, Université Laval; Quebec City, QC, Canada
| | - Marie-Hélène Savard
- CHU de Québec-Université Laval Research Centre; Quebec City, QC, Canada.,Université Laval Cancer Research Centre; Quebec City, QC, Canada
| | - Hans Ivers
- CHU de Québec-Université Laval Research Centre; Quebec City, QC, Canada.,Université Laval Cancer Research Centre; Quebec City, QC, Canada.,School of Psychology, Université Laval; Quebec City, QC, Canada
| | - Philippe Després
- CHU de Québec-Université Laval Research Centre; Quebec City, QC, Canada.,Department of Radiation Oncology, CHU de Québec-Université Laval; Quebec City, QC, Canada.,Université Laval Cancer Research Centre; Quebec City, QC, Canada.,Département de Physique, de Génie Physique et d'Optique, Université Laval; Quebec City, QC, Canada
| | - William Foster
- Department of Radiation Oncology, CHU de Québec-Université Laval; Quebec City, QC, Canada
| | - André-Guy Martin
- CHU de Québec-Université Laval Research Centre; Quebec City, QC, Canada.,Department of Radiation Oncology, CHU de Québec-Université Laval; Quebec City, QC, Canada
| | - Vincent Fradet
- CHU de Québec-Université Laval Research Centre; Quebec City, QC, Canada.,Université Laval Cancer Research Centre; Quebec City, QC, Canada.,Department of Surgery, Université Laval; Quebec City, QC, Canada
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Pham Q, Cafazzo JA, Feifer A. Adoption, Acceptability, and Effectiveness of a Mobile Health App for Personalized Prostate Cancer Survivorship Care: Protocol for a Realist Case Study of the Ned App. JMIR Res Protoc 2017; 6:e197. [PMID: 29025699 PMCID: PMC5658643 DOI: 10.2196/resprot.8051] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/30/2017] [Accepted: 09/13/2017] [Indexed: 12/29/2022] Open
Abstract
Background By 2030, prostate cancer will be the most commonly diagnosed cancer in North America. To mitigate this impending challenge, comprehensive support mechanisms for disease- and treatment-specific changes in health and well-being must be proactively designed and thoughtfully implemented for streamlined survivorship care. mHealth apps have been lauded as a promising complement to current outpatient treatment and monitoring strategies, but have not yet been widely used to support prostate cancer survivorship needs. A realist evaluation is needed to examine the impact of such apps on the prostate cancer survivorship experience. Objective We seek to gain an understanding of how an mHealth app for prostate cancer survivorship care called Ned (No Evident Disease) is adopted and accepted by patients, caregivers, and clinicians. We also aim to determine the effect of Ned on health-related quality of life, satisfaction with cancer care, unmet needs, self-efficacy, and prostate cancer-related levels of anxiety. Methods The Ned case study is a 12-month mixed-methods embedded single-case study with a nested within-group pre-post comparison of health outcomes. We will give 400 patients, 200 caregivers, and 10 clinicians access to Ned. Participants will be asked to complete study assessments at baseline, 2 months, 6 months, and 12 months. We will conduct 30 semistructured qualitative interviews with patients (n=20) and their caregivers (n=10) poststudy to gain insight into their experience with the app. Results We recruited our first survivor in October 2017 and anticipate completing this study by May 2019. Conclusions This will, to our knowledge, be the first realist case study to evaluate an app for prostate cancer survivorship care. Prostate cancer survivors are set to increase in number and longevity, heightening the need for integrated survivorship solutions to provide them with optimal and durable outcomes. The knowledge gained from this study will comprehensively inform how and why Ned works, for whom, and in what circumstances. Understanding the impact of digital health interventions such as Ned on how survivors care for themselves is critical to realizing patient-centered care.
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Affiliation(s)
- Quynh Pham
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada
| | - Joseph A Cafazzo
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.,Centre for Global eHealth Innovation, Techna Institute, University Health Network, Toronto, ON, Canada.,Institute of Biomaterials and Biomedical Engineering, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Andrew Feifer
- Carlo Fidani Regional Cancer Centre, Credit Valley Hospital, Trillium Health Partners, Mississauga, ON, Canada.,Department of Surgery, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
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Bonet M, Cayetano L, Núñez M, Jovell-Fernández E, Aguilar A, Ribas Y. Assessment of acute bowel function after radiotherapy for prostate cancer: Is it accurate enough? Clin Transl Oncol 2017; 20:576-583. [PMID: 28900813 DOI: 10.1007/s12094-017-1749-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Accepted: 09/01/2017] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND PURPOSE Pelvic radiotherapy for prostate cancer can be associated with bowel toxicity, which may have a significant impact on quality of life. Our aim was to assess the adequacy of the tools currently used to assess bowel symptoms after radiotherapy, including physician and patient reported outcomes. This sub-study on acute toxicity was part of a prospective trial assessing long-term bowel dysfunction. MATERIALS AND METHODS Between February 2013 and July 2015, 75 patients with prostate cancer who received radiotherapy completed the LENT/SOMA and the EPIC questionnaires baseline and 2 weeks after the treatment. The Bristol stool scale and two additional questions on faecal urgency were added. Physicians assessed toxicity using Common Terminology Criteria for Adverse Events v.4.0. Agreement between patients and clinicians was assessed using the Cohen's κ coefficient. RESULTS Acute toxicity during radiotherapy was very low. The pattern of overall bowel bother was similar before and after treatment. Faecal urgency significantly increased after radiotherapy compared to baseline but was only detected by the additional questions and not by the physicians or the patient-reported outcomes (PRO) questionnaires. Correlation between physician and PRO was poor for most symptoms. CONCLUSION Bowel symptoms such as urgency may remain undetected by usual tools to assess toxicity after radiotherapy. Assessment of bowel toxicity should be reappraised in order to identify those patients who may have symptoms with an impact on their quality of life.
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Affiliation(s)
- M Bonet
- Department of Radiation Oncology, Consorci Sanitari de Terrassa, Terrassa, Spain.
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Avda. del Dr. Josep Laporte, 2, 43201, Reus, Spain.
| | - L Cayetano
- Department of Surgery, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - M Núñez
- Department of Radiation Oncology, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - E Jovell-Fernández
- Department of Epidemiology, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - A Aguilar
- Department of Urology, Consorci Sanitari de Terrassa, Terrassa, Spain
| | - Y Ribas
- Department of Surgery, Consorci Sanitari de Terrassa, Terrassa, Spain
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Lemanska A, Chen T, Dearnaley DP, Jena R, Sydes MR, Faithfull S. Symptom clusters for revising scale membership in the analysis of prostate cancer patient reported outcome measures: a secondary data analysis of the Medical Research Council RT01 trial (ISCRTN47772397). Qual Life Res 2017; 26:2103-2116. [PMID: 28352980 PMCID: PMC5509840 DOI: 10.1007/s11136-017-1548-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/13/2017] [Indexed: 01/21/2023]
Abstract
PURPOSE To investigate the role of symptom clusters in the analysis and utilisation of patient reported outcome measures (PROMs) for data modelling and clinical practice. To compare symptom clusters with scales, and to explore their value in PROMs interpretation and symptom management. METHODS A dataset called RT01 (ISCRTN47772397) of 843 prostate cancer patients was used. PROMs were reported with the University of California, Los Angeles Prostate Cancer Index (UCLA-PCI). Symptom clusters were explored with hierarchical cluster analysis (HCA) and average linkage method (correlation > 0.6). The reliability of the Urinary Function Scale was evaluated with Cronbach's Alpha. The strength of the relationship between the items was investigated with Spearman's correlation. Predictive accuracy of the clusters was compared to the scales by receiver operating characteristic (ROC) analysis. Presence of urinary symptoms at 3 years measured with the late effects on normal tissue: subjective, objective, management tool (LENT/SOM) was an endpoint. RESULTS Two symptom clusters were identified (urinary cluster and sexual cluster). The grouping of symptom clusters was different than UCLA-PCI Scales. Two items of the urinary function scales ("number of pads" and "urinary leak interfering with sex") were excluded from the urinary cluster. The correlation with the other items in the scale ranged from 0.20 to 0.21 and 0.31 to 0.39, respectively. Cronbach's Alpha showed low correlation of those items with the Urinary Function Scale (0.14-0.36 and 0.33-0.44, respectively). All urinary function scale items were subject to a ceiling effect. Clusters had better predictive accuracy, AUC = 0.70 -0.65, while scales AUC = 0.67-0.61. CONCLUSION This study adds to the knowledge on how cluster analysis can be applied for the interpretation and utilisation of PROMs. We conclude that multiple-item scales should be evaluated and that symptom clusters provide a study-specific approach for modelling and interpretation of PROMs.
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Affiliation(s)
- Agnieszka Lemanska
- Faculty of Health and Medical Sciences, School of Health Sciences, University of Surrey, Guildford, UK.
| | - Tao Chen
- Department of Chemical and Process Engineering, University of Surrey, Guildford, UK
| | - David P Dearnaley
- The Institute of Cancer Research & Royal Marsden NHS Foundation Trust, London, UK
| | - Rajesh Jena
- University of Cambridge Department of Oncology, Cambridge Biomedical Campus, Addenbrooke's Hospital, Cambridge, UK
| | - Matthew R Sydes
- MRC Clinical Trials Unit at UCL, Institute of Clinical Trials and Methodology, London, UK
| | - Sara Faithfull
- Faculty of Health and Medical Sciences, School of Health Sciences, University of Surrey, Guildford, UK
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Khurana V, Sharma H, Afroz N, Callan A, Medin J. Patient-reported outcomes in multiple sclerosis: a systematic comparison of available measures. Eur J Neurol 2017; 24:1099-1107. [PMID: 28695634 DOI: 10.1111/ene.13339] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 05/15/2017] [Indexed: 11/30/2022]
Abstract
Multiple patient-reported outcomes (PROs) are currently being used in multiple sclerosis (MS) but their application is inconsistent and guidance on the appropriateness of each tool is lacking. The objective of our study was to identify MS-specific PROs and systematically to assess the development process and the reliability and validity of various instruments. A systematic literature search was conducted on multiple data sources, including MEDLINE, Embase (using the Ovid platform) and Google Scholar, from 1996 to March 2015. Search terms included combinations of MS, PROs and quality of life. Randomized controlled trials or observational studies conducted on patients with MS and published in English were included. In addition, the PROQOLID database was explored. The MS-specific PROs were systematically assessed using the Evaluating the Measurement of Patient-Reported Outcomes tool. In total, 8094 articles were screened and 405 PROs were identified from 1102 relevant articles. PROs were classified into MS-specific (n = 82) and non-MS-specific (n = 323). The results for the eight PROs that are most commonly used in MS clinical trials are presented here. For these eight PROs, the overall summary scores ranged between 50.1 and 68.7. The Multiple Sclerosis Impact Scale-29 had the best overall mean score (68.7), followed by the Leeds Multiple Sclerosis Quality of Life (67.0). This is the first study to provide a standardized assessment of all PROs for MS. There is a lack of data on content validity for PROs used in MS research, which indicates the need for a robust instrument in MS developed according to the US Food and Drug Administration guidelines.
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Affiliation(s)
- V Khurana
- Product Lifecycle Services - NBS, Novartis Healthcare Private Limited, Hyderabad, India
| | - H Sharma
- Product Lifecycle Services - NBS, Novartis Healthcare Private Limited, Hyderabad, India
| | - N Afroz
- Product Lifecycle Services - NBS, Novartis Healthcare Private Limited, Hyderabad, India
| | - A Callan
- Product Lifecycle Services - NBS, Novartis Global Service Center, Dublin, Ireland
| | - J Medin
- Global Patient Access, Novartis Pharma AG, Basel, Switzerland
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Hsiao CP, Chen MK, Meyers KJ, Saligan LN. Symptoms predicting health-related quality of life in prostate cancer patients treated with localized radiation therapy. Fam Med Community Health 2017; 5:119-128. [PMID: 30263893 PMCID: PMC6155995 DOI: 10.15212/fmch.2017.0133] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Objective Patient-reported health-related quality-of-life (HRQOL) measures can provide guidance for treatment decision making, symptom management, and discharge planning. HRQOL is often influenced by the distress experienced by patients from disease or treatment-related symptoms. This study aimed to identify symptoms that can predict changes in HRQOL in men undergoing external beam radiation therapy (EBRT) for nonmetastatic prostate cancer (NMPC). Methods Fifty-one men with NMPC scheduled for EBRT were assessed at the baseline, at the midpoint of EBRT, and at the end of EBRT. All participants received 38–42 daily doses of EBRT (five times a week), depending on the stage of their disease. Validated questionnaires were administered to evaluate depressive symptoms, urinary and sexual functions, bowel issues, symptom-related distress, fatigue, and HRQOL. Pearson correlations, repeated-measures ANOVA, and multiple regressions examined the relationships among variables. Results Intensification of symptoms and increased symptom-related distress, with a corresponding decline in HRQOL, were observed during EBRT in men with NMPC. Changes in symptoms and symptom distress were associated with changes in HRQOL at the midpoint of EBRT (r=−0.37 to −0.6, P=0.05) and at the end of EBRT (r=−0.3 to −0.47, P=0.01) compared with the baseline. The regression model comprising age, body mass index, Gleason score, T category, androgen-deprivation therapy use, radiation dose received, symptoms (urinary/sexual/bowel problems, fatigue), and overall symptom distress explained 70% of the variance in predicting HRQOL. Urinary problems and fatigue significantly predicted the decline in HRQOL during EBRT. Conclusion Identifying specific symptoms that can influence HRQOL during EBRT for NMPC can provide feasible interventional targets to improve treatment outcomes.
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Affiliation(s)
- Chao-Pin Hsiao
- The Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Mea-Kuang Chen
- University of Arizona, 3009 E 4th St. Tucson, AZ 85716, USA
| | - Kathy J Meyers
- The Frances Payne Bolton School of Nursing, Case Western Reserve University, Cleveland, OH, USA
| | - Leorey N Saligan
- National Institute of Nursing Research, Division of Intramural Research, National Institutes of Health, 9000 Rockville Pike, Building 3, Room 5E14, Bethesda, MD 20892, USA
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Zaorsky NG, Davis BJ, Nguyen PL, Showalter TN, Hoskin PJ, Yoshioka Y, Morton GC, Horwitz EM. The evolution of brachytherapy for prostate cancer. Nat Rev Urol 2017; 14:415-439. [PMID: 28664931 PMCID: PMC7542347 DOI: 10.1038/nrurol.2017.76] [Citation(s) in RCA: 100] [Impact Index Per Article: 14.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Brachytherapy (BT), using low-dose-rate (LDR) permanent seed implantation or high-dose-rate (HDR) temporary source implantation, is an acceptable treatment option for select patients with prostate cancer of any risk group. The benefits of HDR-BT over LDR-BT include the ability to use the same source for other cancers, lower operator dependence, and - typically - fewer acute irritative symptoms. By contrast, the benefits of LDR-BT include more favourable scheduling logistics, lower initial capital equipment costs, no need for a shielded room, completion in a single implant, and more robust data from clinical trials. Prospective reports comparing HDR-BT and LDR-BT to each other or to other treatment options (such as external beam radiotherapy (EBRT) or surgery) suggest similar outcomes. The 5-year freedom from biochemical failure rates for patients with low-risk, intermediate-risk, and high-risk disease are >85%, 69-97%, and 63-80%, respectively. Brachytherapy with EBRT (versus brachytherapy alone) is an appropriate approach in select patients with intermediate-risk and high-risk disease. The 10-year rates of overall survival, distant metastasis, and cancer-specific mortality are >85%, <10%, and <5%, respectively. Grade 3-4 toxicities associated with HDR-BT and LDR-BT are rare, at <4% in most series, and quality of life is improved in patients who receive brachytherapy compared with those who undergo surgery.
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Affiliation(s)
- Nicholas G Zaorsky
- Department of Radiation Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, Pennsylvania 19111-2497, USA
| | - Brian J Davis
- Department of Radiation Oncology, Mayo Clinic, 200 First St SW, Charlton Bldg/Desk R - SL, Rochester, Minnesota 5590, USA
| | - Paul L Nguyen
- Department of Radiation Oncology, Brigham and Women's Hospital, 75 Francis St BWH. Radiation Oncology, Boston, Massachusetts 02115, USA
| | - Timothy N Showalter
- Department of Radiation Oncology, University of Virginia, 1240 Lee St, Charlottesville, Virginia 22908, USA
| | - Peter J Hoskin
- Mount Vernon Cancer Centre, Rickmansworth Road, Northwood, Middlesex HA6 2RN, UK
| | - Yasuo Yoshioka
- Department of Radiation Oncology, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo 135-8550, Japan
| | - Gerard C Morton
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, Ontario M4N 3M5, Canada
| | - Eric M Horwitz
- Department of Radiation Oncology, Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, Pennsylvania 19111-2497, USA
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Protopapa E, van der Meulen J, Moore CM, Smith SC. Patient-reported outcome (PRO) questionnaires for men who have radical surgery for prostate cancer: a conceptual review of existing instruments. BJU Int 2017; 120:468-481. [PMID: 28437031 DOI: 10.1111/bju.13896] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
To critically review conceptual frameworks for available patient-reported outcome (PRO) questionnaires in men having radical prostatectomy (RP), psychometrically evaluate each questionnaire, and identify whether each is appropriate for use at the level of the individual patient. We searched PubMed, the Reports and Publications database of the University of Oxford Patient-Reported Outcomes Measurement Group and the website of the International Consortium for Health Outcomes Measurement (ICHOM) for psychometric reviews of prostate cancer-specific PRO questionnaires. From these we identified relevant questionnaires and critically appraised the conceptual content, guided by the Wilson and Cleary framework and psychometric properties, using well established criteria. The searches found four reviews and one recommendation paper. We identified seven prostate cancer-specific PROs: the Expanded Prostate Cancer Index Composite-26 (EPIC-26), Expanded Prostate Cancer Index Composite-50 (EPIC-50), University of California-Los Angeles Prostate Cancer Index (UCLA-PCI), Functional Assessment of Cancer Therapy - Prostate Cancer Subscale (FACT-P PCS), European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire - prostate specific 25-item (EORTC QLQ-PR25), Prostate Cancer - Quality of Life (PC-QoL), and Symptom Tracking and Reporting (STAR). Six out of seven measures purported to measure health-related quality of life (HRQL), but items focused strongly on urinary and sexual symptoms/functioning. The remaining questionnaire (STAR) claimed to assess functional recovery after RP. The psychometric evidence for these questionnaires was incomplete and variable in quality; none had evidence that they were appropriate for use with individual patients. Several questionnaires provide the basis of measures of urinary and/or sexual symptoms/functioning. Further work should explore other aspects of HRQL that are important for men having RP. Further psychometric work is also needed to determine whether they can be used at the individual level.
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Affiliation(s)
- Evangelia Protopapa
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Jan van der Meulen
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
| | - Caroline M Moore
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Sarah C Smith
- Department of Health Services Research and Policy, London School of Hygiene and Tropical Medicine, London, UK
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Sosnowski R, Kulpa M, Ziętalewicz U, Wolski JK, Nowakowski R, Bakuła R, Demkow T. Basic issues concerning health-related quality of life. Cent European J Urol 2017; 70:206-211. [PMID: 28721291 PMCID: PMC5510334 DOI: 10.5173/ceju.2017.923] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2016] [Revised: 11/09/2016] [Accepted: 04/12/2017] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Chronic diseases such as cancer have a strong influence on both physical health and quality of life, which together comprise the concept of health-related quality of life (HRQoL) - in other words, the complete state of physical, social, and psychological functioning. Herein, we review the literature on the theory of HRQoL in relation to oncological diseases. MATERIAL AND METHODS A literature search of English-language publications that included an analysis of the conceptual models of HRQoL was performed using PubMed. The data were screened and synthesized by all authors and relevant papers were selected. RESULTS We outline the theoretical models most often used to conceptualize HRQoL, including the Centre for Health Promotion model from the University of Toronto, the conceptual model of Wilson and Cleary and the contextual model of Ashing-Giwa formulated specifically for cancer patients. CONCLUSIONS Understanding the theoretical basis of HRQoL is indispensable for valid research in this area.
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Affiliation(s)
- Roman Sosnowski
- Urooncology Department, Maria Sklodowska Curie Memorial Cancer Hospital, Warsaw, Poland
| | - Marta Kulpa
- Department of Medical Psychology, Medical University of Warsaw, Warsaw, Poland
| | - Urszula Ziętalewicz
- Department of Health Psychology and Rehabilitation, Faculty of Psychology, University of Warsaw, Warsaw, Poland
| | - Jan Karol Wolski
- Urooncology Department, Maria Sklodowska Curie Memorial Cancer Hospital, Warsaw, Poland
| | - Robert Nowakowski
- Urooncology Department, Maria Sklodowska Curie Memorial Cancer Hospital, Warsaw, Poland
| | - Robert Bakuła
- Urooncology Department, Maria Sklodowska Curie Memorial Cancer Hospital, Warsaw, Poland
| | - Tomasz Demkow
- Urooncology Department, Maria Sklodowska Curie Memorial Cancer Hospital, Warsaw, Poland
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Downing A, Wright P, Wagland R, Watson E, Kearney T, Mottram R, Allen M, Cairnduff V, McSorley O, Butcher H, Hounsome L, Donnelly C, Selby P, Kind P, Cross W, Catto JWH, Huws D, Brewster DH, McNair E, Matheson L, Rivas C, Nayoan J, Horton M, Corner J, Verne J, Gavin A, Glaser AW. Life after prostate cancer diagnosis: protocol for a UK-wide patient-reported outcomes study. BMJ Open 2016; 6:e013555. [PMID: 27927667 PMCID: PMC5168696 DOI: 10.1136/bmjopen-2016-013555] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Prostate cancer and its treatment may impact physically, psychologically and socially; affecting the health-related quality of life of men and their partners/spouses. The Life After Prostate Cancer Diagnosis (LAPCD) study is a UK-wide patient-reported outcomes study which will generate information to improve the health and well-being of men with prostate cancer. METHODS AND ANALYSIS Postal surveys will be sent to prostate cancer survivors (18-42 months postdiagnosis) in all 4 UK countries (n=∼70 000). Eligible men will be identified and/or verified through cancer registration systems. Men will be surveyed twice, 12 months apart, to explore changes in outcomes over time. Second, separate cohorts will be surveyed once and the design will include evaluation of the acceptability of online survey tools. A comprehensive patient-reported outcome measure has been developed using generic and specific instruments with proven psychometric properties and relevance in national and international studies. The outcome data will be linked with administrative health data (eg, treatment information from hospital data). To ensure detailed understanding of issues of importance, qualitative interviews will be undertaken with a sample of men who complete the survey across the UK (n=∼150) along with a small number of partners/spouses (n=∼30). ETHICS AND DISSEMINATION The study has received the following approvals: Newcastle and North Tyneside 1 Research Ethics Committee (15/NE/0036), Health Research Authority Confidentiality Advisory Group (15/CAG/0110), NHS Scotland Public Benefit and Privacy Panel (0516-0364), Office of Research Ethics Northern Ireland (16/NI/0073) and NHS R&D approval from Wales, Scotland and Northern Ireland. Using traditional and innovative methods, the results will be made available to men and their partners/spouses, the funders, the NHS, social care, voluntary sector organisations and other researchers.
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Affiliation(s)
- Amy Downing
- Leeds Institute of Cancer and Pathology, St James's University Hospital, Leeds, UK
| | - Penny Wright
- Leeds Institute of Cancer and Pathology, St James's University Hospital, Leeds, UK
| | - Richard Wagland
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Eila Watson
- Faculty of Health and Life Sciences, Department of Applied Health and Professional Development, Oxford Brookes University, Oxford, UK
| | - Therese Kearney
- Northern Ireland Cancer Registry, Queens University Belfast, Royal Victoria Hospital, Belfast, UK
| | - Rebecca Mottram
- Leeds Institute of Cancer and Pathology, St James's University Hospital, Leeds, UK
| | - Majorie Allen
- Leeds Institute of Cancer and Pathology, St James's University Hospital, Leeds, UK
| | - Victoria Cairnduff
- Northern Ireland Cancer Registry, Queens University Belfast, Royal Victoria Hospital, Belfast, UK
| | - Oonagh McSorley
- Northern Ireland Cancer Registry, Queens University Belfast, Royal Victoria Hospital, Belfast, UK
| | - Hugh Butcher
- Leeds Institute of Cancer and Pathology, St James's University Hospital, Leeds, UK
- Yorkshire Cancer Patient Forum, c/o Strategic Clinical Network and Senate, Yorkshire and The Humber, Harrogate, UK
| | - Luke Hounsome
- National Cancer Registration and Analysis Service, Public Health England, Bristol, UK
| | - Conan Donnelly
- Northern Ireland Cancer Registry, Queens University Belfast, Royal Victoria Hospital, Belfast, UK
| | - Peter Selby
- Leeds Institute of Cancer and Pathology, St James's University Hospital, Leeds, UK
| | - Paul Kind
- Academic Unit of Health Economics, Institute of Health Sciences, University of Leeds, Leeds, UK
| | - William Cross
- Leeds Teaching Hospitals NHS Trust, St James's University Hospital, Leeds, UK
| | - James W H Catto
- Academic Urology Unit, University of Sheffield, Medical School, Sheffield, UK
| | - Dyfed Huws
- Welsh Cancer Intelligence and Surveillance Unit, Cardiff, UK
| | - David H Brewster
- Public Health and Intelligence (NHS National Services Scotland), Edinburgh, UK
| | - Emma McNair
- Public Health and Intelligence (NHS National Services Scotland), Edinburgh, UK
| | - Lauren Matheson
- Faculty of Health and Life Sciences, Department of Applied Health and Professional Development, Oxford Brookes University, Oxford, UK
| | - Carol Rivas
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Johana Nayoan
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Mike Horton
- Leeds Institute of Cancer and Pathology, St James's University Hospital, Leeds, UK
| | - Jessica Corner
- Faculty of Health Sciences, University of Southampton, Southampton, UK
| | - Julia Verne
- Knowledge and Intelligence Directorate, Public Health England, Bristol, UK
| | - Anna Gavin
- Northern Ireland Cancer Registry, Queens University Belfast, Royal Victoria Hospital, Belfast, UK
| | - Adam W Glaser
- Leeds Institute of Cancer and Pathology, St James's University Hospital, Leeds, UK
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From QOL to QALYs: Comparing nononcologic outcomes in prostate cancer survivors across treatments. Urol Oncol 2016; 35:69-75. [PMID: 27575917 DOI: 10.1016/j.urolonc.2016.07.019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 07/24/2016] [Accepted: 07/25/2016] [Indexed: 11/21/2022]
Abstract
OBJECTIVE We aim to highlight the progression from the early definition of nononcologic outcomes in prostate cancer (PC) to measurement and use of preferences to ensure appropriate treatment decisions in men with localized disease. METHODS We review the assessment of nononcologic outcomes after PC treatment and ways to use the outcomes to augment patient care. RESULTS PC treatments may have similar oncologic efficacy in men with certain clinical features, but they differ in their nononcologic outcomes. Tools to assess these outcomes have been developed and are useful in areas from treatment reimbursement to shared decision-making. CONCLUSIONS The ability to measure and make useful data on nononcologic outcomes evolved substantially over the past 20 years. Current work suggests that individual preference assessment for nononcologic outcomes is a promising means of matching patients with appropriate treatment.
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Ruseckaite R, Beckmann K, O’Callaghan M, Roder D, Moretti K, Millar J, Evans S. A retrospective analysis of Victorian and South Australian clinical registries for prostate cancer: trends in clinical presentation and management of the disease. BMC Cancer 2016; 16:607. [PMID: 27496055 PMCID: PMC4974765 DOI: 10.1186/s12885-016-2655-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Accepted: 07/30/2016] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Prostate cancer (PCa) is the most commonly diagnosed malignancy reported to Australian cancer registries with numerous studies from individual registries summarizing diagnostic and treatment characteristics. The aim of this study was to describe annual trends in clinical and treatment characteristics, and changes in surveillance practice within a large combined cohort of men with PCa in South Australia (SA) and Victoria, Australia in 2008-2013. METHODS Common data items from clinical registries in SA and Victoria were merged to develop a cross-jurisdictional dataset consisting of 13,598 men with PCa. Frequencies were used to describe these variables using the National Comprehensive Cancer Network risk of disease progression categories in 10 year age groups. A logistic regression analysis was performed to assess the impact of a number of factors (both individually and together) on the likelihood of men receiving no active treatment within twelve months of the diagnosis (i.e. managed with active surveillance/watchful waiting). RESULTS Trend analysis showed that over time: (1) men in SA and Victoria are being diagnosed at older age in 2013, 66.1 (SD = 9.7) years compared to 2009 (64.5 (SD = 9.7)); (2) diagnostic methods and characteristics have changed with time; and (3) types of the treatments have changed, with more men having no active treatment. The majority of men were diagnosed with Prostate-Specific Antigen (PSA) <10 ng/mL (66 %) and Grade Group < 4 (65 %). Nearly seventy percent received radical treatment within 12 months of diagnosis, while ~20 % had no active treatment. In 14 % of cases treatment was not recorded or had not commenced. Having no active treatment was strongly associated older age, lower PSA and lower Grade Group at diagnosis, and in 2013 it was offered more frequently (more than 3 times) than in 2009 (OR = 2.63, 95 % CI: 2.16-3.22). CONCLUSIONS Findings of this study provide the first cross-jurisdictional description of PCa characteristics and management in Australia. These findings will provide benchmarking for ongoing monitoring and feedback of disease management and outcomes of PCa through the Prostate Cancer Outcomes Registry-Australia New Zealand to improve evidence-based practice.
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Affiliation(s)
- Rasa Ruseckaite
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC Australia
| | - Kerri Beckmann
- Centre for Population Health Research, Sansom Institute for Health Research, University of South Australia, Adelaide, SA Australia
| | - Michael O’Callaghan
- South Australian Prostate Cancer Clinical Outcomes Collaborative, Department of Urology, Repatriation General Hospital, Adelaide, SA Australia
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, SA Australia
- Freemasons Foundation Centre for Men’s Health and Discipline of Medicine, University of Adelaide, Adelaide, SA Australia
| | - David Roder
- Centre for Population Health Research, Sansom Institute for Health Research, University of South Australia, Adelaide, SA Australia
| | - Kim Moretti
- Centre for Population Health Research, Sansom Institute for Health Research, University of South Australia, Adelaide, SA Australia
- South Australian Prostate Cancer Clinical Outcomes Collaborative, Department of Urology, Repatriation General Hospital, Adelaide, SA Australia
- Flinders Centre for Innovation in Cancer, Flinders University, Adelaide, SA Australia
- Freemasons Foundation Centre for Men’s Health and Discipline of Medicine, University of Adelaide, Adelaide, SA Australia
| | - Jeremy Millar
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC Australia
- Radiation Oncology, Alfred Health, Melbourne, VIC Australia
| | - Sue Evans
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC Australia
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Porter I, Gonçalves-Bradley D, Ricci-Cabello I, Gibbons C, Gangannagaripalli J, Fitzpatrick R, Black N, Greenhalgh J, Valderas JM. Framework and guidance for implementing patient-reported outcomes in clinical practice: evidence, challenges and opportunities. J Comp Eff Res 2016; 5:507-19. [PMID: 27427277 DOI: 10.2217/cer-2015-0014] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Patient-reported outcomes (PROs) are reports of the status of a patient's health condition that come directly from the patient. While PRO measures are a well-developed technology with robust standards in research, their use for informing healthcare decisions is still poorly understood. We review relevant examples of their application in the provision of healthcare and examine the challenges associated with implementing PROs in clinical settings. We evaluate evidence for their use and examine barriers to their uptake, and present an evidence-based framework for the successful implementation of PROs in clinical practice. We discuss current and future developments for the use of PROs in clinical practice, such as individualized measurement and computer-adaptive testing.
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Affiliation(s)
- Ian Porter
- Health Services & Policy Research Group, Exeter Collaboration for Academic Primary Care (APEx) (Person centerd Care), University of Exeter Medical School, University of Exeter, Exeter, UK
| | | | - Ignacio Ricci-Cabello
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Chris Gibbons
- Primary Care Unit, Cambridge Center for Health Services Research, University of Cambridge, UK.,The Psychometrics Centre, Judge Business School, University of Cambridge, UK
| | - Jaheeda Gangannagaripalli
- Health Services & Policy Research Group, Exeter Collaboration for Academic Primary Care (APEx) (Person centerd Care), University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Ray Fitzpatrick
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Nick Black
- Department of Health Services Research & Policy, London School of Hygiene & Tropical Medicine, London, UK
| | | | - Jose M Valderas
- Health Services & Policy Research Group, Exeter Collaboration for Academic Primary Care (APEx) (Person centerd Care), University of Exeter Medical School, University of Exeter, Exeter, UK
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Maratia S, Cedillo S, Rejas J. Assessing health-related quality of life in patients with breast cancer: a systematic and standardized comparison of available instruments using the EMPRO tool. Qual Life Res 2016; 25:2467-2480. [PMID: 27048496 DOI: 10.1007/s11136-016-1284-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/24/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE The objective was to obtain a standardized evaluation of available specific and generic breast cancer health-related quality-of-life instruments. METHODS We carried out systematic literature reviews in the PubMed and EMBASE databases to identify manuscripts which contained information regarding either the development process or metric properties of health-related quality-of-life instruments used among breast cancer patients. Each instrument was evaluated independently by two researchers, and occasionally a third one, using the Evaluating Measures of Patient-Reported Outcomes (EMPRO) tool. An overall score and seven attribute-specific EMPRO scores were calculated (range 0-100, worst to best): concept and measurement model, reliability, validity, responsiveness, interpretability, burden, and alternative forms. RESULTS FACT-B was the instrument with the best global performance, obtaining an overall EMPRO score of 79.27. It was also the most accurate instrument on the Concept and Measurement Model, Reliability, and Interpretability attributes. Four more instruments scored over 50 points on the overall score, which summarizes the five attribute-specific scores: EORTC BR-23, IBCSG, WHO-QOL BREF, and SF-36. An overall score of at least 50 points implies that the use of these instruments could be recommended for assessing health-related quality of life in breast cancer patients. CONCLUSION The FACT-B scored the highest on overall on our EMPRO evaluation of instruments measuring health-related quality of life among breast cancer patients. However, depending on the purpose of the study, several instruments (EORTC BR-23, IBCSG, SF-36, and WHO-QOL BREF) have shown good performance in some of the specific individual dimensions included in the EMPRO.
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Affiliation(s)
| | - Sergio Cedillo
- Universidad Carlos III, Getafe, Madrid, Spain.
- TFS People, Trial Form Support Spain, Arturo Soria 336-7° izquierda, 28033, Madrid, Spain.
| | - Javier Rejas
- Health Economics and Outcomes Research Department, Pfizer, S.L.U., Alcobendas, Madrid, Spain
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Vashistha V, Singh B, Kaur S, Prokop LJ, Kaushik D. The Effects of Exercise on Fatigue, Quality of Life, and Psychological Function for Men with Prostate Cancer: Systematic Review and Meta-analyses. Eur Urol Focus 2016; 2:284-295. [PMID: 28723375 DOI: 10.1016/j.euf.2016.02.011] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Revised: 02/11/2016] [Accepted: 02/22/2016] [Indexed: 11/25/2022]
Abstract
CONTEXT Conflicting data exists on the role of exercise interventions in patients with prostate cancer (PCa) regarding quality of life (QOL) endpoints. OBJECTIVE To evaluate the effects of exercise interventions on fatigue, QOL, depression, and anxiety in PCa patients. EVIDENCE ACQUISITION We searched seven major databases (MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, Web of Science, and Scopus) for randomized control trials (RCTs) of supervised exercise interventions for men with PCa from database inception to October 2015. For meta-analyses, studies required standardized fatigue, QOL, or mood-related scales with standard-care control groups. The effect size was measured in terms of mean difference (MD) with 95% confidence interval (CI) for continuous outcomes using a random-effects model. Statistical heterogeneity between studies was assessed using the Cochrane Q test and I2 statistic. EVIDENCE SYNTHESIS We selected 13 RCTs enrolling 1057 PCa patients (mean age 69.4±2.1 yr) undergoing exercise interventions, of which eight studies involving 675 patients qualified for meta-analyses. The study duration varied from 4 wk to 6 mo. A 12-16-wk exercise intervention significantly improved fatigue symptoms (MD 4.83, 95% CI 3.24-6.43; p<0.00001) as assessed according to the Functional Assessment of Cancer Therapy (FACT)-Fatigue scale. Fatigue remained improved at 6 mo (MD 3.60, 95% CI 2.80-5.12; p<0.00001). Furthermore, exercise interventions improved QOL measured using the FACT-General (MD 3.93, 95% CI 1.37-5.92; p = 0.003) and FACT-Prostate (MD 3.85, 95% CI 1.25-6.46; p=0.04) scales. The pooled data did not reveal a significant improvement in depression or anxiety. CONCLUSIONS Combined evidence from RCTs shows improvement in QOL and fatigue according to FACT scales. No significant differences in depression or anxiety were observed. PATIENT SUMMARY Exercise improves fatigue and quality-of-life outcomes in patients with prostate cancer. Further studies are necessary to identify patient-specific exercise regimens to optimize these benefits.
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Affiliation(s)
- Vishal Vashistha
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Balwinder Singh
- Department of Psychiatry and Behavioral Science, University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
| | - Sukhdeep Kaur
- Department of Internal Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA
| | | | - Dharam Kaushik
- Department of Urology, University of Texas Health Science Center, San Antonio, TX, USA.
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Zimmermann M, Taussky D, Menkarios C, Vigneault É, Beauchemin MC, Bahary JP, Martin AAG, Diaz de Bedoya LV, Lambert C. Prospective Phase II Trial of Once-weekly Hypofractionated Radiation Therapy for Low-risk Adenocarcinoma of the Prostate: Late Toxicities and Outcomes. Clin Oncol (R Coll Radiol) 2016; 28:386-92. [PMID: 26782838 DOI: 10.1016/j.clon.2015.12.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Revised: 11/25/2015] [Accepted: 11/30/2015] [Indexed: 10/22/2022]
Abstract
AIMS To report the long-term toxicities and sexual quality of life of a once-weekly hypofractionated radiation therapy schedule for low-risk prostate cancer. MATERIALS AND METHODS A multi-institutional phase II trial was conducted, using a three-dimensional conformal radiation therapy (3D-CRT) approach for low-risk prostate cancer (T1a-T2a, Gleason ≤ 6 and prostate-specific antigen ≤ 10 ng/ml). Forty-five Gray (Gy) were delivered in nine fractions of 5 Gy given on a weekly basis. Acute and late genitourinary and gastrointestinal toxicities were graded according to the Radiation Therapy Oncology Group toxicity scale. Sexual function and sexual bother were assessed with the Expanded Prostate Cancer Index Composite (EPIC) questionnaire. RESULTS Between March 2006 and August 2008, 80 patients were treated, with a median age of 69 years (interquartile range 64-72). The median follow-up was 83 months (interquartile range 73-85 months). At 7 years, overall survival was 88%. No patients died of prostate cancer. Cumulative grade ≥2 genitourinary and gastrointestinal late toxicity was reported for 31.3% and 30% of our patients, respectively. Cumulative grade ≥3 genitourinary and gastrointestinal late toxicity was seen in 3.8% and 12.5% of cases, respectively. Late genitourinary grade 2 toxicity was correlated with the occurrence of acute genitourinary grade 2 toxicity (P = 0.006). The occurrence of late gastrointestinal toxicity was not correlated with acute gastrointestinal toxicity. Pre-treatment EPIC sexual function was low (37.5%) and the mean EPIC sexual function score at 7 years after treatment was 14%. On the other hand, pre-treatment EPIC sexual bother reached 80.5%, meaning little bother, and remained stable during follow-up. CONCLUSIONS Once-weekly 3D-CRT leads to excellent biochemical disease-free survival and acceptable toxicities. Pre-treatment EPIC sexual function dropped by 42% at 5 years of follow-up. This functional deficit did not bother patients, possibly due to the already low sexual function at baseline.
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Affiliation(s)
- M Zimmermann
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM) - Hôpital Notre-Dame, Montreal, Canada
| | - D Taussky
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM) - Hôpital Notre-Dame, Montreal, Canada.
| | - C Menkarios
- Department of Radiation Oncology, Hôpital Maisonneuve-Rosemont (HMR), Montreal, Canada
| | - É Vigneault
- Department of Radiation Oncology, Centre Hospitalier Universitaire de Québec (CHUQ), Quebec City, Canada
| | - M-C Beauchemin
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM) - Hôpital Notre-Dame, Montreal, Canada
| | - J-P Bahary
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM) - Hôpital Notre-Dame, Montreal, Canada
| | - A-A-G Martin
- Department of Radiation Oncology, Centre Hospitalier Universitaire de Québec (CHUQ), Quebec City, Canada
| | - L-V Diaz de Bedoya
- Department of Radiation Oncology, Centre Hospitalier Universitaire de Québec (CHUQ), Quebec City, Canada
| | - C Lambert
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal (CHUM) - Hôpital Notre-Dame, Montreal, Canada
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