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Garin O, Kowalski C, Zamora V, Roth R, Ferrer M, Breidenbach C, Pont A, Belin TR, Elashoff D, Wilhalme H, Nguyen AV, Kwan L, Pearman EK, Bolagani A, Sampurno F, Papa N, Moore C, Millar J, Connor SE, Villanti P, Litwin MS. Patient-reported outcomes before treatment for localized prostate cancer: are there differences among countries? Data from the True North Global Registry. BMC Urol 2023; 23:178. [PMID: 37919726 PMCID: PMC10623840 DOI: 10.1186/s12894-023-01344-0] [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: 04/03/2023] [Accepted: 10/17/2023] [Indexed: 11/04/2023] Open
Abstract
INTRODUCTION Similar Patient-Reported Outcomes (PROs) at diagnosis for localized prostate cancer among countries may indicate that different treatments are recommended to the same profile of patients, regardless the context characteristics (health systems, medical schools, culture, preferences…). The aim of this study was to assess such comparison. METHODS We analyzed the EPIC-26 results before the primary treatment of men diagnosed of localized prostate cancer from January 2017 onwards (revised data available up to September 2019), from a multicenter prospective international cohort including seven regions: Australia/New Zealand, Canada, Central Europe (Austria / Czech Republic / Germany), United Kingdom, Italy, Spain, and the United States. The EPIC-26 domain scores and pattern of three selected items were compared across regions (with Central Europe as reference). All comparisons were made stratifying by treatment: radical prostatectomy, external radiotherapy, brachytherapy, and active surveillance. RESULTS The sample included a total of 13,483 men with clinically localized or locally advanced prostate cancer. PROs showed different domain patterns before treatment across countries. The sexual domain was the most impaired, and the one with the highest dispersion within countries and with the greatest medians' differences across countries. The urinary incontinence domain, together with the bowel and hormonal domains, presented the highest scores (better outcomes) for all treatment groups, and homogeneity across regions. CONCLUSIONS Patients with localized or locally advanced prostate cancer undergoing radical prostatectomy, EBRT, brachytherapy, or active surveillance presented mainly negligible or small differences in the EPIC-26 domains before treatment across countries. The results on urinary incontinence or bowel domains, in which almost all patients presented the best possible score, may downplay the baseline data role for evaluating treatments' effects. However, the heterogeneity within countries and the magnitude of the differences found across countries in other domains, especially sexual, support the need of implementing the PRO measurement from diagnosis.
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Affiliation(s)
- O Garin
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute) Barcelona Biomedical Research Park, Office 144, Doctor Aiguader 88, Barcelona, 08003, Spain
- CIBER en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | | | - V Zamora
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute) Barcelona Biomedical Research Park, Office 144, Doctor Aiguader 88, Barcelona, 08003, Spain
- CIBER en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
- Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
| | - R Roth
- Institute of Medical Statistics and Computational Biology (IMSB), Medical Faculty, University of Cologne, Cologne, Germany
| | - M Ferrer
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute) Barcelona Biomedical Research Park, Office 144, Doctor Aiguader 88, Barcelona, 08003, Spain.
- CIBER en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.
- Universitat Pompeu Fabra (UPF), Barcelona, Spain.
| | | | - A Pont
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute) Barcelona Biomedical Research Park, Office 144, Doctor Aiguader 88, Barcelona, 08003, Spain
- CIBER en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | - T R Belin
- University of California, Los Angeles, USA
| | - D Elashoff
- University of California, Los Angeles, USA
| | - H Wilhalme
- University of California, Los Angeles, USA
| | - A V Nguyen
- University of California, Los Angeles, USA
| | - L Kwan
- University of California, Los Angeles, USA
| | | | - A Bolagani
- University of California, Los Angeles, USA
| | - F Sampurno
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - N Papa
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - C Moore
- University College London, London, UK
| | - J Millar
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - S E Connor
- University of California, Los Angeles, USA
| | - P Villanti
- Movember Foundation, Melbourne, Australia
| | - M S Litwin
- University of California, Los Angeles, USA
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Wang J, An D. Effect of Internet combined with pelvic floor muscle training on postpartum urinary incontinence. Int Urogynecol J 2023; 34:2539-2546. [PMID: 37227458 DOI: 10.1007/s00192-023-05561-x] [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: 01/10/2023] [Accepted: 04/05/2023] [Indexed: 05/26/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Urinary incontinence is one of the most common complications associated with parturition or child delivery. The Internet combined with pelvic floor training may be a good way to reduce the spread of the epidemic and treat postpartum incontinence. METHODS A total of 38 participants were randomly assigned to Kegel alone (group A = 14), Internet plus Kegel (group B = 12), or Internet plus Pilates (group C = 12). We used the 1-h pad test, the number of episodes of incontinence, the number of pads used, the Oxford Scale, and The International Consultation Incontinence Questionnaire for evaluation. RESULTS In the 1-h pad test (g), group A decreased from 40.93 ± 4.66 to 24.00 ± 3.94, group B from 41.75 ± 3.62 to 20.67 ± 3.89, and group C from 40.33 ± 3.89 to 18.67 ± 3.55. In the number of episodes of incontinence, group A decreased from 4.71 ± 1.13 to 2.93 ± 0.62, group B from 4.92 ± 1.16 to 2.42 ± 0.52, and group C from 4.92 ± 1.08 to 2.08 ± 0.52. In the use of urinary pads, group A decreased from 7.14 ± 0.95 to 3.50 ± 0.52, group B from 7.25 ± 0.75 to 3.00 ± 0.95, and group C from 7.42 ± 1.08 to 2.50 ± 0.67. In the Oxford Scale and International Consultation Incontinence Questionnaire Short Form, the difference among the three groups before and after treatment was statistically significant. After 6 weeks of pelvic floor muscle training, most patients achieved grade 3 or higher muscle strength on the Oxford scale. CONCLUSIONS The Internet combined with pelvic floor training is a good choice during the current pandemic. Pelvic floor exercises can improve urinary incontinence symptoms.
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Affiliation(s)
- Jianxia Wang
- Department of Intensive Care Unit, Cancer Hospital Chinese Academy of Medical Science, National Cancer Center/ National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Chaoyang District, Beijing, China.
| | - Di An
- Department of Physiotherapy 2 (PT2), China Rehabilitation Research Center, the School of Rehabilitation, Capital Medical University, Fengtai District, Beijing, China
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Azal W, Capibaribe DM, Col LSBD, Andrade DL, Moretti TBC, Reis LO. Incontinence after laparoscopic radical prostatectomy: a reverse systematic review. Int Braz J Urol 2022; 48:389-396. [PMID: 35168312 PMCID: PMC9060170 DOI: 10.1590/s1677-5538.ibju.2021.0632] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 09/17/2021] [Indexed: 11/21/2022] Open
Abstract
PURPOSE To report the prevalence of the definitions used to identify post-prostatectomy incontinence (PPI) after laparoscopic radical prostatectomy (LRP), and to compare the rates of PPI over time under different criteria. MATERIALS AND METHODS In the period from January 1, 2000, until December 31, 2017, we used a recently described methodology to perform evidence acquisition called reverse systematic review (RSR). The continence definition and rates were evaluated and compared at 1, 3, 6, 12, and >18 months post-operative. Moreover, the RSR showed the "natural history" of PPI after LRP. RESULTS We identified 353 review articles in the systematized search, 137 studies about PPI were selected for data collection, and finally were included 203 reports (nr) with 51.436 patients. The most used criterion of continence was No pad (nr=121; 59.6%), the second one was Safety pad (nr=57; 28.1%). A statistically significant difference between continence criteria was identified only at >18 months (p=0.044). From 2013 until the end of our analysis, the Safety pad and Others became the most reported. CONCLUSION RSR revealed the "natural history" of PPI after the LRP technique, and showed that through time the Safety pad concept was mainly used. However, paradoxically, we demonstrated that the two most utilized criteria, Safety pad and No pad, had similar PPI outcomes. Further effort should be made to standardize the PPI denomination to evaluate, compare and discuss the urinary post-operatory function.
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Affiliation(s)
- Wilmar Azal
- Universidade Estadual de CampinasDepartamento de UrologiaCampinasSPBrasilUrociência; Departamento de Urologia da Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil
| | - Diego M. Capibaribe
- Universidade Estadual de CampinasDepartamento de UrologiaCampinasSPBrasilUrociência; Departamento de Urologia da Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil
| | - Luciana S. B. Dal Col
- Pontifícia Universidade Católica de CampinasCampinasSPBrasilPontifícia Universidade Católica de Campinas, PUC-Campinas - Campinas, SP, Brasil
| | - Danilo L. Andrade
- Universidade Estadual de CampinasDepartamento de UrologiaCampinasSPBrasilUrociência; Departamento de Urologia da Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil
| | - Tomas B. C. Moretti
- Pontifícia Universidade Católica de CampinasCampinasSPBrasilPontifícia Universidade Católica de Campinas, PUC-Campinas - Campinas, SP, Brasil
| | - Leonardo O. Reis
- Universidade Estadual de CampinasDepartamento de UrologiaCampinasSPBrasilUrociência; Departamento de Urologia da Universidade Estadual de Campinas - UNICAMP, Campinas, SP, Brasil
- Pontifícia Universidade Católica de CampinasCampinasSPBrasilPontifícia Universidade Católica de Campinas, PUC-Campinas - Campinas, SP, Brasil
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Roth R, Dieng S, Oesterle A, Feick G, Carl G, Hinkel A, Steiner T, Kaftan BT, Kunath F, Hadaschik B, Oostdam SJ, Palisaar RJ, Koralewski M, Beyer B, Haben B, Tsaur I, Wesselmann S, Kowalski C. Determinants of self-reported functional status (EPIC-26) in prostate cancer patients prior to treatment. World J Urol 2020; 39:27-36. [PMID: 32040715 PMCID: PMC7858203 DOI: 10.1007/s00345-020-03097-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 01/19/2020] [Indexed: 12/11/2022] Open
Abstract
PURPOSE The self-reported functional status (sr-FS) of prostate cancer (PCa) patients varies substantially between patients and health-care providers before treatment. Information about this issue is important for evaluating comparisons between health-care providers and to assist in treatment decision-making. There have been few reports on correlates of pretherapeutic sr-FS. The objective of the article, therefore, is to describe clinical and sociodemographic correlates of pretherapeutic sr-FS, based on a subset of the TrueNTH Global Registry, a prospective cohort study. METHODS A total of 3094 PCa patients receiving local treatment in 44 PCa centers in Germany were recruited between July 2016 and April 2018. Multilevel regression models were applied to predict five pretherapeutic sr-FS (EPIC-26) scores based on clinical characteristics (standard set suggested by the International Consortium for Health Outcomes Measurement), sociodemographic characteristics, and center characteristics. RESULTS Impaired pretherapeutic sr-FS tended to be associated with lower educational level and poorer disease characteristics-except for "urinary incontinence" which was only associated with age. Notably, age was a risk factor ("urinary incontinence," "urinary irritative/obstructive," "sexual") as well as a protective factor ("hormonal") for pretherapeutic sr-FS. Pretherapeutic sr-FS varies little across centers. CONCLUSIONS Pretherapeutic sr-FS varies by clinical patient characteristics and age as well as by socioeconomic status. The findings point out the benefit of collecting and considering socioeconomic information in addition to clinical and demographic patient characteristics for treatment decision-making and fair comparisons between health-care providers.
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Affiliation(s)
- Rebecca Roth
- Institute of Medical Statistics and Computational Biology (IMSB), Medical Faculty, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany.
| | | | | | - Günter Feick
- Federal Association of German Prostate Cancer Patient Support Groups, Thomas-Mann-Str. 40, 5311, Bonn, Germany
| | - Günther Carl
- Help for Prostate Cancer Patients (Förderverein Hilfe Bei Prostatakrebs e.V., FHbP), Louise Schroeder Ring 2, 25436, Tornesch, Germany
| | - Andreas Hinkel
- Franziskus Hospital, Kiskerstraße 26, 33615, Bielefeld, Germany
| | - Thomas Steiner
- Helios Klinikum Erfurt, Nordhäuser Straße 74, 99089, Erfurt, Germany
| | | | - Frank Kunath
- Department of Urology and Pediatric Urology, University Hospital Erlangen, FAU Erlangen-Nürnberg, Krankenhausstraße 12, 91052, Erlangen, Germany
| | - Boris Hadaschik
- Klinik und Poliklinik für Urologie, Kinderurologie und Uroonkologie, Universitätsklinikum Essen (AöR), Hufelandstraße 55, 45147, Essen, Germany
| | | | - Rein Jüri Palisaar
- Urologische Klinik, Marien Hospital Herne, Universitätsklinikum der Ruhr-Universität Bochum, Mitten in der ST. ELISABETH GRUPPE GmbH, Katholische Kliniken Rhein-Ruhr, Widumer Str. 8, Herne, 44627, Germany
| | - Mateusz Koralewski
- Urologie, Krankenhaus der Barmherzigen Brüder Trier, Nordallee 1, 54292, Trier, Germany
| | - Burkhard Beyer
- Martini-Klinik Prostate Cancer Center Hamburg, Martinistraße 52, 20246, Hamburg, Germany
| | - Björn Haben
- St. Marien Hospital Ahaus, Wüllener Str. 101, 48683, Ahaus, Germany
| | - Igor Tsaur
- Klinik und Poliklinik für Urologie und Kinderurologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Simone Wesselmann
- German Cancer Society, Kuno-Fischer-Straße 8, 14057, Berlin, Germany
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Storås AH, Sanda MG, Boronat OG, Chang P, Patil D, Crociani C, Suarez JF, Cvancarova M, Loge JH, Fosså SD. Erectile Dysfunction and Sexual Problems Two to Three Years After Prostatectomy Among American, Norwegian, and Spanish Patients. Clin Genitourin Cancer 2016; 14:e265-73. [DOI: 10.1016/j.clgc.2015.10.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2015] [Revised: 10/10/2015] [Accepted: 10/17/2015] [Indexed: 11/25/2022]
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Fosså SD, Dahl AA. Global Quality of Life After Curative Treatment for Prostate Cancer: What Matters? A Study Among Members of the Norwegian Prostate Cancer Patient Association. Clin Genitourin Cancer 2015; 13:518-24. [PMID: 26303590 DOI: 10.1016/j.clgc.2015.07.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2015] [Revised: 07/17/2015] [Accepted: 07/18/2015] [Indexed: 12/31/2022]
Abstract
INTRODUCTION The purpose of this study was to identify factors that are associated with quality of life (QoL) in relapse-free patients after radical prostatectomy or high-dose radiotherapy with or without hormone treatment. PATIENTS AND METHODS A cross-sectional postal survey among members of the Norwegian Prostate Cancer Patient Association was used. We analyzed associations between QoL and general health, "typical" adverse effects (sexual, urinary, and bowel assessed using the Expanded Prostate Cancer Composite items) and psychosocial variables (work ability, family life, social life and/or leisure activities) in univariate and multivariate regression analyses. Statistical significance was defined as P < .01. RESULTS Among 612 responders (approximately 50% compliance; median age, 70 years), in univariate analyses QoL was significantly associated with functional aspects and the level of bother within the sexual, urinary, and bowel domains and with general health and psychosocial aspects of daily life. In the multivariate analysis only general health and social life and/or leisure activities remained associated with QoL, with work ability being a third factor in patients younger than 65 years old. Posttreatment worsening of partnership was reported by 12% of the patients. CONCLUSION Prostate cancer patients who are to undergo curative treatment should be informed about the risk of reduced function within the sexual, urinary, and bowel domains, but also about these dysfunctions' relation to bother and QoL, considered together with the patients' general health and their preferences as to their social life activities.
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Affiliation(s)
- Sophie D Fosså
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital Oslo, Oslo, Norway.
| | - Alv A Dahl
- Department of Oncology, Oslo University Hospital, The Norwegian Radium Hospital Oslo, Oslo, Norway
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Schmidt S, Francés A, Lorente Garin JA, Juanpere N, Lloreta Trull J, Bonfill X, Martinez-Zapata MJ, Morales Suarez-Varela M, de la Cruz J, Emparanza JI, Sánchez MJ, Zamora J, Pijoan JI, Alonso J, Ferrer M. Quality of life in patients with non-muscle-invasive bladder cancer: one-year results of a multicentre prospective cohort study. Urol Oncol 2014; 33:19.e7-19.e15. [PMID: 25443270 DOI: 10.1016/j.urolonc.2014.09.012] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Revised: 09/10/2014] [Accepted: 09/12/2014] [Indexed: 01/08/2023]
Abstract
OBJECTIVE Few studies describe the effect of non-muscle-invasive bladder cancer (NMIBC) on health-related quality of life (HRQL), although patients are mostly diagnosed at this stage of the disease. Taking into account this current evidence gap and the high incidence rates in Spain, we aimed to describe the evolution over time of HRQL in Spanish patients with NMIBC and to examine the clinical and treatment-related factors associated with HRQL change during the first year of management. METHODS AND MATERIALS Observational multicenter prospective inception cohort study conducted in urology departments of 7 Spanish hospitals. A consecutive sample of 244 patients with anatomopathologically confirmed NMIBC, recruited from October 2010 to September 2011, was followed during the diagnostic process, and 6 and 12 months later. HRQL was assessed by generic and disease-specific instruments: the Short Form-36 (covering physical and mental health) and the Bladder Cancer Index, measuring urinary, bowel, and sexual domains (summary scores: 0-100). Bivariate analysis was performed and generalized estimating equation models were constructed to assess HRQL score change. RESULTS Almost 52% of the patients were diagnosed at stage I, and 84% were men. The number of patients treated only with transurethral resection (TUR) was 144, and 82 also received intravesical therapy with bacillus Calmette-Guérin (BCG) or mitomycin C. Mental health was significantly worse than Short Form-36 reference norms at diagnosis (mean of 49.7 vs. 53.3, 95% CI: 52.5-54.2). Urinary domain improved significantly from diagnosis (85.2, 95% CI: 82.9-87.4) to 12-month evaluation (90.2, 95% CI: 87.7-92.8), whereas sexual domain showed deterioration from 56.4 (95% CI: 52.8-59.9) to 53.7 (95% CI: 50.0-57.4). Adjusted HRQL score changes from baseline to 12-month follow-up estimated with generalized estimating equation models showed improvement on the following parameters: urinary domain after TUR with or without intravesical therapy (+3.9, 95% CI: 0.1-7.7), bowel domain among patients treated with TUR and BCG (+7.0, 95% CI: 2.4-11.5), and sexual domain among those treated with TUR and mitomycin C (+13.1, 95% CI: 5.9-20.2). CONCLUSIONS For the first time, a distinctive HRQL pattern of bladder cancer treatment benefits emerges for TUR alone, and in combination with BCG or mitomycin C, which deserves further research. Treatment differences cannot be interpreted in terms of efficacy but can be useful to generate hypotheses to test in future studies.
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Affiliation(s)
- Stefanie Schmidt
- Health Services Research Group, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Albert Francés
- Department of Urology, Hospital del Mar, Barcelona, Spain
| | | | - Nuria Juanpere
- Department of Pathology, Hospital del Mar, Barcelona, Spain
| | - José Lloreta Trull
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain; Department of Pathology, Hospital del Mar, Barcelona, Spain
| | - Xavier Bonfill
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain; Department of Pediatric, Obstetrics and Gynecology and Preventive Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - María José Martinez-Zapata
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Iberoamerican Cochrane Centre, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain
| | - Maria Morales Suarez-Varela
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Unit of Public Health and Environmental Care, Department of Preventive Medicine, University of Valencia, Valencia, Spain; Center for Public Health Research (CSISP), Valencia, Spain
| | - Javier de la Cruz
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Clinical Research Unit, Hospital 12 de Octubre, Madrid, Spain
| | - José Ignacio Emparanza
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Clinical Epidemiology Unit, Hospital Universitario Donostia, BioDonostia, San Sebastian, Spain
| | - María-José Sánchez
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Escuela Andaluza de Salud Pública, Instituto de Investigación Biosanitaria ibs.GRANADA, Hospitales Universitarios de Granada/Universidad de Granada, Granada, Spain
| | - Javier Zamora
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Clinical Biostatistics Unit, Hospital Ramón y Cajal (IRYCIS), Madrid, Spain
| | - José Ignacio Pijoan
- CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Clinical Epidemiology Unit, Hospital Universitario Cruces, BioCruces, Barakaldo, Spain
| | - Jordi Alonso
- Health Services Research Group, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Montse Ferrer
- Health Services Research Group, IMIM-Hospital del Mar Medical Research Institute, Barcelona, Spain; CIBER Epidemiología y Salud Pública (CIBERESP), Spain; Department of Pediatric, Obstetrics and Gynecology and Preventive Medicine, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain.
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Holm HV, Fosså SD, Hedlund H, Schultz A, Dahl AA. How should continence and incontinence after radical prostatectomy be evaluated? A prospective study of patient ratings and changes with time. J Urol 2014; 192:1155-61. [PMID: 24727062 DOI: 10.1016/j.juro.2014.03.113] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/28/2014] [Indexed: 01/22/2023]
Abstract
PURPOSE We examined prevalence rates, and changes in continence and incontinence before and after radical prostatectomy for prostate cancer by comparing different definitions. We also studied the descriptive validity of the grading system of Ellison et al for post-prostatectomy incontinence and baseline predictors of post-prostatectomy incontinence at 12 months. MATERIALS AND METHODS This national prospective study included 844 patients treated with radical prostatectomy between 2005 and 2009. Adverse effects, including urinary dysfunction and bother, were reported by 735 patients (88%) using the EPIC-50 and UCLA-PCI validated questionnaires at baseline and 12-month followup. Linear regression analysis was done to examine baseline predictors and the degree of post-prostatectomy incontinence at followup. RESULTS At 12 months after radical prostatectomy 74% of patients reported post-prostatectomy incontinence, of whom 40% used pads daily, 34% reported occasional dribbling without pads and 26% had total urinary control. When defined as total incontinence/no urinary control, severe post-prostatectomy incontinence was reported by 3% of the men but 25% had severe post-prostatectomy incontinence according to the stratification of Ellison et al. Of patients with preoperative incontinence 14% improved postoperatively. Predictors of post-prostatectomy incontinence were age 65 years or greater, not working, sexual dysfunction and incontinence preoperatively. The latter 2 remained the strongest predictors on multivariate analysis. Prostate cancer related variables were not associated with post-prostatectomy incontinence. CONCLUSIONS The prevalence of post-prostatectomy incontinence varied considerably according to the definition applied. In our opinion incontinence may be reported as any leakage and not only as pad use with grading done on a symptom scale. Preoperative sexual dysfunction and urinary incontinence were the strongest predictors of post-prostatectomy incontinence at 12-month followup.
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Affiliation(s)
| | - Sophie D Fosså
- Department of Oncology, Oslo University Hospital, Radiumhospitalet, Oslo, Norway; University of Oslo, Oslo, Norway
| | - Hans Hedlund
- Department of Urology, Oslo University Hospital, Rikshospitalet, Oslo, Norway; University of Oslo, Oslo, Norway
| | - Alexander Schultz
- Department of Urology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Alv A Dahl
- Department of Oncology, Oslo University Hospital, Radiumhospitalet, Oslo, Norway; University of Oslo, Oslo, Norway
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Schmidt S, Riel R, Frances A, Lorente Garin JA, Bonfill X, Martinez-Zapata MJ, Morales Suarez-Varela M, dela Cruz J, Emparanza JI, Sánchez MJ, Zamora J, Goñi JMR, Alonso J, Ferrer M. Bladder cancer index: cross-cultural adaptation into Spanish and psychometric evaluation. Health Qual Life Outcomes 2014; 12:20. [PMID: 24528506 PMCID: PMC3928086 DOI: 10.1186/1477-7525-12-20] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Accepted: 02/11/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Bladder Cancer Index (BCI) is so far the only instrument applicable across all bladder cancer patients, independent of tumor infiltration or treatment applied. We developed a Spanish version of the BCI, and assessed its acceptability and metric properties. METHODS For the adaptation into Spanish we used the forward and back-translation method, expert panels, and cognitive debriefing patient interviews. For the assessment of metric properties we used data from 197 bladder cancer patients from a multi-center prospective study. The Spanish BCI and the SF-36 Health Survey were self-administered before and 12 months after treatment. Reliability was estimated by Cronbach's alpha. Construct validity was assessed through the multi-trait multi-method matrix. The magnitude of change was quantified by effect sizes to assess responsiveness. RESULTS Reliability coefficients ranged 0.75-0.97. The validity analysis confirmed moderate associations between the BCI function and bother subscales for urinary (r = 0.61) and bowel (r = 0.53) domains; conceptual independence among all BCI domains (r ≤ 0.3); and low correlation coefficients with the SF-36 scores, ranging 0.14-0.48. Among patients reporting global improvement at follow-up, pre-post treatment changes were statistically significant for the urinary domain and urinary bother subscale, with effect sizes of 0.38 and 0.53. CONCLUSIONS The Spanish BCI is well accepted, reliable, valid, responsive, and similar in performance compared to the original instrument. These findings support its use, both in Spanish and international studies, as a valuable and comprehensive tool for assessing quality of life across a wide range of bladder cancer patients.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | - Montse Ferrer
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute), Doctor Aiguader 88, 08003 Barcelona, Spain.
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