1
|
Sibert NT, Garin O, Ferrer M, Connor SE, Graham ID, Litwin MS, Millar J, Moore CM, Nguyen AV, Paich K, Kowalski C. International Variations in Surgical Quality of Care in Men With Prostate Cancer: Results From the TrueNTH Global Registry. JCO Glob Oncol 2024; 10:e2300420. [PMID: 38815192 DOI: 10.1200/go.23.00420] [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: 12/01/2023] [Revised: 02/20/2024] [Accepted: 03/28/2024] [Indexed: 06/01/2024] Open
Abstract
PURPOSE Functional problems such as incontinence and sexual dysfunction after radical prostatectomy (RP) are important outcomes to evaluate surgical quality in prostate cancer (PC) care. Differences in survival after RP between countries are known, but differences in functional outcomes after RP between providers from different countries are not well described. METHODS Data from a multinational database of patients with PC (nonmetastatic, treated by RP) who answered the EPIC-26 questionnaire at baseline (before RP, T0) and 1 year after RP (T1) were used, linking survey data to clinical information. Casemix-adjusted incontinence and sexual function scores (T1) were calculated for each country and provider on the basis of regression models and then compared using minimally important differences (MIDs). RESULTS A total of 21,922 patients treated by 151 providers from 10 countries were included. For the EPIC-26 incontinence domain, the median adjusted T1 score of countries was 76, with one country performing more than one MID (for incontinence: 6) worse than the median. Eighteen percent of the variance (R2) of incontinence scores was explained by the country of the providers. The median adjusted T1 score of sexual function was 33 with no country performing perceivably worse than the median (more than one MID worse), and 34% (R2) of the variance of the providers' scores could be explained by country. CONCLUSION To our knowledge, this is the first comparison of functional outcomes 1 year after surgical treatment of patients with PC between different countries. Country is a relevant predictor for providers' incontinence and sexual function scores. Although the results are limited because of small samples from some countries, they should be used to enhance cross-country initiatives on quality improvement in PC care.
Collapse
Affiliation(s)
| | - Olatz Garin
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Montserrat Ferrer
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Sarah E Connor
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Mark S Litwin
- Department of Urology and Department of Health Policy & Management, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Jeremy Millar
- Departments of Surgery (Central Clinical School), and Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Anissa V Nguyen
- Departments of Urology, OBGYN, and Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | | | | |
Collapse
|
2
|
Sibert NT, Kurth T, Breidenbach C, Wesselmann S, Feick G, Carl EG, Dieng S, Albarghouth MH, Aziz A, Baltes S, Bartolf E, Bedke J, Blana A, Brock M, Conrad S, Darr C, Distler F, Drosos K, Duwe G, Gaber A, Giessing M, Harke NN, Heidenreich A, Hijazi S, Hinkel A, Kaftan BT, Kheiderov S, Knoll T, Lümmen G, Peters I, Polat B, Schrodi V, Stolzenburg JU, Varga Z, von Süßkind-Schwendi J, Zugor V, Kowalski C. Prediction models of incontinence and sexual function one year after radical prostatectomy based on data from 20 164 prostate cancer patients. PLoS One 2023; 18:e0295179. [PMID: 38039308 PMCID: PMC10691723 DOI: 10.1371/journal.pone.0295179] [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: 08/09/2023] [Accepted: 11/16/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND Incontinence and sexual dysfunction are long-lasting side effects after surgical treatment (radical prostatectomy, RP) of prostate cancer (PC). For an informed treatment decision, physicians and patients should discuss expected impairments. Therefore, this paper firstly aims to develop and validate prognostic models that predict incontinence and sexual function of PC patients one year after RP and secondly to provide an online decision making tool. METHODS Observational cohorts of PC patients treated between July 2016 and March 2021 in Germany were used. Models to predict functional outcomes one year after RP measured by the EPIC-26 questionnaire were developed using lasso regression, 80-20 splitting of the data set and 10-fold cross validation. To assess performance, R2, RMSE, analysis of residuals and calibration-in-the-large were applied. Final models were externally temporally validated. Additionally, percentages of functional impairment (pad use for incontinence and firmness of erection for sexual score) per score decile were calculated to be used together with the prediction models. RESULTS For model development and internal as well as external validation, samples of 11 355 and 8 809 patients were analysed. Results from the internal validation (incontinence: R2 = 0.12, RMSE = 25.40, sexual function: R2 = 0.23, RMSE = 21.44) were comparable with those of the external validation. Residual analysis and calibration-in-the-large showed good results. The prediction tool is freely accessible: https://nora-tabea.shinyapps.io/EPIC-26-Prediction/. CONCLUSION The final models showed appropriate predictive properties and can be used together with the calculated risks for specific functional impairments. Main strengths are the large study sample (> 20 000) and the inclusion of an external validation. The models incorporate meaningful and clinically available predictors ensuring an easy implementation. All predictions are displayed together with risks of frequent impairments such as pad use or erectile dysfunction such that the developed online tool provides a detailed and informative overview for clinicians as well as patients.
Collapse
Affiliation(s)
| | - Tobias Kurth
- Institute of Public Health, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | | | | | - Günther Feick
- Bundesverband Prostatakrebs Selbsthilfe, Bonn, Germany
| | | | | | | | | | - Stefan Baltes
- KRH Klinikum Region Hannover, Klinikum Siloah—Oststadt—Heidehaus, Hannover, Germany
| | | | - Jens Bedke
- University Hospital Tübingen, Tübingen, Germany
| | | | - Marko Brock
- Ruhr-University Bochum, Marien Hospital, Herne, Germany
| | | | | | | | | | | | - Amr Gaber
- Carl-Thiem-Klinikum, Cottbus, Germany
| | | | | | | | | | | | | | | | - Thomas Knoll
- Klinikum Sindelfingen-Böblingen, Sindelfingen, Germany
| | | | - Inga Peters
- Krankenhaus Nordwest, Frankfurt am Main, Germany
| | | | | | | | - Zoltan Varga
- SRH Kliniken Landkreis Sigmaringen, Sigmaringen, Germany
| | | | | | | |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Young K, Xiong T, Pfisterer KJ, Ng D, Jiao T, Lohani R, Nunn C, Bryant-Lukosius D, Rendon R, Berlin A, Bender J, Brown I, Feifer A, Gotto G, Cafazzo JA, Pham Q. A qualitative study on healthcare professional and patient perspectives on nurse-led virtual prostate cancer survivorship care. COMMUNICATIONS MEDICINE 2023; 3:159. [PMID: 37919491 PMCID: PMC10622495 DOI: 10.1038/s43856-023-00387-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/12/2023] [Indexed: 11/04/2023] Open
Abstract
BACKGROUND Virtual nurse-led care models designed with health care professionals (HCPs) and patients may support addressing unmet prostate cancer (PCa) survivor needs. Within this context, we aimed to better understand the optimal design of a service model for a proposed nurse-led PCa follow-up care platform (Ned Nurse). METHODS A qualitative descriptive study exploring follow-up and virtual care experiences to inform a nurse-led virtual clinic (Ned Nurse) with an a priori convenience sample of 10 HCPs and 10 patients. We provide a health ecosystem readiness checklist mapping facilitators onto CFIR and Proctor's implementation outcomes. RESULTS We show that barriers within the current standard of care include: fragmented follow-up, patient uncertainty, and long, persisting wait times despite telemedicine modalities. Participants indicate that a nurse-led clinic should be scoped to coordinate care and support patient self-management, with digital literacy considerations. CONCLUSION A nurse-led follow-up care model for PCa is seen by HCPs as acceptable, feasible, and appropriate for care delivery. Patients value its potential to provide role clarity, reinforce continuity of care, enhance mental health support, and increase access to timely and targeted care. These findings inform design, development, and implementation strategies for digital health interventions within complex settings, revealing opportunities to optimally situate these interventions to improve care.
Collapse
Affiliation(s)
- Karen Young
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Centre for Digital Therapeutics, University Health Network, Toronto, ON, Canada
| | - Ting Xiong
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Centre for Digital Therapeutics, University Health Network, Toronto, ON, Canada
| | - Kaylen J Pfisterer
- Centre for Digital Therapeutics, University Health Network, Toronto, ON, Canada
- Systems Design Engineering, University of Waterloo, Waterloo, ON, Canada
| | - Denise Ng
- Centre for Digital Therapeutics, University Health Network, Toronto, ON, Canada
| | - Tina Jiao
- Centre for Digital Therapeutics, University Health Network, Toronto, ON, Canada
| | - Raima Lohani
- Centre for Digital Therapeutics, University Health Network, Toronto, ON, Canada
| | - Caitlin Nunn
- Centre for Digital Therapeutics, University Health Network, Toronto, ON, Canada
| | | | - Ricardo Rendon
- Department of Urology, Queen Elizabeth II Health Sciences Centre, Halifax, ON, Canada
| | - Alejandro Berlin
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
| | - Jacqueline Bender
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Princess Margaret Cancer Centre, University Health Network, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ian Brown
- Division of Urology, Niagara Health System, Saint Catharines, ON, Canada
| | - Andrew Feifer
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Geoffrey Gotto
- Division of Urology, University of Calgary, Calgary, AB, Canada
| | - Joseph A Cafazzo
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada
- Centre for Digital Therapeutics, University Health Network, Toronto, ON, Canada
| | - Quynh Pham
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, ON, Canada.
- Centre for Digital Therapeutics, University Health Network, Toronto, ON, Canada.
- Telfer School of Management, University of Ottawa, Ottawa, ON, Canada.
| |
Collapse
|
5
|
Li J, Chen T, Gao J, Peng F, Gu T, Jin B. Developing and validating utility parameters to establish patient-reported outcome-based perioperative symptom management in patients undergoing prostatectomy: a multicentre, prospective, observational cohort study protocol. BMJ Open 2023; 13:e074763. [PMID: 37553190 PMCID: PMC10414067 DOI: 10.1136/bmjopen-2023-074763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Accepted: 07/20/2023] [Indexed: 08/10/2023] Open
Abstract
INTRODUCTION Symptom monitoring and alerting based on patient-reported outcomes have proven valuable in a postoperative setting. However, the parameters of the implemented patient-centred symptom management system for patients with prostate cancer (PC) remain unclear. This study aims to develop a perioperative symptom scale (PSS) to monitor symptoms, determine the appropriate timing for symptom assessment and establish intervention criteria for physicians. METHODS AND ANALYSIS We will prospectively recruit 387 patients undergoing PC surgery in 3 hospitals. The Chinese version of the MD Anderson Symptom Inventory (MDASI) will be used for longitudinal symptom data collection, presurgery and 1, 2, 3, 5, 7, 14, 21, 28, 42 and 90 days post surgery. A PSS will be generated when symptoms change significantly over time. A linear mixed model will be used to determine appropriate follow-up time points. The functional status determined by MDASI interference can then be used to establish alarm thresholds. ETHICS AND DISSEMINATION This study was approved by the Lishui Municipal Central Hospital Ethics Committee on 13 April 2022 (No. LSMCHEC-2022-54) and the Ethics Committee of Huzhou Central Hospital on 5 July 2023 (No. HZCHEC-202306017-01), the Ethics Committee of the First Affiliated Hospital of Huzhou Normal College on 20 June 2023 (No. HZYYEC-2023KYLL055). The latest protocol used in this study was V.2.0, dated on 25 February 2023. Before publication in a peer-reviewed journal, our findings will be presented and discussed at relevant medical conferences. TRIAL REGISTRATION NUMBER ChiCTR2200059110.
Collapse
Affiliation(s)
- Jie Li
- Department of Urology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Department of Urology, Lishui Municipal Central Hospital and Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, Zhejiang, China
| | - Ting Chen
- Department of Urology, Lishui Municipal Central Hospital and Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, Zhejiang, China
| | - Jianguo Gao
- Department of Urology, The First Affiliated Hospital of Huzhou Normal College, Huzhou, Zhejiang, China
| | - Fusheng Peng
- Department of Urology, Huzhou Central Hospital, Huzhou, Zhejiang, China
| | - Tengfei Gu
- Department of Urology, Lishui Municipal Central Hospital and Fifth Affiliated Hospital of Wenzhou Medical College, Lishui, Zhejiang, China
| | - Baiye Jin
- Department of Urology, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
- Zhejiang Engineering Research Center for Urinary Bladder Carcinoma Innovation Diagnosis and Treatment, Hangzhou, Zhejiang, China
| |
Collapse
|
6
|
Kuhl DR, Lutz K, Wu E, Arsovska O, Berkowitz J, Klimas J, Sundar M, Goldenberg SL, Higano CS. Living with prostate cancer: a mixed-method evaluation of group therapy intervention to alleviate psychological distress in a Canadian setting. Support Care Cancer 2023; 31:398. [PMID: 37326757 DOI: 10.1007/s00520-023-07866-5] [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: 12/09/2022] [Accepted: 06/05/2023] [Indexed: 06/17/2023]
Abstract
PURPOSE To assess the effects of group therapy focused on the experience of living with prostate cancer (PC) on depression and mental well-being among men with the disease and to explore participant experiences of a guided opportunity to 'speak the unspeakable' as it pertains to living with PC. METHODS We used a mixed-method convergent design. Participants completed four validated self-report questionnaires at baseline, immediately after the final session, and at three, six, and 12 months follow-up. A repeated measures mixed-effect model examined the effects of the program on depression, mental well-being, and masculinity. Seven focus groups (n = 37) and 39 semi-structured individual interviews explored participant reactions at follow-up. RESULTS Thirty-nine (93%) participants completed the questionnaires at all follow-ups. Responses indicated improved mental well-being up to three months (p < 0.01) and a decrease in depressive symptoms to 12 months (p < 0.05). Qualitative analysis revealed how the cohesive group environment alleviated psychological stress, enabled participants to identify significant issues and concerns in their lives, and improved communication and relationship skills that were of value in the group as well as with family and friends. The facilitation was essential to guiding participants to 'speak the unspeakable.' CONCLUSION Men with PC who speak of their experience in a group setting with a guided process incorporating features of a life review appear to gain insight into the impact of PC in their lives, experience diminished features of depression and isolation, and enhance their communication skills within the groups as well as with family members and friends.
Collapse
Affiliation(s)
- David R Kuhl
- Department of Family Practice, University of British Columbia, 3rd Floor David Strangway Building, 5950 University Blvd, Vancouver, BC, V6T 2A1, Canada.
- Prostate Cancer Supportive Care Program, Vancouver Prostate Centre, Gordon and Leslie Diamond Health Care Centre, 6th Floor, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.
| | - Kevin Lutz
- University of British Columbia, Vancouver, BC, V6T 2A1, Canada
| | - Eugenia Wu
- Prostate Cancer Supportive Care Program, Vancouver Prostate Centre, Gordon and Leslie Diamond Health Care Centre, 6th Floor, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Olga Arsovska
- Prostate Cancer Supportive Care Program, Vancouver Prostate Centre, Gordon and Leslie Diamond Health Care Centre, 6th Floor, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - Jonathan Berkowitz
- Sauder School of Business, University of British Columbia, Henry Angus-HA 475, 2053 Main Mall, Vancouver, BC, V6T 1Z2, Canada
| | - Jan Klimas
- Department of Family Practice, University of British Columbia, 3rd Floor David Strangway Building, 5950 University Blvd, Vancouver, BC, V6T 2A1, Canada
| | - Monita Sundar
- Prostate Cancer Supportive Care Program, Vancouver Prostate Centre, Gordon and Leslie Diamond Health Care Centre, 6th Floor, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
| | - S Larry Goldenberg
- Prostate Cancer Supportive Care Program, Vancouver Prostate Centre, Gordon and Leslie Diamond Health Care Centre, 6th Floor, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
- University of British Columbia, Vancouver, BC, V6T 2A1, Canada
| | - Celestia S Higano
- Prostate Cancer Supportive Care Program, Vancouver Prostate Centre, Gordon and Leslie Diamond Health Care Centre, 6th Floor, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada
- University of British Columbia, Vancouver, BC, V6T 2A1, Canada
| |
Collapse
|
7
|
Sælen MG, Hjelle LV, Aarsæther E, Knutsen T, Andersen S, Bentzen AG, Richardsen E, Fosså SD, Haugnes HS. Patient-reported outcomes after curative treatment for prostate cancer with prostatectomy, primary radiotherapy or salvage radiotherapy. Acta Oncol 2023; 62:657-665. [PMID: 37353983 DOI: 10.1080/0284186x.2023.2224051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 05/29/2023] [Indexed: 06/25/2023]
Abstract
BACKGROUND Trials reporting adverse health outcomes (AHOs) in terms of patient-reported outcome measures (PROMs) after contemporary curative treatment of prostate cancer (PC) are hampered by study heterogeneity and lack of new treatment techniques. Particularly, the evidence regarding toxicities after radiotherapy (RT) with the volumetric arc therapy (VMAT) technique is limited, and comparisons between men treated with surgery, primary radiotherapy (PRT) and salvage radiotherapy (SRT) are lacking. The aim of the study was to evaluate change in PROMs 3 months after treatment with robotic-assisted laparoscopic prostatectomy (RALP), PRT and SRT administered with VMAT. MATERIAL AND METHODS A prospective cohort study of men with PC who received curative treatment at the University Hospital of North Norway between 2012 and 2017 for RALP and between 2016 and 2021 for radiotherapy was conducted. A cohort of 787 men were included; 406 men treated with RALP, 265 received PRT and 116 received SRT. Patients completed the validated PROM instrument EPIC-26 before (pre-treatment) and 3 months after treatment. EPIC-26 domain summary scores (DSSs) were analysed, and changes from pre-treatment to 3 months reported. Changes were deemed clinically relevant if exceeding validated minimally clinically important differences (MCIDs). RESULTS Men treated with RALP reported clinically relevant declining urinary incontinence DSS (-41.7 (SD 30.7)) and sexual DSS (-46.1 (SD 30.2)). Men who received PRT reported worsened urinary irritative DSS (-5.2 (SD 19.6)), bowel DSS (-8.2 (SD 15.1)) and hormonal DSS (-9.6 (SD 18.2)). Men treated with SRT experienced worsened urinary incontinence DSS (-7.3 (SD 18.2)), urinary irritative DSS (-7.5 (SD 14.0)), bowel DSS (-12.5 (SD 16.1)), sexual DSS (-14.9 (SD 18.9)) and hormonal DSS (-23.8 (SD 20.9)). CONCLUSION AHOs 3 months after contemporary curative treatment for PC varied according to treatment modality and worsened in all treatment groups, although most in SRT.
Collapse
Affiliation(s)
- Marie G Sælen
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
| | - Line V Hjelle
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
| | - Erling Aarsæther
- Department of Urology, University Hospital of North Norway, Tromsø, Norway
| | - Tore Knutsen
- Department of Urology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UIT The Artic University, Tromsø, Norway
| | - Sigve Andersen
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UIT The Artic University, Tromsø, Norway
| | - Anne G Bentzen
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
| | - Elin Richardsen
- Department of Pathology, University Hospital of North Norway, Tromsø, Norway
| | - Sophie D Fosså
- Division of Cancer Medicine and Radiotherapy, Oslo University Hospital, Oslo, Norway
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Hege S Haugnes
- Department of Oncology, University Hospital of North Norway, Tromsø, Norway
- Department of Clinical Medicine, UIT The Artic University, Tromsø, Norway
| |
Collapse
|
8
|
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).
Collapse
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
| |
Collapse
|
9
|
Hashimoto Y, Motegi A, Akimoto T, Mitsuhashi N, Ohmatsu K, Kawanishi M, Kono S, Kuribayashi S, Iizuka J, Karasawa K. Relationship between changes in quality of life and genitourinary toxicity grade after brachytherapy with I-125 alone for localised prostate cancer. Rep Pract Oncol Radiother 2023; 28:24-35. [PMID: 37122903 PMCID: PMC10132191 DOI: 10.5603/rpor.a2023.0015] [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: 07/26/2022] [Accepted: 03/15/2023] [Indexed: 05/02/2023] Open
Abstract
Background The relationship between the grading of toxicities based on toxicity criteria and longitudinal changes in quality of life (QOL) scores after permanent prostate brachytherapy (PPB) for localized prostate cancer remains unclear. This study aimed to evaluate these relationships. Materials and methods We assessed 107 patients treated with PPB using Iodine-125 alone from May 2007 to April 2010. Disease-specific QOL scores before PPB and at 1, 3, 6, 12, and 24 months after PPB were retrospectively evaluated with the Expanded Prostate Cancer Index Composite (EPIC), focusing on urinary domains. Toxicities were graded using the Radiation therapy oncology group and the European organization for research and treatment of cancer toxicity criteria. Results The median follow-up duration was 116 (range 18-148) months. Thirty-four patients (31.8%) developed grade ≥ 2 acute genitourinary (GU) toxicities; six (5.6%) developed grade ≥ 2 late GU toxicities. The general urinary domain score dropped significantly at 1 month (77.1 ± 14.1) post-PPB compared to the baseline score (92.2 ± 8.2), and then gradually returned to the baseline level by 12 months (93.7 ± 8.3) post-PPB. Reductions in the general urinary domain scores, including its subscale scores at 1, 3, and 6-months post-PPB were significantly greater among patients with grade ≥ 2 GU toxicity than among those with grade 0-1 GU toxicity. Changes in urinary domain scores demonstrated a close relationship with acute GU toxicity grades after PPB. Conclusions Longitudinal assessments of the EPIC QOL scores provided additional information regarding time-course changes in GU toxicities after PPB.
Collapse
Affiliation(s)
- Yaichiro Hashimoto
- Radiation Oncology, Tokyo Joshi Ika Daigaku Byoin, Kawata-cho, Shinjuku-ku, Japan
| | - Atsushi Motegi
- Radiation Oncology and Particle Therapy, National Cancer Center-Hospital East, Kashiwa, Japan
| | - Tetsuo Akimoto
- Radiation Oncology and Particle Therapy, National Cancer Center-Hospital East, Kashiwa, Japan
| | - Norio Mitsuhashi
- Radiation Therapy Center, Hitachinaka General Hospital, Hitachinaka, Japan
| | - Kenta Ohmatsu
- Radiation Oncology, Tokyo Joshi Ika Daigaku Byoin, Kawata-cho, Shinjuku-ku, Japan
| | - Miki Kawanishi
- Radiation Oncology, Tokyo Joshi Ika Daigaku Byoin, Kawata-cho, Shinjuku-ku, Japan
| | - Sawa Kono
- Radiation Oncology, Tokyo Joshi Ika Daigaku Byoin, Kawata-cho, Shinjuku-ku, Japan
| | | | - Junpei Iizuka
- Urology, Tokyo Joshi Ika Daigaku Byoin, Shinjuku-ku, Japan
| | - Kumiko Karasawa
- Radiation Oncology, Tokyo Joshi Ika Daigaku Byoin, Kawata-cho, Shinjuku-ku, Japan
| |
Collapse
|
10
|
Plumptre IR, Said JT, Sun T, Larocca C, Virgen CA, Kupper TS, Fisher DC, Devlin PM, Elco CP, Song JS, LeBoeuf NR. Clinical features and treatment outcomes for primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder: a retrospective cohort study from the Dana-Farber Cancer Institute and updated literature review. Leuk Lymphoma 2022; 63:2832-2846. [PMID: 35862569 DOI: 10.1080/10428194.2022.2098287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Primary cutaneous CD4+ small/medium T-cell lymphoproliferative disorder (PCSM-TCLPD) was reclassified in 2016 as a rare benign entity with an excellent prognosis, yet its clinical features and best treatments remain poorly defined. We collected clinical data, treatments, and treatment-responses from our institution's patients with PCSM-TCLPD through September 2018 and an identical PubMed review through June 2021. Among 36 cases (median-age 54 years; 58.3% head/neck), diagnostic biopsy resulted in sustained complete remission (CR) in 13/33 punch/shave biopsies and 3/3 excisional biopsies. The remaining 20 patients further required topical corticosteroids (n = 5); intralesional corticosteroids (n = 1); surgical-excision (n = 5); electron-beam-radiation (n = 6); or brachytherapy (n = 3). All patients ultimately achieved CR, excluding one patient continuing treatment at end-of-study. 57/59 (96.6%) of institutional and literature-reported radiation-treated patients experienced CR. No institutional cases progressed beyond skin; 5/209 (2.4%) literature-reported cases progressed to systemic/extracutaneous involvement, all pre-reclassification. PCSM-TCLPD responds well to local-directed therapy including radiation, and only rarely if ever progresses.
Collapse
Affiliation(s)
| | - Jordan T Said
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
| | - Tiffany Sun
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA.,Center for Cutaneous Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Cecilia Larocca
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Center for Cutaneous Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Cesar A Virgen
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Center for Cutaneous Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Thomas S Kupper
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Center for Cutaneous Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - David C Fisher
- Harvard Medical School, Boston, MA, USA.,Center for Cutaneous Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Philip M Devlin
- Harvard Medical School, Boston, MA, USA.,Center for Cutaneous Oncology, Dana-Farber Cancer Institute, Boston, MA, USA.,Department of Radiation Oncology, Brigham and Women's Hospital, Boston, MA, USA
| | - Christopher P Elco
- Harvard Medical School, Boston, MA, USA.,Department of Pathology, Brigham and Women's Hospital, Boston, MA, USA
| | - Johanna Sheu Song
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA.,Center for Cutaneous Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| | - Nicole R LeBoeuf
- Department of Dermatology, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA.,Center for Cutaneous Oncology, Dana-Farber Cancer Institute, Boston, MA, USA
| |
Collapse
|
11
|
Tiruye T, O’Callaghan M, Moretti K, Jay A, Higgs B, Santoro K, Boyle T, Ettridge K, Beckmann K. Patient-reported functional outcome measures and treatment choice for prostate cancer. BMC Urol 2022; 22:169. [PMID: 36335325 PMCID: PMC9637295 DOI: 10.1186/s12894-022-01117-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2022] [Accepted: 10/06/2022] [Indexed: 11/07/2022] Open
Abstract
Background The aim of this study was to describe changes in patient-reported functional outcome measures (PROMs) comparing pre-treatment and 12 months after radical prostatectomy (RP), external beam radiation therapy (EBRT), brachytherapy and active surveillance (AS). Methods Men enrolled from 2010 to 2019 in the South Australian Prostate Cancer Clinical Outcomes Collaborative registry a prospective clinical registry were studied. Urinary, bowel, and sexual functions were measured using Expanded Prostate Cancer Index Composite (EPIC-26) at baseline and 12 months post-treatment. Higher scores on the EPIC-26 indicate better function. Multivariable regression models were applied to compare differences in function and extent of bother by treatment. Results Of the 4926 eligible men, 57.0% underwent RP, 20.5% EBRT, 7.0% brachytherapy and 15.5% AS. While baseline urinary and bowel function varied little across treatment groups, sexual function differed greatly (adjusted mean scores: RP = 56.3, EBRT = 45.8, brachytherapy = 61.4, AS = 52.8; p < 0.001). Post-treatment urinary continence and sexual function declined in all treatment groups, with the greatest decline for sexual function after RP (adjusted mean score change − 28.9). After adjustment for baseline differences, post-treatment sexual function scores after EBRT (6.4; 95%CI, 0.9–12.0) and brachytherapy (17.4; 95%CI, 9.4–25.5) were higher than after RP. Likewise, urinary continence after EBRT (13.6; 95%CI, 9.0-18.2), brachytherapy (10.6; 95%CI, 3.9–17.3) and AS (10.6; 95%CI, 5.9–15.3) were higher than after RP. Conversely, EBRT was associated with lower bowel function (− 7.9; 95%CI, − 12.4 to − 3.5) than RP. EBRT and AS were associated with lower odds of sexual bother (OR 0.51; 95%CI, 0.29–0.89 and OR 0.60; 95%CI, 0.38–0.96, respectively), and EBRT with higher odds of bowel bother (OR 2.01; 95%CI, 1.23–3.29) compared with RP. Conclusion The four common treatment approaches for prostate cancer were associated with different patterns of patient-reported functional outcomes, both pre- and 12 months post-treatment. However, after adjustment, RP was associated with a greater decline in urinary continence and sexual function than other treatments. This study underscores the importance of collecting baseline PROMs to interpret post-treatment functional outcomes. Supplementary Information The online version contains supplementary material available at 10.1186/s12894-022-01117-1.
Collapse
Affiliation(s)
- Tenaw Tiruye
- grid.1026.50000 0000 8994 5086Cancer Epidemiology and Population Health Research Group, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia ,grid.449044.90000 0004 0480 6730Public Health Department,, Debre Markos University,, Debre Markos, Ethiopia
| | - Michael O’Callaghan
- South Australian Prostate Cancer Clinical Outcomes Collaborative, Adelaide, South Australia ,grid.1014.40000 0004 0367 2697Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia ,grid.1010.00000 0004 1936 7304Discipline of Medicine, University of Adelaide, Adelaide, South Australia , Urology Unit, Southern Adelaide Local Health Network, Adelaide, South Australia
| | - Kim Moretti
- grid.1026.50000 0000 8994 5086Cancer Epidemiology and Population Health Research Group, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia ,South Australian Prostate Cancer Clinical Outcomes Collaborative, Adelaide, South Australia ,grid.1010.00000 0004 1936 7304Discipline of Surgery, University of Adelaide, Adelaide, South Australia
| | - Alex Jay
- grid.414925.f0000 0000 9685 0624Flinders Medical Centre, Bedford Park, South Australia
| | - Braden Higgs
- grid.1026.50000 0000 8994 5086Cancer Epidemiology and Population Health Research Group, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia ,grid.416075.10000 0004 0367 1221 Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, South Australia
| | - Kerry Santoro
- Urology Unit, Southern Adelaide Local Health Network, Adelaide, South Australia
| | - Terry Boyle
- grid.1026.50000 0000 8994 5086Australian Centre for Precision Health, University of South Australia, Adelaide, South Australia
| | - Kerry Ettridge
- grid.430453.50000 0004 0565 2606Health Policy Centre, South Australian Health and Medical Research Institute, Adelaide, South Australia ,grid.1010.00000 0004 1936 7304School of Public Health, University of Adelaide, Adelaide, South Australia
| | - Kerri Beckmann
- grid.1026.50000 0000 8994 5086Cancer Epidemiology and Population Health Research Group, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia
| |
Collapse
|
12
|
Adequacy of sexual care information given to prostate cancer patients receiving radical external beam radiotherapy. JOURNAL OF RADIOTHERAPY IN PRACTICE 2022. [DOI: 10.1017/s1460396922000310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Abstract
Background:
Despite the acknowledged value of providing prostate radiotherapy patients with sexual dysfunction (SD) information, there is little evidence related to patient perceptions of this or the extent to which information is provided to them. This study aimed to critically evaluate the quality and format of SD information given to patients before, during and after radical EBRT to treat prostate cancer.
Method:
Members of UK prostate cancer support groups were asked to complete an anonymous online survey tool seeking opinions of the SD information they were given before, during and after external beam radiotherapy (EBRT).
Results:
There were 56 responses to the survey with over 42% of respondents reporting that they had not received any SD information. Of those who did, 78·1% (25/32) received information before the start of EBRT. Physicians were the most involved in the provision of SD information, with nurses and therapeutic radiographers being underutilised. Responses were mostly negative, or neutral regarding the quality of SD information and the information received about impact on relationships, psychological and emotional health. Many participants wanted more information and support.
Conclusion:
This study demonstrates that prostate cancer patients who have undergone radical EBRT have not received adequate information relating to potential sexual function side effects and the psychological and emotional effects of SD. This information should be included in verbal and written information provided at all stages of the radiotherapy pathway.
Collapse
|
13
|
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.
Collapse
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
| |
Collapse
|
14
|
Hjälm-Eriksson M, Ullén A, Nilsson S, Johansson H, Nilsson J, Castellanos E, Brandberg Y. High levels of health-related quality of life five years after curative treatment of prostate cancer with HDR-brachytherapy and external beam radiation. Acta Oncol 2022; 61:1179-1185. [PMID: 36062835 DOI: 10.1080/0284186x.2022.2115314] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND AND PURPOSE The aim of this cross-sectional study was to investigate long-term health-related quality of life (HRQoL) in men with prostate cancer treated 2002-2008 with external beam radiotherapy (EBRT) combined with high dose-rate brachytherapy (HDRBT), Cohort A, and to compare these data with age-adjusted normative data. In addition, differences in HRQoL following adjustments of the brachytherapy technique in 2001 were investigated by comparing Cohort A with men treated at the same clinic from 1998-2000, Cohort B. METHODS AND MATERIAL Cohort A: 1495 men treated with EBRT 2 Gy to 50 Gy and 2 fractions of 10 Gy HDRBT at a single centre, 2002-2008, still alive at five years. As part of routine follow-up, the patients responded to the EORTC QLQ-C30 and PR-25 questionnaires. Cohort B: HRQoL data was retrieved from an earlier study from the original article. RESULTS In Cohort A, 1046 (70%) men completed the questionnaires at five years, median age 66 years. In general, HRQoL mean scores were high and similar to Swedish age-matched normative data. Concerning disease-specific HRQoL, low levels of bowel and urinary problems were reported, in contrast to a substantial effect on sexual functioning. 'No' or 'A little' problems with faecal incontinence and urinary incontinence were reported by 98% and 93% of patients, respectively. The corresponding figure for sexual functioning was 39%. A difference in the frequency of nocturia in favour of Cohort A was the only statistically significant difference between Cohort A and B found in general and disease-specific HRQOL (p = 0.03), despite modifications in the brachytherapy procedure introduced in 2001. CONCLUSION Long-term general HRQoL was rated high and comparable to an aged-matched reference population five years after treatment with combined radiotherapy. Disease-specific HRQoL was still affected, foremost in the sexual domain.
Collapse
Affiliation(s)
- Marie Hjälm-Eriksson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Surgery, Capio S:t Göran's Hospital, Stockholm, Sweden
| | - Anders Ullén
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Pelvic cancer, Genitourinary oncology and urology unit, Karolinska University Hospital, Stockholm, Sweden
| | - Sten Nilsson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Hemming Johansson
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden
| | - Josef Nilsson
- Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
| | - Enrique Castellanos
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Pelvic cancer, Genitourinary oncology and urology unit, Karolinska University Hospital, Stockholm, Sweden
| | - Yvonne Brandberg
- Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.,Department of Pelvic cancer, Genitourinary oncology and urology unit, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
15
|
Choinière R, Violette PD, Morin M, Tu LM, Guyatt GH, Reed C, Philie CA, Legault B, Beaudry MM, Ahmed MM, Richard PO. Evaluation of Benefits and Harms of Surgical Treatments for Post-radical Prostatectomy Urinary Incontinence: A Systematic Review and Meta-analysis. Eur Urol Focus 2022; 8:1042-1052. [PMID: 34563480 DOI: 10.1016/j.euf.2021.09.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 08/09/2021] [Accepted: 09/08/2021] [Indexed: 12/29/2022]
Abstract
CONTEXT No meta-analysis has comprehensively addressed both benefits and harms, or the certainty of evidence of the implantable continence devices used in men to treat postprostatectomy urinary incontinence (PPI). OBJECTIVE To evaluate the benefits and harms of surgical treatments for patients suffering from PPI and assess the certainty of evidence. The primary benefit was cure (one or fewer pad per day), and the primary harm was reoperations defined by surgical procedures following implantation. EVIDENCE ACQUISITION We perform a search of Medline, PubMed, Embase, Cochrane Library, and gray literature. We included observational studies addressing PPI surgical interventions if they involved cohorts of ≥50 participants. The Grading of Recommendations, Assessment, Development and Evaluations (GRADE) approach provided the framework for certainty of evidence assessment informed by value and preference judgments provided by patients, and an advocacy group member (Canadian Cancer Society). EVIDENCE SYNTHESIS Of 85 observational studies involving 13 100 patients, three addressed bulking agents, 35 male synthetic slings, ten adjustable continence therapies (ACTs), and 37 artificial urinary sphincters (AUSs). Cure was 26.1% (95% confidence interval [CI]: 10.6-51.4, I2 = 92.8%, very-low-quality evidence) for bulking agents, 58.6% (95% CI: 51.3-65.5, I2 = 89.1%, low-quality evidence) for slings, 63.2% (95% CI: 57.6-68.5, I2 = 22.5%, very-low-quality evidence) for ACT, and 74.0% (95% CI:61.2-83.7, I2 = 92.1%, very-low-quality evidence) for AUS. Estimated rates of reoperation were 5.8% (95% CI: 1.9-11.6, I2 = 94.1%, moderate-quality evidence) for slings, 23.8% (95% CI: 5.9-61.0, I2 = 95.5%, low-quality evidence) for ACT, and 22.2% (95% CI: 15.2-31.3, I2 = 92.3%, high-quality evidence) for AUS. CONCLUSIONS Available evidence regarding the benefits of surgical interventions for PPI remains mainly uncertain while suggesting important harms. These results should guide consent procedures for PPI surgery in the context of shared decision-making, with disclosure of the uncertainty of evidence. PATIENT SUMMARY Despite being used worldwide, available evidence regarding the benefits of surgeries to treat postprostatectomy urinary incontinence remains mainly uncertain while suggesting important harms. This highlights the need for a more rigorous evaluation process for commercially available surgical devices.
Collapse
Affiliation(s)
- Roselyne Choinière
- Centre Hospitalier Universitaire de Sherbrooke, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Philippe D Violette
- Department of Health Research Methods Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada; Department of Surgery, McMaster University, Hamilton, ON, Canada.
| | - Mélanie Morin
- School of Rehabilitation, Centre Hospitalier Universitaire de Sherbrooke, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Le Mai Tu
- Department of Urology, Centre Hospitalier Universitaire de Sherbrooke, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Gordon H Guyatt
- Department of Health Research Methods Evidence and Impact (HEI), McMaster University, Hamilton, ON, Canada
| | - Christine Reed
- Centre Hospitalier Universitaire de Sherbrooke, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Camille-Ariane Philie
- Department of Family Medicine, GMF-U Deux-Rives, University of Sherbrooke, Sherbrooke, QC, Canada
| | | | | | | | - Patrick O Richard
- Department of Urology, Centre Hospitalier Universitaire de Sherbrooke, University of Sherbrooke, Sherbrooke, QC, Canada
| |
Collapse
|
16
|
Handley NR, Wen KY, Gomaa S, Brassil K, Shimada A, Leiby B, Jackson L, McMorris M, Calvaresi A, Dicker AP. A Pilot Feasibility Study of Digital Health Coaching for Men With Prostate Cancer. JCO Oncol Pract 2022; 18:e1132-e1140. [PMID: 35394806 DOI: 10.1200/op.21.00712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Prostate cancer is the most common cancer among men in the United States. The majority of prostate cancer treatment occurs in the ambulatory setting, and patients and their caregivers take on significant responsibility for monitoring and managing treatment and disease-related toxicity. Digital health coaching has shown promise as a tool to positively influence outcomes. We completed a single-arm pilot study to assess the feasibility of digital health coaching in men with prostate cancer. METHODS Men with a history of prostate cancer requiring treatment in the past 2 years were eligible for inclusion. Participants engaged in a 12-week health coaching program, consisting of a combination of at least one telephone call and up to four digital nudges (defined as content delivered via text, e-mail, or app on the basis of the participant's preference) per week. Prostate cancer-specific content addressed one of the following topics each week: fatigue, pain management, healthy eating, exercise, managing incontinence, sexual health, managing stress and anxiety, financial toxicity, goal setting during treatment, managing side effects, communicating with the health care team, and medication adherence. Services were provided at no cost to the participant. RESULTS A hundred patients were consented for the study, and 88 enrolled. The feasibility threshold of 60% was met with 63 of the 88 enrolled individuals completing the 3-month program (proportion = 71.6%; 90% CI, 62.6 to 79.4; P = .016). CONCLUSION Digital health coaching for men with prostate cancer is feasible. These findings support further evaluation of digital health coaching for men with prostate cancer in larger randomized controlled trials.
Collapse
Affiliation(s)
- Nathan R Handley
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA.,Center for Connected Care, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, PA
| | - Kuang-Yi Wen
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Sameh Gomaa
- Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | | | - Ayako Shimada
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA
| | - Benjamin Leiby
- Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA
| | | | | | - Anne Calvaresi
- Department of Urology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| | - Adam P Dicker
- Department of Radiation Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA
| |
Collapse
|
17
|
Marziliano A, Diefenbach MA, Hudson SV, Tagai EK, Handorf EA, Bator A, Miller SM. Demographic and Psychosocial Characteristics Associated With Use of a Prostate Cancer Survivorship Website: Implications From a Multisite Randomized Controlled Trial. J Med Internet Res 2022; 24:e27890. [PMID: 35311678 PMCID: PMC8981019 DOI: 10.2196/27890] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2021] [Revised: 09/13/2021] [Accepted: 10/14/2021] [Indexed: 11/23/2022] Open
Abstract
Background Many prostate cancer (PC) survivors experience disease and treatment-related symptomatology in both the physical and psychosocial domains. Although the benefits and barriers to using web-based resources for cancer patients are well-documented, less research has focused on the personal characteristics important for efficient tailoring and targeting of information that are associated with usage. Objective We used the Cognitive-Social Health Information Processing (C-SHIP) framework to guide our exploration of personal characteristics associated with use of PROGRESS, an informational PC survivorship website that addresses physical, emotional, interpersonal, and practical concerns relevant for PC survivors. Methods PC survivors (N=217) were randomized to the intervention arm (PROGRESS) of a randomized controlled trial. Of those randomized to the intervention arm, 84 used PROGRESS, and 133 did not use PROGRESS. Multivariable analyses evaluated demographic and psychosocial characteristics (eg, style of coping, health literacy, self-efficacy, affective states of depression, anxiety, and fatigue) associated with website use. Results A larger proportion of non-Hispanic White (68/160, 42.5%), compared with non-Hispanic Black (9/40, 23%), participants used PROGRESS (P<.001). Further, PROGRESS users were older in age (P<.001), had a monitoring style of coping (P=.01), and were less depressed (P=.004), anxious (P=.02), and fatigued (P<.001) than nonusers. Education, income, health literacy, blunting style of coping, self-efficacy, and treatment type (radiation therapy or surgery) were not significantly related to use. On multivariable analyses, race (OR 0.28, P<.001), age (OR 1.05, P<.001), monitoring style of coping (OR 1.27, P=.02), and overall mood (OR 0.98, P<.001) remained significant. Conclusions A combination of monitoring and low levels of negative affect were associated with website use. Additionally, users were older, non-Hispanic White survivors. To ensure that important survivorship-relevant information reaches users, future efforts need to focus on enhancing patient engagement. Trial Registration ClinicalTrials.gov NCT02224482; https://clinicaltrials.gov/ct2/show/NCT02224482
Collapse
Affiliation(s)
- Allison Marziliano
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Michael A Diefenbach
- Center for Health Innovations and Outcomes Research, Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States
| | - Shawna V Hudson
- Rutgers Robert Wood Johnson Medical School, Rutgers, The State University of New Jersey, New Brunswick, NJ, United States
| | - Erin K Tagai
- Cancer Prevention and Control, Fox Chase Cancer Center/Temple University Health System, Philadelphia, PA, United States
| | - Elizabeth A Handorf
- Cancer Prevention and Control, Fox Chase Cancer Center/Temple University Health System, Philadelphia, PA, United States
| | - Alicja Bator
- Cancer Prevention and Control, Fox Chase Cancer Center/Temple University Health System, Philadelphia, PA, United States
| | - Suzanne M Miller
- Cancer Prevention and Control, Fox Chase Cancer Center/Temple University Health System, Philadelphia, PA, United States
| |
Collapse
|
18
|
Monsen KV, Fosså SD, Myklebust TÅ, Smeland S, Dahl AA, Stensvold A. Long-term satisfaction with curative treatment and follow-up in prostate cancer survivors. Acta Oncol 2022; 61:357-362. [PMID: 35103559 DOI: 10.1080/0284186x.2021.2006775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
PURPOSE In a cross-sectional observational study to explore long-term satisfaction with treatment among men who had undergone radical prostatectomy (RP) or definitive pelvic radiotherapy (RT) for prostate cancer (PCa). METHODS After mean 7 years from therapy (range: 6-8), 431 PCa-survivors (RP: n = 313, RT: n = 118) completed a mailed questionnaire assessing persistent treatment-related adverse effects (AEs) (Expanded Prostate cancer Index Composite [EPIC-26]) and seven Quality indicators describing satisfaction with the health care service following a most often general practitioner (GP)-led follow-up plan. A logistic regression model evaluated the associations between long-term satisfaction and treatment modality, age, the seven satisfaction-related Quality indicators, and persistent AEs. The significance level was set at p< .05. RESULTS Four of five (81%) PCa-survivors reported long-term satisfaction with their treatment. In a multivariable model, satisfaction was positively associated with sufficient information about treatment and AEs, patient-perceived sufficient cooperation between the hospital and the GP and sufficient follow-up of AEs (ref.: insufficient). Age ≥70 years (ref.: <70) and a rising summary score within the EPIC-26 sexual domain additionally increased long-term satisfaction. The treatment modality itself (RP versus RT) did not significantly impact on satisfaction. CONCLUSIONS The majority of curatively treated PCa-survivors are satisfied with their treatment more than 5 years after primary therapy. Sufficient information, improved cooperation between the hospital specialists and the responsible GP and optimized follow-up of AEs may further increase long-term satisfaction among prostatectomized and irradiated PCa-survivors.
Collapse
Affiliation(s)
- Kari V. Monsen
- Section for Clinical Cancer Research, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Norway
| | - Sophie D. Fosså
- Section for Clinical Cancer Research, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Norway
| | - Tor Å. Myklebust
- Department of Research and Innovation, Møre and Romsdal Hospital Trust, Ålesund, Norway
- Cancer Registry of Norway, Oslo, Norway
| | - Sigbjørn Smeland
- Faculty of Medicine, University of Oslo, Norway
- Division of Cancer Medicine, Oslo University Hospital, Oslo, Norway
| | - Alv A. Dahl
- Section for Clinical Cancer Research, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Norway
| | - Andreas Stensvold
- Division of Clinical Oncology, Østfold Hospital Trust, Kalnes, Norway
| |
Collapse
|
19
|
Narita S, Hatakeyama S, Sakamoto S, Kato T, Inokuchi J, Matsui Y, Kitamura H, Nishiyama H, Habuchi T. Management of prostate cancer in older patients. Jpn J Clin Oncol 2022; 52:513-525. [PMID: 35217872 DOI: 10.1093/jjco/hyac016] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Accepted: 01/31/2022] [Indexed: 01/22/2023] Open
Abstract
The incidence of prostate cancer among older men has increased in many countries, including Asian countries. However, older patients are ineligible for inclusion in large randomized trials, and the existing guidelines for the management of patients with prostate cancer do not provide specific treatment recommendations for older men. Therefore, generation of evidence for older patients with prostate cancer is a key imperative. The International Society of Geriatric Oncology has produced and updated several guidelines for management of prostate cancer in older men since 2010. Regarding localized prostate cancer, both surgery and radiotherapy are considered as feasible treatment options for intermediate- and high-risk prostate cancer even in older men, whereas watchful waiting and active surveillance are useful options for a proportion of these patients. With regard to advanced disease, androgen-receptor axis targets and taxane chemotherapy are standard treatment modalities, although dose modification and prevention of adverse events need to be considered. Management strategy for older patients with prostate cancer should take cognizance of not only the chronological age but also psychological and physical condition, socio-economic status and patient preferences. Geriatric assessment and patient-reported health-related quality of life are important tools for assessing health status of older patients with prostate cancer; however, there is a paucity of evidence of the impact of these tools on the clinical outcomes. Personalized management according to the patient's health status and tumour characteristics as well as socio-economic condition may be necessary for treatment of older patients with prostate cancer.
Collapse
Affiliation(s)
- Shintaro Narita
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| | - Shingo Hatakeyama
- Department of Urology, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Shinichi Sakamoto
- Department of Urology, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Takuma Kato
- Department of Urology, Kagawa University School of Medicine, Kagawa, Japan
| | - Juichi Inokuchi
- Department of Urology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Yoshiyuki Matsui
- Department of Urology, National Cancer Center Hospital, Tokyo, Japan
| | - Hiroshi Kitamura
- Department of Urology, University of Toyama Faculty of Medicine, Toyama, Japan
| | - Hiroyuki Nishiyama
- Department of Urology, Tsukuba University School of Medicine, Tsukuba, Japan
| | - Tomonori Habuchi
- Department of Urology, Akita University Graduate School of Medicine, Akita, Japan
| |
Collapse
|
20
|
Pignot G, Touzani R, Bendiane MK, Mancini J, Walz J, Marino P, Rybikowski S, Maubon T, Salem N, Gravis G, Bouhnik AD. Self-reported functional assessment after treatment for prostate cancer: 5-year results of the prospective cohort VICAN. Future Oncol 2022; 18:1733-1744. [PMID: 35172586 DOI: 10.2217/fon-2021-1420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Objective: We aimed to assess the long-term association of therapeutic strategies with urinary, sexual function and health-related quality of life (HR-QOL) for 5-year prostate cancer (PC) survivors. Materials & methods: The VICAN survey consisted of self-reported data prospectively collected, including living conditions, treatment side effects and quality of life (QOL) of cancer survivors. Results: Among the 434 PC survivors, 52.8% reported urinary incontinence (UI) and 55.8% reported erectile dysfunction (ED). Patients treated with radical prostatectomy with salvage radiotherapy reported significantly more UI (p = 0.014) and more ED (p = 0.012) compared with other strategies. UI was significantly associated with physical and mental health-related QOL (p = 0.045 and p = 0.049, respectively). Conclusion: Self-assessed functional outcomes 5 years after PC diagnosis remain poor and could have an impact on health-related QOL.
Collapse
Affiliation(s)
- Géraldine Pignot
- Department of Surgical Oncology 2, Institut Paoli-Calmettes, Marseille, France
| | - Rajae Touzani
- Institut Paoli-Calmettes, Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | | | - Julien Mancini
- Institut Paoli-Calmettes, Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | - Jochen Walz
- Department of Surgical Oncology 2, Institut Paoli-Calmettes, Marseille, France
| | - Patricia Marino
- Institut Paoli-Calmettes, Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| | | | - Thomas Maubon
- Department of Surgical Oncology 2, Institut Paoli-Calmettes, Marseille, France
| | - Naji Salem
- Department of Radiotherapy, Institut Paoli-Calmettes, Marseille, France
| | - Gwenaelle Gravis
- Department of Medical Oncology, Institut Paoli-Calmettes, Marseille, France
| | - Anne-Déborah Bouhnik
- Institut Paoli-Calmettes, Aix Marseille Univ, INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l'Information Médicale, Marseille, France
| |
Collapse
|
21
|
Zamora V, Garin O, Pardo Y, Pont À, Gutiérrez C, Cabrera P, Gómez-Veiga F, Pijoan JI, Litwin MS, Ferrer M. Mapping the Patient-Oriented Prostate Utility Scale From the Expanded Prostate Cancer Index Composite and the Short-Form Health Surveys. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1676-1685. [PMID: 34711369 DOI: 10.1016/j.jval.2021.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 03/01/2021] [Accepted: 03/29/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES This study aimed to develop mapping algorithms from the Expanded Prostate Cancer Index Composite (EPIC) and the Short-Form (SF) Health Surveys to the Patient-Oriented Prostate Utility Scale (PORPUS), an econometric instrument specifically developed for patients with prostate cancer. METHODS Data were drawn from 2 cohorts concurrently administering PORPUS, EPIC-50, and SF-36v2. The development cohort included patients who had received a diagnosis of localized or locally advanced prostate cancer from 2017 to 2019. The validation cohort included men who had received a diagnosis of localized prostate cancer from 2014 to 2016. Linear regression models were constructed with ln(1 - PORPUS utility) as the dependent variable and scores from the original and brief versions of the EPIC and SF as independent variables. The predictive capacity of mapping models constructed with all possible combinations of these 2 instruments was assessed through the proportion of variance explained (R2) and the agreement between predicted and observed values. Validation was based on the comparison between estimated and observed utility values in the validation cohort. RESULTS Models constructed with EPIC-50 with and without SF yielded the highest predictive capacity (R2 = 0.884, 0.871, and 0.842) in comparison with models constructed with EPIC-26 (R2 = 0.844, 0.827, and 0.776). The intraclass correlation coefficient was excellent in the 4 models (>0.9) with EPIC and SF. In the validation cohort, predicted PORPUS utilities were slightly higher than those observed, but differences were not statistically significant. CONCLUSIONS Mapping algorithms from both the original and the abbreviated versions of the EPIC and the SF Health Surveys allow estimating PORPUS utilities for economic evaluations with cost-utility analyses in patients with prostate cancer.
Collapse
Affiliation(s)
- Víctor Zamora
- Health Services Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain; Department of Paediatrics, Obstetrics and Gynaecology, and Preventive Medicine, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
| | - Olatz Garin
- Health Services Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain; Universitat Pompeu Fabra, Barcelona, Spain.
| | - Yolanda Pardo
- Health Services Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
| | - Àngels Pont
- Health Services Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
| | | | - Patricia Cabrera
- Department of Radiation Oncology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Francisco Gómez-Veiga
- Complejo Hospitalario Universitario de Salamanca, Grupo de Investigación Translacional de Urología, Instituto de Investigación de Salamanca, Salamanca, Spain
| | - José Ignacio Pijoan
- CIBER en Epidemiología y Salud Pública, CIBERESP, Spain; Department of Clinical Epidemiology, Hospital Universitario de Cruces, Barakaldo, Vizcaya, Spain
| | - Mark S Litwin
- Schools of Medicine, Public Health and Nursing, University of California, Los Angeles, CA, USA
| | - Montse Ferrer
- Health Services Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain; Department of Paediatrics, Obstetrics and Gynaecology, and Preventive Medicine, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
| |
Collapse
|
22
|
Huang J, Ma J, Wang J, Ma K, Zhou K, Huang W, Zhao F, Lv B, Hu Q. Whole-transcriptome analysis of rat cavernosum and identification of circRNA-miRNA-mRNA networks to investigate nerve injury erectile dysfunction pathogenesis. Bioengineered 2021; 12:6516-6528. [PMID: 34461805 PMCID: PMC8806524 DOI: 10.1080/21655979.2021.1973863] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
There is growing evidence that circular RNAs (circRNAs) play a vital role in many kinds of diseases, including erectile dysfunction (ED). Nevertheless, the role of circRNAs in cavernous nerve-damaging ED (CNI-ED) is unknown. Here, we aimed to discover novel circRNAs, probed their potential role in the CNI-ED, and construct a ceRNA network of circRNAs. Twelve male Sprague Dawley rats were randomly divided into 2 groups by us: bilateral cavernous nerve crush (BCNC) and control groups. Four weeks after surgery, the spongy smooth muscle tissue of the rat penis was sequenced using high-throughput full transcriptome sequencing. We analyzed the expression of circRNAs, miRNAs, and mRNAs in the two groups. Twenty circRNAs with significantly different expressions were selected for RT-qPCR. CeRNA network of circRNAs was established using Cytoscape. GO and KEGG analysis was done by R package. Sequencing showed that 4,587 circRNAs, 762 miRNAs, and 21,661 mRNAs were dysregulated in the BCNC group. The top 20 differentially expressed circRNAs were further verified via RT-qPCR. The ceRNA network contained ten circRNAs, six miRNAs, and 227 mRNAs, including 23 circRNA-miRNA pairs and 227 miRNA-mRNA pairs. GO and KEGG analysis suggested that these ten circRNAs could main regulate energy metabolism processes. A protein‐protein interaction network was constructed with the mRNAs in ceRNA network, and five hub genes were identified. Our study revealed a potential link between circRNAs, miRNAs, and mRNAs in CNI-ED, suggesting that circRNAs may contribute to the occurrence of ED by regulating the cellular energy metabolism in CNI-ED.
Collapse
Affiliation(s)
- Jie Huang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jianxiong Ma
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jie Wang
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Ke Ma
- Department of Urology, First People's Hospital of Yuhang District, Hangzhou, China.,Department of Urology, Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Kang Zhou
- The Second Clinical Medical College, Zhejiang Chinese Medical University, Hangzhou, China
| | - Wenjie Huang
- Department of Urology and Andrology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Fan Zhao
- Department of Urology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
| | - Bodong Lv
- Zhejiang Provincial Key Laboratory of Prevention and Treatment of Combined Chinese and Western Sexual Dysfunction, Zhejiang Chinese Medical University, Hangzhou, China.,Department of Urology, The Second Affiliated Hospital of Zhejiang University, Hangzhou, China
| | - Qing Hu
- Department of Urology and Andrology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| |
Collapse
|
23
|
Yamamoto S, Fukuhara H, Seki H, Kawada C, Nakayama T, Karashima T, Ogura SI, Inoue K. Predictors of therapeutic efficacy of 5-aminolevulinic acid-based photodynamic therapy in human prostate cancer. Photodiagnosis Photodyn Ther 2021; 35:102452. [PMID: 34303032 DOI: 10.1016/j.pdpdt.2021.102452] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Revised: 07/13/2021] [Accepted: 07/19/2021] [Indexed: 01/10/2023]
Abstract
BACKGROUND Photodynamic therapy (PDT) is a minimally invasive cancer therapy. However, its therapeutic efficacy for prostate cancer is not yet fully understood. In this study, the predictors of therapeutic efficacy of 5-aminolevulinic acid-based PDT (ALA-PDT) on prostate cancer cells are investigated. MATERIALS AND METHODS The human prostate cancer cell lines, PC-3, 22Rv1, DU145, and LNCap were used to investigate the effects of ALA-PDT on protoporphyrin IX (PpIX) intracellular accumulation, which was measured by flow cytometry. The cytotoxicity of ALA-PDT was evaluated by MTT (3-(4, 5-dimethylthiazolyl-2)-2, 5-diphenyltetrazolium bromide) assay. The levels of porphyrin metabolism-related enzyme and transporter mRNA were comprehensively evaluated by quantitative real-time polymerase chain reaction (qRT-PCR). Protein expression was evaluated by Western blot. A xenograft model was created using PC-3 and 22Rv1, and then, pathological analysis was performed to determine the therapeutic effect of ALA-PDT RESULTS: PC-3 and LNCap cells showed high accumulation of PpIX and high sensitivity to ALA-PDT, while 22Rv1 and DU145 showed low accumulation of PpIX and low sensitivity to ALA-PDT. ALA-PDT-induced cytotoxicity correlated negatively with PpIX accumulation. The in vitro assays identified the ATP-binding cassette transporter subfamily G2 (ABCG2) transporter dimer as a predictor of treatment response. In vivo immunohistochemical staining of ABCG2 transporter showed low expression in PC-3 cells and high expression in 22Rv1 cells, and ALA-PDT-induced tumor tissue degeneration was greater in PC-3 cells than in 22Rv1 cells. CONCLUSION The ABCG2 transporter is a useful predictor of the therapeutic effect of ALA-PDT on human prostate cancer cells.
Collapse
Affiliation(s)
- Shinkuro Yamamoto
- Department of Urology, Kochi Medical School, Kohasu, Oko-cho, Nankoku-shi, Kochi, 783-8505, Japan.
| | - Hideo Fukuhara
- Department of Urology, Kochi Medical School, Kohasu, Oko-cho, Nankoku-shi, Kochi, 783-8505, Japan; Center for Photodynamic Medicine, Kochi Medical School, Kohasu, Oko-cho, Nankoku-shi, Kochi, 783-8505, Japan.
| | - Hitomi Seki
- Department of Urology, Kochi Medical School, Kohasu, Oko-cho, Nankoku-shi, Kochi, 783-8505, Japan.
| | - Chiaki Kawada
- Department of Urology, Kochi Medical School, Kohasu, Oko-cho, Nankoku-shi, Kochi, 783-8505, Japan.
| | - Taku Nakayama
- Center for Photodynamic Medicine, Kochi Medical School, Kohasu, Oko-cho, Nankoku-shi, Kochi, 783-8505, Japan; School of Life Science and Technology, Tokyo Institute of Technology, 4259 Nagatsuta-cho, Midori-ku, Yokohama, Kanagawa, 226-8501, Japan
| | - Takashi Karashima
- Department of Urology, Kochi Medical School, Kohasu, Oko-cho, Nankoku-shi, Kochi, 783-8505, Japan.
| | - Shun-Ichiro Ogura
- Center for Photodynamic Medicine, Kochi Medical School, Kohasu, Oko-cho, Nankoku-shi, Kochi, 783-8505, Japan; School of Life Science and Technology, Tokyo Institute of Technology, 4259 Nagatsuta-cho, Midori-ku, Yokohama, Kanagawa, 226-8501, Japan.
| | - Keiji Inoue
- Department of Urology, Kochi Medical School, Kohasu, Oko-cho, Nankoku-shi, Kochi, 783-8505, Japan; Center for Photodynamic Medicine, Kochi Medical School, Kohasu, Oko-cho, Nankoku-shi, Kochi, 783-8505, Japan.
| |
Collapse
|
24
|
Leuteritz K, Richter D, Mehnert-Theuerkauf A, Stolzenburg JU, Hinz A. Quality of life in urologic cancer patients: importance of and satisfaction with specific quality of life domains. Qual Life Res 2021; 31:759-767. [PMID: 34275030 PMCID: PMC8921173 DOI: 10.1007/s11136-021-02954-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 11/15/2022]
Abstract
Purpose Quality of life (QoL) has been the subject of increasing interest in oncology. Most examinations of QoL have focused on health-related QoL, while other factors often remain unconsidered. Moreover, QoL questionnaires implicitly assume that the subjective importance of the various QoL domains is identical from one patient to the next. The aim of this study was to analyze QoL in a broader sense, considering the subjective importance of the QoL components. Methods A sample of 173 male urologic patients was surveyed twice: once while hospitalized (t1) and once again 3 months later (t2). Patients completed the Questions on Life Satisfaction questionnaire (FLZ-M), which includes satisfaction and importance ratings for eight dimensions of QoL. A control group was taken from the general population (n = 477). Results Health was the most important QoL dimension for both the patient and the general population groups. While satisfaction with health was low in the patient group, the satisfaction ratings of the other seven domains were higher in the patient group than in the general population. The satisfaction with the domain partnership/sexuality showed a significant decline from t1 to t2. Multiple regression analyses showed that the domains health and income contributed most strongly to the global QoL score at t2 in the patient group. Conclusion Health is not the only relevant category when assessing QoL in cancer patients; social relationships and finances are pertinent as well. Importance ratings contribute to a better understanding of the relevance of the QoL dimensions for the patients.
Collapse
Affiliation(s)
- Katja Leuteritz
- Department of Medical Psychology and Medical Sociology, University of Leipzig, 04103, Leipzig, Germany
| | - Diana Richter
- Department of Medical Psychology and Medical Sociology, University of Leipzig, 04103, Leipzig, Germany
| | - Anja Mehnert-Theuerkauf
- Department of Medical Psychology and Medical Sociology, University of Leipzig, 04103, Leipzig, Germany
| | | | - Andreas Hinz
- Department of Medical Psychology and Medical Sociology, University of Leipzig, 04103, Leipzig, Germany.
| |
Collapse
|
25
|
Garin O, Suárez JF, Guedea F, Pont À, Pardo Y, Goñi A, Mariño A, Hervás A, Herruzo I, Cabrera P, Sancho G, Ponce de León J, Macías V, Gutierrez C, Castells M, Ferrer M. Comparative Effectiveness Research in Localized Prostate Cancer: A 10-Year Follow-up Cohort Study. Int J Radiat Oncol Biol Phys 2021; 110:718-726. [PMID: 33388360 DOI: 10.1016/j.ijrobp.2020.12.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/27/2020] [Accepted: 12/22/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Long-term comparative effectiveness research on localized prostate cancer treatments is scarce, and evidence is lacking especially for brachytherapy. The aim of this study was to assess the long-term impact of the side effects of radical prostatectomy, brachytherapy, and external radiation therapy on patients with localized prostate cancer at 10 years, using propensity score analyses. METHODS AND MATERIALS This was a prospective observational study of a cohort of men who received a diagnosis of clinically localized prostate cancer (clinical stage T1 or T2, low and intermediate risk group) and were treated with radical prostatectomy (n = 139), brachytherapy (n = 317), or external radiation therapy (n = 194). Treatment decisions were jointly made by patients and physicians. Patient-reported outcome (PRO) evaluation included the Expanded Prostate Cancer Index Composite and Short Form-36, administered centrally by telephone interviews before and annually after treatment. The Expanded Prostate Cancer Index Composite covers urinary, bowel, sexual, and hormonal domains. To assess PRO changes over time, while accounting for correlation among repeated measures, generalized estimating equation models adjusted by propensity scores were constructed. RESULTS The PRO completion rate at 10 years was 85.8%. Generalized estimating equation models showed that the pattern of radical prostatectomy side effects, with substantial urinary incontinence and sexual dysfunction, remained until 10 years after treatment (standard deviation [SD], -1.1 and -1.3, respectively). Brachytherapy produced late deterioration in urinary continence (SD, -0.4) and sexual function (SD, -0.9) that appeared midterm, but the differences from radical prostatectomy remained statistically significant at 10 years (P < .001 after adjusting by propensity score). External radiation therapy showed similar results to brachytherapy, but with bowel bother (SD, -0.3). CONCLUSIONS Although late deterioration in radiation therapy groups attenuated differences from radical prostatectomy, relevant PRO differences still remained after 10 years. Our findings support that brachytherapy is the treatment option that causes the least impact on PROs; it is therefore an alternative to be considered when making evidence-based decisions on localized prostate cancer treatment.
Collapse
Affiliation(s)
- Olatz Garin
- Health Services Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain; Pompeu Fabra University, Barcelona, Spain
| | | | - Ferran Guedea
- Institut Català d'Oncologia, L'Hospitalet de Llobregat, Spain
| | - Àngels Pont
- Health Services Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
| | - Yolanda Pardo
- Health Services Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain; Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Alai Goñi
- Institutu Onkologikoa, San Sebastián, Spain
| | - Alfonso Mariño
- Servicio de Oncología Radioterápica, Centro Oncológico de Galicia, A Coruña, Spain
| | - Asunción Hervás
- Servicio de Oncología Radioterápica, Hospital Ramón y Cajal, Madrid, Spain
| | - Ismael Herruzo
- Servicio de Oncología Radioterápica, Hospital Regional Carlos Haya, Málaga, Spain
| | - Patricia Cabrera
- Servicio de Oncología Radioterápica, Hospital Virgen del Rocío, Sevilla, Spain
| | - Gemma Sancho
- Servicio de Oncología Radioterápica, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Víctor Macías
- Hospital Universitario y Politecnico La Fe, Valencia, Spain
| | | | - Manel Castells
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Montse Ferrer
- Health Services Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain; Universitat Autònoma de Barcelona, Bellaterra, Spain.
| |
Collapse
|
26
|
Munoz F, Sanguineti G, Bresolin A, Cante D, Vavassori V, Waskiewicz JM, Girelli G, Avuzzi B, Garibaldi E, Faiella A, Villa E, Magli A, Noris Chiorda B, Gatti M, Rancati T, Valdagni R, Di Muzio NG, Fiorino C, Cozzarini C. Predictors of Patient-Reported Incontinence at Adjuvant/Salvage Radiotherapy after Prostatectomy: Impact of Time between Surgery and Radiotherapy. Cancers (Basel) 2021; 13:cancers13133243. [PMID: 34209562 PMCID: PMC8269132 DOI: 10.3390/cancers13133243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/16/2021] [Accepted: 06/24/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Baseline urinary incontinence (UI) strongly modulates UI recovery after adjuvant/salvage radiotherapy (ART/SRT), inducing clinicians to postpone it "as much as possible", maximizing UI recovery but possibly reducing efficacy. This series aims to analyze the trend of UI recovery and its predictors at radiotherapy start. METHODS A population of 408 patients treated with ART/SRT enrolled in a cohort study (ClinicalTrials.gov #NCT02803086) aimed at developing predictive models of radiation-induced toxicities. Self-reported UI and personality traits, evaluated by means of the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-SF) and Eysenck Personality Questionnaire - Revised (EPQ-R) questionnaires, were assessed at ART/SRT start. Several endpoints based on baseline ICIQ-SF were investigated: frequency and amount of urine loss (ICIQ3 and ICIQ4, respectively), "objective" UI (ICIQ3 + 4), "subjective" UI (ICIQ5), and "TOTAL" UI (ICIQ3 +4 + 5). The relationship between each endpoint and time from prostatectomy to radiotherapy (TTRT) was investigated. The association between clinical and personality variables and each endpoint was tested by uni- and multivariable logistic regression. RESULTS TTRT was the strongest predictor for all endpoints (p-values ≤ 0.001); all scores improved between 4 and 8 months after prostatectomy, without any additional long-term recovery. Neuroticism independently predicted subjective UI, TOTAL UI, and daily frequency. CONCLUSIONS Early UI recovery mostly depends on TTRT with no further improvement after 8 months from prostatectomy. Higher levels of neuroticism may overestimate UI.
Collapse
Affiliation(s)
- Fernando Munoz
- SC Radioterapia Oncologica, Ospedale Regionale Parini-AUSL Valle d’Aosta, 11100 Aosta, Italy;
| | - Giuseppe Sanguineti
- Deptartment of Radiotherapy, IRCCS Istituto Nazionale dei Tumori “Regina Elena”, 00144 Roma, Italy; (G.S.); (A.F.)
| | - Andrea Bresolin
- Deptartment of Medical Physics and Deptartment of Radiotherapy, IRCCS Istituto Scientifico Ospedale San Raffaele, 20132 Milano, Italy; (A.B.); (N.G.D.M.); (C.C.)
| | - Domenico Cante
- Deptartment of Radiotherapy, ASL TO4, Ospedale di Ivrea, 10015 Ivrea, Italy;
| | - Vittorio Vavassori
- Deptartment of Radiotherapy, Cliniche Gavazzeni-Humanitas, 24125 Bergamo, Italy; (V.V.); (E.V.)
| | | | - Giuseppe Girelli
- Deptartment of Radiotherapy, Ospedale degli Infermi, 22399 Biella, Italy;
| | - Barbara Avuzzi
- Deptartment of Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (B.A.); (B.N.C.); (T.R.); (R.V.)
| | - Elisabetta Garibaldi
- SC Radioterapia, AO SS Antonio e Biagio e Cesare Arrigo Alessandria, 15121 Alessandria, Italy;
| | - Adriana Faiella
- Deptartment of Radiotherapy, IRCCS Istituto Nazionale dei Tumori “Regina Elena”, 00144 Roma, Italy; (G.S.); (A.F.)
| | - Elisa Villa
- Deptartment of Radiotherapy, Cliniche Gavazzeni-Humanitas, 24125 Bergamo, Italy; (V.V.); (E.V.)
| | - Alessandro Magli
- Deptartment of Radiotherapy, Azienda Ospedaliero Universitaria S. Maria della Misericordia, 33100 Udine, Italy;
| | - Barbara Noris Chiorda
- Deptartment of Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (B.A.); (B.N.C.); (T.R.); (R.V.)
| | - Marco Gatti
- Istituto di Candiolo, Fondazione del Piemonte per l’Oncologia IRCCS, Candiolo, 10060 Torino, Italy;
| | - Tiziana Rancati
- Deptartment of Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (B.A.); (B.N.C.); (T.R.); (R.V.)
- Programma Prostata, Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
| | - Riccardo Valdagni
- Deptartment of Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy; (B.A.); (B.N.C.); (T.R.); (R.V.)
- Programma Prostata, Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, 20133 Milan, Italy
- Deptartment of Oncology and Hemato-Oncology, Università degli Studi di Milano, 20122 Milan, Italy
| | - Nadia G. Di Muzio
- Deptartment of Medical Physics and Deptartment of Radiotherapy, IRCCS Istituto Scientifico Ospedale San Raffaele, 20132 Milano, Italy; (A.B.); (N.G.D.M.); (C.C.)
| | - Claudio Fiorino
- Deptartment of Medical Physics and Deptartment of Radiotherapy, IRCCS Istituto Scientifico Ospedale San Raffaele, 20132 Milano, Italy; (A.B.); (N.G.D.M.); (C.C.)
- Correspondence:
| | - Cesare Cozzarini
- Deptartment of Medical Physics and Deptartment of Radiotherapy, IRCCS Istituto Scientifico Ospedale San Raffaele, 20132 Milano, Italy; (A.B.); (N.G.D.M.); (C.C.)
| |
Collapse
|
27
|
Ettridge K, Wright K, Smith D, Chambers S, Corsini N, Evans S, Moretti K, Roder D, Scuffham P, Miller C. Measuring psychosocial outcomes of men living with prostate cancer: feasibility of regular assessment of patient-reported outcomes. Eur J Cancer Care (Engl) 2020; 30:e13393. [PMID: 33368738 DOI: 10.1111/ecc.13393] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 11/21/2020] [Accepted: 11/27/2020] [Indexed: 01/29/2023]
Abstract
OBJECTIVE To trial collecting patient-reported outcome measures (PROMs) to assess psychosocial outcomes in men with prostate cancer (PC). METHODS A cross-sectional postal survey was sent to three groups of 160 men with PC (6, 12 and 24 months post-initial treatment; ntotal = 480), through the South Australian Prostate Cancer Clinical Outcomes Collaborative (SAPCCOC) registry (2017). Outcomes were as follows: response rate, completeness, general and disease-specific quality of life, distress, insomnia, fear of recurrence, decisional difficulties and unmet need. RESULTS A response rate of 57-61% (n = 284) was achieved across groups. Data completeness was over 90% for 88% of survey items, with lower response (76-78%) for EPIC-26 urinary and sexual functioning subscales, sexual aid use (78%) and physical activity (68%). In general, higher socio-economic indicators were associated with higher completion of these measures (absolute difference 12-26%, p < 0.05). Lower unmet need on the sexuality domain (SCNS-SF34) was associated with lower completion of the EPIC-26 sexual functioning subscale [M (SD) = 12.4 (21.6); M (SD) = 26.3 (27.3), p < .001]. Worse leaking urine was associated with lower completion of urinary pad/diaper use question (EPIC-26) [M (SD) = 65.9 (26.5), M (SD) = 77.3 (23.9), p < .01]. CONCLUSION Assessment of psychosocial PROMs through a PC registry is feasible and offers insight beyond global quality of life assessment, to facilitate targeting and improvements in services and treatments.
Collapse
Affiliation(s)
- Kerry Ettridge
- South Australian Health and Medical Institute, Adelaide, SA, Australia.,University of Adelaide, Adelaide, SA, Australia
| | - Kathleen Wright
- South Australian Health and Medical Institute, Adelaide, SA, Australia.,University of Adelaide, Adelaide, SA, Australia
| | - David Smith
- Cancer Council NSW, Woolloomooloo, NSW, Australia
| | - Suzanne Chambers
- University of Technology Sydney, Sydney, NSW, Australia.,Griffith University, Nathan, Qld, Australia
| | - Nadia Corsini
- University of South Australia, Adelaide, SA, Australia
| | - Susan Evans
- Monash University, Melbourne, Vic., Australia
| | - Kim Moretti
- University of Adelaide, Adelaide, SA, Australia.,University of South Australia, Adelaide, SA, Australia.,Monash University, Melbourne, Vic., Australia
| | - David Roder
- University of South Australia, Adelaide, SA, Australia
| | | | - Caroline Miller
- South Australian Health and Medical Institute, Adelaide, SA, Australia.,University of Adelaide, Adelaide, SA, Australia
| |
Collapse
|
28
|
Mazariego CG, Egger S, King MT, Juraskova I, Woo H, Berry M, Armstrong BK, Smith DP. Fifteen year quality of life outcomes in men with localised prostate cancer: population based Australian prospective study. BMJ 2020; 371:m3503. [PMID: 33028540 PMCID: PMC7539021 DOI: 10.1136/bmj.m3503] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To assess treatment related changes in quality of life up to 15 years after diagnosis of localised prostate cancer. DESIGN Population based, prospective cohort study with follow-up over 15 years. SETTING New South Wales, Australia. PARTICIPANTS 1642 men with localised prostate cancer, aged less than 70, and 786 controls randomly recruited from the New South Wales electoral roll into the New South Wales Prostate Cancer Care and Outcomes Study (PCOS). MAIN OUTCOME MEASURES General health and disease specific quality of life were self-reported at seven time points over a 15 year period, using the 12-item Short Form Health Survey scale, University of California, Los Angeles prostate cancer index, and expanded prostate cancer index composite short form (EPIC-26). Adjusted mean differences were calculated with controls as the comparison group. Clinical significance of adjusted mean differences was assessed by the minimally important difference, defined as one third of the standard deviation (SD) from the baseline score. RESULTS At 15 years, all treatment groups reported high levels of erectile dysfunction, depending on treatment (62.3% (active surveillance/watchful waiting, n=33/53) to 83.0% (non-nerve sparing radical prostatectomy, n=117/141)) compared with controls (42.7% (n=44/103)). Men who had external beam radiation therapy or high dose rate brachytherapy or androgen deprivation therapy as primary treatment reported more bowel problems. Self-reported urinary incontinence was particularly prevalent and persistent for men who underwent surgery, and an increase in urinary bother was reported in the group receiving androgen deprivation therapy from 10 to 15 years (year 10: adjusted mean difference -5.3, 95% confidence interval -10.8 to 0.2; year 15: -15.9; -25.1 to -6.7). CONCLUSIONS Patients receiving initial active treatment for localised prostate cancer had generally worse long term self-reported quality of life than men without a diagnosis of prostate cancer. Men treated with radical prostatectomy faired especially badly, particularly in relation to long term sexual outcomes. Clinicians and patients should consider these long term quality of life outcomes when making treatment decisions.
Collapse
Affiliation(s)
- Carolyn G Mazariego
- Cancer Research Division, Cancer Council New South Wales, Sydney, NSW, Australia
- University of Sydney, School of Public Health, Faculty of Medicine and Health, Sydney, NSW, Australia
| | - Sam Egger
- Cancer Research Division, Cancer Council New South Wales, Sydney, NSW, Australia
| | - Madeleine T King
- University of Sydney, Faculty of Science, School of Psychology, Sydney, NSW, Australia
| | - Ilona Juraskova
- University of Sydney, Faculty of Science, School of Psychology, Sydney, NSW, Australia
- Centre for Medical Psychology and Evidenced-based Decision-making (CeMPED), School of Psychology, Faculty of Science, University of Sydney, Sydney, NSW, Australia
| | - Henry Woo
- Chris O'Brien Lifehouse, Camperdown, NSW, Australia
| | - Martin Berry
- Riverina Cancer Centre, Wagga Wagga, NSW, Australia
| | - Bruce K Armstrong
- Cancer Epidemiology and Prevention Research, Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia
| | - David P Smith
- Cancer Research Division, Cancer Council New South Wales, Sydney, NSW, Australia
- University of Sydney, School of Public Health, Faculty of Medicine and Health, Sydney, NSW, Australia
- Menzies Health Institute Queensland, Griffith University, QLD, Australia
- School of Public Health and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| |
Collapse
|
29
|
Abstract
PURPOSE OF REVIEW Rapid advances in imaging of the prostate have facilitated the development of focal therapy and provided a non-invasive method of estimating tumour volume. Focal therapy relies on an accurate estimate of tumour volume for patient selection and treatment planning so that the optimal energy dose can be delivered to the target area(s) of the prostate while minimising toxicity to surrounding structures. This review provides an overview of different imaging modalities which may be used to optimise tumour volume assessment and critically evaluates the published evidence for each modality. RECENT FINDINGS Multi-parametric MRI (mp-MRI) has become the standard tool for patient selection and guiding focal therapy treatment. The current evidence suggests that mp-MRI may underestimate tumour volume, although there is a large variability in results. There remain significant methodological challenges associated with pathological processing and accurate co-registration of histopathological data with mp-MRI. Advances in different ultrasound modalities are showing promise but there has been limited research into tumour volume estimation. The role of PSMA PET/CT is still evolving and further investigation is needed to establish if this is a viable technique for prostate tumour volumetric assessment. mp-MRI provides the necessary tumour volume information required for selecting patients and guiding focal therapy treatment. The potential for underestimation of tumour volume should be taken into account and an additional margin applied to ensure adequate treatment coverage. At present, there are no other viable image-based alternatives although advances in new technologies may refine volume estimations in the future.
Collapse
|
30
|
|
31
|
Gross MD, Al Hussein Al Awamlh B, Hu JC. Assessing Treatment-Related Toxicity Using Administrative Data, Patient-Reported Outcomes, or Physician-Graded Toxicity: Where Is the Truth? Semin Radiat Oncol 2019; 29:333-337. [DOI: 10.1016/j.semradonc.2019.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
|
32
|
[Role of the nurse in the implementation of enhanced recovery after surgery]. Prog Urol 2019; 29:904-907. [PMID: 31473104 DOI: 10.1016/j.purol.2019.08.269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 08/08/2019] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Enhanced recovery after surgery (ERAS) requires a reorganization of care and optimal coordination of the different perioperative steps. The coordinating nurse has a crucial role in setting up such a protocol. MATERIAL AND METHODS We have identified the tasks of the coordinating nurse in the patient's management. RESULTS The role of the coordinator is major in the different steps to: inform the patient, reduce the consequences of surgical stress, solicit other actors according to the needs of the patient, anticipate the organization of care and discharge of the patient by staying in touch with a network of liberal nurses, detect alerts justifying readmission, promote and stimulate recovery of autonomy of the patient. CONCLUSION The coordinating nurse is one of the pillars of ERAS protocol, allowing a harmonization of the multidisciplinary management in order to establish an optimal organization between the patient and the different actors of the care course.
Collapse
|
33
|
Tyritzis SI, Wilderäng U, Lantz ΑW, Steineck G, Hugosson J, Bjartell A, Stranne J, Haglind E, Wiklund NP. Hospital readmissions after limited vs. extended lymph node dissection during open and robot-assisted radical prostatectomy. Urol Oncol 2019; 38:5.e1-5.e8. [PMID: 31445896 DOI: 10.1016/j.urolonc.2019.07.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2019] [Revised: 07/17/2019] [Accepted: 07/19/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE Differences exist concerning when and how to perform lymph node dissection (LND) during radical prostatectomy due to lack of high-grade evidence to its safety and efficacy. We aimed to compare readmission rates between limited and extended LND during open radical prostatectomy (ORP) and robot-assisted radical prostatectomy (RARP). MATERIALS AND METHODS We conducted a prospective trial of 3,706 eligible patients comparing ORP vs. RARP (LAPPRO). Six hundred and twenty-seven underwent concomitant LND. Data were retrieved for readmissions within 90 days from surgery from the Swedish Patient Registry. Causes for readmissions were classified according to the modified Clavien-Dindo classification system. We estimated risks for readmission stratified by type of LND and surgical approach. RESULTS We recorded 107 readmissions in 90 patients. The overall readmission rate was 14% (90/627). In the open group, extended LND had a higher, but not statistically significant readmission rate of 18% compared to 11% after limited LND (95%CI 0.87-3.01). In the robot-assisted group, readmissions after extended LND did not differ from limited LND (15% vs. 18%, 95%CI 0.49-1.61). RARP with limited LND showed a higher risk for any (RR 1.98, 95%CI [1.02-3.81]) as well as Clavien-Dindo grade 1 to 2 readmissions (RR 2.49, 95%CI [1.10-5.63]) compared to open approach with limited LND. Robot-assisted extended LND reduced the risk for Clavien-Dindo grade 3 to 5 complications leading to readmissions compared to the open approach by 59% (RR 0.41, 95%CI [0.19-0.87]). CONCLUSIONS The risk for hospital readmission was similar when performing limited or extended LND during a radical prostatectomy. Robot-assisted technique for performing extended LND may decrease the risk for severe complications.
Collapse
Affiliation(s)
- Stavros I Tyritzis
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institute; Department of Urology, HYGEIA Hospital, Athens, Greece.
| | - Ulrica Wilderäng
- Division of Clinical Cancer Epidemiology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg
| | | | - Gunnar Steineck
- Division of Clinical Cancer Epidemiology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg; Division of Clinical Cancer Epidemiology, Karolinska Institutet
| | - Jonas Hugosson
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg
| | - Anders Bjartell
- Department of Urology, Skåne University Hospital; Dept of Translational Medicine, Medical Faculty, Lund University, Sweden
| | - Johan Stranne
- Department of Urology, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg; Region Västra Götaland, Sahlgrenska University Hospital, Department of Urology, Gothenburg, Sweden
| | - Eva Haglind
- Department of Surgery, Institute of Clinical Sciences, Sahlgrenska Academy at the University of Gothenburg
| | - Nils Peter Wiklund
- Department of Molecular Medicine and Surgery, Section of Urology, Karolinska Institute; Department of Urology, ICAHN School of Medicine, Mount Sinai, New York, USA
| |
Collapse
|
34
|
Choiniere R, Richard PO, Morin M, Tu LM, Guyatt GH, Violette PD. Evaluation of benefits and harms of surgical treatments for post-radical prostatectomy urinary incontinence: a systematic review and meta-analysis protocol. F1000Res 2019; 8:1155. [PMID: 33381297 PMCID: PMC7689604 DOI: 10.12688/f1000research.19484.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2019] [Indexed: 12/29/2022] Open
Abstract
Background: Post-radical prostatectomy urinary incontinence (PPI) is a frequent and feared complication that can affect approximately 25% of patients. Between 1 and 10% of patients suffering from PPI will require surgery. The effectiveness of the available surgical interventions has only been compared in a few randomized controlled trials and the available reviews have important limitations regarding both benefits and harms that make them insufficient to inform decision-making. The aim of the study is to provide systematic summaries of benefits and harms of contemporary surgical treatment options for PPI through systematic review and meta-analysis using GRADE methodology and reporting in accord with the PRISMA-P statement. Methods: Studies pertaining to bulking agents, male synthetic slings, compressive balloon systems (ProACT) or artificial urinary sphincters (AUS) used for the treatment of patients suffering from PPI will be included. A systematic search will be conducted using the OVID and PubMED platforms in MEDLINE, Embase and Cochrane databases, and reference lists of relevant reviews and guidelines. Trained independent reviewers will conduct study selection and data extraction. Outcomes will include the number of pads used per day, the 24-h pad weight test, the Patient Global Impression of Improvement (PGI-I) and the Incontinence Quality of Life (IQOL) as possible benefits and the reoperations, the Clavien-Dindo complications and the other reported adverse events as the harms. When possible, pooled analyses will be completed. Risk of bias will be assessed using the CLARITY tools and a new tool for the before-and-after studies without a control group. Finally, study heterogeneity will be assessed, publication bias will be evaluated with funnel plots and quality of evidence rated for each outcome. Discussion: Our study will address patient-important outcomes and will be useful in clinical decision-making as well as identifying key elements for future research. Study registration: PROSPERO: CRD42018073923 05/12/2018.
Collapse
Affiliation(s)
| | - Patrick O. Richard
- Research Center, University of Sherbrooke, Sherbrooke, Quebec, Canada
- Division of Urology, Department of Surgery, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Melanie Morin
- Research Center, University of Sherbrooke, Sherbrooke, Quebec, Canada
- School of Rehabilitation, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Le-Mai Tu
- Research Center, University of Sherbrooke, Sherbrooke, Quebec, Canada
- Division of Urology, Department of Surgery, University of Sherbrooke, Sherbrooke, Quebec, Canada
| | - Gordon H. Guyatt
- Departments of Health Research Methods, Evidence and Impact (HEI) and Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Philippe D. Violette
- Departments of Health Research Methods, Evidence and Impact (HEI) and Surgery, McMaster University, Hamilton, Ontario, Canada
| |
Collapse
|
35
|
Abstract
Multimodal regimens consist en more than one treatment to treat localized prostate cancer. They are now proposed routinely for high-risk diseases. Different approaches could be defined: In conclusion, multimodal regimens increase the risk of side effects compared to surgery or radiotherapy alone. Indications of these approaches muste be discussed with the patients after a careful evaluation of the benefit/risk ratio.
Collapse
Affiliation(s)
- C Hennequin
- Service d'oncologie radiothérapie, hôpital Saint-Louis, AP-HP, Paris France.
| |
Collapse
|
36
|
Agochukwu NQ, Wittmann D, Boileau NR, Dunn RL, Montie JE, Kim T, Miller DC, Peabody J, Carlozzi NE. Validity of the Patient-Reported Outcome Measurement Information System (PROMIS) Sexual Interest and Satisfaction Measures in Men Following Radical Prostatectomy. J Clin Oncol 2019; 37:2017-2027. [PMID: 31232671 DOI: 10.1200/jco.18.01782] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
Abstract
PURPOSE Patient-reported outcomes after radical prostatectomy have focused on erectile function. To date, no studies have validated the Patient-Reported Outcome Measurement Information System (PROMIS) Sexual Interest and Satisfaction single item measures in patients with prostate cancer, nor have studies examined how these measures relate to erectile function. In addition, data are lacking with regard to the clinical responsiveness of these measures to treatment. We sought to validate and examine the clinical utility of these measures in men after radical prostatectomy. PATIENTS AND METHODS We identified men who underwent a robotic radical prostatectomy from May 2014 to January 2016 in the Michigan Urological Surgery Improvement Collaborative. A single item from the PROMIS Global Satisfaction With Sex Life subdomain and a single item from the PROMIS Interest in Sexual Activity subdomain were administered. Erectile function was also assessed. Differences between baseline and 24-month T-scores for both PROMIS interest and satisfaction were examined. Multilevel models were constructed to examine change over time. RESULTS A total of 1,604 patients were included in the analysis. Convergent and discriminant validity of the PROMIS measures was supported. The mean PROMIS interest T-score decreased significantly from baseline to 3 months (P = .001) and significantly increased from 3 months to 24 months in this cohort, with 24-month scores exceeding baseline scores (P < .001). The mean PROMIS satisfaction T-score declined from baseline to 3 months and increased from 3 months to 24 months (P < .002). CONCLUSION PROMIS Global Satisfaction With Sex Life and Interest in Sexual Activity single-item measures are fundamental measures in prostate cancer survivorship. Patients are interested in sex despite functional losses and can salvage satisfaction, thereby giving insight into attainable patient-centered survivorship goals for sexual recovery after radical prostatectomy.
Collapse
Affiliation(s)
- Nnenaya Q Agochukwu
- 1University of Michigan Health System, Ann Arbor, MI.,2University of Michigan, Ann Arbor, MI
| | - Daniela Wittmann
- 1University of Michigan Health System, Ann Arbor, MI.,2University of Michigan, Ann Arbor, MI
| | | | - Rodney L Dunn
- 1University of Michigan Health System, Ann Arbor, MI.,2University of Michigan, Ann Arbor, MI
| | - James E Montie
- 1University of Michigan Health System, Ann Arbor, MI.,2University of Michigan, Ann Arbor, MI
| | - Tae Kim
- 1University of Michigan Health System, Ann Arbor, MI.,2University of Michigan, Ann Arbor, MI
| | - David C Miller
- 1University of Michigan Health System, Ann Arbor, MI.,2University of Michigan, Ann Arbor, MI
| | | | | | | |
Collapse
|
37
|
Moon DH, Basak RS, Usinger DS, Dickerson GA, Morris DE, Perman M, Lim M, Wibbelsman T, Chang J, Crawford Z, Broughman JR, Godley PA, Chen RC. Patient-reported Quality of Life Following Stereotactic Body Radiotherapy and Conventionally Fractionated External Beam Radiotherapy Compared with Active Surveillance Among Men with Localized Prostate Cancer. Eur Urol 2019; 76:391-397. [PMID: 30857758 PMCID: PMC6698206 DOI: 10.1016/j.eururo.2019.02.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2018] [Accepted: 02/19/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Evidence supporting the efficacy of stereotactic body radiotherapy (SBRT) for localized prostate cancer is accumulating, but comparative studies of patient-reported quality of life (QOL) following SBRT versus conventionally fractionated external beam radiotherapy (EBRT) or active surveillance (AS) are limited. OBJECTIVE To compare QOL of patients pursuing SBRT and EBRT versus AS. DESIGN, SETTING, AND PARTICIPANTS A population-based cohort of 680 men with newly diagnosed localized prostate cancer was prospectively enrolled from 2011 to 2013. INTERVENTION SBRT, EBRT without androgen deprivation therapy, or AS. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS QOL was prospectively assessed before treatment (baseline), and at 3, 12, and 24mo after treatment using the validated Prostate Cancer Symptom Indices, which contain four domains: sexual dysfunction, urinary obstruction/irritation, urinary incontinence, and bowel problems. Propensity weighting via logistic regression models was used to balance baseline characteristics, and the mean QOL scores of EBRT and SBRT patients were compared against AS patients as the control group. RESULTS AND LIMITATIONS Compared with AS patients, EBRT patients had worse urinary obstructive/irritative symptoms and sexual dysfunction at 3mo, and worse bowel symptoms at 3 and 24mo. SBRT patients had similar scores as AS patients in all domains and across all time points; however, due to small sample size, worse sexual function and urinary incontinence in SBRT patients cannot be ruled out. Further research is needed to assess long-term outcomes. CONCLUSIONS In a nonrandomized cohort of men with localized prostate cancer, SBRT appeared to result in favorable QOL results through 2yr of follow-up, but worse sexual function and urinary incontinence compared with AS cannot be ruled out completely. Larger studies with longer follow-up are needed to confirm these findings. PATIENT SUMMARY Stereotactic body radiotherapy (SBRT) and active surveillance appear to have similar quality of life outcomes through 2yr, although worse sexual function and urinary incontinence from SBRT cannot be ruled out completely.
Collapse
Affiliation(s)
- Dominic H Moon
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ram S Basak
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Deborah S Usinger
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | | | | | - Maili Lim
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Turner Wibbelsman
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jerry Chang
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Zachary Crawford
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - James R Broughman
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Paul A Godley
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Ronald C Chen
- Department of Radiation Oncology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| |
Collapse
|
38
|
Chien CH, Chuang CK, Liu KL, Pang ST, Wu CT, Chang YH. Prostate cancer-specific anxiety and the resulting health-related quality of life in couples. J Adv Nurs 2018; 75:63-74. [DOI: 10.1111/jan.13828] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 05/21/2018] [Accepted: 07/18/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Ching-Hui Chien
- College of Nursing; National Taipei University of Nursing and Health Sciences; Taipei Taiwan
| | - Cheng-Keng Chuang
- Division of Urology; Department of Surgery; Chang Gung Memorial Hospital at Linkou; Taiwan
- College of Medicine; Chang Gung University; Tao-Yuan Taiwan
| | - Kuan-Lin Liu
- Division of Urology; Department of Surgery; Chang Gung Memorial Hospital at Linkou; Taiwan
| | - See-Tong Pang
- Division of Urology; Department of Surgery; Chang Gung Memorial Hospital at Linkou; Taiwan
- College of Medicine; Chang Gung University; Tao-Yuan Taiwan
| | - Chun-Te Wu
- College of Medicine; Chang Gung University; Tao-Yuan Taiwan
- Division of Urology; Department of Surgery; Chang Gung Memorial Hospital at Keelung; Taiwan
| | - Ying-Hsu Chang
- Division of Urology; Department of Surgery; Chang Gung Memorial Hospital at Linkou; Taiwan
- College of Medicine; Chang Gung University; Tao-Yuan Taiwan
| |
Collapse
|