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Devlies W, Silversmit G, Ameye F, Dekuyper P, Quackels T, Roumeguère T, Van Cleynenbreugel B, Van Damme N, Claessens F, Everaerts W, Joniau S. Functional Outcomes and Quality of Life in High-risk Prostate Cancer Patients Treated by Robot-assisted Radical Prostatectomy with or Without Adjuvant Treatments. Eur Urol Oncol 2024:S2588-9311(24)00107-X. [PMID: 38755093 DOI: 10.1016/j.euo.2024.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/26/2024] [Accepted: 04/23/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND Robot-assisted laparoscopic prostatectomy (RALP) is used frequently to treat prostate cancer; yet, prospective data on the quality of life and functional outcomes are lacking. OBJECTIVE To assess the quality of life and functional outcomes after radical prostatectomy in different risk groups with or without adjuvant treatments. DESIGN, SETTING, AND PARTICIPANTS The Be-RALP database is a prospective multicentre database that covers 9235 RALP cases from 2009 until 2016. Of these 9235 patients, 2336 high-risk prostate cancer patients were matched with low/intermediate-risk prostate cancer patients. INTERVENTION Patients were treated with RALP only or followed by radiotherapy and/or hormone treatment. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We used a mixed-model analysis to longitudinally analyse quality of life, urinary function, and erectile function between risk groups with or without additional treatments. RESULTS AND LIMITATIONS Risk group was not significant in predicting quality of life, erectile function, or urinary function after RALP. Postoperative treatment (hormone and/or radiotherapy treatment) was significant in predicting International Index of Erectile Function (IIEF-5), sexual activity, and sexual functioning. CONCLUSIONS Risk group was not linked with clinically relevant declines in functional outcomes after RALP. The observed functional outcomes and quality of life are in favour of considering RALP for high-risk prostate cancer. Postoperative treatment resulted in lower erectile function measures without clinically relevant changes in quality of life and urinary functions. Hormone therapy seems to have the most prominent negative effects on these outcomes. PATIENT SUMMARY This study investigated the quality of life, and urinary and erectile function in patients with aggressive and less aggressive prostate cancer after surgery only or in combination with hormones or radiation. We found that quality of life recovers completely, while erectile and urinary function recovers only partially after surgery. Aggressiveness of the disease had a minimal effect on the outcomes; yet, postoperative treatments lowered erectile function further.
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Affiliation(s)
- Wout Devlies
- Department of Urology, KU Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Leuven, Belgium.
| | | | - Filip Ameye
- Department of Urology, Maria Middelares Hospital, Ghent, Belgium
| | - Peter Dekuyper
- Department of Urology, Maria Middelares Hospital, Ghent, Belgium
| | - Thierry Quackels
- Department of Urology, Université Libre De Bruxelles, Brussels, Belgium
| | | | | | | | - Frank Claessens
- Laboratory of Molecular Endocrinology, KU Leuven, Leuven, Belgium
| | - Wouter Everaerts
- Department of Urology, KU Leuven, Leuven, Belgium; Department of Cellular and Molecular Medicine, KU Leuven, Belgium
| | - Steven Joniau
- Department of Urology, KU Leuven, Leuven, Belgium; Department of Development and Regeneration, KU Leuven, Leuven, Belgium
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Qazi SU, Altaf Z, Zafar M, Tariq MA, Khalid A, Kaleem A, Saad E, Qazi S. Development of depression in patients using androgen deprivation therapy: A systemic review and meta-analysis. Prostate 2024; 84:525-538. [PMID: 38372065 DOI: 10.1002/pros.24676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 12/29/2023] [Accepted: 02/02/2024] [Indexed: 02/20/2024]
Abstract
BACKGROUND Androgen deprivation therapy (ADT) is an effective treatment for advanced prostate cancer (PCa). Multiple studies have highlighted serious consequences this therapy poses to mental health, particularly depression. We aimed to review the incidence and association between ADT in men with PCa and the risk of depression. METHODS We systematically searched multiple databases, including MEDLINE, Scopus till August 2023 for studies that compared ADT versus control for treating PCa reporting depression as outcome. Meta-analysis was performed using random-effects models and results presented as odds ratios (ORs) with 95% confidence interval (CI). Quality assessment of the included studies was conducted using Joanna Briggs Institute critical appraisal checklists. RESULTS A total of 38 studies (17 retrospective studies, 16 prospective studies, two cross-sectional studies and two randomized trials) with 360,650 subjects met the inclusion criteria and were included in this meta-analysis. The estimated pooled incidence of depression among ADT patients is 209.5 (95% CI = 122.3; 312.2) per 1000 patients. There is statistically significant relationship between ADT treatment and depression (OR = 1.46, 95% CI = 1.28, 1.67; p = 0, I2 = 86.4%). The results remained consistent across various subgroups. No risk of publication bias was detected by funnel plot and Eggers's test (p > 0.05). CONCLUSION There is a higher risk of depression for men receiving ADT. Further studies evaluating optimal treatments for depression in men on ADT are warranted.
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Affiliation(s)
- Shurjeel Uddin Qazi
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Zahabia Altaf
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Mariam Zafar
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Ali Tariq
- Department of Surgery, Dow International Medical College, Karachi, Pakistan
| | - Areesha Khalid
- Department of Surgery, Dow International Medical College, Karachi, Pakistan
| | - Aleesha Kaleem
- Department of Surgery, Dow International Medical College, Karachi, Pakistan
| | - Emaan Saad
- Department of Surgery, Dow International Medical College, Karachi, Pakistan
| | - Sana Qazi
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
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Hu S, Chang CP, Snyder J, Deshmukh V, Newman M, Date A, Galvao C, Haaland B, Porucznik CA, Gren LH, Sanchez A, Lloyd S, O’Neil B, Hashibe M. Mental health outcomes in a population-based cohort of patients with prostate cancer. J Natl Cancer Inst 2024; 116:445-454. [PMID: 37867158 PMCID: PMC10919332 DOI: 10.1093/jnci/djad175] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 06/07/2023] [Accepted: 08/24/2023] [Indexed: 10/24/2023] Open
Abstract
BACKGROUND Few studies have evaluated mental health disorders comprehensively among patients with prostate cancer on long-term follow-up. The primary aim of our study was to assess the incidence of mental health disorders among patients with prostate cancer compared with a general population cohort. A secondary aim was to investigate potential risk factors for mental health disorders among patients with prostate cancer. METHODS Cohorts of 18 134 patients with prostate adenocarcinomas diagnosed between 2004 and 2017 and 73470 men without cancer matched on age, birth state, and follow-up time were identified. Mental health diagnoses were identified from electronic health records and statewide health-care facilities data. Cox proportional hazard models were used to estimate hazard ratios. All statistical tests were 2-sided. RESULTS The hazard ratios for mood disorders, including depression, among prostate cancer survivors increased for all follow-up periods compared with the general population. The hazard ratios for any mental illness increased with Hispanic, Black, or multiple races; people who were underweight or obese; those with advanced prostate cancer; and those undergoing their first course cancer treatment. We also observed statistically significantly increased hazard ratios for mental health disorders among patients with lower socioeconomic status (P < .0001) and increasing duration of androgen-deprivation therapy (P = .0348). Prostate cancer survivors had a 61% increased hazard ratio for death with a depression diagnosis. CONCLUSION Prostate cancer diagnosis was associated with a higher risk of mental health disorders compared with the general population, which was observed as long as 10-16 years after cancer diagnosis. Providing long-term mental health support may be beneficial to increasing life expectancy for patients with prostate cancer.
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Affiliation(s)
- Siqi Hu
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Chun-Pin Chang
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - John Snyder
- Intermountain Healthcare, Salt Lake City, UT, USA
| | - Vikrant Deshmukh
- University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Michael Newman
- University of Utah Health Sciences Center, Salt Lake City, UT, USA
| | - Ankita Date
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Carlos Galvao
- Pedigree and Population Resource, Population Sciences, Huntsman Cancer Institute, Salt Lake City, UT, USA
| | - Benjamin Haaland
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Department of Population Health Sciences, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Christina A Porucznik
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Lisa H Gren
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Alejandro Sanchez
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Shane Lloyd
- Department of Radiation Oncology, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Brock O’Neil
- Division of Urology, Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Mia Hashibe
- Huntsman Cancer Institute, Salt Lake City, UT, USA
- Division of Public Health, Department of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, UT, USA
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Spampinato S, Rancati T, Waskiewicz JM, Avuzzi B, Garibaldi E, Faiella A, Villa E, Magli A, Cante D, Girelli G, Gatti M, Noris Chiorda B, Rago L, Ferrari P, Piva C, Pavarini M, Valdagni R, Vavassori V, Munoz F, Sanguineti G, Di Muzio N, Kirchheiner K, Fiorino C, Cozzarini C. Patient-reported persistent symptoms after radiotherapy and association with quality of life for prostate cancer survivors. Acta Oncol 2023; 62:1440-1450. [PMID: 37801288 DOI: 10.1080/0284186x.2023.2259597] [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: 05/25/2023] [Accepted: 09/11/2023] [Indexed: 10/07/2023]
Abstract
PURPOSE To evaluate the persistence of symptoms after radiotherapy (RT) for localised prostate cancer (PCa) and the association with quality of life (QOL). MATERIALS AND METHODS Prospective patient-reported outcome (PRO) from a multi-institutional study on PCa treated with radical RT (2010-2014) was analysed. Data was collected at baseline (BL) and follow-ups (FUPs) up to 5 years. Patients with BL and ≥3 late FUPs (≥6 months) were analysed. PRO was scored by means of the IPSS and ICIQ-SF (urinary), LENT-SOMA (gastrointestinal [GI]), and EORTC-C30 (pain, insomnia, fatigue, and QOL) questionnaires. Symptoms were defined 'persistent' if the median score over FUPs was ≥3 (urinary) or ≥2 (GI, pain, insomnia, and fatigue), and worse than BL. Different thresholds were chosen to have enough events for each symptom. QOL was linearly transformed on a continuous scale (0-100). Linear-mixed models were used to identify significant differences between groups with and without persistent symptoms including age, smoking status, previous abdominal surgery, and diabetes as confounders. Mean QOL differences between groups were evaluated longitudinally over FUPs. RESULTS The analysis included 293 patients. Persistent urinary symptoms ranged from 2% (straining) to 12% (weak stream, and nocturia). Gastrointestinal symptoms ranged from 7% (rectal pain, and incontinence) to 30% (urgency). Proportions of pain, insomnia, and fatigue were 6, 13, and 18%. Significant QOL differences of small-to-medium clinical relevance were found for urinary incontinence, frequency, urgency, and nocturia. Among GI symptoms, rectal pain and incontinence showed small-to-medium differences. Fatigue was associated with the largest differences. CONCLUSIONS The analysis showed that symptoms after RT for PCa occur with different persistence and their association with QOL varies in magnitude. A number of persistent urinary and GI symptoms showed differences in a comparable range. Urinary incontinence and frequency, rectal pain, and faecal incontinence more often had significant associations. Fatigue was also prevalent and associated with largely deteriorated QOL.
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Affiliation(s)
- Sofia Spampinato
- Danish Centre for Particle Therapy, Aarhus University Hospital, Aarhus, Denmark
| | - Tiziana Rancati
- Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
| | | | - Barbara Avuzzi
- Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Elisabetta Garibaldi
- Department of Radiotherapy, Ospedale Regionale Parini-AUSL Valle d'Aosta, Aosta, Italy
| | - Adriana Faiella
- Department of Radiotherapy, IRCCS Istituto Tumori 'Regina Elena', Rome, Italy
| | - Elisa Villa
- Department of Radiotherapy, Humanitas Gavazzeni, Bergamo, Italy
| | - Alessandro Magli
- Department of Radiotherapy, Azienda Ospedaliero Universitaria S. Maria della Misericordia, Udine, Italy
| | - Domenico Cante
- Department of Radiotherapy, ASL TO4 Ospedale di Ivrea, Ivrea, Italy
| | - Giuseppe Girelli
- Department of Radiotherapy, Ospedale degli Infermi, Biella, Italy
| | - Marco Gatti
- Department of Radiotherapy, Istituto di Candiolo - Fondazione del Piemonte per l'Oncologia IRCCS, Candiolo, Italy
| | - Barbara Noris Chiorda
- Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Luciana Rago
- Department of Radiotherapy, IRCCS CROB, Rionero in Vulture, Italy
| | - Paolo Ferrari
- Department of Health Physics, Provincial Hospital of Bolzano (SABES-ASDAA), Bolzano-Bozen, Italy; Lehrkrankenhaus der Paracelsus Medizinischen Privatuniversität
| | - Cristina Piva
- Department of Radiotherapy, ASL TO4 Ospedale di Ivrea, Ivrea, Italy
| | - Maddalena Pavarini
- Department of Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Riccardo Valdagni
- Department of Radiation Oncology, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | | | - Fernando Munoz
- Department of Radiotherapy, Ospedale Regionale Parini-AUSL Valle d'Aosta, Aosta, Italy
| | - Giuseppe Sanguineti
- Department of Radiotherapy, IRCCS Istituto Tumori 'Regina Elena', Rome, Italy
| | - Nadia Di Muzio
- Department of Radiotherapy, San Raffaele Scientific Institute and Università Vita Salute San Raffaele, Milan, Italy
| | - Kathrin Kirchheiner
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria
| | - Claudio Fiorino
- Department of Medical Physics, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Cesare Cozzarini
- Department of Radiotherapy, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Physical and psychosocial factors associated with sexual satisfaction in long-term cancer survivors 5 and 10 years after diagnosis. Sci Rep 2023; 13:2011. [PMID: 36737619 PMCID: PMC9898518 DOI: 10.1038/s41598-023-28496-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 01/19/2023] [Indexed: 02/05/2023] Open
Abstract
Our study provides data on sexual satisfaction among long-term cancer survivors 5 and 10 years after diagnosis, and identifies factors detrimental (e.g. psychosocial and physical symptom burden) or beneficial (e.g. social support) to survivors' sexual satisfaction. We measured sexual satisfaction among cancer survivors recruited via the local clinical cancer registry across a wide range of tumor sites 5 years (cohort 1) and 10 years (cohort 2) after diagnosis. We further assessed chronic comorbidity index (CCI) and symptom scales (EORTC QLQ-C30), depression (PHQ-9) and anxiety (GAD-7), satisfaction with partnership (PFB), quality of life (EORTC QLQ-C30), and social support (OSSS). 924 patients (5-year cohort = 608/10-year cohort = 316) participated in the study (53% men, 80% cohabiting, mean age 66 years, range 18-85). We found that nearly half of the respondents perceived their sexual life as less satisfying than before cancer. High sexual satisfaction was associated with a low chronic comorbidities index (r = - 0.27, p < .001), less fatigue (r = - 0.35, p<.001), less nausea/vomiting (r = - 0.13, p<.001) and less pain (r = - 0.23, p<.001), r ; less depression (r = - 0.24, p < .001), less anxiety(r = - 0.23, p < .001); a high level of social support (r = 0.16, p < .001), a high level of satisfaction with their relationship (r = 0.24, p < .001), and high quality of life (r = 0.33, p < .001). Sexual satisfaction may be affected by both psychosocial and physical symptom burden, with the latter having a greater impact on sexual satisfaction. It is essential for health care providers that sexual health issues are understood, evaluated, and treated, including those of long-term cancer survivors.
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Health-related quality of life in long-term Caribbean prostate cancer survivors: comparisons with prostate cancer-free men. Qual Life Res 2022; 31:3391-3401. [PMID: 35900615 DOI: 10.1007/s11136-022-03202-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/09/2022] [Indexed: 11/12/2022]
Abstract
PURPOSE Prostate cancer (PCa) and its treatment can impact health-related quality of life (HRQoL). There are few studies of HRQoL in long-term PCa survivors of African ancestry from low- and middle-income countries. We examined the effect of PCa treatment on HRQoL of Jamaican PCa survivors compared with cancer-free controls and explored the effect of demographic and clinical factors on these outcomes. METHODS PCa survivors (n = 64) treated with and without ADT along with PCa-free controls (n = 88) from a case-control study of 10 years post enrolment. HRQoL was measured using the European Organisation for Research and Treatment of Cancer Quality of Life (EORTC-QLQ-C30). Effects of demographic and clinical variables on HRQoL on PCa and type of therapy were evaluated in multivariable linear regression models. RESULTS HRQoL of PCa survivors (overall and by treatment group) indicated a high quality of life, comparable to PCa-free men. However, ADT-treated survivors had lower physical functioning that was of small clinical relevance compared with those not on ADT. Symptom burden scores of PCa survivors and controls were similar excluding fatigue and dyspnoea which were highest in men on ADT and controls. In multivariable models, PCa was not an important determinant of overall HRQoL, functioning or symptom burdens. Underlying medical conditions and marital status were the main contributors to HRQoL in PCa survivors. CONCLUSION PCa cancer status was not an independent determinant of long-term HRQoL in Jamaican men. Interventions addressing social factors and comorbid illnesses could improve HRQOL in long-term PCa survivors.
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Stamp E, Clarke G, Wright P, Velikova G, Crossfield SSR, Zucker K, McInerney C, Bojke C, Martin A, Baxter P, Woroncow B, Wilson D, Warrington L, Absolom K, Burke D, Stables GI, Mitra A, Hutson R, Glaser AW, Hall G. Collection of cancer Patient Reported Outcome Measures (PROMS) to link with primary and secondary electronic care records to understand and improve long term cancer outcomes: A protocol paper. PLoS One 2022; 17:e0266804. [PMID: 35427401 PMCID: PMC9012381 DOI: 10.1371/journal.pone.0266804] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 03/29/2022] [Indexed: 12/24/2022] Open
Abstract
Introduction More people are living with and beyond a cancer diagnosis. There is limited understanding of the long-term effects of cancer and cancer treatment on quality of life and personal and household finances when compared to people without cancer. In a separate protocol we have proposed to link de-identified data from electronic primary care and hospital records for a large population of cancer survivors and matched controls. In this current protocol, we propose the linkage of Patient Reported Outcomes Measures data to the above data for a subset of this population. The aim of this study is to investigate the full impact of living with and beyond a cancer diagnosis compared to age and gender matched controls. A secondary aim is to test the feasibility of the collection of Patient Reported Outcomes Measures (PROMS) data and the linkage procedures of the PROMs data to electronic health records data. Materials and methods This is a cross-sectional study, aiming to recruit participants treated at the Leeds Teaching Hospitals National Health Service Trust. Eligible patients will be cancer survivors at around 5 years post-diagnosis (breast, colorectal and ovarian cancer) and non-cancer patient matched controls attending dermatology out-patient clinics. They will be identified by running a query on the Leeds Teaching Hospitals Trust patient records system. Approximately 6000 patients (2000 cases and 4000 controls) will be invited to participate via post. Participants will be invited to complete PROMs assessing factors such as quality of life and finances, which can be completed on paper or online (surveys includes established instruments, and bespoke instruments (demographics, financial costs). This PROMs data will then be linked to routinely collected de-identified data from patient’s electronic primary care and hospital records. Discussion This innovative work aims to create a truly ‘comprehensive patient record’ to provide a broad picture of what happens to cancer patients across their cancer pathway, and the long-term impact of cancer treatment. Comparisons can be made between the cases and controls, to identify the aspects of life that has had the greatest impact following a cancer diagnosis. The feasibility of linking PROMs data to electronic health records can also be assessed. This work can inform future support offered to people living with and beyond a cancer diagnosis, clinical practice, and future research methodologies.
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Affiliation(s)
- Elizabeth Stamp
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, United Kingdom
- School of Sport, Exercise, and Health Sciences, Loughborough University, Loughborough, United Kingdom
- * E-mail:
| | - Gemma Clarke
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, United Kingdom
- Academic Unit of Palliative Care, University of Leeds School of Medicine, Leeds, United Kingdom
| | - Penny Wright
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, United Kingdom
| | - Galina Velikova
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, United Kingdom
| | | | - Kieran Zucker
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, United Kingdom
| | | | - Chris Bojke
- Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Adam Martin
- Academic Unit of Health Economics, School of Medicine, University of Leeds, Leeds, United Kingdom
| | - Paul Baxter
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, United Kingdom
| | - Barbara Woroncow
- PPI Member, Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, United Kingdom
| | - David Wilson
- PPI Member, Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, United Kingdom
| | - Lorraine Warrington
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, United Kingdom
| | - Kate Absolom
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, United Kingdom
| | - Dermot Burke
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | | | - Angana Mitra
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Richard Hutson
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Adam W. Glaser
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, United Kingdom
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
| | - Geoff Hall
- Leeds Institute of Medical Research at St James’s, University of Leeds, Leeds, United Kingdom
- Leeds Teaching Hospitals NHS Trust, Leeds, United Kingdom
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Fukuda K, Muto S, China T, Koyasu H, Noma Y, Ashizawa T, Hirano H, Kitamura K, Shimizu F, Nagata M, Isotani S, Horie S. Clinical use of expanded prostate cancer index composite-based health-related quality of life outcomes after robot-assisted radical prostatectomy for localized prostate cancer. Prostate Int 2021; 10:62-67. [PMID: 35510095 PMCID: PMC9042679 DOI: 10.1016/j.prnil.2021.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 07/11/2021] [Accepted: 08/22/2021] [Indexed: 11/19/2022] Open
Abstract
Background This study aimed to assess the longitudinal health-related quality of life (HRQOL) using the Expanded Prostate Cancer Index Composite (EPIC) and HRQOL change between the nerve-sparing technique in Japanese men treated with robot-assisted radical prostatectomy (RARP). Methods A total of 573 patients who received RARP were included in this study. EPIC questionnaire was administered before treatment and up to 36 months after RARP. Clinical recovery was defined as half of the standard deviation of the baseline score for each domain. We divided all patients into recovery group or nonrecovery group. The time from survey to each domain recovery was calculated using the Kaplan–Meier method. We compared the sexual and urinary score change between groups using analysis of variance to confirm the effect of nerve-sparing technique. Results The median age was 67 years (interquartile range, 62–71 years). The mean score of all urinary domains worsened noticeably after 1 month. All postoperative urinary summary, function, and incontinence scores were significantly lower than preoperative scores up to 3 years post-RARP. Postoperative sexual summary and functional scores were significantly lower than preoperative score at all follow-up times throughout the 36 months. The recovery rate for the urinary incontinence domain was the lowest (44.5%), whereas the recovery rate for the urinary irritative–obstructive domain was the highest (73.7%). In the sexual domain, the bother domain had a higher recovery rate (73.0%) than the functional domain (29.7%). Although the recovery of sexual domains was slower compared with other domains, by 36 months after RARP, almost all values had recovered. Compared with other technique groups, bilateral intrafascial nerve-sparing group showed significantly decreased change in subscale scores before and after RARP in several sexual and urinary domain. Conclusion The time course and extent of functional and bother domain recovery documented in this study may prove useful for RARP patient selection in Japan.
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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.
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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.
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Joshy G, Thandrayen J, Koczwara B, Butow P, Laidsaar-Powell R, Rankin N, Canfell K, Stubbs J, Grogan P, Bailey L, Yazidjoglou A, Banks E. Disability, psychological distress and quality of life in relation to cancer diagnosis and cancer type: population-based Australian study of 22,505 cancer survivors and 244,000 people without cancer. BMC Med 2020; 18:372. [PMID: 33256726 PMCID: PMC7708114 DOI: 10.1186/s12916-020-01830-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Accepted: 10/27/2020] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Improved survival means that cancer is increasingly becoming a chronic disease. Understanding and improving functional outcomes are critical to optimising survivorship. We quantified physical and mental health-related outcomes in people with versus without cancer, according to cancer type. METHODS Questionnaire data from an Australian population-based cohort study (45 and Up Study (n = 267,153)) were linked to cancer registration data to ascertain cancer diagnoses up to enrolment. Modified Poisson regression estimated age- and sex-adjusted prevalence ratios (PRs) for adverse person-centred outcomes-severe physical functional limitations (disability), moderate/high psychological distress and fair/poor quality of life (QoL)-in participants with versus without cancer, for 13 cancer types. RESULTS Compared to participants without cancer (n = 244,000), cancer survivors (n = 22,505) had greater disability (20.6% versus 12.6%, respectively, PR = 1.28, 95%CI = (1.25-1.32)), psychological (22.2% versus 23.5%, 1.05 (1.02-1.08)) and poor/fair QoL (15.2% versus 10.2%; 1.28 (1.24-1.32)). The outcomes varied by cancer type, being worse for multiple myeloma (PRs versus participants without cancer for disability 3.10, 2.56-3.77; distress 1.53, 1.20-1.96; poor/fair QoL 2.40, 1.87-3.07), lung cancer (disability 2.81, 2.50-3.15; distress 1.67, 1.46-1.92; poor/fair QoL 2.53, 2.21-2.91) and non-Hodgkin's lymphoma (disability 1.56, 1.37-1.78; distress 1.20, 1.05-1.36; poor/fair QoL 1.66, 1.44-1.92) and closer to those in people without cancer for breast cancer (disability 1.23, 1.16-1.32; distress 0.95, 0.90-1.01; poor/fair QoL 1.15, 1.05-1.25), prostate cancer (disability 1.11, 1.04-1.19; distress 1.09, 1.02-1.15; poor/fair QoL 1.15, 1.08-1.23) and melanoma (disability 1.02, 0.94-1.10; distress 0.96, 0.89-1.03; poor/fair QoL 0.92, 0.83-1.01). Outcomes were worse with recent diagnosis and treatment and advanced stage. Physical disability in cancer survivors was greater in all population subgroups examined and was a major contributor to adverse distress and QoL outcomes. CONCLUSIONS Physical disability, distress and reduced QoL are common after cancer and vary according to cancer type suggesting priority areas for research, and care and support.
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Affiliation(s)
- Grace Joshy
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Mills Road, Acton, Canberra, ACT, 2601, Australia.
| | - Joanne Thandrayen
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Mills Road, Acton, Canberra, ACT, 2601, Australia
| | - Bogda Koczwara
- Flinders University and Flinders Medical Centre, Adelaide, SA, Australia
| | - Phyllis Butow
- Centre for Medical Psychology and Evidence-based Medicine, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Rebekah Laidsaar-Powell
- Centre for Medical Psychology and Evidence-based Medicine, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Nicole Rankin
- Centre for Medical Psychology and Evidence-based Medicine, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia
| | - Karen Canfell
- Centre for Medical Psychology and Evidence-based Medicine, School of Psychology, Faculty of Science, The University of Sydney, Sydney, NSW, Australia.,Cancer Research Division, Cancer Council New South Wales, Kings Cross, NSW, Australia.,Prince of Wales Clinical School, University of New South Wales, Sydney, NSW, Australia
| | | | - Paul Grogan
- Cancer Research Division, Cancer Council New South Wales, Kings Cross, NSW, Australia
| | - Louise Bailey
- Primary Care Collaborative Cancer Clinical Trials Group Community Advisory Group, Melbourne, VIC, Australia.,Psycho-oncology Cooperative Research Group Community Advisory Group, Camperdown, NSW, Australia
| | - Amelia Yazidjoglou
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Mills Road, Acton, Canberra, ACT, 2601, Australia
| | - Emily Banks
- National Centre for Epidemiology and Population Health, Research School of Population Health, Australian National University, Mills Road, Acton, Canberra, ACT, 2601, Australia.,Sax Institute, Haymarket, NSW, Australia
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11
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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.
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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
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12
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Xiao D, Guizard AV, Daubisse-Marliac L, Woronoff AS, Trétarre B, Delafosse P, Molinié F, Cowppli-Bony A, Lapôtre-Ledoux B, Bara S, Marrer E, Velten M, Laroche L, Heutte N, Grosclaude P, Joly F. Evaluation of long-term living conditions in patients treated for localised prostate cancer. Eur J Cancer Care (Engl) 2020; 30:e13333. [PMID: 32969128 DOI: 10.1111/ecc.13333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 06/07/2020] [Accepted: 08/07/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To evaluate the evolution of living conditions (LC) in long-term survivors of localised prostate cancer 10 years after treatment compared with those of a same-age control group from the general population. METHODS Two hundred and eighty-seven patients diagnosed with prostate cancer in 2001 were selected in 11 French cancer registries. They were matched with controls randomly selected for age and residency. Both patients and controls completed a self-administered LC questionnaire concerning their familial, social and professional life, and general and specific quality of life (QoL) and anxiety and depression questionnaires. RESULTS Compared with controls, patients reported more sexual modifications (p < .0001), but without any difference in marital status. Patients' circle of friends was more stable than that of the controls (91% vs. 63%; p < .0001) and patients reported fewer friendship modifications than controls (p < .0006). Their professional and physical activities were also preserved. They reported more anxiolytic intake (p = .002) but did not consult their general practitioner more often. Type of specialist consulted differed in the two groups. CONCLUSION Patients treated for localised prostate cancer had the same living conditions as men of the same age. Their social life was satisfying on the whole, albeit they reported more sexual difficulties than their counterparts.
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Affiliation(s)
- Dingyu Xiao
- General Cancer Registry of Calvados, François Baclesse Cancer Center, Caen, France
| | - Anne-Valérie Guizard
- General Cancer Registry of Calvados, François Baclesse Cancer Center, Caen, France.,UMR 1086 « Cancers et Préventions », Inserm - University of Basse-Normandie, Caen, France
| | - Laetitia Daubisse-Marliac
- Claudius Regaud Institute, IUCT-O, Tarn Cancer Registry, Toulouse, France.,UMR1027, University of Toulouse, UPS, Inserm, Toulouse, France.,FRANCIM Network of French Cancer Registries, Toulouse, France
| | - Anne-Sophie Woronoff
- FRANCIM Network of French Cancer Registries, Toulouse, France.,General Cancer Registry of Doubs, Besançon, France
| | - Brigitte Trétarre
- FRANCIM Network of French Cancer Registries, Toulouse, France.,General Cancer Registry of Hérault, Montpellier, France
| | - Patricia Delafosse
- FRANCIM Network of French Cancer Registries, Toulouse, France.,General Cancer Registry of Isère, Grenoble, France
| | - Florence Molinié
- FRANCIM Network of French Cancer Registries, Toulouse, France.,General Cancer Registry of Loire-Atlantique-Vendée, Nantes, France
| | - Anne Cowppli-Bony
- FRANCIM Network of French Cancer Registries, Toulouse, France.,General Cancer Registry of Vendée, Nantes, France
| | - Bénédicte Lapôtre-Ledoux
- FRANCIM Network of French Cancer Registries, Toulouse, France.,General Cancer Registry of Somme, Amiens, France
| | - Simona Bara
- FRANCIM Network of French Cancer Registries, Toulouse, France.,General Cancer Registry of Manche, Cherbourg, France
| | - Emilie Marrer
- FRANCIM Network of French Cancer Registries, Toulouse, France.,General Cancer Registry of Haut-Rhin, Mulhouse, France
| | - Michel Velten
- FRANCIM Network of French Cancer Registries, Toulouse, France.,General Cancer Registry of Bas-Rhin, Strasbourg, France
| | - Lucie Laroche
- General Cancer Registry of Calvados, François Baclesse Cancer Center, Caen, France
| | - Natacha Heutte
- CETAPS EA 3832, Normandie University, UNIROUEN, Mont Saint Aignan, France.,Quality of Life in Oncology National Platform, France
| | - Pascale Grosclaude
- Claudius Regaud Institute, IUCT-O, Tarn Cancer Registry, Toulouse, France.,UMR1027, University of Toulouse, UPS, Inserm, Toulouse, France.,FRANCIM Network of French Cancer Registries, Toulouse, France
| | - Florence Joly
- UMR 1086 « Cancers et Préventions », Inserm - University of Basse-Normandie, Caen, France.,Department of Medical Oncology, François Baclesse Cancer Center, Caen, France.,CHU Côte de Nacre, University of Basse-Normandie, Caen, France
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13
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Saim A, Gernier F, Licaj I, Rod J, Velten M, Klein D, Mercier M, Joly F. [Long-term occupational situation after cancer: A French registry-based study]. Bull Cancer 2020; 107:867-880. [PMID: 32919610 DOI: 10.1016/j.bulcan.2020.06.004] [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: 11/14/2019] [Revised: 04/16/2020] [Accepted: 06/09/2020] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Few studies have explored the long-term occupational situation after cancer. The aim of our study were to study the employment status among long-term cancer survivors and to compare it to cancer-free controls from the general population at 5, 10 or 15 years after cancer diagnosis. METHODS From data of a registry-based study, long-term survivors from breast,cervical and colorectal cancer, randomly selected from three tumor registries in France, were compared to cancer-free controls randomly selected from electoral lists. We selected active cancer survivors and cancer-free controls aged less than 60 at the time of the survey. We have studied the employment status of cases vs. controls and the factors associated with employment status. RESULTS At 5, 10 or 15 years after diagnosis, we did not observe any significant difference in employment status between cases and controls. Among cases, 17% had lost their jobs. Older age, lower incomes, lower education, a short-term employment contract, the presence of co-morbidities, fatigue and a worse quality of life were associated with job loss. DISCUSSION Although the employment status of the cases was comparable to that of the controls, efforts should be intensified to make it easier for patients diagnosed with cancer to return to work.
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Affiliation(s)
- Akila Saim
- Université de Caen Basse-Normandie, Caen, France; Centre François-Baclesse, UMR 1086 Inserm « ANTICIPE », Caen, France
| | - François Gernier
- Centre François-Baclesse, UMR 1086 Inserm « ANTICIPE », Caen, France; Centre de lutte contre le cancer François-Baclesse, département de recherche clinique, UNICANCER, Caen, France.
| | - Idlir Licaj
- Centre François-Baclesse, UMR 1086 Inserm « ANTICIPE », Caen, France; Centre de lutte contre le cancer François-Baclesse, département de recherche clinique, UNICANCER, Caen, France
| | - Julien Rod
- Centre François-Baclesse, UMR 1086 Inserm « ANTICIPE », Caen, France; CHU de Caen, département de pédiatrie, Caen, France
| | - Michel Velten
- Centre Paul-Strauss, département de biostatistique et d'épidémiologie, EA3430, Strasbourg, France; Hôpitaux universitaires de Strasbourg, Inserm IRFAC UMR-S 1113, Strasbourg, France; Registre des cancers du Bas-Rhin, Strasbourg, France
| | | | - Mariette Mercier
- Université of Franche-Comté, EA3181, Besançon, France; Université de Franche-Comté, Inserm UMR 1098, Besançon, France
| | - Florence Joly
- Université de Caen Basse-Normandie, Caen, France; Centre François-Baclesse, UMR 1086 Inserm « ANTICIPE », Caen, France; Centre de lutte contre le cancer François-Baclesse, département de recherche clinique, UNICANCER, Caen, France; CHU de Caen, département d'oncologie, Caen, France
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14
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Houédé N, Rébillard X, Bouvet S, Kabani S, Fabbro-Peray P, Trétarre B, Ménégaux F. Impact on quality of life 3 years after diagnosis of prostate cancer patients below 75 at diagnosis: an observational case-control study. BMC Cancer 2020; 20:757. [PMID: 32787797 PMCID: PMC7424648 DOI: 10.1186/s12885-020-07244-y] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 07/30/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Prostate cancer patients are known to suffer from poor sexual and urinary long-term side-effects following treatment, potentially impacting quality of life. The purpose of our study was to compare health-related quality of life at 3 years between prostate cancer patients and healthy controls according to key life-style characteristics. Secondary objectives were to compare urological dysfunction, sexual function, anxiety and depression. METHODS Multicentric, case-control, observational prospective, open, follow-up study including 819 prostate cancer patients < 75 years old from the EPICAP cohort, newly diagnosed from 1 December 2011 to 31 March 2014 and 879 healthy controls. Participants were excluded if they experienced a relapse. Controls from the same geographical region were age-matched and were excluded if they were diagnosed with prostate cancer. Patients received one of the following treatments: active surveillance (AS), radical prostatectomy (RP), external beam radiotherapy (EBRT), High-intensity Focused Ultrasound (HIFU), chemotherapy (CT), or androgen deprivation therapy (ADT) as appropriate. The primary outcome was the quality of life as evaluated by the QLQ-C30 questionnaire. Scores were analyzed by multivariate analysis to adjust for predefined socio-demographic confounding effects. RESULTS In total, 564 participants were included (mean age 67.9 years): 376 patients and 188 controls. Treatment breakdown was: 258 underwent RP, 90 received EBRT, 52 brachytherapy or HIFU, 15 CT, 26 ADT and 61 AS. There was no difference in median global quality of life between patients and controls (94.87 vs 94.15, p = 0.71). Multivariate analysis showed poorer social functioning in patients (24.3% vs. 16.3%, p = 0.0209), more dyspnea (22% vs. 12.4%, p = 0.0078), and yet less current pain (23% vs 33%, p = 0.0151). CONCLUSIONS Global health status score at 3 years after diagnosis was similar between patients and controls, though patients showed a significantly worse social functioning. Prostate cancer diagnosis per se does not seem to impact the quality of life of patients < 75 years at diagnosis. However, the therapeutic option that will be chosen following diagnosis should be carefully discussed with the medical staff in terms of benefit-risk ratios as it could have a long-term impact on urinary or erectile dysfunction. TRIAL REGISTRATION clinicaltrials.gov, NCT02854982 . Registered 4 August 2016, retrospectively registered.
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Affiliation(s)
- Nadine Houédé
- Institut de Cancérologie du Gard, CHU Nîmes, Rue du Pr Henri Pujol, 30029, Nîmes Cedex 9, France. .,INSERM U1194, Montpellier Cancer Research Institute & Université de Montpellier, Montpellier, France.
| | | | - Sophie Bouvet
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology, (BESPIM), CHU Nîmes, Nîmes, France
| | - Sarah Kabani
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology, (BESPIM), CHU Nîmes, Nîmes, France
| | - Pascale Fabbro-Peray
- Department of Biostatistics, Epidemiology, Public Health and Innovation in Methodology, (BESPIM), CHU Nîmes, Nîmes, France
| | | | - Florence Ménégaux
- Center for Research in Epidemiology and Population Health, INSERM U1018, Villejuif, France
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15
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Hamdy FC, Donovan JL, Lane JA, Mason M, Metcalfe C, Holding P, Wade J, Noble S, Garfield K, Young G, Davis M, Peters TJ, Turner EL, Martin RM, Oxley J, Robinson M, Staffurth J, Walsh E, Blazeby J, Bryant R, Bollina P, Catto J, Doble A, Doherty A, Gillatt D, Gnanapragasam V, Hughes O, Kockelbergh R, Kynaston H, Paul A, Paez E, Powell P, Prescott S, Rosario D, Rowe E, Neal D. Active monitoring, radical prostatectomy and radical radiotherapy in PSA-detected clinically localised prostate cancer: the ProtecT three-arm RCT. Health Technol Assess 2020; 24:1-176. [PMID: 32773013 PMCID: PMC7443739 DOI: 10.3310/hta24370] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Prostate cancer is the most common cancer among men in the UK. Prostate-specific antigen testing followed by biopsy leads to overdetection, overtreatment as well as undertreatment of the disease. Evidence of treatment effectiveness has lacked because of the paucity of randomised controlled trials comparing conventional treatments. OBJECTIVES To evaluate the effectiveness of conventional treatments for localised prostate cancer (active monitoring, radical prostatectomy and radical radiotherapy) in men aged 50-69 years. DESIGN A prospective, multicentre prostate-specific antigen testing programme followed by a randomised trial of treatment, with a comprehensive cohort follow-up. SETTING Prostate-specific antigen testing in primary care and treatment in nine urology departments in the UK. PARTICIPANTS Between 2001 and 2009, 228,966 men aged 50-69 years received an invitation to attend an appointment for information about the Prostate testing for cancer and Treatment (ProtecT) study and a prostate-specific antigen test; 82,429 men were tested, 2664 were diagnosed with localised prostate cancer, 1643 agreed to randomisation to active monitoring (n = 545), radical prostatectomy (n = 553) or radical radiotherapy (n = 545) and 997 chose a treatment. INTERVENTIONS The interventions were active monitoring, radical prostatectomy and radical radiotherapy. TRIAL PRIMARY OUTCOME MEASURE Definite or probable disease-specific mortality at the 10-year median follow-up in randomised participants. SECONDARY OUTCOME MEASURES Overall mortality, metastases, disease progression, treatment complications, resource utilisation and patient-reported outcomes. RESULTS There were no statistically significant differences between the groups for 17 prostate cancer-specific (p = 0.48) and 169 all-cause (p = 0.87) deaths. Eight men died of prostate cancer in the active monitoring group (1.5 per 1000 person-years, 95% confidence interval 0.7 to 3.0); five died of prostate cancer in the radical prostatectomy group (0.9 per 1000 person-years, 95% confidence interval 0.4 to 2.2 per 1000 person years) and four died of prostate cancer in the radical radiotherapy group (0.7 per 1000 person-years, 95% confidence interval 0.3 to 2.0 per 1000 person years). More men developed metastases in the active monitoring group than in the radical prostatectomy and radical radiotherapy groups: active monitoring, n = 33 (6.3 per 1000 person-years, 95% confidence interval 4.5 to 8.8); radical prostatectomy, n = 13 (2.4 per 1000 person-years, 95% confidence interval 1.4 to 4.2 per 1000 person years); and radical radiotherapy, n = 16 (3.0 per 1000 person-years, 95% confidence interval 1.9 to 4.9 per 1000 person-years; p = 0.004). There were higher rates of disease progression in the active monitoring group than in the radical prostatectomy and radical radiotherapy groups: active monitoring (n = 112; 22.9 per 1000 person-years, 95% confidence interval 19.0 to 27.5 per 1000 person years); radical prostatectomy (n = 46; 8.9 per 1000 person-years, 95% confidence interval 6.7 to 11.9 per 1000 person-years); and radical radiotherapy (n = 46; 9.0 per 1000 person-years, 95% confidence interval 6.7 to 12.0 per 1000 person years; p < 0.001). Radical prostatectomy had the greatest impact on sexual function/urinary continence and remained worse than radical radiotherapy and active monitoring. Radical radiotherapy's impact on sexual function was greatest at 6 months, but recovered somewhat in the majority of participants. Sexual and urinary function gradually declined in the active monitoring group. Bowel function was worse with radical radiotherapy at 6 months, but it recovered with the exception of bloody stools. Urinary voiding and nocturia worsened in the radical radiotherapy group at 6 months but recovered. Condition-specific quality-of-life effects mirrored functional changes. No differences in anxiety/depression or generic or cancer-related quality of life were found. At the National Institute for Health and Care Excellence threshold of £20,000 per quality-adjusted life-year, the probabilities that each arm was the most cost-effective option were 58% (radical radiotherapy), 32% (active monitoring) and 10% (radical prostatectomy). LIMITATIONS A single prostate-specific antigen test and transrectal ultrasound biopsies were used. There were very few non-white men in the trial. The majority of men had low- and intermediate-risk disease. Longer follow-up is needed. CONCLUSIONS At a median follow-up point of 10 years, prostate cancer-specific mortality was low, irrespective of the assigned treatment. Radical prostatectomy and radical radiotherapy reduced disease progression and metastases, but with side effects. Further work is needed to follow up participants at a median of 15 years. TRIAL REGISTRATION Current Controlled Trials ISRCTN20141297. FUNDING This project was funded by the National Institute for Health Research Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 24, No. 37. See the National Institute for Health Research Journals Library website for further project information.
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Affiliation(s)
- Freddie C Hamdy
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | | | - J Athene Lane
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Malcolm Mason
- School of Medicine, University of Cardiff, Cardiff, UK
| | - Chris Metcalfe
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Peter Holding
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Julia Wade
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Sian Noble
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Grace Young
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Michael Davis
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Tim J Peters
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Emma L Turner
- Bristol Medical School, University of Bristol, Bristol, UK
| | | | - Jon Oxley
- Department of Cellular Pathology, North Bristol NHS Trust, Bristol, UK
| | - Mary Robinson
- Department of Cellular Pathology, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - John Staffurth
- Division of Cancer and Genetics, School of Medicine, Cardiff University, Cardiff, UK
| | - Eleanor Walsh
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Jane Blazeby
- Bristol Medical School, University of Bristol, Bristol, UK
| | - Richard Bryant
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Prasad Bollina
- Department of Urology and Surgery, Western General Hospital, University of Edinburgh, Edinburgh, UK
| | - James Catto
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Andrew Doble
- Department of Urology, Addenbrooke's Hospital, Cambridge, UK
| | - Alan Doherty
- Department of Urology, Queen Elizabeth Hospital, Birmingham, UK
| | - David Gillatt
- Department of Urology, Southmead Hospital and Bristol Urological Institute, Bristol, UK
| | | | - Owen Hughes
- Department of Urology, Cardiff and Vale University Health Board, Cardiff, UK
| | - Roger Kockelbergh
- Department of Urology, University Hospitals of Leicester, Leicester, UK
| | - Howard Kynaston
- Department of Urology, Cardiff and Vale University Health Board, Cardiff, UK
| | - Alan Paul
- Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Edgar Paez
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Philip Powell
- Department of Urology, Freeman Hospital, Newcastle upon Tyne, UK
| | - Stephen Prescott
- Department of Urology, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Derek Rosario
- Academic Urology Unit, University of Sheffield, Sheffield, UK
| | - Edward Rowe
- Department of Urology, Southmead Hospital and Bristol Urological Institute, Bristol, UK
| | - David Neal
- Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
- Academic Urology Group, University of Cambridge, Cambridge, UK
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16
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Palmer NR, Avis NE, Fino NF, Tooze JA, Weaver KE. Rural cancer survivors' health information needs post-treatment. PATIENT EDUCATION AND COUNSELING 2020; 103:1606-1614. [PMID: 32147307 PMCID: PMC7311274 DOI: 10.1016/j.pec.2020.02.034] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 02/03/2020] [Accepted: 02/26/2020] [Indexed: 06/10/2023]
Abstract
OBJECTIVE This study describes the most common cancer-related health information needs among rural cancer survivors and characteristics associated with reporting more information needs. METHODS Rural breast, prostate, and colorectal cancer survivors, two to five years post-diagnosis, identified from an institutional cancer registry, completed a mailed/telephone-administered survey. Respondents were asked about 23 health information needs in eight domains (tests and treatment, side effects and symptoms, health promotion, fertility, interpersonal, occupational, emotional, and insurance). Poisson regression models were used to assess relationships between number of health information needs and demographic and cancer characteristics. RESULTS Participants (n = 170) reported an average of four health information needs, with the most common domains being: side effects and symptoms (58 %), health promotion (54 %), and tests and treatment (41 %). Participants who were younger (compared to 5-year increase, rate ratio [RR] = 1.11, 95 % CI = 1.02-1.21), ethnic minority (RR = 1.89, 95 % CI = 1.17-3.06), less educated (RR = 1.49, 95 % CI = 1.00-2.23), and financially stressed (RR = 1.87, 95 % CI = 1.25-2.81) had a greater number of information needs. CONCLUSIONS Younger, ethnic minority, less educated, and financially strained rural survivors have the greatest need for informational support. PRACTICE IMPLICATIONS The provision of health information for rural cancer survivors should consider type of cancer, treatments received, and sociocultural differences to tailor information provided.
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Affiliation(s)
- Nynikka R Palmer
- Department of Medicine, University of California San Francisco, San Francisco, CA, USA.
| | - Nancy E Avis
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Nora F Fino
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Janet A Tooze
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, NC, USA
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Can Comprehensive Geriatric Assessment Predict Tolerance of Radiotherapy for Localized Prostate Cancer in Men Aged 75 Years or Older? Cancers (Basel) 2020; 12:cancers12030635. [PMID: 32182949 PMCID: PMC7139355 DOI: 10.3390/cancers12030635] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 02/07/2023] Open
Abstract
Curative radiotherapy for prostate cancer is common in the elderly. However, concerns about potential toxicity have inhibited access to radiotherapy for this population, for whom preserving quality of life (QoL) is crucial. The primary endpoint was to identify predictors of impaired QoL in men aged 75 years or older treated with curative intent radiotherapy with or without androgen deprivation therapy (ADT) for localized prostate cancer. We prospectively performed comprehensive geriatric assessment (CGA) and administered QoL questionnaires to 208 elderly (>75 years) patients prior to, plus two and six months after, radiotherapy (NCT 02876237). The median age of the patients was 77 years (range 75–89). At the start of the study, comorbidities were highlighted in 65% of patients: 23% were depressed, 23% had cognitive impairment, and 16% had reduced independence. At six months, 9% of patients had a consistently decreased QoL (>20 points), and a further 16% had a more moderate reduction (10 to 20 points) in QoL. None of the parameters studied (tumor characteristic, treatment, or oncogeriatric parameters) were predictive of a reduced QoL following radiotherapy. Though co-existing geriatric impairment was common, QoL was maintained for 75% of patients six months after radiotherapy. CGA was poorly predictive of tolerance of prostatic radiotherapy. Geriatric assessments dedicated to quality of life following radiotherapy need to be developed.
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Adam S, Doege D, Koch-Gallenkamp L, Thong MSY, Bertram H, Eberle A, Holleczek B, Pritzkuleit R, Waldeyer-Sauerland M, Waldmann A, Zeissig SR, Jansen L, Rohrmann S, Brenner H, Arndt V. Age-specific health-related quality of life in disease-free long-term prostate cancer survivors versus male population controls-results from a population-based study. Support Care Cancer 2019; 28:2875-2885. [PMID: 31736000 DOI: 10.1007/s00520-019-05120-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 10/02/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Prostate cancer (PC) and its treatment may affect PC survivors differently with respect to age. However, little is known regarding age-specific health-related quality of life (HRQoL) in PC survivors 5 years or even ≥ 10 years post-diagnosis. METHODS The sample included 1975 disease-free PC survivors (5-16 years post-diagnosis) and 661 cancer-free population controls, recruited from two German population-based studies (CAESAR+, LinDe). HRQoL in both populations was assessed using the EORTC QLQ-C30 questionnaire. Additionally, PC survivors completed the PC-specific EORTC QLQ-PR25 questionnaire. Differences in HRQoL between survivors and controls, as well as differences according to age and time since diagnosis were analyzed with multiple regression after adjustment for age, education, stage, and time since diagnosis, where appropriate. RESULTS In general, PC survivors reported HRQoL and symptom-burden levels comparable to the general population, except for significantly poorer social functioning and higher burden for diarrhea and constipation. In age-specific analyses, PC survivors up to 69 years indicated poorer global health and social functioning than population controls. Stratification by time since diagnosis revealed little difference between the subgroups. On PC-specific symptoms, burden was highest for urinary bother and symptoms, and lowest for bowel symptoms. Younger age was associated with less urinary symptoms but higher urinary bother. CONCLUSION Long-term disease-free PC survivors reported overall good HRQoL, but experienced persistent specific detriments. Our data suggest that these detriments do not improve substantially with increasing time since diagnosis. Targeted interventions are recommended to prevent PC-related and treatment-related symptoms becoming chronic and to enhance social functioning.
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Affiliation(s)
- Salome Adam
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Daniela Doege
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Lena Koch-Gallenkamp
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Melissa S Y Thong
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Heike Bertram
- Cancer Registry of North Rhine-Westphalia, Gesundheitscampus 10, 44801, Bochum, Germany
| | - Andrea Eberle
- Bremen Cancer Registry, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359, Bremen, Germany
| | - Bernd Holleczek
- Saarland Cancer Registry, Präsident Baltz Straße 5, 66119, Saarbrücken, Germany
| | - Ron Pritzkuleit
- Schleswig-Holstein Cancer Registry, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | | | - Annika Waldmann
- Hamburg Cancer Registry, Billstraße 80, 20539, Hamburg, Germany.,Institute of Social Medicine and Epidemiology, University Lübeck, Ratzeburger Allee 160, 23562, Lübeck, Germany
| | - Sylke Ruth Zeissig
- Cancer Registry of Rhineland-Palatinate, Große Bleiche 46, 55116, Mainz, Germany
| | - Lina Jansen
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Sabine Rohrmann
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, 8001, Zurich, Switzerland
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.,German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Volker Arndt
- Unit of Cancer Survivorship, Division of Clinical Epidemiology and Aging Research, German Cancer Research Center (DKFZ), Im Neuenheimer Feld 280, 69120, Heidelberg, Germany.
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Ernstmann N, Herden J, Weissbach L, Karger A, Hower K, Ansmann L. Prostate-specific health-related quality of life and patient-physician communication - A 3.5-year follow-up. PATIENT EDUCATION AND COUNSELING 2019; 102:2114-2121. [PMID: 31399225 DOI: 10.1016/j.pec.2019.07.030] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 07/15/2019] [Accepted: 07/23/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE The aim of this study is to examine associations between prostate-specific health-related quality of life (HRQOL) and aspects of patient-physician communication in localized prostate cancer treatment. METHODS Data of patients with localized prostate cancer were collected at 6-month intervals over a 3.5-year period within a prospective, observational study (HAROW). Data collection comprised D'Amico risk categories, the Charlson Comorbidity Index, patient-physician communication (information, shared decision making, support, devotion), and prostate-specific HRQOL (incontinence aid, urinary symptoms, bowel symptoms, hormonal treatment-related symptoms, sexual functioning, sexual activity). Data of N = 1722 patients undergoing radical prostatectomy were analyzed by longitudinal multilevel analysis. RESULTS The mean patient age was 65 years; 31% had a low risk and 38% an intermediate risk of cancer growth and spread; 73% had a Charlson Comorbidity Index of 0. Significant associations were found between prostate-specific HRQOL and shared decision making, support and devotion. Patient information was not significantly associated with aspects of prostate-specific HRQOL. CONCLUSION Patient reported long term outcomes are associated with aspects of patient-physician communication in prostate cancer patients. Patients feeling involved by their urologists experience less side effects of (surgical) treatment. PRACTICE IMPLICATIONS Special communication training programmes should be developed and implemented for urologists.
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Affiliation(s)
- Nicole Ernstmann
- Department of Psychosomatic Medicine and Psychotherapy, University Hospital Bonn, Bonn, Germany; Center for Integrated Oncology Bonn (CIO), Bonn, Germany.
| | - Jan Herden
- Department of Urology, University Hospital Cologne, Cologne, Germany.
| | | | - André Karger
- Clinical Institute of Psychosomatic Medicine and Psychotherapy, Heinrich-Heine-University Duesseldorf, Duesseldorf, Germany.
| | - Kira Hower
- Institute for Medical Sociology, Health Services Research, and Rehabilitation Science (IMVR), University of Cologne, Cologne, Germany.
| | - Lena Ansmann
- Department of Health Services Research, Carl von Ossietzky University Oldenburg, Oldenburg, Germany.
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20
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Haab AC, Tornic J, John HA. Urethral pressure profile assessment after artificial urinary sphincter implantation (FlowSecure ™ and AMS-800 ™): A case series. SAGE Open Med Case Rep 2019; 7:2050313X19851379. [PMID: 31205716 PMCID: PMC6537050 DOI: 10.1177/2050313x19851379] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 04/26/2019] [Indexed: 11/17/2022] Open
Abstract
The AMS-800™ artificial urinary sphincter has become the 'gold standard' in the treatment of male stress urinary incontinence. In 2006, the novel artificial urinary sphincter FlowSecure™ containing a stress relief balloon providing low cuff pressures at rest with conditional pressure elevation during periods of stress has been launched. We assessed the intraurethral pressure in the cuff area of the AMS-800 and the FlowSecure by urethral pressure profile in four patients each. Urethral pressure profile was performed at rest and during coughing. In addition, continence situation and patient satisfaction after artificial urinary sphincter implantation was assessed. At rest, median pressure in the cuff region was 74 (38-117, FlowSecure) cm H2O and 102 (95-110, AMS-800) cm H2O. During coughing, pressure peaks rose to 135 (54-162, FlowSecure) cm H2O and 202 (128-216, AMS-800) cm H2O. Median pad usage before artificial urinary sphincter implantation in the FlowSecure and the AMS-800 group was 4 (3-4) and 4.5 (2-6) pads/24 h, respectively. At the time of urodynamic investigation, median pad usage declined to 1.5 (0-4) pads/24 h in the FlowSecure and to 1 (1-2) pads/24 h in the AMS-800 group. Seven of eight patients reported on a satisfactory quality of life, and one patient remained unhappy after FlowSecure implantation. It remains unclear if the trade-off in favour of lower cuff pressures, and consecutively lower intraurethral pressures, holds truly long-term benefits regarding device revision, explantation and patient satisfaction.
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Affiliation(s)
- Alexander C Haab
- Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Jure Tornic
- Department of Neuro-Urology, Spinal Cord Injury Centre & Research, University Hospital Balgrist, Zürich, Switzerland
| | - Hubert A John
- Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
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21
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Lemanska A, Poole K, Griffin BA, Manders R, Saxton JM, Turner L, Wainwright J, Faithfull S. Community pharmacy lifestyle intervention to increase physical activity and improve cardiovascular health of men with prostate cancer: a phase II feasibility study. BMJ Open 2019; 9:e025114. [PMID: 31186245 PMCID: PMC6585832 DOI: 10.1136/bmjopen-2018-025114] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVES To assess the feasibility and acceptability of a community pharmacy lifestyle intervention to improve physical activity and cardiovascular health of men with prostate cancer. To refine the intervention. DESIGN Phase II feasibility study of a complex intervention. SETTING Nine community pharmacies in the UK. INTERVENTION Community pharmacy teams were trained to deliver a health assessment including fitness, strength and anthropometric measures. A computer algorithm generated a personalised lifestyle prescription for a home-based programme accompanied by supporting resources. The health assessment was repeated 12 weeks later and support phone calls were provided at weeks 1 and 6. PARTICIPANTS 116 men who completed treatment for prostate cancer. OUTCOME MEASURES The feasibility and acceptability of the intervention and the delivery model were assessed by evaluating study processes (rate of participant recruitment, consent, retention and adverse events), by analysing delivery data and semi-structured interviews with participants and by focus groups with pharmacy teams. Physical activity (measured with accelerometry at baseline, 3 and 6 months) and patient reported outcomes (activation, dietary intake and quality of life) were evaluated. Change in physical activity was used to inform the sample size calculations for a future trial. RESULTS Out of 403 invited men, 172 (43%) responded and 116 (29%) participated. Of these, 99 (85%) completed the intervention and 88 (76%) completed the 6-month follow-up (attrition 24%). Certain components of the intervention were feasible and acceptable (eg, community pharmacy delivery), while others were more challenging (eg, fitness assessment) and will be refined for future studies. By 3 months, moderate to vigorous physical activity increased on average by 34 min (95% CI 6 to 62, p=0.018), but this was not sustained over 6 months. CONCLUSIONS The community pharmacy intervention was feasible and acceptable. Results are encouraging and warrant a definitive trial to assess the effectiveness of the refined intervention.
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Affiliation(s)
- Agnieszka Lemanska
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Karen Poole
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Bruce A Griffin
- Department of Nutritional Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Ralph Manders
- School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - John M Saxton
- Department of Sport, Exercise and Rehabilitation, Northumbria University, Newcastle upon Tyne, UK
| | | | - Joe Wainwright
- Surrey Human Performance Institute, University of Surrey, Guildford, UK
| | - Sara Faithfull
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
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Joachim C, Veronique-Baudin J, Almont T, Ulric-Gervaise S, Macni J, Pierre-Louis O, Godaert L, Drame M, Novella JL, Farid K, Vinh-Hung V, Escarmant P. Cohort profile: the Martinique Cancer Registry and the quality of life prostate cancer cohort (QoL Prostate-MQ): challenges and prospects for reducing disparities in the Caribbean. BMJ Open 2018; 8:e021540. [PMID: 30049695 PMCID: PMC6067331 DOI: 10.1136/bmjopen-2018-021540] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Recording cancer data in cancer registries is essential for producing reliable population-based data for service planning, monitoring and evaluation. Prostate cancer (PCa) remains the most frequent type of cancer in terms of incidence and mortality in men in the Caribbean. The quality of life PCa cohort will assess quality of life and patient outcomes in Martinique using a digital platform for patient-reported outcome measures. PARTICIPANTS The Martinique Cancer Registry database is the largest clinical database among the French population-based cancer registries in the Caribbean, including more than 38 000 cancer cases, with 1650 new cancer cases per year, including 550 new PCa cases per year (2010-2014 latest period). In 2018, follow-up will include vital status, assessment of quality of life with the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ) Core 30 and the Prostate cancer module QLQ-PR25. Urinary incontinence and erectile dysfunction recorded prior to treatment will be analysed 1 and 5 years after treatment. FINDINGS TO DATE The registry includes data on circumstances of diagnosis, clinical stage at diagnosis. For PCa, the registry includes blood prostate-specific antigen level at the time of diagnosis, Gleason score and primary treatment. FUTURE PLANS Further studies will provide detailed data regarding the quality of diagnosis and management of patients with PCa in Martinique; analysing quality of care will be the next challenge.Quality of life and patient outcomes will be evaluated using a digital platform for patient-reported outcome measurement and electronic records.
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Affiliation(s)
- Clarisse Joachim
- UF1441 Registre des cancers de la Martinique, Pôle de Cancérologie Hématologie Urologie Pathologie, CHU Martinique, Fort-de-France, Martinique
| | - Jacqueline Veronique-Baudin
- UF1441 Registre des cancers de la Martinique, Pôle de Cancérologie Hématologie Urologie Pathologie, CHU Martinique, Fort-de-France, Martinique
| | - Thierry Almont
- Groupe d’Étude, de Formation et de Recherche en Andrologie, Urologie et Sexologie Médecine de la Reproduction, Toulouse, France
- Groupe de recherche en fertilité humaine, CHU Toulouse Paule de Viguier, Toulouse, France
| | - Stephen Ulric-Gervaise
- UF1441 Registre des cancers de la Martinique, Pôle de Cancérologie Hématologie Urologie Pathologie, CHU Martinique, Fort-de-France, Martinique
| | - Jonathan Macni
- UF1441 Registre des cancers de la Martinique, Pôle de Cancérologie Hématologie Urologie Pathologie, CHU Martinique, Fort-de-France, Martinique
| | - Olivier Pierre-Louis
- Pôle de Cancérologie Hématologie Urologie Pathologie, CHU Martinique, Fort-de-France, Martinique
| | - Lidvine Godaert
- Pôle de Gériatrie, CHU de Martinique, Fort-de-France, Martinique
| | - Moustapha Drame
- Unité d’aide Méthodologique, Pôle Recherche et Santé publique, CHU de Reims, Reims, France
- EA 3797, Université de Reims Champagne-Ardenne, Faculté de Médecine, Reims, France
| | - Jean-Luc Novella
- EA 3797, Université de Reims Champagne-Ardenne, Faculté de Médecine, Reims, France
- Département de Médecine Interne et Gériatrie, CHU de Reims, Reims, France
| | - Karim Farid
- Service de Médecine nucléaire, Pole d’imagerie Médicale, CHU Martinique, Fort-de-France, Martinique
| | - Vincent Vinh-Hung
- Pôle de Cancérologie Hématologie Urologie Pathologie, CHU Martinique, Fort-de-France, Martinique
| | - Patrick Escarmant
- Pôle de Cancérologie Hématologie Urologie Pathologie, CHU Martinique, Fort-de-France, Martinique
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Morishita S, Tsubaki A, Fu JB, Mitobe Y, Onishi H, Tsuji T. Cancer survivors exhibit a different relationship between muscle strength and health-related quality of life/fatigue compared to healthy subjects. Eur J Cancer Care (Engl) 2018; 27:e12856. [PMID: 29767832 DOI: 10.1111/ecc.12856] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/19/2018] [Indexed: 01/22/2023]
Abstract
We investigated the difference in relationship between muscle strength and quality of life (QOL)/fatigue in long-term cancer survivors and healthy subjects. Thirty-six cancer survivors and 29 healthy subjects were assessed for body composition and bone status at the calcaneus using the Osteo Sono Assessment Index. Muscle strength was evaluated via handgrip and knee extensor strength. Health-related QOL was assessed using the Medical Outcome Study 36-item Short-Form Health Survey. Fatigue was measured using the brief fatigue inventory. Cancer survivors exhibited lower QOL scores in the physical functioning, physical role function, bodily pain and general health domains (p < .05). Grip and knee extension muscle strength in cancer survivors was positively correlated with the physical function and bodily pain of QOL (p < .05). The usual fatigue subscale score was only significantly higher in cancer survivors than in healthy subjects (p < .05). However, there were no correlations between muscle strength and fatigue in cancer survivors. Our results showed that muscle strength was an important factor for improving QOL in cancer survivors. We believe that the findings of this study will be relevant in the context of planning rehabilitation for cancer survivors.
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Affiliation(s)
- S Morishita
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - A Tsubaki
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - J B Fu
- Department of Palliative, Rehabilitation and Integrative Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Y Mitobe
- Department of Nursing, Niigata University of Health and Welfare, Niigata, Japan
| | - H Onishi
- Institute for Human Movement and Medical Sciences, Niigata University of Health and Welfare, Niigata, Japan
| | - T Tsuji
- Department of Rehabilitation Medicine, Keio University School of Medicine, Tokyo, Japan
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Goineau A, Campion L, d’Aillières B, Vié B, Ghesquière A, Béra G, Jaffres D, de Laroche G, Magné N, Artignan X, Chamois J, Bergerot P, Martin E, Créhange G, Deniaud-Alexandre E, Buthaud X, Belkacémi Y, Doré M, de Decker L, Supiot S. Comprehensive Geriatric Assessment and quality of life after localized prostate cancer radiotherapy in elderly patients. PLoS One 2018; 13:e0194173. [PMID: 29630602 PMCID: PMC5890970 DOI: 10.1371/journal.pone.0194173] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 02/26/2018] [Indexed: 02/07/2023] Open
Abstract
Introduction Radiotherapy can diminish quality of life (QoL) for prostate cancer patients. Our objective was to evaluate the effect of radiotherapy on QoL in men aged 75 years or older treated with radiotherapy for a localized prostate cancer, and to identify predictors of reduced QoL. Patients and methods We prospectively administered a battery of geriatric (MNA, GDS, Get up and Go Test, CIRS-G, ADL, IADL, MMSE), toxicity (IPSS; IIEF 5), and QoL (QLQ C30) screening tests in 100 elderly patients before and two months after prostate cancer radiotherapy (NCT 02876237). Patients ≥ 75 years undergoing radiotherapy with a curative intent for localized prostate cancer with or without androgen deprivation therapy (ADL) were eligible for study inclusion. Correlations between patient-assessed QoL and tumor characteristics, radiotherapy treatment or CGA parameters were sought using the Fisher or the Mann and Whitney tests. Changes in QoL parameters over time were analyzed using the Wilcoxon signed-rank test. Results At study entry, scores for IADL impairments were present in 51%, reduced autonomy in activities of daily living in 16%, cognitive impairment found in 20%, depression-related symptoms in 31%, and 66% of patients had significant co-morbidities. Eight percent were judged to be at risk of fall and 2% were found to be undernourished. Severely impaired (IPSS ≥ 20) urinary function was observed in 11.2% and 13.5% of patients before and two months after completion of radiotherapy respectively. Significantly decreased QoL (> 20 points) at two months after treatment was found in 13% of patients and a moderate but clinically relevant reduction (10 to 20 points) in 17% of patients. No tumor characteristic, treatment, or oncogeriatric parameter was predictive of reduced QoL following prostate cancer radiotherapy. Conclusion Despite sometimes markedly diminished oncogeriatric parameters, prostate cancer radiotherapy was generally well tolerated in these elderly patients. We found no predictive factor to determine which patients would experience impaired quality of life following radiotherapy.
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Affiliation(s)
- Aurore Goineau
- Department of Radiation Oncology, Institut de Cancérologie de l’Ouest, Angers, France
- * E-mail:
| | - Loïc Campion
- Department of Statistics, Institut de Cancérologie de l’Ouest, Saint Herblain, France
| | - Bénédicte d’Aillières
- Department of Radiation Oncology, Institut de Cancérologie de l’Ouest, Angers, France
| | - Brigitte Vié
- Department of Radiation Oncology, Clinique Armoricaine de Radiologie, St Brieuc, France
| | - Agnès Ghesquière
- Department of Radiation Oncology, Clinique Armoricaine de Radiologie, St Brieuc, France
| | - Guillaume Béra
- Department of Radiation Oncology, Centre Hospitalier de Bretagne Sud, Lorient, France
| | - Didier Jaffres
- Department of Radiation Oncology, Centre Hospitalier de Bretagne Sud, Lorient, France
| | - Guy de Laroche
- Department of Radiation Oncology, Institut de Cancérologie de Loire, St Priest en Jarez, France
| | - Nicolas Magné
- Department of Radiation Oncology, Institut de Cancérologie de Loire, St Priest en Jarez, France
| | - Xavier Artignan
- Department of Radiation Oncology, CHP St Grégoire, St Grégoire, France
| | - Jérôme Chamois
- Department of Radiation Oncology, CHP St Grégoire, St Grégoire, France
| | - Philippe Bergerot
- Department of Radiation Oncology, Clinique Mutualiste de l’Estuaire, St Nazaire, France
| | - Etienne Martin
- Department of Radiation Oncology, Centre Georges François Leclerc, Dijon, France
| | - Gilles Créhange
- Department of Radiation Oncology, Centre Georges François Leclerc, Dijon, France
| | | | - Xavier Buthaud
- Department of Radiation Oncology, Centre Catherine de Sienne, Nantes, France
| | - Yazid Belkacémi
- Department of Radiation Oncology, CHU Henri Mondor, Créteil, France
| | - Mélanie Doré
- Department of Radiation Oncology, Institut de Cancérologie de l’Ouest, Saint Herblain, France
| | - Laure de Decker
- Department of Radiation Oncology, Institut de Cancérologie de l’Ouest, Saint Herblain, France
| | - Stéphane Supiot
- Department of Radiation Oncology, Institut de Cancérologie de l’Ouest, Saint Herblain, France
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Nead KT, Sinha S, Yang DD, Nguyen PL. Association of androgen deprivation therapy and depression in the treatment of prostate cancer: A systematic review and meta-analysis. Urol Oncol 2017; 35:664.e1-664.e9. [PMID: 28803700 DOI: 10.1016/j.urolonc.2017.07.016] [Citation(s) in RCA: 68] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2017] [Revised: 07/05/2017] [Accepted: 07/17/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND There is increasing evidence that androgen deprivation therapy (ADT) may be associated with depression. Existing studies have shown conflicting results. METHODS PubMed, Web of Science, Embase, and PsycINFO were queried on April 5, 2017. Eligible studies were in English and reported depression among individuals with prostate cancer exposed to a course of ADT vs. a lesser-exposed group (e.g., any-ADT vs. no ADT and continuous ADT vs. intermittent ADT). We used the MOOSE statement guidelines and the Cochrane Review Group's data extraction template. Study quality was evaluated by Newcastle-Ottawa Scale criteria. We conducted a random-effects meta-analysis to calculate summary statistic risk ratios (RRs) and 95% CIs. Heterogeneity was quantified using the I2 statistic and prespecified subgroup analysis. Small study effects were evaluated using Begg and Egger statistics. RESULTS A total of 1,128 studies were initially identified and evaluated. A meta-analysis of 18 studies among 168,756 individuals found that ADT use conferred a 41% increased risk of depression (RR = 1.41; 95% CI: 1.18-1.70; P<0.001). We found a consistent strong statistically significant association when limiting our analysis to studies in localized disease (RR = 1.85; 95% CI: 1.20-2.85; P = 0.005) and those using a clinical diagnosis of depression (RR = 1.19; 95% CI: 1.08-1.32; P = 0.001). We did not find an association for continuous ADT with depression risk compared to intermittent ADT (RR = 1.00; 95% CI: 0.50-1.99; P = 0.992). There was no statistically significant evidence of small study effects. Statistically significant heterogeneity in the full analysis (I2 = 80%; 95% CI: 69-87; P<0.001) resolved when examining studies using a clinical diagnosis of depression (I2 = 16%; 95% CI: 0-60; P = 0.310). CONCLUSION The currently available evidence suggests that ADT in the treatment of prostate cancer is associated with an increased risk of depression.
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Affiliation(s)
- Kevin T Nead
- Department of Radiation Oncology, Perelman School of Medicine, Perelman Center for Advanced Medicine, University of Pennsylvania, Philadelphia, PA.
| | - Sumi Sinha
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - David D Yang
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Harvard Medical School, Boston, MA
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van Stam MA, van der Poel HG, Bosch JLHR, Tillier CN, Horenblas S, Mols F, Aaronson NK. Prevalence and correlates of mental health problems in prostate cancer survivors: A case-control study comparing survivors with general population peers. Urol Oncol 2017; 35:531.e1-531.e7. [PMID: 28457651 DOI: 10.1016/j.urolonc.2017.03.028] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Revised: 03/22/2017] [Accepted: 03/27/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The purpose of this study was to identify factors associated with mental health (MH) problems in prostate cancer (PC) survivors. Toward this end, we evaluated (1) differences in the prevalence of MH problems between PC survivors and age-matched men from the general population (GenPop) and (2) correlates of MH in PC survivors and the GenPop. METHODS AND MATERIALS In this observational case-control study, we age-matched PC survivors (n = 644, alive≥5y after diagnosis of a stage I-IV carcinoma) recruited from Dutch community hospitals (Patient Reported Outcomes Following Initial treatment and Long-term Evaluation of Survivorship registry) with GenPop peers (n = 644) selected from a population-based sample recruited in general practices (NIVEL). MH was operationalized using the 5-item Mental Health Inventory of the Short Form Health Survey (SF-36). Potential correlates of MH included sociodemographic characteristics, health-related quality of life scores, and clinical characteristics (PC survivors only). We used analysis of (co)variance and chi-square tests to address the 2 research questions. RESULTS We observed clinically relevant MH symptoms in 14% of the PC survivors and 6% of the GenPop controls (P<0.01, odds ratio = 2.45 [1.66-3.62]). The most important correlates of lower MH scores in the PC survivors were being widowed, a lower educational level, lower general health perceptions, more bodily pain and urinary bother, and less sexual satisfaction. The most important correlates of lower MH scores in the GenPop were as follows: lower general health perceptions, more role limitations because of physical problems, and more bodily pain. CONCLUSIONS Our results indicate that long-term PC survivors have poorer MH, as assessed by the 5-item Mental Health Inventory questionnaire, than men of a comparable age from the GenPop without a history of PC. Attention to potentially modifiable factors associated with MH problems in PC survivors, such as urinary function and its related bother, bodily pain, and sexual satisfaction, may help to prevent or limit MH problems in this survivor population.
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Affiliation(s)
- Marie-Anne van Stam
- Urology Department, University Medical Center Utrecht, Utrecht, The Netherlands; Urology Department, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Henk G van der Poel
- Urology Department, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - J L H Ruud Bosch
- Urology Department, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Corinne N Tillier
- Urology Department, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Simon Horenblas
- Urology Department, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Floor Mols
- Department of Medical and Clinical Psychology, Social and Behavioural Sciences, Tilburg University, Tilburg, The Netherlands
| | - Neil K Aaronson
- Division of Psychosocial Research & Epidemiology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Skolarus TA, Metreger T, Hwang S, Kim HM, Grubb RL, Gingrich JR, Hawley ST. Optimizing veteran-centered prostate cancer survivorship care: study protocol for a randomized controlled trial. Trials 2017; 18:181. [PMID: 28420419 PMCID: PMC5395886 DOI: 10.1186/s13063-017-1925-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Accepted: 03/30/2017] [Indexed: 11/17/2022] Open
Abstract
Background Although prostate cancer is the most common cancer among veterans receiving care in the Veterans Health Administration (VA), more needs to be done to understand and improve survivorship care for this large population. This study, funded by VA Health Services Research & Development (HSR&D), seeks to address the need to improve patient-centered survivorship care for veterans with prostate cancer. Methods/Design This is a two-armed randomized controlled trial (RCT) with a target enrollment of up to 325 prostate cancer survivors per study arm (total anticipated n = 600). Patients will be recruited from four VA sites. Patient eligibility criteria include age range of 40–80 years, one to ten years post-treatment, and currently experiencing prostate cancer symptom burden. We will compare the “Building Your New Normal” program, a personally-tailored automated telephone symptom management intervention for improving symptom self-management to usual care enhanced with a non-tailored newsletter about symptom management. Primary outcomes include changes in symptom burden, bother, and health services utilization at five and 12 months after enrollment. Secondary outcomes include long-term psychosocial outcomes (e.g. subjective health, perceived cancer control). We will use multivariable regression analysis to evaluate the impact of the intervention on primary and secondary outcomes. We will conduct a process evaluation to understand the effective intervention components and explore possibilities for broader implementation and dissemination. Discussion Our central hypothesis is that intervention group participants will have improved and more confident symptom self-management and prostate cancer quality of life following the intervention and that these outcomes will translate to more efficient use of health services. The study results will provide much needed information about how to optimize the quality of care, and life, of veteran prostate cancer survivors. Trial registration ClinicalTrials.gov ID NCT01900561; Registered on 22 July 2013. Electronic supplementary material The online version of this article (doi:10.1186/s13063-017-1925-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Ted A Skolarus
- VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.,Department of Urology, Dow Division of Health Services Research, University of Michigan, Ann Arbor, MI, USA
| | - Tabitha Metreger
- VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA
| | - Soohyun Hwang
- VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA
| | - Hyungjin Myra Kim
- VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA.,University of Michigan Center for Consulting for Statistics, Computing and Analytics Research, Ann Arbor, MI, USA
| | - Robert L Grubb
- Department of Surgery (Urology), St. Louis VA Medical Center, Washington University School of Medicine, 915 North Grand Blvd., St. Louis, MO, 63106, USA
| | - Jeffrey R Gingrich
- Department of Urology, VA Pittsburgh Healthcare System, University of Pittsburgh, 7180 Highland Drive, Pittsburgh, PA, 15206, USA
| | - Sarah T Hawley
- VA HSR&D Center for Clinical Management Research, VA Ann Arbor Healthcare System, 2215 Fuller Road, Ann Arbor, MI, 48105, USA. .,Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.
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