1
|
Sibert NT, Garin O, Ferrer M, Connor SE, Graham ID, Litwin MS, Millar J, Moore CM, Nguyen AV, Paich K, Kowalski C. International Variations in Surgical Quality of Care in Men With Prostate Cancer: Results From the TrueNTH Global Registry. JCO Glob Oncol 2024; 10:e2300420. [PMID: 38815192 DOI: 10.1200/go.23.00420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/20/2024] [Accepted: 03/28/2024] [Indexed: 06/01/2024] Open
Abstract
PURPOSE Functional problems such as incontinence and sexual dysfunction after radical prostatectomy (RP) are important outcomes to evaluate surgical quality in prostate cancer (PC) care. Differences in survival after RP between countries are known, but differences in functional outcomes after RP between providers from different countries are not well described. METHODS Data from a multinational database of patients with PC (nonmetastatic, treated by RP) who answered the EPIC-26 questionnaire at baseline (before RP, T0) and 1 year after RP (T1) were used, linking survey data to clinical information. Casemix-adjusted incontinence and sexual function scores (T1) were calculated for each country and provider on the basis of regression models and then compared using minimally important differences (MIDs). RESULTS A total of 21,922 patients treated by 151 providers from 10 countries were included. For the EPIC-26 incontinence domain, the median adjusted T1 score of countries was 76, with one country performing more than one MID (for incontinence: 6) worse than the median. Eighteen percent of the variance (R2) of incontinence scores was explained by the country of the providers. The median adjusted T1 score of sexual function was 33 with no country performing perceivably worse than the median (more than one MID worse), and 34% (R2) of the variance of the providers' scores could be explained by country. CONCLUSION To our knowledge, this is the first comparison of functional outcomes 1 year after surgical treatment of patients with PC between different countries. Country is a relevant predictor for providers' incontinence and sexual function scores. Although the results are limited because of small samples from some countries, they should be used to enhance cross-country initiatives on quality improvement in PC care.
Collapse
Affiliation(s)
| | - Olatz Garin
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
| | - Montserrat Ferrer
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain
| | - Sarah E Connor
- Department of Urology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Ian D Graham
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Canada
- Centre for Implementation Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Mark S Litwin
- Department of Urology and Department of Health Policy & Management, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | - Jeremy Millar
- Departments of Surgery (Central Clinical School), and Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | | | - Anissa V Nguyen
- Departments of Urology, OBGYN, and Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA
| | | | | |
Collapse
|
2
|
Pedreira PB, Fleszar-Pavlović SE, Walsh EA, Noriega Esquives B, Moreno PI, Perdomo D, Heller AS, Antoni MH, Penedo FJ. Familism, family cohesion, and health-related quality of life in Hispanic prostate cancer survivors. J Behav Med 2024:10.1007/s10865-024-00479-1. [PMID: 38429598 DOI: 10.1007/s10865-024-00479-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 02/09/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Familism, the cultural value that emphasizes feelings of loyalty and dedication to one's family, has been related to both positive and negative outcomes in Hispanic cancer survivors. One potential source of observed inconsistencies may be limited attention to the family environment, as familism may be protective in a cohesive family whereas it can exacerbate distress in a conflictive family. PURPOSE The current study explored the associations of familism with general and disease-specific health-related quality of life (HRQoL) in Hispanic men who completed prostate cancer (PC) treatment, and whether family cohesion may help explain these relationships. METHODS Hispanic men treated for localized PC (e.g., radiation, surgery) were enrolled in a randomized controlled stress management trial and assessed prior to randomization. Familism (familial obligation) was assessed using Sabogal's Familism Scale and family cohesion was measured using the Family Environment Scale (ranging from high to low). The sexual, urinary incontinence, and urinary obstructive/irritative domains of the Expanded Prostate Cancer Index Composite - Short Form measured disease-specific HRQoL. The physical, emotional, and functional well-being subscales of the Functional Assessment of Cancer Therapy - General captured general HRQoL. Hierarchical linear regression and the SPSS PROCESS macro were used to conduct moderation analyses, while controlling for relevant covariates. RESULTS Participants were 202 older men on average 65.7 years of age (SD = 8.0) who had been diagnosed with PC an average of 22 months prior to enrollment. Familism was not directly associated with general and disease-specific HRQoL. Moderation analyses revealed that greater familism was related to poorer urinary functioning in the incontinence (p = .03) and irritative/obstructive domains (p = .01), and lower emotional well-being (p = .02), particularly when family cohesion was low. CONCLUSIONS These findings underscore the importance of considering contextual factors, such as family cohesion, in understanding the influence of familism on general and disease-specific HRQoL among Hispanic PC patients. The combined influence of familism and family cohesion predicts clinically meaningful differences in urinary functioning and emotional well-being during the posttreatment phase. Culturally sensitive psychosocial interventions to boost family cohesion and leverage the positive impact of familistic attitudes are needed to enhance HRQoL outcomes in this population.
Collapse
Affiliation(s)
| | - Sara E Fleszar-Pavlović
- Department of Psychology, University of Miami, Coral Gables, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Emily A Walsh
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Blanca Noriega Esquives
- Department of Psychology, University of Miami, Coral Gables, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Patricia I Moreno
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Dolores Perdomo
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Aaron S Heller
- Department of Psychology, University of Miami, Coral Gables, FL, USA
| | - Michael H Antoni
- Department of Psychology, University of Miami, Coral Gables, FL, USA
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Frank J Penedo
- Department of Psychology, University of Miami, Coral Gables, FL, USA.
- Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA.
| |
Collapse
|
3
|
Zamora V, Garin O, Suárez JF, Gutiérrez C, Guedea F, Cabrera P, Castells M, Herruzo I, Fumadó L, Samper P, Ferrer C, Regis L, Pont À, Ferrer M. Comparative effectiveness of new treatment modalities for localized prostate cancer through patient-reported outcome measures. Clin Transl Radiat Oncol 2024; 44:100694. [PMID: 38021091 PMCID: PMC10663757 DOI: 10.1016/j.ctro.2023.100694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 10/18/2023] [Accepted: 10/24/2023] [Indexed: 12/01/2023] Open
Abstract
Purpose There is scarce comparative effectiveness research on the new treatment modalities for localized prostate cancer. We aim to compare through Patient-Reported Outcome Measures (PROMs) the impact of active surveillance, robot-assisted radical prostatectomy (RARP), intensity-modulated radiotherapy (IMRT), and real-time brachytherapy, considering side effects (incontinence, irritative/obstructive urinary symptoms, sexual dysfunction and bowel symptoms) and physical and mental health. Materials and Methods Prospective cohort of men diagnosed with clinically localized prostate cancer (age 50-75y, T1-T2, and low risk including Gleason 3 + 4 in T1c) from 18 Spanish hospitals, followed up to 24 months. Treatment decisions were jointly made by patients and physicians (n = 572). The Expanded Prostate cancer Index Composite (EPIC-26) and Short-Form 36 (SF-36v2) were administered through telephone interviews before and three, six, 12, and 24 months after treatment. To account for correlation among repeated measures, generalized estimating equation models were constructed. All analyses were performed with propensity score weights to solve treatment selection bias. Results The PROMs completion rate at 24 months was 95.0 %. Active surveillance entails the fewest side effects, but with significant sexual (0.4 standard deviations [SD], p < 0.001) and physical health deterioration (0.5 SD, p < 0.001); and moderate mental health improvement (0.4 SD, p = 0.001) at 24 months. Compared with active surveillance, RARP presented greater urinary incontinence (p = 0.030), and IMRT and real-time brachytherapy worse bowel symptoms (p = 0.027 and p = 0.007) at 24 months. Conclusions Most side effects of the new treatment modalities seem to be limited to short-term deteriorations, except for moderate-large urinary incontinence in patients who had undergone RARP and moderate bowel deterioration in patients treated with IMRT or with real-time brachytherapy. Furthermore, patients under active surveillance, IMRT, and real-time brachytherapy showed a moderate improvement in mental health.
Collapse
Affiliation(s)
- Víctor Zamora
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute) Barcelona, Spain
- CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
- Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Olatz Garin
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute) Barcelona, Spain
- CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - José Francisco Suárez
- Urology Department, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Cristina Gutiérrez
- Radiation Oncology Department, Institut Català d’Oncologia, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Ferran Guedea
- Radiation Oncology Department, Institut Català d’Oncologia, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Patricia Cabrera
- Radiation Oncology Department, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Manuel Castells
- Urology Department, Hospital Universitari de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Ismael Herruzo
- Radiation Oncology Department, Hospital Regional Universitario Carlos Haya, Málaga, Spain
| | - Lluis Fumadó
- Urology Department, Hospital del Mar, Barcelona, Spain
| | - Pilar Samper
- Radiation Oncology Department, Hospital Universitario Rey Juan Carlos, Móstoles, Spain
| | - Carlos Ferrer
- Radiation Oncology Department, Hospital Provincial de Castellón, Castellón, Spain
| | - Lucas Regis
- Urology Department, Hospital Universitario Vall d’Hebron, Barcelona, Spain
| | - Àngels Pont
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute) Barcelona, Spain
- CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
| | - Montse Ferrer
- Health Services Research Group, IMIM (Hospital del Mar Medical Research Institute) Barcelona, Spain
- CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
- Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | | |
Collapse
|
4
|
Zamora V, Garin O, Suárez JF, Jové J, Castells M, Ferrer F, Gutiérrez C, Guedea F, Boladeras A, Fumadó L, Roselló A, Pastor J, Samper P, Pont À, Ferrer M. Psychometric validation of the Spanish version of the Expanded Prostate Cancer Index Composite-26. World J Urol 2023; 41:3511-3518. [PMID: 37947846 PMCID: PMC10693511 DOI: 10.1007/s00345-023-04691-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 10/10/2023] [Indexed: 11/12/2023] Open
Abstract
PURPOSE To assess the validity, reliability, and responsiveness of the Spanish version of the Expanded Prostate cancer Index Composite (EPIC) with 26 items. METHODS Multicentric longitudinal study of patients diagnosed with localized or locally advanced prostate cancer (any T, any N, M0) treated with active surveillance, surgery, external radiotherapy, or brachytherapy. The EPIC-50 was administered initially to the cohort (n = 324 patients), until it was replaced in November 2019 by the EPIC-26 (n = 543), in both groups before treatment and 12 months after. We assessed confirmatory factor analysis (CFA), reliability with Cronbach's alpha coefficient, criterion validity with the intraclass correlation coefficient (ICC), and responsiveness by testing a priori hypotheses on deterioration effect size (ES). RESULTS The CFA confirmed the five-domain structure of the EPIC-26 proposed by the original instrument (comparative fit index = 0.95). The agreement between EPIC-50 (gold standard) and EPIC-26 domains was excellent (ICC > 0.90). Cronbach's alpha was > 0.7 in almost all domains, and the floor effect was near zero, although ceiling effect was higher than 50% in urinary incontinence and bowel domains. Hypothesized changes between before and 12 months after treatment were confirmed: ES > 0.8 in both urinary incontinence and sexual domains among patients who underwent surgery; and ES ranging 0.44-0.48 for bowel and sexual domains in patients treated with external radiotherapy. CONCLUSION The Spanish version of the EPIC-26 has demonstrated adequate metric properties, similar to those of the original version, with acceptable goodness-of-fit indices, good criterion validity, reliability, and responsiveness to detect changes after radical prostatectomy or external radiotherapy.
Collapse
Affiliation(s)
- Víctor Zamora
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona Biomedical Research Park, Office 144. Doctor Aiguader, 88, 08003, Barcelona, Spain
- Universitat Autònoma de Barcelona (UAB), Bellaterra, Spain
- CIBER en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | - Olatz Garin
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona Biomedical Research Park, Office 144. Doctor Aiguader, 88, 08003, Barcelona, Spain.
- CIBER en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.
- Universitat Pompeu Fabra, Barcelona, Spain.
| | - José Francisco Suárez
- Urology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Josep Jové
- Radiation Oncology Department, Institut Català d'Oncologia, Badalona, Spain
| | - Manuel Castells
- Urology Department, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Ferran Ferrer
- Radiation Oncology Department, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Spain
| | - Cristina Gutiérrez
- Radiation Oncology Department, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Spain
| | - Ferran Guedea
- Radiation Oncology Department, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Spain
| | - Ana Boladeras
- Radiation Oncology Department, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Spain
| | - Lluis Fumadó
- Urology Department, Hospital del Mar, Barcelona, Spain
| | - Alvar Roselló
- Radiation Oncology Department, Institut Català d'Oncologia, Girona, Spain
| | - Jorge Pastor
- Radiation Oncology Department, ASCIRES GRUPO BIOMÉDICO, Valencia, Spain
| | - Pilar Samper
- Radiation Oncology Department, Hospital Universitario Rey Juan Carlos, Móstoles, Spain
| | - Àngels Pont
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona Biomedical Research Park, Office 144. Doctor Aiguader, 88, 08003, Barcelona, Spain
- CIBER en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain
| | - Montse Ferrer
- Health Services Research Group, Hospital del Mar Research Institute, Barcelona Biomedical Research Park, Office 144. Doctor Aiguader, 88, 08003, Barcelona, Spain.
- CIBER en Epidemiología y Salud Pública, CIBERESP, Madrid, Spain.
- Universitat Pompeu Fabra, Barcelona, Spain.
| |
Collapse
|
5
|
Lazo A, de la Torre-Luque A, Arregui G, Rivas D, Serradilla A, Gómez J, Jurado F, Núñez MI, López E. Long-Term Outcomes of Dose-Escalated Hypofractionated Radiotherapy in Localized Prostate Cancer. BIOLOGY 2022; 11:435. [PMID: 35336808 PMCID: PMC8945092 DOI: 10.3390/biology11030435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 03/02/2022] [Accepted: 03/09/2022] [Indexed: 06/14/2023]
Abstract
This retrospective study aimed to provide some clinical outcomes regarding effectiveness, toxicity, and quality of life in PCa patients treated with dose-escalated moderately hypofractionated radiation therapy (HFRT). Patients received HFRT to a total dose of 66 Gy in 22 fractions (3 Gy/fraction) delivered via volume modulated arc therapy (VMAT) in 2011-2016. Treatment effectiveness was measured by the biochemical failure-free survival rate. Toxicity was assessed according to the criteria of the Radiation Therapy Oncology Group (RTOG) and quality of life according to the criteria of the European Organization for Research and Treatment of Cancer (EORTC). In this regard, quality of life (QoL) was measured longitudinally, at a median of 2 and 5 years after RT. Enrolled patients had low-risk (40.2%), intermediate-risk (47.5%), and high-risk (12.3%) PCa. Median follow-up was 75 months. The biochemical failure-free survival rate was 94.2%. The incidence of acute grade 2 or higher gastrointestinal (GI) and genitourinary (GU) toxicity was 9.84% and 28.69%, respectively. The incidence rate of late grade 2 or higher GI and GU toxicity was 1.64% and 4.10%, respectively. Expanded Prostate Cancer Index Composite (EPIC) scores showed that the majority of patients maintained their QoL. HFRT to 66 Gy with VMAT was associated with adequate biochemical control, low toxicity and good reported GU and GI quality of life.
Collapse
Affiliation(s)
- Antonio Lazo
- Department of Radiation Oncology, San Cecilio Clinical University Hospital, 18016 Granada, Spain;
| | - Alejandro de la Torre-Luque
- Department of Legal Medicine, Psychiatry and Pathology, CIBERSAM, Complutense University of Madrid, 28040 Madrid, Spain
| | | | - Daniel Rivas
- Department of Radiation Oncology, GenesisCare, 29018 Malaga, Spain;
| | - Ana Serradilla
- Department of Radiation Oncology, GenesisCare, 18004 Granada, Spain;
| | - Joaquin Gómez
- Department of Radiation Oncology, Torrecardenas Hospitalary Complex, 04009 Almeria, Spain;
| | - Francisca Jurado
- Department of Radiation Oncology, GenesisCare, 14012 Cordoba, Spain;
| | - María Isabel Núñez
- Department of Radiology and Physical Medicine, Granada University, 18012 Granada, Spain
- Biopathology and Regenerative Medicine Institute (IBIMER), Centre for Biomedical Research, Granada University, 18016 Granada, Spain
- Biosanitary Research Institute, ibs. Granada, 18012 Granada, Spain
| | - Escarlata López
- Department of Radiation Oncology, GenesisCare, 28043 Madrid, Spain;
| |
Collapse
|
6
|
Zamora V, Garin O, Pardo Y, Pont À, Gutiérrez C, Cabrera P, Gómez-Veiga F, Pijoan JI, Litwin MS, Ferrer M. Mapping the Patient-Oriented Prostate Utility Scale From the Expanded Prostate Cancer Index Composite and the Short-Form Health Surveys. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1676-1685. [PMID: 34711369 DOI: 10.1016/j.jval.2021.03.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 03/01/2021] [Accepted: 03/29/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES This study aimed to develop mapping algorithms from the Expanded Prostate Cancer Index Composite (EPIC) and the Short-Form (SF) Health Surveys to the Patient-Oriented Prostate Utility Scale (PORPUS), an econometric instrument specifically developed for patients with prostate cancer. METHODS Data were drawn from 2 cohorts concurrently administering PORPUS, EPIC-50, and SF-36v2. The development cohort included patients who had received a diagnosis of localized or locally advanced prostate cancer from 2017 to 2019. The validation cohort included men who had received a diagnosis of localized prostate cancer from 2014 to 2016. Linear regression models were constructed with ln(1 - PORPUS utility) as the dependent variable and scores from the original and brief versions of the EPIC and SF as independent variables. The predictive capacity of mapping models constructed with all possible combinations of these 2 instruments was assessed through the proportion of variance explained (R2) and the agreement between predicted and observed values. Validation was based on the comparison between estimated and observed utility values in the validation cohort. RESULTS Models constructed with EPIC-50 with and without SF yielded the highest predictive capacity (R2 = 0.884, 0.871, and 0.842) in comparison with models constructed with EPIC-26 (R2 = 0.844, 0.827, and 0.776). The intraclass correlation coefficient was excellent in the 4 models (>0.9) with EPIC and SF. In the validation cohort, predicted PORPUS utilities were slightly higher than those observed, but differences were not statistically significant. CONCLUSIONS Mapping algorithms from both the original and the abbreviated versions of the EPIC and the SF Health Surveys allow estimating PORPUS utilities for economic evaluations with cost-utility analyses in patients with prostate cancer.
Collapse
Affiliation(s)
- Víctor Zamora
- Health Services Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain; Department of Paediatrics, Obstetrics and Gynaecology, and Preventive Medicine, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
| | - Olatz Garin
- Health Services Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain; Universitat Pompeu Fabra, Barcelona, Spain.
| | - Yolanda Pardo
- Health Services Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain; Department of Psychiatry and Legal Medicine, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
| | - Àngels Pont
- Health Services Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
| | | | - Patricia Cabrera
- Department of Radiation Oncology, Hospital Universitario Virgen del Rocío, Sevilla, Spain
| | - Francisco Gómez-Veiga
- Complejo Hospitalario Universitario de Salamanca, Grupo de Investigación Translacional de Urología, Instituto de Investigación de Salamanca, Salamanca, Spain
| | - José Ignacio Pijoan
- CIBER en Epidemiología y Salud Pública, CIBERESP, Spain; Department of Clinical Epidemiology, Hospital Universitario de Cruces, Barakaldo, Vizcaya, Spain
| | - Mark S Litwin
- Schools of Medicine, Public Health and Nursing, University of California, Los Angeles, CA, USA
| | - Montse Ferrer
- Health Services Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain; Department of Paediatrics, Obstetrics and Gynaecology, and Preventive Medicine, Universitat Autònoma de Barcelona, Bellaterra, Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
| |
Collapse
|
7
|
Zapatero A, Maldonado Pijoan X, Gómez-Caamaño A, Pardo Masferrer J, Macías Hernández V, Hervás Morón A, Muñoz García JL, Palacios Eito A, Anguita-Alonso P, González-Junco C, López Torrecilla J. Health-related quality of life in men with localized prostate cancer treated with radiotherapy: validation of an abbreviated version of the Expanded Prostate Cancer Index Composite for Clinical Practice in Spain. Health Qual Life Outcomes 2021; 19:223. [PMID: 34563208 PMCID: PMC8466718 DOI: 10.1186/s12955-021-01856-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 08/29/2021] [Indexed: 12/03/2022] Open
Abstract
Background Health-related quality of life (HRQoL) is greatly affected by prostate cancer (PCa) and associated treatments. This study aimed to measure the impact of radiotherapy on HRQoL and to further validate the Spanish version of the 16-item Expanded Prostate Cancer Index Composite (EPIC-16) in routine clinical practice. Methods An observational, non-interventional, multicenter study was conducted in Spain with localized PCa patients initiating treatment with external beam radiotherapy (EBRT) or brachytherapy (BQT). Changes from baseline in EPIC-16, University of California-Los Angeles Prostate Cancer Index (UCLA-PCI), and patient-perceived health status were longitudinally assessed at end of radiotherapy (V2) and 90 days thereafter (V3). Psychometric evaluations of the Spanish EPIC-16 were conducted. Results Of 516 patients enrolled, 495 were included in the analysis (EBRT, n = 361; BQT, n = 134). At baseline, mean (standard deviation [SD]) EPIC-16 global scores were 11.9 (7.5) and 10.3 (7.7) for EBRT and BQT patients, respectively; scores increased, i.e., HRQoL worsened, from baseline, by mean (SD) of 6.8 (7.6) at V2 and 2.4 (7.4) at V3 for EBRT and 4.2 (7.6) and 3.9 (8.2) for BQT patients. Changes in Spanish EPIC-16 domains correlated well with urinary, bowel, and sexual UCLA-PCI domains. EPIC-16 showed good internal consistency (Cronbach’s alpha = .84), reliability, and construct validity. Conclusion The Spanish EPIC-16 questionnaire demonstrated sensitivity, strong discriminative properties and reliability, and validity for use in clinical practice. EPIC-16 scores worsened after radiotherapy in different HRQoL domains; however, a strong tendency towards recovery was seen at the 3-month follow-up visit. Supplementary Information The online version contains supplementary material available at 10.1186/s12955-021-01856-z.
Collapse
Affiliation(s)
- Almudena Zapatero
- Department of Radiation Oncology, Hospital Universitario de La Princesa, Madrid, Spain.
| | | | - Antonio Gómez-Caamaño
- Department of Radiation Oncology, Hospital Clínico Universitario de Santiago de Compostela, Santiago de Compostela, A Coruña, Spain
| | - José Pardo Masferrer
- Department of Radiation Oncology, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | | | | | | | - Amalia Palacios Eito
- Department of Radiation Oncology, Hospital Universitario Reina Sofía, Córdoba, Spain
| | | | | | - José López Torrecilla
- Department of Radiation Oncology, ERESA, Hospital General Universitario de València, València, Spain
| |
Collapse
|
8
|
Garin O, Suárez JF, Guedea F, Pont À, Pardo Y, Goñi A, Mariño A, Hervás A, Herruzo I, Cabrera P, Sancho G, Ponce de León J, Macías V, Gutierrez C, Castells M, Ferrer M. Comparative Effectiveness Research in Localized Prostate Cancer: A 10-Year Follow-up Cohort Study. Int J Radiat Oncol Biol Phys 2021; 110:718-726. [PMID: 33388360 DOI: 10.1016/j.ijrobp.2020.12.032] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 11/27/2020] [Accepted: 12/22/2020] [Indexed: 12/24/2022]
Abstract
PURPOSE Long-term comparative effectiveness research on localized prostate cancer treatments is scarce, and evidence is lacking especially for brachytherapy. The aim of this study was to assess the long-term impact of the side effects of radical prostatectomy, brachytherapy, and external radiation therapy on patients with localized prostate cancer at 10 years, using propensity score analyses. METHODS AND MATERIALS This was a prospective observational study of a cohort of men who received a diagnosis of clinically localized prostate cancer (clinical stage T1 or T2, low and intermediate risk group) and were treated with radical prostatectomy (n = 139), brachytherapy (n = 317), or external radiation therapy (n = 194). Treatment decisions were jointly made by patients and physicians. Patient-reported outcome (PRO) evaluation included the Expanded Prostate Cancer Index Composite and Short Form-36, administered centrally by telephone interviews before and annually after treatment. The Expanded Prostate Cancer Index Composite covers urinary, bowel, sexual, and hormonal domains. To assess PRO changes over time, while accounting for correlation among repeated measures, generalized estimating equation models adjusted by propensity scores were constructed. RESULTS The PRO completion rate at 10 years was 85.8%. Generalized estimating equation models showed that the pattern of radical prostatectomy side effects, with substantial urinary incontinence and sexual dysfunction, remained until 10 years after treatment (standard deviation [SD], -1.1 and -1.3, respectively). Brachytherapy produced late deterioration in urinary continence (SD, -0.4) and sexual function (SD, -0.9) that appeared midterm, but the differences from radical prostatectomy remained statistically significant at 10 years (P < .001 after adjusting by propensity score). External radiation therapy showed similar results to brachytherapy, but with bowel bother (SD, -0.3). CONCLUSIONS Although late deterioration in radiation therapy groups attenuated differences from radical prostatectomy, relevant PRO differences still remained after 10 years. Our findings support that brachytherapy is the treatment option that causes the least impact on PROs; it is therefore an alternative to be considered when making evidence-based decisions on localized prostate cancer treatment.
Collapse
Affiliation(s)
- Olatz Garin
- Health Services Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain; Pompeu Fabra University, Barcelona, Spain
| | | | - Ferran Guedea
- Institut Català d'Oncologia, L'Hospitalet de Llobregat, Spain
| | - Àngels Pont
- Health Services Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
| | - Yolanda Pardo
- Health Services Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain; Universitat Autònoma de Barcelona, Bellaterra, Spain
| | - Alai Goñi
- Institutu Onkologikoa, San Sebastián, Spain
| | - Alfonso Mariño
- Servicio de Oncología Radioterápica, Centro Oncológico de Galicia, A Coruña, Spain
| | - Asunción Hervás
- Servicio de Oncología Radioterápica, Hospital Ramón y Cajal, Madrid, Spain
| | - Ismael Herruzo
- Servicio de Oncología Radioterápica, Hospital Regional Carlos Haya, Málaga, Spain
| | - Patricia Cabrera
- Servicio de Oncología Radioterápica, Hospital Virgen del Rocío, Sevilla, Spain
| | - Gemma Sancho
- Servicio de Oncología Radioterápica, Hospital Santa Creu i Sant Pau, Barcelona, Spain
| | | | - Víctor Macías
- Hospital Universitario y Politecnico La Fe, Valencia, Spain
| | | | - Manel Castells
- Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Montse Ferrer
- Health Services Research Group, Hospital del Mar Medical Research Institute, Barcelona, Spain; CIBER en Epidemiología y Salud Pública, CIBERESP, Spain; Universitat Autònoma de Barcelona, Bellaterra, Spain.
| |
Collapse
|
9
|
Five-year quality of life in patients with high-risk localized prostate cancer treated with external beam radiotherapy alone versus external beam radiotherapy with high-dose-rate brachytherapy boost: a prospective multicenter study. J Contemp Brachytherapy 2021; 13:1-11. [PMID: 34025730 PMCID: PMC8117716 DOI: 10.5114/jcb.2021.103580] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2020] [Accepted: 12/24/2020] [Indexed: 11/26/2022] Open
Abstract
Purpose Brachytherapy (BT) and external beam radiation therapy (EBRT) are effective treatments for high-risk prostate cancer (PCa). However, the impact of these treatments on health-related quality of life (HRQL) remains unclear. In this study, we compared EBRT alone with EBRT plus a boost with high-dose rate (HDR)-BT to determine the impact on HRQL in patients with high-risk PCa. Material and methods Prospective, multicenter study comparing patients with high-risk PCa treated with EBRT alone or EBRT + HDR-BT from 2004 to 2006. HRQL was assessed at baseline (pre-treatment) and periodically over the 5-year follow-up, using the SF-36 (v.2), EPIC, and FACT-G and FACT-P questionnaires. Results A total of 129 patients were included in the study, of these, 41 received EBRT alone and 88 EBRT + HDR-BT. All patients received hormonotherapy. Baseline clinical characteristics were similar, except for a slightly higher mean number of comorbidities in the EBRT group. During follow-up, the only significant between-group difference was a greater worsening on EPIC hormonal domain in the EBRT alone group (p = 0.028). There were no significant differences in time and interaction of treatment in SF-36, and FACT-G and FACT-P questionnaires or EPIC urinary incontinence, urinary irritative-obstructive, and bowel and sexual domains over the 5-year follow-up. Oncological outcomes were similar in both groups. Conclusions After five years of follow-up, EBRT alone or combined with HDR-BT boost had a similar impact on HRQL in patients with high-risk localized PCa. However, patients in the EBRT alone group experienced greater worsening of hormonal domain according to EPIC questionnaire.
Collapse
|
10
|
Sureda A, Fumadó L, Ferrer M, Garín O, Bonet X, Castells M, Mir MC, Abascal JM, Vigués F, Cecchini L, Suárez JF. Health-related quality of life in men with prostate cancer undergoing active surveillance versus radical prostatectomy, external-beam radiotherapy, prostate brachytherapy and reference population: a cross-sectional study. Health Qual Life Outcomes 2019; 17:11. [PMID: 30642340 PMCID: PMC6332524 DOI: 10.1186/s12955-019-1082-4] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Accepted: 01/07/2019] [Indexed: 01/22/2023] Open
Abstract
Background The purpose of this study is to describe Health-Related Quality of Life (HRQoL) of localized prostate cancer patients in an Active Surveillance (AS) program, and to compare them with those undergoing radical prostatectomy (RP), external-beam radiotherapy (XRT) and brachytherapy (BT). Methods Multi-institutional pooled cross-sectional analysis on patients in an AS protocol: < 75 years old; pathologically confirmed LPC (maximum of three positive cylinders); Gleason score < 3 + 4; clinical stage T1a-T2b; and PSA < 15 ng/ml. Exclusion criteria for this study were: less than 6 months in AS, termination of AS protocol, or incomplete data. Patients in AS were matched with those treated with RP, XRT or BT from the ‘Spanish Multicentric Study of Clinically Localized Prostate Cancer’ cohort according to risk group, time from treatment selection to HRQoL survey, and age. Prostate-specific (EPIC) and generic (SF-36) HRQoL instruments were completed. Analysis was stratified by HRQoL survey moment (>or < 2.5 years from treatment selection), and age (>or < 70 years old). Results Median of time from treatment selection to HRQoL survey in the total 396 patients (99 per treatment group) was 2.4 years (range 0.5–8.3). Patients in AS presented higher (better) urinary incontinence scores than RP ones in both stratus of time from treatment selection to HRQoL survey (92.6 vs 67.0 and 81.4 vs 64.4, p < 0.01). Patients in AS for < 2.5 years presented greater sexual scores than any active treatment (p < 0.01), but only statistically higher than RP for those in AS for longer than 2.5 years. The magnitude of the differences between AS and RP groups in both EPIC domains ranged from moderate (0.7 SD) to large (1.0 SD). Regardless of treatment applied, patients presented similar and slightly increased SF-36 scores than US general population reference norms. Nonetheless, patients in AS for < 2.5 years reported worse outcomes than other treatment groups on physical health domains, especially in bodily pain (0.5–0.6 SD), and vitality (0.6–0.8 SD). Conclusions Considering patients’ well-being, AS can be a good therapeutic option due to the low impact caused on urinary continence and sexual function. However, longitudinal studies are required to take into account HRQoL evolution over time. Electronic supplementary material The online version of this article (10.1186/s12955-019-1082-4) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- A Sureda
- Urology Department, Hospital del Mar-IMIM, Autonomous University of Barcelona, Passeig Marítim 25-29, 08003, Barcelona, Spain.,Autonomous University of Barcelona, Barcelona, Spain
| | - L Fumadó
- Urology Department, Hospital del Mar-IMIM, Autonomous University of Barcelona, Passeig Marítim 25-29, 08003, Barcelona, Spain.
| | - M Ferrer
- Autonomous University of Barcelona, Barcelona, Spain.,IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain.,CIBER en Epidemiología y Salud Pública, CIBERESP, Barcelona, Spain
| | - O Garín
- IMIM (Institut Hospital del Mar d'Investigacions Mèdiques), Barcelona, Spain.,CIBER en Epidemiología y Salud Pública, CIBERESP, Barcelona, Spain.,Universitat Pompeu Fabra, Barcelona, Spain
| | - X Bonet
- Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Spain
| | - M Castells
- Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Spain
| | - M C Mir
- Urology Department, Hospital del Mar-IMIM, Autonomous University of Barcelona, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - J M Abascal
- Urology Department, Hospital del Mar-IMIM, Autonomous University of Barcelona, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - F Vigués
- Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Spain
| | - L Cecchini
- Urology Department, Hospital del Mar-IMIM, Autonomous University of Barcelona, Passeig Marítim 25-29, 08003, Barcelona, Spain
| | - J F Suárez
- Hospital Universitari de Bellvitge, l'Hospitalet de Llobregat, Barcelona, Spain
| |
Collapse
|
11
|
Development and Validation of Crosswalks for Patient-reported Sexual and Urinary Outcomes Between Commonly Used Instruments. Eur Urol 2018; 75:723-730. [PMID: 30573317 DOI: 10.1016/j.eururo.2018.12.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 12/04/2018] [Indexed: 11/24/2022]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) have become widely adopted in the care of patients with prostate cancer, but there is no validated crosswalk between two commonly used instruments, the Expanded Prostate Cancer Index Composite Short Form (EPIC-26) and the Memorial Sloan Kettering (MSK) instrument, which consists of the International Index of Erectile Function-6 (IIEF-6) questionnaire and the MSK radical prostatectomy urinary outcome scale. OBJECTIVE To develop and validate bidirectional crosswalks between the sexual and urinary domains (single domain in MSK, separate incontinence and irritative/obstructive domains in EPIC-26) of the MSK and EPIC-26 instruments. DESIGN, SETTING, AND PARTICIPANTS Radical prostatectomy (RP) patients completing instruments at MSK and Michigan Urological Surgery Improvement Collaborative (MUSIC) between January and May of 2017 were invited to enroll. Stratified random sampling (by institution, MSK urinary function score, and MSK erectile function score) was used to divide patient data into training and test sets. Models were developed to predict the domain score for each instrument using the other's item responses and domain scores. Performance was evaluated using capped root-mean-squared error and accuracy at established thresholds. RESULTS AND LIMITATIONS We received 517 instruments at MSK and 1033 within MUSIC, which were assigned to training (825), post-RP test (412), and pre-RP test (313) sets. We found the crosswalks to have low error and high accuracy. Although the crosswalks are more accurate if responses to each item are known, it is possible to convert between instruments on the basis of a total domain score. CONCLUSIONS The crosswalks are a valid way to convert between sexual and urinary domains of the MSK and EPIC-26 instruments. PATIENT SUMMARY We developed and validated a set of formulas that allow conversion of sexual and urinary function scores between the Memorial Sloan Kettering and Expanded Prostate Cancer Index Composite Short Form patient-reported outcome questionnaires. These crosswalks allow seamless transition between the two questionnaires.
Collapse
|
12
|
Penedo FJ, Antoni MH, Moreno PI, Traeger L, Perdomo D, Dahn J, Miller GE, Cole S, Orjuela J, Pizarro E, Yanez B. Study design and protocol for a culturally adapted cognitive behavioral stress and self-management intervention for localized prostate cancer: The Encuentros de Salud study. Contemp Clin Trials 2018; 71:173-180. [PMID: 29909057 PMCID: PMC6145066 DOI: 10.1016/j.cct.2018.06.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2018] [Revised: 06/07/2018] [Accepted: 06/11/2018] [Indexed: 12/12/2022]
Abstract
Almost 2.8 million men in the U.S. are living with prostate cancer (PC), accounting for 40% of all male cancer survivors. Men diagnosed with prostate cancer may experience chronic and debilitating treatment side effects, including sexual and urinary dysfunction, pain and fatigue. Side effects can be stressful and can also lead to poor psychosocial functioning. Prior trials reveal that group-based cognitive behavioral stress and self-management (CBSM) is effective in reducing stress and mitigating some of these symptoms, yet little is known about the effects of culturally-translated CBSM among Spanish-speaking men with PC. This manuscript describes the rationale and study design of a multi-site, randomized controlled trial to determine whether participation in a culturally adapted cognitive behavioral stress management (C-CBSM) intervention leads to significantly greater reductions in symptom burden and improvements in health-related quality of life relative to participation in a non-culturally adapted cognitive behavioral stress management (CBSM) intervention. Participants (N = 260) will be Spanish-speaking Hispanic/Latino men randomized to the standard, non-culturally adapted CBSM intervention (e.g., cognitive behavioral strategies, stress management, and health maintenance) or the culturally adapted C-CBSM intervention (e.g., content adapted to be compatible with Hispanic/Latino cultural patterns and belief systems, meanings, values and social context) for 10 weeks. Primary outcomes (i.e., disease-specific symptom burden and health-related quality of life) will be assessed across time. We hypothesize that a culturally adapted C-CBSM intervention will be more efficacious in reducing symptom burden and improving health-related quality of life among Hispanic/Latino men when compared to a non-culturally adapted CBSM intervention.
Collapse
Affiliation(s)
- Frank J Penedo
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States.
| | - Michael H Antoni
- Department of Psychology, University of Miami, Coral Gables, FL, United States
| | - Patricia I Moreno
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Lara Traeger
- Massachusetts General Hospital, Harvard Medical School, Boston, MA, United States
| | - Dolores Perdomo
- Department of Psychology, University of Miami, Coral Gables, FL, United States
| | - Jason Dahn
- Miami VA Healthcare System, Miami, FL, United States
| | - Gregory E Miller
- Institute for Policy Research and Department of Psychology, Northwestern University, Evanston, IL, United States
| | - Steve Cole
- Department of Medicine, University of California Los Angeles, Los Angeles, CA, United States
| | - Julian Orjuela
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Edgar Pizarro
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| | - Betina Yanez
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, United States
| |
Collapse
|
13
|
Lee TK, Poon DMC, Ng ACF, Ho T, Singh-Carlson S, Joffres M, Oshan G, Kohli J, Kwan W. Cultural adaptation and validation of the Chinese version of the expanded prostate cancer index composite. Asia Pac J Clin Oncol 2018; 14 Suppl 1:10-15. [PMID: 29508938 DOI: 10.1111/ajco.12855] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
AIM The expanded prostate cancer index composite (EPIC) is a widely adopted instrument for the quality of life of patients with prostate cancer. We aimed to create a Chinese version of EPIC to further research in the Chinese-speaking population. METHODS A prototype was created by forward-backward translations and revisions. During cultural adaptation, 15 participants were interviewed after they had completed the prototype. A few issues highlighted included confusion related to the question format, subject non-familiarity with the Chinese term for "hot flashes," and the use of the Chinese term for "breast" as a strictly female body part. A pilot version was created based on the cultural adaptation findings. Validation of the pilot version was performed by having 50 participants complete the Chinese EPIC and EORTC QLQ-c30 twice within a 4-week period. Test-retest reliability (Pearson's correlations and difference distribution) and internal consistency (Cronbach's α) were measured using SAS version 9.4. RESULTS Test-retest reliability values for the urinary, bowel, sexual and hormone domains were 0.71, 0.51, 0.51 and 0.66, respectively; subscale test-retest reliability ranged between 0.29 and 0.82. Internal consistency for domains was good with Cronbach's α ranging from 0.76 to 0.78 for the initial test and 0.67 to 0.85 for the retest. The performance of this version of EPIC was comparable to the validated EORTC QLQ-C30. CONCLUSION The EPIC questionnaire was successfully translated into Chinese and was culturally adapted. The resultant Chinese version has high reliability and validity and will be an important tool for research on quality of life in the Chinese population.
Collapse
Affiliation(s)
- Tsz Kin Lee
- Department of Radiation Oncology, Abbotsford Cancer Centre, British Columbia Cancer Agency, Canada
| | - Darren M C Poon
- Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong
| | - Anthony C F Ng
- Department of Surgery, The Chinese University of Hong Kong, Hong Kong
| | - Terrence Ho
- Department of Clinical Oncology, The Chinese University of Hong Kong, Hong Kong
| | | | - Michel Joffres
- Faculty of Health Sciences, Simon Fraser University, Canada
| | - Gurpreet Oshan
- Department of Medicine, University of British Columbia, Canada
| | - Jagbir Kohli
- Department of Radiation Oncology, Abbotsford Cancer Centre, British Columbia Cancer Agency, Canada
| | - Winkle Kwan
- Department of Radiation Oncology, Fraser Valley Cancer Centre, British Columbia Cancer Agency, Canada
| |
Collapse
|
14
|
Umbehr MH, Bachmann LM, Poyet C, Hammerer P, Steurer J, Puhan MA, Frei A. The German version of the Expanded Prostate Cancer Index Composite (EPIC): translation, validation and minimal important difference estimation. Health Qual Life Outcomes 2018; 16:36. [PMID: 29458434 PMCID: PMC5819270 DOI: 10.1186/s12955-018-0859-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2017] [Accepted: 02/05/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND No official German translation exists for the 50-item Expanded Prostate Cancer Index Composite (EPIC), and no minimal important difference (MID) has been established yet. The aim of the study was to translate and validate a German version of the EPIC with cultural adaptation to the different German speaking countries and to establish the MID. METHODS We translated and culturally adapted the EPIC into German. For validation, we included a consecutive subsample of 92 patients with localized prostate cancer undergoing radical prostatectomy who participated the Prostate Cancer Outcomes Cohort. Baseline and follow-up assessments took place before and six weeks after prostatectomy in 2010 and 2011. We assessed the EPIC, EORTC QLQ-PR25, Feeling Thermometer, SF-36 and a global rating of health state change variable. We calculated the internal consistency, test-retest reliability, construct validity, responsiveness and MID. RESULTS For most EPIC domains and subscales, our a priori defined criteria for reliability were fulfilled (construct reliability: Cronbach's alpha 0.7-0.9; test-retest reliability: intraclass-correlation coefficient ≥ 0.7). Cross-sectional and longitudinal correlations between EPIC and EORTC QLQ-PR25 domains ranged from 0.14-0.79, and 0.06-0.5 and 0.08-0.72 for Feeling Thermometer and SF-36, respectively. We established MID values of 10, 4, 12, and 6 for the urinary, bowel, sexual and hormonal domain. CONCLUSION The German version of the EPIC is reliable, responsive and valid to measure HRQL in prostate cancer patients and is now available in German language. With the suggested MID we provide interpretation to what extent changes in HRQL are clinically relevant for patients. Hence, study results are of interest beyond German speaking countries.
Collapse
Affiliation(s)
- Martin H. Umbehr
- Department of Urology, City Hospital Triemli of Zurich, Birmensdorferstrasse 497, 8063 Zurich, Switzerland
- Horten Centre of patient orientated research and knowledge transfer, University of Zurich, Zurich, Switzerland
| | | | - Cedric Poyet
- Department of Urology, University Hospital of Zurich, Zurich, Switzerland
| | - Peter Hammerer
- Clinic of Urology, Städtisches Klinikum Braunschweig, Braunschweig, Germany
| | - Johann Steurer
- Horten Centre of patient orientated research and knowledge transfer, University of Zurich, Zurich, Switzerland
| | - Milo A. Puhan
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Anja Frei
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| |
Collapse
|
15
|
Vigneault É, Savard J, Savard MH, Ivers H, Després P, Foster W, Martin AG, Fradet V. Validation of the French-Canadian version of the Expanded Prostate Cancer Index Composite (EPIC) in a French-Canadian population. Can Urol Assoc J 2017; 11:404-410. [PMID: 29106365 DOI: 10.5489/cuaj.4428] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
INTRODUCTION This study aims to empirically validate the French-Canadian version of the Expanded Prostate Cancer Index Composite (EPIC), a measure of health-related quality of life for prostate cancer patients. METHODS Two hundred fifty-one participants completed a battery of self-report scales, including the French-Canadian version of the EPIC, after having received radiation therapy or radical prostatectomy for prostate cancer. RESULTS The internal consistency for the urinary incontinence, bowel, and sexual domains of the EPIC-26 was high (Cronbach's alpha coefficients from 0.80-0.92), while coefficients for the urinary irritation/obstruction (0.59) and hormonal (0.67) domains were lower. Item-total correlations (rs=0.15-0.85), and temporal stability (rs=0.72-0.93) generally supported the reliability of the instrument. The five-factor structure of the EPIC-26 was confirmed for the most part. The construct validity of the instrument was also supported by high correlations obtained between each domain and measures assessing similar constructs (rs=-0.56-0.83). The EPIC also showed an excellent sensitivity to change with significant differences obtained on EPIC scores (all p<0.05) between pre- and post-prostate cancer treatment. CONCLUSIONS The psychometric qualities of the French-Canadian version of the EPIC are well-supported, thus providing a valid tool to assess health-related quality of life in prostate cancer patients.
Collapse
Affiliation(s)
- Éric Vigneault
- CHU de Québec-Université Laval Research Centre; Quebec City, QC, Canada.,Department of Radiation Oncology, CHU de Québec-Université Laval; Quebec City, QC, Canada
| | - Josée Savard
- CHU de Québec-Université Laval Research Centre; Quebec City, QC, Canada.,Université Laval Cancer Research Centre; Quebec City, QC, Canada.,School of Psychology, Université Laval; Quebec City, QC, Canada
| | - Marie-Hélène Savard
- CHU de Québec-Université Laval Research Centre; Quebec City, QC, Canada.,Université Laval Cancer Research Centre; Quebec City, QC, Canada
| | - Hans Ivers
- CHU de Québec-Université Laval Research Centre; Quebec City, QC, Canada.,Université Laval Cancer Research Centre; Quebec City, QC, Canada.,School of Psychology, Université Laval; Quebec City, QC, Canada
| | - Philippe Després
- CHU de Québec-Université Laval Research Centre; Quebec City, QC, Canada.,Department of Radiation Oncology, CHU de Québec-Université Laval; Quebec City, QC, Canada.,Université Laval Cancer Research Centre; Quebec City, QC, Canada.,Département de Physique, de Génie Physique et d'Optique, Université Laval; Quebec City, QC, Canada
| | - William Foster
- Department of Radiation Oncology, CHU de Québec-Université Laval; Quebec City, QC, Canada
| | - André-Guy Martin
- CHU de Québec-Université Laval Research Centre; Quebec City, QC, Canada.,Department of Radiation Oncology, CHU de Québec-Université Laval; Quebec City, QC, Canada
| | - Vincent Fradet
- CHU de Québec-Université Laval Research Centre; Quebec City, QC, Canada.,Université Laval Cancer Research Centre; Quebec City, QC, Canada.,Department of Surgery, Université Laval; Quebec City, QC, Canada
| |
Collapse
|
16
|
Ávila M, Becerra V, Guedea F, Suárez JF, Fernandez P, Macías V, Mariño A, Hervás A, Herruzo I, Ortiz MJ, Ponce de León J, Sancho G, Cunillera O, Pardo Y, Cots F, Ferrer M. Estimating preferences for treatments in patients with localized prostate cancer. Int J Radiat Oncol Biol Phys 2014; 91:277-87. [PMID: 25491504 DOI: 10.1016/j.ijrobp.2014.09.044] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 09/25/2014] [Accepted: 09/30/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE Studies of patients' preferences for localized prostate cancer treatments have assessed radical prostatectomy and external radiation therapy, but none of them has evaluated brachytherapy. The aim of our study was to assess the preferences and willingness to pay of patients with localized prostate cancer who had been treated with radical prostatectomy, external radiation therapy, or brachytherapy, and their related urinary, sexual, and bowel side effects. METHODS AND MATERIALS This was an observational, prospective cohort study with follow-up until 5 years after treatment. A total of 704 patients with low or intermediate risk localized prostate cancer were consecutively recruited from 2003 to 2005. The estimation of preferences was conducted using time trade-off, standard gamble, and willingness-to-pay methods. Side effects were measured with the Expanded Prostate Index Composite (EPIC), a prostate cancer-specific questionnaire. Tobit models were constructed to assess the impact of treatment and side effects on patients' preferences. Propensity score was applied to adjust for treatment selection bias. RESULTS Of the 580 patients reporting preferences, 165 were treated with radical prostatectomy, 152 with external radiation therapy, and 263 with brachytherapy. Both time trade-off and standard gamble results indicated that the preferences of patients treated with brachytherapy were 0.06 utilities higher than those treated with radical prostatectomy (P=.01). Similarly, willingness-to-pay responses showed a difference of €57/month (P=.004) between these 2 treatments. Severe urinary incontinence presented an independent impact on the preferences elicited (P<.05), whereas no significant differences were found by bowel and sexual side effects. CONCLUSIONS Our findings indicate that urinary incontinence is the side effect with the highest impact on preferences and that brachytherapy and external radiation therapy are more valued than radical prostatectomy. These time trade-off and standard gamble preference assessments as well as the willingness-to-pay estimation could be useful to perform respectively cost-utility or cost-benefit analyses, which can guide health policy decisions.
Collapse
Affiliation(s)
- Mónica Ávila
- Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain; Universitat Pompeu Fabra, Barcelona, Spain
| | - Virginia Becerra
- Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Ferran Guedea
- Servicio de Oncología Radioterápica, Institut Català d'Oncologia, L'Hospitalet de Llobregat, Spain
| | - José Francisco Suárez
- Servicio de Urología, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Spain
| | - Pablo Fernandez
- Servicio de Oncología Radioterápica, Instituto Oncológico de Guipúzcoa, San Sebastián, Spain
| | - Víctor Macías
- Servicio de Oncología Radioterápica, Hospital Clínico Universitario de Salamanca, Salamanca, Spain; Servicio de Oncología Radioterápica, Institut Oncologic del Valles-Hospital General de Catalunya, Sant Cugat del Vallès, Spain
| | - Alfonso Mariño
- Servicio de Oncología Radioterápica, Centro Oncológico de Galicia, A Coruña, Spain
| | - Asunción Hervás
- Servicio de Oncología Radioterápica, Hospital Ramón y Cajal, Madrid, Spain
| | - Ismael Herruzo
- Servicio de Oncología Radioterápica, Hospital Regional Carlos Haya, Málaga, Spain
| | - María José Ortiz
- Servicio de Oncología Radioterápica, Hospital Virgen del Rocío, Sevilla, Spain
| | | | - Gemma Sancho
- Servicio de Oncología Radioterápica, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Oriol Cunillera
- Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Yolanda Pardo
- Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain
| | - Francesc Cots
- Epidemiology and Evaluation Research Group, Epidemiology and Evaluation Department, Hospital del Mar, Barcelona, Spain
| | - Montse Ferrer
- Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain; CIBER en Epidemiología y Salud Pública (CIBERESP), Spain; Universitat Autònoma de Barcelona, Bellaterra, Spain.
| | | |
Collapse
|
17
|
Avila M, Pardo Y, Castells M, Ferrer F, Boladeras A, Pera J, Prada PJ, Guix B, de Paula B, Hernandez H, Pont A, Alonso J, Garin O, Bremner K, Krahn M, Ferrer M. Adaptation and validation of the Spanish version of the Patient-Oriented Prostate Utility Scale (PORPUS). Qual Life Res 2014; 23:2481-7. [PMID: 24789667 DOI: 10.1007/s11136-014-0701-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/15/2014] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The Patient-Oriented Prostate Utility Scale (PORPUS) is a combined profile and utility-based quality of life measure for prostate cancer patients. Our objectives were to adapt the PORPUS into Spanish and to assess its acceptability, reliability, and validity. METHODS The PORPUS was adapted into Spanish using forward and back translations and cognitive debriefing. PORPUS was administered jointly with the SF-36 and the Expanded Prostate Index Composite (EPIC) to 480 Spanish prostate cancer patients treated with radical prostatectomy or radiotherapy. The Spanish PORPUS scores' distribution and reliability were examined and compared with the original instrument. To evaluate construct validity, relationships were assessed between PORPUS and other instruments (testing hypotheses of the original PORPUS study), and among known groups defined by side effect severity. RESULTS Reliability coefficient was 0.76 (similar to the original PORPUS' 0.81). Spanish PORPUS items presented correlations ranging 0.57-0.88 with the corresponding EPIC domains, as in the original PORPUS study (0.60-0.83). Both PORPUS-P and PORPUS-U showed significant differences and large effect sizes (0.94-1.90) when comparing severe versus no problem groups on urinary, bowel, sexual and hormonal side effects defined by EPIC. CONCLUSIONS A conceptually equivalent Spanish version was obtained, with high reliability and good construct validity, similar to the original Canadian PORPUS version. It can therefore be used to measure health-related quality of life and utilities in Spanish prostate cancer patients.
Collapse
Affiliation(s)
- Mónica Avila
- Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Doctor Aiguader 88, 08003, Barcelona, Spain
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Ferrer M, Guedea F, Suárez JF, de Paula B, Macías V, Mariño A, Hervás A, Herruzo I, Ortiz MJ, Ponce de León J, Sancho G, Boladeras A, Ayala A, Craven-Bratle J, Ávila M, Cunillera O, Pardo Y, Alonso J, Aguiló F. Quality of life impact of treatments for localized prostate cancer: Cohort study with a 5year follow-up. Radiother Oncol 2013; 108:306-13. [DOI: 10.1016/j.radonc.2013.05.038] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 05/23/2013] [Accepted: 05/30/2013] [Indexed: 01/24/2023]
|
19
|
Hernández Fernández C, Brenes Bermúdez F, Moncada Iribarren I. [Update of the usefulness of α-blockers in the treatment of different urologic pathologies]. Med Clin (Barc) 2012; 139:582-7. [PMID: 22982131 DOI: 10.1016/j.medcli.2012.06.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 06/24/2012] [Accepted: 06/28/2012] [Indexed: 12/28/2022]
Abstract
OBJECTIVE To review the role of α-blockers in various urological conditions such as benign prostatic hyperplasia, overactive bladder, chronic prostatitis, and erectile dysfunction and as expulsive treatment of distal ureteral stones. MATERIAL AND METHODS We reviewed the latest scientific evidence in all the fields mentioned above, performing a critical analysis. CONCLUSION α-blockers are now considered first-line treatment in lower urinary tract symptoms secondary to benign prostatic hyperplasia, but the indications go beyond, and are able to improve, alone or in combination with other drugs, the previously mentioned pathologies. The uroselective properties of some α-blockers make them a highly safe medication.
Collapse
|
20
|
Katz A, Ferrer M, Suárez JF. Comparison of quality of life after stereotactic body radiotherapy and surgery for early-stage prostate cancer. Radiat Oncol 2012; 7:194. [PMID: 23164305 PMCID: PMC3528663 DOI: 10.1186/1748-717x-7-194] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2012] [Accepted: 11/15/2012] [Indexed: 11/10/2022] Open
Abstract
Background As the long-term efficacy of stereotactic body radiation therapy (SBRT) becomes established and other prostate cancer treatment approaches are refined and improved, examination of quality of life (QOL) following prostate cancer treatment is critical in driving both patient and clinical treatment decisions. We present the first study to compare QOL after SBRT and radical prostatectomy, with QOL assessed at approximately the same times pre- and post-treatment and using the same validated QOL instrument. Methods Patients with clinically localized prostate cancer were treated with either radical prostatectomy (n = 123 Spanish patients) or SBRT (n = 216 American patients). QOL was assessed using the Expanded Prostate Cancer Index Composite (EPIC) grouped into urinary, sexual, and bowel domains. For comparison purposes, SBRT EPIC data at baseline, 3 weeks, 5, 11, 24, and 36 months were compared to surgery data at baseline, 1, 6, 12, 24, and 36 months. Differences in patient characteristics between the two groups were assessed using Chi-squared tests for categorical variables and t-tests for continuous variables. Generalized estimating equation (GEE) models were constructed for each EPIC scale to account for correlation among repeated measures and used to assess the effect of treatment on QOL. Results The largest differences in QOL occurred in the first 1–6 months after treatment, with larger declines following surgery in urinary and sexual QOL as compared to SBRT, and a larger decline in bowel QOL following SBRT as compared to surgery. Long-term urinary and sexual QOL declines remained clinically significantly lower for surgery patients but not for SBRT patients. Conclusions Overall, these results may have implications for patient and physician clinical decision making which are often influenced by QOL. These differences in sexual, urinary and bowel QOL should be closely considered in selecting the right treatment, especially in evaluating the value of non-invasive treatments, such as SBRT.
Collapse
Affiliation(s)
- Alan Katz
- Flushing Radiation Oncology, Flushing, NY 11354, USA.
| | | | | | | |
Collapse
|
21
|
Fernández-Arjona M, de la Cruz G, Delgado JA, Malet JM, Portillo JA. [Validation in Spain of the quality of life questionnaire PROSQOLI in patients with advanced prostate cancer]. Actas Urol Esp 2012; 36:410-7. [PMID: 22464195 DOI: 10.1016/j.acuro.2011.11.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2011] [Accepted: 11/12/2011] [Indexed: 01/09/2023]
Abstract
OBJECTIVES Validation of the PROSQOLI questionnaire adapted to Spanish, pursing an instrument to evaluate, in the common clinical practice, the quality of life in patients with locally advanced or disseminated prostate cancer in our country. MATERIAL AND METHODS A cross-sectional prospective study was designed in 750 patients (150 centers) with disseminated or locally advanced prostate cancer (TNM criterion) who came to the scheduled check-up. Socio-demographic and clinical data of the participants were collected. The subjects filled out the PROSQOLI and EQ-5D questionnaires. The analysis included 561 cases that met the selection criteria. The psychometric characteristics (feasibility, validity and reliability) of the adapted PROSQOLI questionnaire were studied. RESULTS Mean age was 73.63 (7.59) years. A total of 72.01% of the participants had locally advanced disease. In 28.16%, the primary treatment was radiotherapy, in 12.30% it was prostatectomy. A total of 83.48% received hormone treatment. The mean for each scale of the PROSQOLI questionnaire varied from 68.86 to 74.51. The percentage of no response was less than 3% for each scale. The percentage of subjects with minimum score in any scale was negligible, and the maximum score did not surpass 5%. Mean time to fill out the questionnaire was 109.42 (101.00) seconds. Cronbach's α coefficient was 0.937 and the total item correlation was superior to 0.7 for all the items. Correlations with the EQ-5D questionnaire were moderate. Scores on the questionnaire were associated to all the parameters studied related to the disease. CONCLUSIONS The adapted questionnaire has adequate psychometric properties for its use in research and in the clinical practice.
Collapse
|
22
|
Chung KJ, Kim JJ, Lim SH, Kim TH, Han DH, Lee SW. Development and validation of the korean version of expanded prostate cancer index composite: questionnaire assessing health-related quality of life after prostate cancer treatment. Korean J Urol 2010; 51:601-12. [PMID: 20856644 PMCID: PMC2941808 DOI: 10.4111/kju.2010.51.9.601] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2010] [Accepted: 07/28/2010] [Indexed: 11/28/2022] Open
Abstract
Purpose Although the quality of life (QoL) of prostate cancer (PCa) patients is a major issue, there is no unified and useful methodology for assessing QoL. The Expanded Prostate Cancer Index Composite (EPIC) is a globally used tool to measure QoL after PCa treatment that comprises urinary, bowel, sexual, and hormonal domains. Acknowledging the need for such a tool applicable to Korean PCa patients, we translated EPIC into Korean and validated the new version. Materials and Methods The Korean version of EPIC was devised by translation, back-translation, and reconciliation. Subsequently, we randomly selected 153 patients with localized PCa treated with radical perineal prostatectomy (67, 43.8%), radical retropubic prostatectomy (19, 12.4%), laparoscopic radical prostatectomy (12, 7.8%), robot-assisted laparoscopic radical prostatectomy (36, 23.5%), and high-intensity focused ultrasound ablation of the prostate (19, 12.4%) and asked them to complete EPIC. Reliability was assessed by test-retest correlation and Cronbach's alpha. Validity was assessed by factor analysis, interscale correlation, and correlation with Functional Assessment of Cancer Therapy-Prostate (FACT-P). Results Test-retest correlation and Cronbach's alpha were high in each of the domains (0.92, 0.91, 0.76, 0.84 and 0.86, 0.84, 0.92, 0.83, p<0.0001). Interscale correlation among the domains was low (r<0.37), which indicated that EPIC is composed of proper domains. Interscale correlation between the function and bother subscales was high (0.94, 0.81, 0.84 and 0.80, p<0.0001). EPIC domains had low correlation with FACT-P, permitting complementary use. Conclusions The Korean version of EPIC was developed by a proper process, as evident by its high reliability and validity. Therefore, it is a reliable, comprehensive, systematic method that evaluates QoL in Korean patients after PCa treatment. Furthermore, it can be adapted as an objective methodology for research globally.
Collapse
Affiliation(s)
- Kyung Jin Chung
- Department of Urology, Gachon University Gil Hospital, Incheon, Korea
| | | | | | | | | | | |
Collapse
|
23
|
Guedea F, Ferrer M. Spanish researchers at the forefront of clinical investigation: the case of quality of life in prostate cancer. Clin Transl Oncol 2009; 11:403-4. [PMID: 19574196 DOI: 10.1007/s12094-009-0377-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
24
|
Gómez Veiga F, José Olmo Cozar M, Günthner S, Puyol Pallas M, Silmi Moyano Á, Baró Ramos E, Francisco Rebollo J. Desarrollo y validación del primer cuestionario español de calidad de vida en pacientes con cáncer de próstata, basado en la percepción del paciente. Actas Urol Esp 2009; 33:623-34. [DOI: 10.1016/s0210-4806(09)74200-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
|