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Dinkel A, Jahnen M. [Patient-reported outcomes-the role of the patient's subjective perspective for research and clinical care]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:886-892. [PMID: 39110186 PMCID: PMC11343820 DOI: 10.1007/s00120-024-02405-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/02/2024] [Indexed: 08/24/2024]
Abstract
Because only patients can adequately assess symptoms, disability, and quality of life, concordance between a patient's and physician's assessment is often low. Accordingly, patient-reported outcomes (PROs) are increasingly used in research and routine clinical care. In daily practice, PROs are not only applied to measure the patient's perceived outcome of medical treatments, but also to assess their health status before intervention starts. Typically, several patient-reported outcome measures (PROMs), which are reliable and valid, are available for the assessment of the most important PROMs. In daily clinical practice, the integration of PROs can be useful for clinical assessment and treatment planning or for quality management. Currently, the most promising application is routine patient monitoring using digital PROMs (ePROMs). Systematic reviews have revealed that the routine use of PROMs in daily clinical care is associated with, among others, improved physician-patient communication, higher patient satisfaction, reduced symptom burden, higher quality of life, and improved survival. This effect is especially strong if health care professionals continuously receive the results of the PRO monitoring. Patients are usually inclined to disclose their health status, and the positive effects of routine patient monitoring are widely recognized. However, several barriers to using PROs and PROMs still exist.
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Affiliation(s)
- Andreas Dinkel
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Klinikum rechts der Isar, School of Medicine and Health, Technische Universität München, Langerstr. 3, 81675, München, Deutschland.
| | - Matthias Jahnen
- Klinik und Poliklinik für Psychosomatische Medizin und Psychotherapie, Klinikum rechts der Isar, School of Medicine and Health, Technische Universität München, Langerstr. 3, 81675, München, Deutschland
- Klinik und Poliklinik für Urologie, Klinikum rechts der Isar, School of Medicine and Health, Technische Universität München, Ismaninger Str. 22, 81675, München, Deutschland
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Ross A, Brewer K, Hudgens S, Brown B, Fallick M, de Paauw-Holt S, Arondekar B, Clegg J, Hunsche E. Development of a Novel Patient-Reported Outcome Measure to Assess Symptoms and Impacts of Androgen Deprivation Therapy for Advanced Prostate Cancer. Adv Ther 2024; 41:3076-3088. [PMID: 38861216 PMCID: PMC11263404 DOI: 10.1007/s12325-024-02888-9] [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: 03/12/2024] [Accepted: 04/25/2024] [Indexed: 06/12/2024]
Abstract
INTRODUCTION This qualitative research study was conducted to develop a novel, comprehensive, patient-reported outcome measure (PRO), the "Symptoms and Impacts of Androgen Deprivation Therapy (ADT) for Prostate Cancer" (SIADT-PC), assessing hormonal therapy-related symptoms and their impacts on men with advanced prostate cancer. METHODS Concept elicitation (CE) interviews were conducted among adult men with prostate cancer to evaluate their experiences with ADT. Based on key symptom and impact concepts mentioned, an initial PRO measure was developed. The draft measure was further assessed in cognitive debriefing (CD) interviews with men with prostate cancer, in which participants reviewed items, response options, and recall periods. Initial item-based psychometric analyses were conducted using interview data. The draft questionnaire was revised on the basis of participant feedback, quantitative psychometric results, and consultation with clinical experts. RESULTS A total of 21 participants were interviewed (CE concept elicitation, n = 12; CD cognitive debriefing, n = 17; n = 8 completed both). Mean participant age (SD) was 59.7 (8.7) years and 76.2% were white. The de novo SIADT-PC measure consists of 27 items: 11 symptoms (e.g., fatigue, hot flashes, and erectile dysfunction), 2 long-term symptoms (e.g., weight gain), 10 impacts (e.g., impacts on physical activities and relationships), and 4 related to mode of administration (i.e., injection-site reactions). Items were assessed with a 5-point verbal rating scale, with answer choices that capture frequency or severity. CONCLUSIONS Once fully validated, this de novo measure may be used in clinical studies and clinical practice to assess hormone therapy-related symptoms and impacts, enabling physicians to identify timely and appropriate interventions.
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Affiliation(s)
- Ashley Ross
- Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | | | | | | | | | - Simon de Paauw-Holt
- Sumitomo Pharma Switzerland GmbH, Aeschengraben 27, 4051, Basel, Switzerland
| | | | | | - Elke Hunsche
- Sumitomo Pharma Switzerland GmbH, Aeschengraben 27, 4051, Basel, Switzerland.
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Mertens LS, Bruins HM, Contieri R, Babjuk M, Rai BP, Puig AC, Escrig JLD, Gontero P, van der Heijden AG, Liedberg F, Martini A, Masson-Lecomte A, Meijer RP, Mostafid H, Neuzillet Y, Pradere B, Redlef J, van Rhijn BWG, Rouanne M, Rouprêt M, Sæbjørnsen S, Seisen T, Shariat SF, Soria F, Soukup V, Thalmann G, Xylinas E, Mariappan P, Alfred Witjes J. Consistencies in Follow-up After Radical Cystectomy for Bladder Cancer: A Framework Based on Expert Practices Collaboratively Developed by the European Association of Urology Bladder Cancer Guideline Panels. Eur Urol Oncol 2024:S2588-9311(24)00141-X. [PMID: 38906795 DOI: 10.1016/j.euo.2024.05.010] [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: 03/07/2024] [Revised: 04/30/2024] [Accepted: 05/24/2024] [Indexed: 06/23/2024]
Abstract
BACKGROUND AND OBJECTIVE There is no standardized regimen for follow-up after radical cystectomy (RC) for bladder cancer (BC). To address this gap, we conducted a multicenter study involving urologist members from the European Association of Urology (EAU) bladder cancer guideline panels. Our objective was to identify consistent post-RC follow-up strategies and develop a practice-based framework based on expert opinion. METHODS We surveyed 27 urologist members of the EAU guideline panels for non-muscle-invasive bladder cancer and muscle-invasive and metastatic bladder cancer using a pre-tested questionnaire with dichotomous responses. The survey inquired about follow-up strategies after RC and the use of risk-adapted strategies. Consistency was defined as >75% affirmative responses for follow-up practices commencing 3 mo after RC. Descriptive statistics were used for analysis. KEY FINDINGS AND LIMITATIONS We received responses from 96% of the panel members, who provided data from 21 European hospitals. Risk-adapted follow-up is used in 53% of hospitals, with uniform criteria for high-risk (at least ≥pT3 or pN+) and low-risk ([y]pT0/a/1N0) cases. In the absence of agreement for risk-based follow up, a non-risk-adapted framework for follow-up was developed. Higher conformity was observed within the initial 3 yr, followed by a decline in subsequent follow-up. Follow-up was most frequent during the first year, including patient assessments, physical examinations, and laboratory tests. Computed tomography of the chest and abdomen/pelvis was the most common imaging modality, initially at least biannually, and then annually from years 2 to 5. There was a lack of consistency for continuing follow-up beyond 10 yr after RC. CONCLUSIONS AND CLINICAL IMPLICATIONS This practice-based post-RC follow-up framework developed by EAU bladder cancer experts may serve as a valuable guide for urologists in the absence of prospective randomized studies. PATIENT SUMMARY We asked urologists from the EAU bladder cancer guideline panels about their patient follow-up after surgical removal of the bladder for bladder cancer. We found that although urologists have varying approaches, there are also common follow-up practices across the panel. We created a practical follow-up framework that could be useful for urologists in their day-to-day practice.
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Affiliation(s)
- Laura S Mertens
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | - Harman Maxim Bruins
- Department of Urology, Zuyderland Medical Center, Sittard-Heerlen, The Netherlands
| | - Roberto Contieri
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Marek Babjuk
- Department of Urology, Teaching Hospital Motol, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Bhavan P Rai
- Department of Urology, Freeman Hospital, The Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Albert Carrión Puig
- Department of Urology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Paolo Gontero
- Division of Urology, Department of Surgical Sciences, AOU Citta della Salute e della Scienca, Torina School of Medicine, Turin, Italy
| | | | - Fredrik Liedberg
- Department of Urology, Skane University Hospital, Malmö, Sweden; Institute of Translational Medicine, Lund University, Malmö, Sweden
| | - Alberto Martini
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | | | - Richard P Meijer
- Department of Oncological Urology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Hugh Mostafid
- Department of Urology, Royal Surrey Hospital, Guildford, UK
| | - Yann Neuzillet
- Department of Urology, Foch Hospital, University of Versailles-Saint-Quentin-en-Yvelines, Suresnes, France
| | - Benjamin Pradere
- Department of Urology, La Croix du Sud Hospital, Quint Fonsegrives, France
| | - John Redlef
- Patient Representative, European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Bas W G van Rhijn
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Urology, Caritas St. Josef Medical Centre, University of Regensburg, Regensburg, Germany
| | - Matthieu Rouanne
- Department of Urology, Foch Hospital, University of Versailles-Saint-Quentin-en-Yvelines, Suresnes, France
| | - Morgan Rouprêt
- GRC 5, Predictive Onco-Urology, Sorbonne University, Department of Urology, Pitié-Salpetriere Hospital, Paris, France
| | - Sæbjørn Sæbjørnsen
- Patient Representative, European Association of Urology Guidelines Office, Arnhem, The Netherlands
| | - Thomas Seisen
- GRC 5, Predictive Onco-Urology, Sorbonne University, Department of Urology, Pitié-Salpetriere Hospital, Paris, France
| | - Shahrokh F Shariat
- Department of Urology, Comprehensive Cancer Center, Medical University of Vienna, Vienna, Austria; Division of Urology, Department of Special Surgery, University of Jordan, Amman, Jordan; Karl Landsteiner Institute of Urology and Andrology, Vienna, Austria; Department of Urology, Weill Cornell Medical College, New York, NY, USA; Department of Urology, University of Texas Southwestern, Dallas, TX, USA; Department of Urology, 2nd Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Francesco Soria
- Division of Urology, Department of Surgical Sciences, AOU Citta della Salute e della Scienca, Torina School of Medicine, Turin, Italy
| | - Viktor Soukup
- Department of Urology, General Teaching Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - George Thalmann
- Department of Urology, Inselspital, University Hospital Bern, Bern, Switzerland
| | - Evanguelos Xylinas
- Department of Urology, Bichat-Claude Bernard Hospital, AP-HP, Université Paris Cité, Paris, France
| | - Paramananthan Mariappan
- Edinburgh Bladder Cancer Surgery, University of Edinburgh, Western General Hospital, Edinburgh, UK
| | - J Alfred Witjes
- Department of Urology, Radboud University Medical Center, Nijmegen, The Netherlands
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Jia Y, Li Q, Zhang X, Yan Y, Yan S, Li S, Li W, Wu X, Rong H, Liu J. Application of Patient-Reported Outcome Measurements in Adult Tumor Clinical Trials in China: Cross-Sectional Study. J Med Internet Res 2024; 26:e45719. [PMID: 38718388 PMCID: PMC11112474 DOI: 10.2196/45719] [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: 01/14/2023] [Revised: 10/29/2023] [Accepted: 02/09/2024] [Indexed: 05/14/2024] Open
Abstract
BACKGROUND International health policies and researchers have emphasized the value of evaluating patient-reported outcomes (PROs) in clinical studies. However, the characteristics of PROs in adult tumor clinical trials in China remain insufficiently elucidated. OBJECTIVE This study aims to assess the application and characteristics of PRO instruments as primary or secondary outcomes in adult randomized clinical trials related to tumors in China. METHODS This cross-sectional study identified tumor-focused randomized clinical trials conducted in China between January 1, 2010, and June 30, 2022. The ClinicalTrials.gov database and the Chinese Clinical Trial Registry were selected as the databases. Trials were classified into four groups based on the use of PRO instruments: (1) trials listing PRO instruments as primary outcomes, (2) trials listing PRO instruments as secondary outcomes, (3) trials listing PRO instruments as coprimary outcomes, and (4) trials without any mention of PRO instruments. Pertinent data, including study phase, settings, geographic regions, centers, participant demographics (age and sex), funding sources, intervention types, target diseases, and the names of PRO instruments, were extracted from these trials. The target diseases involved in the trials were grouped according to the American Joint Committee on Cancer Staging Manual, 8th Edition. RESULTS Among the 6445 trials examined, 2390 (37.08%) incorporated PRO instruments as part of their outcomes. Within this subset, 26.82% (641/2390) listed PRO instruments as primary outcomes, 52.72% (1260/2390) as secondary outcomes, and 20.46% (489/2390) as coprimary outcomes. Among the 2,155,306 participants included in these trials, PRO instruments were used to collect data from 613,648 (28.47%) patients as primary or secondary outcomes and from 74,287 (3.45%) patients as coprimary outcomes. The most common conditions explicitly using specified PRO instruments included thorax tumors (217/1280, 16.95%), breast tumors (176/1280, 13.75%), and lower gastrointestinal tract tumors (173/1280, 13.52%). Frequently used PRO instruments included the European Organisation for Research and Treatment of Cancer Quality of Life Core Questionnaire-30, the visual analog scale, the numeric rating scale, the Traditional Chinese Medicine Symptom Scale, and the Pittsburgh Sleep Quality Index. CONCLUSIONS Over recent years, the incorporation of PROs has demonstrated an upward trajectory in adult randomized clinical trials on tumors in China. Nonetheless, the infrequent measurement of the patient's voice remains noteworthy. Disease-specific PRO instruments should be more effectively incorporated into various tumor disease categories in clinical trials, and there is room for improvement in the inclusion of PRO instruments as clinical trial end points.
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Affiliation(s)
- Yan Jia
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Qi Li
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Dongzhimen Hospital, Beijing University of Chinese Medicine, Beijing, China
| | - Xiaowen Zhang
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Yi Yan
- School of Traditional Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Shiyan Yan
- College of Acupuncture and Massage, Beijing University of Chinese Medicine, Beijing, China
| | - Shunping Li
- Centre for Health Management and Policy Research, Shandong University, Shandong, China
| | - Wei Li
- International Research Center for Medicinal Administration, Peking University, Beijing, China
| | - Xiaowen Wu
- Peking University Cancer Hospital & Institute, Peking University, Beijng, China
| | - Hongguo Rong
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Institute for Excellence in Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
| | - Jianping Liu
- Center for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
- Institute for Excellence in Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, Beijing, China
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Cowan BA, Olivier K, Tombal B, Wefel JS. Treatment-Related Cognitive Impairment in Patients with Prostate Cancer: Patients' Real-World Insights for Optimizing Outcomes. Adv Ther 2024; 41:476-491. [PMID: 37979089 PMCID: PMC10838823 DOI: 10.1007/s12325-023-02721-9] [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: 09/11/2023] [Accepted: 10/26/2023] [Indexed: 11/19/2023]
Abstract
Cognitive impairment (CI) is an issue that needs to be at the forefront of unmet healthcare needs in patients with prostate cancer (PCa) as it can negatively impact quality of life during long-term care. CI in patients with prostate cancer is thought to be influenced by treatment, androgen deprivation therapy (ADT), and novel androgen receptor (AR) pathway inhibitors in particular; however, current understanding is limited on how treatment affects cognition. Additionally, the experience of patients with CI who are receiving PCa treatment is not well understood or represented in clinical literature, which is a barrier to optimal patient outcomes in managing prostate cancer treatment-related cognitive impairment (PCa-TRCI). To help understand the patient journey and elucidate management gaps in PCa-TRCI, an international roundtable of healthcare provider and patient panelists was convened. The panelists focused on four key topic areas: (1) the patient experience when afflicted with, or at risk of, PCa-TRCI, (2) the physical, emotional, and social impact of CI on patients' quality of life (QoL), (3) the challenges that patients with PCa-TRCI face, and their impact on clinical decision-making, and (4) ways in which managing PCa-TRCI should evolve to improve patient outcomes. The purpose of the roundtable was to include patients in a direct discussion with healthcare providers (HCPs) regarding the patient journey and highlight real-world evidence of areas where patient outcomes could be improved in the absence of clinical evidence. The resulting discussion highlighted important healthcare gaps for patients with, and at risk of, PCa-TRCI and offered potential solutions as a roadmap to effective medicine.
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Affiliation(s)
| | - Kara Olivier
- Massachusetts General Hospital Cancer Center, Boston, MA, USA
| | - Bertrand Tombal
- Division of Urology at the Université catholique de Louvain, Ottignies-Louvain-la-Neuve, Belgium
| | - Jeffrey S Wefel
- The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
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Raj P, Cho Y, Jiang Y, Gong Y. Selecting patient-reported outcome measures for a patient-facing technology. JAMIA Open 2023; 6:ooad104. [PMID: 38098479 PMCID: PMC10719077 DOI: 10.1093/jamiaopen/ooad104] [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: 03/31/2023] [Revised: 09/11/2023] [Accepted: 11/17/2023] [Indexed: 12/17/2023] Open
Abstract
Objective This article provides insight into our process and considerations for selecting patient-reported outcome measures (PROMs) designed for self-reporting symptoms and quality-of-life among breast cancer (BCA) patients undergoing oral anticancer agent treatment via a patient-facing technology (PFT) platform. Methods Following established guidelines, we conducted a thorough assessment of a specific set of PROMs, comparing their content to identify the most suitable options for studying BCA patients. Results We recommend utilizing the combination of EORTC QLQ-C30 + EORTC QLQ-BR45 as the preferred instrument, especially when developing a dedicated "breast cancer-only" application. Discussion When developing and maintaining a dashboard for a PFT platform that includes multiple cancer types, it is important to consider the feasibility of interface design and workload. To achieve this, we recommend using PRO-CTCAE+PROMIS 10 GH for the PFT. Moreover, it is important to consider adding ad hoc items to complement the chosen PROM(s). Conclusion This article describes our efforts to identify PROMs for self-reported data while considering patient and developer burdens, providing guidance to PFT developers facing similar challenges in PROM selection.
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Affiliation(s)
- Priyank Raj
- D. Bradley McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, United States
| | - Youmin Cho
- D. Bradley McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, United States
| | - Yun Jiang
- School of Nursing, University of Michigan, Ann Arbor, MI 48109, United States
| | - Yang Gong
- D. Bradley McWilliams School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, United States
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Venderbos LDF, Remmers S, Deschamps A, Dowling J, Carl EG, Pereira-Azevedo N, Roobol MJ. The Europa Uomo Patient Reported Outcome Study 2.0-Prostate Cancer Patient-reported Outcomes to Support Treatment Decision-making. Eur Urol Focus 2023; 9:1024-1036. [PMID: 37268512 DOI: 10.1016/j.euf.2023.05.006] [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: 03/02/2023] [Revised: 04/21/2023] [Accepted: 05/23/2023] [Indexed: 06/04/2023]
Abstract
BACKGROUND To further strengthen the voice of patients, Europa Uomo initiated the Europa Uomo Patient Reported Outcome Study 2.0 (EUPROMS 2.0) in October 2021. OBJECTIVE To collect the self-reported perspective of prostate cancer (PCa) patients on physical and mental well-being after PCa treatment outside a clinical trial setting to inform future fellow patients about the impact of PCa treatment. DESIGN, SETTING, AND PARTICIPANTS Europa Uomo invited PCa patients to complete a cross-sectional survey including the validated EQ-5D-5L, EORTC-QLQ-C30, and the EPIC-26 questionnaires. Furthermore, the nine-item Shared Decision Making Questionnaire (SDM-Q-9) and diagnostic clinical scenarios were included. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS Descriptive statistics was used to assess the demographic and clinical characteristics and to analyze the patient-reported outcome data. RESULTS AND LIMITATIONS Between October 25, 2021 and January 17, 2022, 3571 men from 30 countries completed the EUPROMS 2.0 survey. The median age of respondents was 70 yr (interquartile range 65-75 yr). Half of the respondents underwent one treatment, most often radical prostatectomy. Men who are treated actively experience lower health-related quality of life than men on active surveillance, mainly regarding sexual function, fatigue, and insomnia. Lower urinary incontinence levels were seen for men who underwent radical prostatectomy (single treatment or in combination with other treatments). Of the respondents, 42% indicated that the determination of the prostate-specific antigen (PSA) value was part of a routine blood test; 25% wanted to undergo screening/early detection for PCa, and 20% indicated that the determination of the PSA value had a clinical reason. CONCLUSIONS A large sample of 3571 international patients has contributed patient experience after PCa treatment in the EUPROMS 2.0 study, confirming that treatment for PCa mainly affects urinary incontinence, sexual function, fatigue, and insomnia. Such information can be used to direct toward a better patient-doctor relationship, to offer patients ready access to responsible information and a better understanding of their disease and treatment. PATIENT SUMMARY Through the EUPROMS 2.0 survey, Europa Uomo has strengthened the voice of the patient. Such information can be used to inform future prostate cancer (PCa) patients about the impact of PCa treatment and to engage them in informed and shared decision-making.
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Affiliation(s)
- Lionne D F Venderbos
- Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Sebastiaan Remmers
- Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | | | | | - Nuno Pereira-Azevedo
- Department of Urology, Entre o Douro e Vouga Medical Center, Santa Maria da Feira, Portugal
| | - Monique J Roobol
- Department of Urology, Erasmus MC Cancer Institute, Erasmus University Medical Center, Rotterdam, The Netherlands
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Ong WL, Millar J. Late, persistent, substantial treatment-related symptoms (LAPERS) following low-dose-rate brachytherapy for prostate cancer. Brachytherapy 2023; 22:524-530. [PMID: 36707331 DOI: 10.1016/j.brachy.2023.01.001] [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: 04/25/2022] [Revised: 09/25/2022] [Accepted: 01/03/2023] [Indexed: 01/26/2023]
Abstract
PURPOSE We aim to report 1) prevalence, 2) incidence, and 3) late, persistent, substantial treatment-related symptoms (LAPERS) after low-dose-rate brachytherapy (LDRBT) for prostate cancer. METHODS AND MATERIALS The study comprised men treated with LDRBT in a single Australian institution between 2014 and 2019. All men completed the Expanded Prostate Cancer Index Composite 26 (EPIC-26) questionnaire pretreatment, and at regular intervals posttreatment. 'Substantial' symptoms were defined as 'moderate' or 'big' problems in EPIC-26 which assesses the degree of symptom bother for each functional domain. 'Persistent' symptoms were defined as 'substantial' symptoms that present in at least half of the 'late' followup assessments. This provided a binary LAPERS outcome (yes/no). Prevalence (at each time point) and cumulative incidence of substantial symptoms were also reported. RESULTS A total of 172 men with 'baseline' and at least three 'late' followup EPIC-26 were included in the study. The median followup was 60 months (IQR: 36-74 months). For overall urinary function, prevalence of substantial symptoms was highest at 10% 6-month posttreatment, with 5-year cumulative incidence of 18%, but only 2% had LAPERS. For overall bowel function, prevalence of substantial symptoms was highest at 7% 12-months posttreatment, with 5-year cumulative incidence of 15%, and only 2% had LAPERS. For sexual function, prevalence of substantial symptoms was highest at 28% 6-months posttreatment, with 5-year cumulative incidence of 49%, and 22% had LAPERS (baseline-adjusted LAPERS 17%). CONCLUSIONS There were considerable differences in late toxicities using different toxicity-reporting approaches. LAPERS approach is more reflective of 'true' late toxicities considering duration and persistence of symptoms.
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Affiliation(s)
- Wee Loon Ong
- Alfred Health Radiation Oncology, Melbourne VIC, Australia; Central Clinical School, Monash University, Melbourne VIC, Australia; Department of Radiation Oncology, Sunnybrook Health Sciences Centre, Odette Cancer Centre, University of Toronto, Toronto, ON, Canada..
| | - Jeremy Millar
- Alfred Health Radiation Oncology, Melbourne VIC, Australia; Central Clinical School, Monash University, Melbourne VIC, Australia
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