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Li CL, Chen PY, Yang TY, Chang JTC, Tang WR, Chen ML. Changes in fatigue among cancer patients before, during, and after radiation therapy: A meta-analysis. Worldviews Evid Based Nurs 2024; 21:234-244. [PMID: 37574783 DOI: 10.1111/wvn.12672] [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: 12/05/2022] [Revised: 07/02/2023] [Accepted: 07/04/2023] [Indexed: 08/15/2023]
Abstract
BACKGROUND Fatigue is a common symptom in cancer patients receiving radiotherapy. However, previous studies report inconsistent patterns of fatigue change. AIM The aim of this study was to estimate changes in fatigue among patients with cancer before, during, and after radiotherapy. METHODS Five databases (PubMed, SDOL, CINAHL Plus with Full Text, Medline [ProQuest], and ProQuest Dissertations) were searched for studies published from January 2006 to May 2021. Three effect sizes of fatigue change (immediate, short-term, and long-term) were calculated for each primary study using standardized mean difference. A random-effect model was used to combine effect sizes across studies. Subgroup analyses and meta-regression were performed to identify potential categorical and continuous moderators, respectively. RESULTS Sixty-five studies were included in this meta-analysis. The weighted mean effect size for immediate, short-term, and long-term effects was 0.409 (p < .001; 95% CI [0.280, 0.537]), 0.303 (p < .001; 95% CI [0.189, 0.417]), and 0.201 (p = .05; 95% CI [-0.001, 0.404]), respectively. Studies with prostate cancer patients had a significantly higher short-term (0.588) and long-term weight mean effect size (0.531) than studies with breast (0.128, -0.072) or other cancers (0.287, 0.215). Higher radiotherapy dosage was significantly associated with a higher effect size for both immediate (β = .0002, p < .05) and short-term (β = .0002, p < .05) effect. LINKING EVIDENCE TO ACTION Findings from this meta-analysis indicated that radiotherapy-induced fatigue (RIF) exist for more than 3 months after the completion of treatment. Assessment of radiation-induced fatigue in cancer patients should extend long after treatment completion, especially for patients with prostate cancer and patients receiving a higher radiation dose. Interventions to reduce fatigue tailored for different treatment phases may be developed.
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Affiliation(s)
- Chia-Ling Li
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Pei-Ying Chen
- Department of Nursing, Yuanpei University of Medical Technology, Hsin-Chu, Taiwan
| | - Tsui-Yun Yang
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Joseph Tung-Chieh Chang
- Department of Radiation Oncology, Chang Gung Memorial Hospital, Tao-Yuan, Linkou, Taiwan
- School of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Woung-Ru Tang
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
- Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Tao-Yuan, Taiwan
| | - Mei-Ling Chen
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
- Division of Medical Oncology, Department of Internal Medicine, Chang Gung Memorial, Tao-Yuan, Taiwan
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Cornford P, Robijn E, Rogers E, Wassersug R, Fleure L. Fatigue in Prostate Cancer: A Roundtable Discussion and Thematic Literature Review. EUR UROL SUPPL 2024; 63:119-125. [PMID: 38596782 PMCID: PMC11001642 DOI: 10.1016/j.euros.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2024] [Indexed: 04/11/2024] Open
Abstract
Context Cancer and its treatments cause fatigue in up to 90% of men with advanced prostate cancer. As men with prostate cancer are surviving longer, cancer-related fatigue is becoming increasingly important for clinicians to understand and proactively manage. Objective The aim of this work is to identify knowledge gaps that may support healthcare professionals to recommend personalised fatigue management strategies. Evidence acquisition This manuscript is based on a roundtable discussion held during the European Association of Urology 2022 Annual Symposium, combined with a review of the literature. Five core themes were generated from the roundtable: (1) meaning of fatigue in prostate cancer patients, (2) impact of fatigue, (3) association between fatigue and treatment selection, (4) benefits of managing fatigue, and (5) barriers to exercise. Evidence synthesis Cancer-related fatigue has complex underlying aetiology and is a subjective experience that may be under-reported. Some studies have shown that techniques such as education, cognitive behavioural therapy, guided imagery, and progressive muscle relaxation can result in clinically meaningful improvements in fatigue. However, the largest body of evidence, and a theme echoed in the roundtable discussions, was the benefit of exercise on fatigue. Despite the benefits of exercise, for some men, objective barriers to exercise exist and knowledge of benefits does not automatically translate into implementation and adherence. Conclusions Understanding the specific health needs of individual patients and their desired health outcomes is essential to identify personalised strategies for minimising fatigue. As an outcome of the roundtable meeting, we developed a quick reference guide for healthcare providers. A high-resolution copy can be downloaded from https://patients.uroweb.org/library/fatigue-in-prostate-cancer-patients-guide/. Patient summary This article is based on dialogue between a group of specialists, patients, and caregivers, which took place at a roundtable meeting during the European Association of Urology 2022 Annual Symposium. The group discussed how healthcare providers can best support their patients who experience fatigue. The group subsequently developed a guide to help healthcare providers during appointments.
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Affiliation(s)
- Philip Cornford
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Esther Robijn
- Liverpool University Hospitals NHS Foundation Trust, Liverpool, UK
| | - Eamonn Rogers
- European Association of Urology, Arnhem, The Netherlands
| | | | - Louisa Fleure
- Guy's and St Thomas' NHS Foundation Trust, London, UK
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Maggio A, Rancati T, Gatti M, Cante D, Avuzzi B, Bianconi C, Badenchini F, Farina B, Ferrari P, Giandini T, Girelli G, Landoni V, Magli A, Moretti E, Petrucci E, Salmoiraghi P, Sanguineti G, Villa E, Waskiewicz JM, Guarneri A, Valdagni R, Fiorino C, Cozzarini C. Quality of Life Longitudinal Evaluation in Prostate Cancer Patients from Radiotherapy Start to 5 Years after IMRT-IGRT. Curr Oncol 2024; 31:839-848. [PMID: 38392056 PMCID: PMC10887595 DOI: 10.3390/curroncol31020062] [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: 12/24/2023] [Revised: 01/22/2024] [Accepted: 01/30/2024] [Indexed: 02/24/2024] Open
Abstract
PURPOSE The purpose of this study is to study the evolution of quality of life (QoL) in the first 5 years following Intensity-modulated radiation therapy (IMRT) for prostate cancer (PCa) and to determine possible associations with clinical/treatment data. MATERIAL AND METHODS Patients were enrolled in a prospective multicentre observational trial in 2010-2014 and treated with conventional (74-80 Gy, 1.8-2 Gy/fr) or moderately hypofractionated IMRT (65-75.2 Gy, 2.2-2.7 Gy/fr). QoL was evaluated by means of EORTC QLQ-C30 at baseline, at radiation therapy (RT) end, and every 6 months up to 5 years after IMRT end. Fourteen QoL dimensions were investigated separately. The longitudinal evaluation of QoL was analysed by means of Analysis of variances (ANOVA) for multiple measures. RESULTS A total of 391 patients with complete sets of questionnaires across 5 years were available. The longitudinal analysis showed a trend toward the significant worsening of QoL at RT end for global health, physical and role functioning, fatigue, appetite loss, diarrhoea, and pain. QoL worsening was recovered within 6 months from RT end, with the only exception being physical functioning. Based on ANOVA, the most impaired time point was RT end. QoL dimension analysis at this time indicated that acute Grade ≥ 2 gastrointestinal (GI) toxicity significantly impacted global health, physical and role functioning, fatigue, appetite loss, diarrhoea, and pain. Acute Grade ≥ 2 genitourinary (GU) toxicity resulted in lower role functioning and higher pain. Prophylactic lymph-nodal irradiation (WPRT) resulted in significantly lower QoL for global health, fatigue, appetite loss, and diarrhoea; lower pain with the use of neoadjuvant/concomitant hormonal therapy; and lower fatigue with the use of an anti-androgen. CONCLUSIONS In this prospective, longitudinal, observational study, high radiation IMRT doses delivered for PCa led to a temporary worsening of QoL, which tended to be completely resolved at six months. Such transient worsening was mostly associated with acute GI/GU toxicity, WPRT, and higher prescription doses.
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Affiliation(s)
- Angelo Maggio
- Istituto di Candiolo-FPO, IRCCS, 10060 Candiolo, Italy; (M.G.); (A.G.)
| | - Tiziana Rancati
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy; (T.R.); (B.A.); (F.B.); (T.G.); (R.V.)
| | - Marco Gatti
- Istituto di Candiolo-FPO, IRCCS, 10060 Candiolo, Italy; (M.G.); (A.G.)
| | - Domenico Cante
- Ospedale di Ivrea, A.S.L. TO4, 10015 Ivrea, Italy; (D.C.); (E.P.)
| | - Barbara Avuzzi
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy; (T.R.); (B.A.); (F.B.); (T.G.); (R.V.)
| | - Cinzia Bianconi
- IRCCS Ospedale San Raffaele, 20132 Milano, Italy; (C.B.); (C.F.); (C.C.)
| | - Fabio Badenchini
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy; (T.R.); (B.A.); (F.B.); (T.G.); (R.V.)
| | - Bruno Farina
- Ospedale degli Infermi, 13875 Biella, Italy; (B.F.); (G.G.)
| | - Paolo Ferrari
- Comprensorio Sanitario di Bolzano, 39100 Bolzano, Italy; (P.F.); (J.M.W.)
| | - Tommaso Giandini
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy; (T.R.); (B.A.); (F.B.); (T.G.); (R.V.)
| | | | - Valeria Landoni
- IRCCS Istituto Tumori Regina Elena, 00144 Roma, Italy; (V.L.); (G.S.)
| | | | | | - Edoardo Petrucci
- Ospedale di Ivrea, A.S.L. TO4, 10015 Ivrea, Italy; (D.C.); (E.P.)
| | | | | | - Elisa Villa
- Cliniche Gavazzeni-Humanitas, 24121 Bergamo, Italy; (P.S.); (E.V.)
| | | | - Alessia Guarneri
- Istituto di Candiolo-FPO, IRCCS, 10060 Candiolo, Italy; (M.G.); (A.G.)
| | - Riccardo Valdagni
- Fondazione IRCCS Istituto Nazionale dei Tumori di Milano, 20133 Milano, Italy; (T.R.); (B.A.); (F.B.); (T.G.); (R.V.)
- Department of Oncology and Hemato-Oncology, Università degli Studi di Milano, 20122 Milano, Italy
| | - Claudio Fiorino
- IRCCS Ospedale San Raffaele, 20132 Milano, Italy; (C.B.); (C.F.); (C.C.)
| | - Cesare Cozzarini
- IRCCS Ospedale San Raffaele, 20132 Milano, Italy; (C.B.); (C.F.); (C.C.)
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Evangelista L, Morigi JJ. Why does PSMA PET improve quality of life? Eur J Nucl Med Mol Imaging 2023; 50:3185-3187. [PMID: 37351610 DOI: 10.1007/s00259-023-06307-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Affiliation(s)
- Laura Evangelista
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072 Pieve Emanuele, Milan, Italy.
- IRCCS Humanitas Research Hospital, Via Manzoni 56, 20089 Rozzano, Milan, Italy.
| | - Joshua James Morigi
- Molecular Imaging Unit, Medical Imaging Department, Royal Darwin Hospital, 105 Rocklands Drive, 0810 TIWI (NT), Darwin, Australia
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Jensen GL, Jhavar SG, Ha CS, Hammonds KP, Swanson GP. The cost of elective nodal coverage in prostate cancer: Late quality of life outcomes and dosimetric analysis with 0, 45 or 54 Gy to the pelvis. Clin Transl Radiat Oncol 2022; 36:63-69. [PMID: 35813937 PMCID: PMC9256976 DOI: 10.1016/j.ctro.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 11/30/2022] Open
Abstract
Pelvic nodal radiation to 54 Gy correlates with worse urinary quality of life. Pelvic nodal radiation to 45 Gy does not correlate with urinary quality of life. Post-operative radiation resulted in greater urinary quality of life decline. Pelvic nodal radiation did not correlate with bowel quality of life.
Purpose Elective pelvic lymph node radiotherapy (PLNRT) in prostate cancer is often omitted from definitive (n = 267) and post prostatectomy (n = 160) radiotherapy (RT) due to concerns regarding toxicity and efficacy. Data comparing patient-reported outcome measures (PROMs) with or without PLNRT is limited. Our long-term supposition is that PLNRT, particularly to higher doses afforded by IMRT, will decrease pelvic failure rate in select patients. We aim to establish the impact of two different PLNRT doses on long term quality of life (QOL). Methods and materials Prostate cancer patients (n = 428) recorded baseline scores using the Expanded Prostate Cancer Index Composite (EPIC), prior to definitive or post-prostatectomy RT. PLNRT, if given, was prescribed to 45 or 54 Gy at 1.8 Gy per fraction. New EPIC scores were recorded 20–36 months after radiotherapy. Absolute change in each domain subscale and summary score was recorded, along with if these changes met minimally important difference (MID) criteria. A separate multivariate analysis (MVA) was performed for each measure. Subsequent dosimetric analysis was performed. Results Frequency of a MID decline was significantly greater with PLNRT to 54 Gy for urinary function, incontinence, and overall. No urinary decline was correlated with PLNRT to 45 Gy. PLNRT to 54 Gy was significant for decline in urinary function, bother, irritative, incontinence, and overall score in one or both MVA models while 45 Gy was not. Postoperative status was significant for decline in urinary function, incontinence, and overall. Amongst postoperative patients, there was significantly greater decline in urinary function score in the salvage setting. Neither 54 nor 45 Gy significantly affected bowel subscale or overall score decline. Conclusions Using conventional fractionation, adding PLNRT to 54 Gy, but not 45 Gy, correlates with worse urinary QOL, with postoperative patients experiencing a steeper decline. PLNRT had no significant impact on bowel QOL with either dose.
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Affiliation(s)
- Garrett L. Jensen
- Departments of Radiation Oncology, Baylor Scott & White Health, 2401 S. 31st St., Temple, TX 76508, USA
| | - Sameer G. Jhavar
- Departments of Radiation Oncology, Baylor Scott & White Health, 2401 S. 31st St., Temple, TX 76508, USA
| | - Chul S Ha
- Department of Radiation Oncology, UT Health San Antonio, 8300 Floyd Curl Dr., San Antonio, TX 78229, USA
| | - Kendall P. Hammonds
- Departments of Biostatistics, Baylor Scott & White Health, 2401 S. 31st St., Temple, TX 76508, USA
| | - Gregory P. Swanson
- Departments of Radiation Oncology, Baylor Scott & White Health, 2401 S. 31st St., Temple, TX 76508, USA
- Corresponding author.
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Smet S, Spampinato S, Pötter R, Jürgenliemk-Schulz IM, Nout RA, Chargari C, Mahantshetty U, Sturdza A, Segedin B, Bruheim K, Hoskin P, Rai B, Huang F, Cooper R, Van der Steen-Banasik E, Sundset M, Van Limbergen E, Tan LT, Lutgens LCHW, Villafranca E, Pieters BR, Tanderup K, Kirchheiner K. Risk factors for late persistent fatigue after chemoradiotherapy in locally advanced cervical cancer: an analysis from the EMBRACE-I study. Int J Radiat Oncol Biol Phys 2021; 112:1177-1189. [PMID: 34838868 DOI: 10.1016/j.ijrobp.2021.11.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 11/10/2021] [Accepted: 11/19/2021] [Indexed: 11/17/2022]
Abstract
Objective To evaluate patient- and treatment-related risk factors for late persistent fatigue within the prospective, multi-center XXX study. Methods Fatigue was prospectively assessed (CTCAE v.3) at baseline and during regular follow-up in 993 locally advanced cervical cancer patients, after treatment with chemoradiotherapy and MRI-guided brachytherapy. Risk factors for baseline and late persistent fatigue were evaluated with multivariable logistic regression. Late persistent fatigue was defined, when either G≥1 or G≥2 was scored in at least half of follow-ups. Results Median follow-up was 57 months. Baseline fatigue G≥1/G≥2 (35.8%/6.3%, respectively) was associated with pre-existing co-morbidities, WHO Performance Status, underweight, severe pain and tumor volume. Late persistent G≥1/G≥2 fatigue (36.3%/5.8%, respectively) was associated with patient-related factors (baseline fatigue, younger age, obesity), alongside the size of irradiated volumes and the level of radiation doses from external beam radiotherapy (EBRT) and brachytherapy (EBRT: V43Gy, V57Gy; EBRT+brachytherapy: V60Gy EQD2). Large volume lymph node (LN) boost compared to no LN boost, increased the risk for late persistent fatigue G≥2 by 18% and 5% (in patients with and without baseline fatigue, respectively). The risk for late persistent fatigue G≥1 increased by 7% and 4% with V43Gy <2000cm³ versus >3000cm³ (in patients with and without baseline fatigue, respectively). Late persistent G≥1 fatigue occurred in 13% of patients without late persistent organ-related symptoms (gastro-intestinal, genito-urinary and vaginal), versus 34-43%, 50-58% and 73% in patients suffering from persistent symptoms involving 1,2 or 3 organs, respectively. Conclusion Late persistent fatigue occurs in a considerable number of patients after chemoradiotherapy. It is associated with patient-related factors, the size of volumes irradiated to intermediate and high EBRT and brachytherapy doses, and other persistent organ-related morbidity. These findings support the importance of ongoing efforts to better tailor the target dose and reduce irradiation of healthy tissue without compromising target coverage, using highly conformal EBRT and brachytherapy techniques.
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Affiliation(s)
- Stéphanie Smet
- Department of Radiation Oncology, AZ Turnhout, Turnhout, Belgium; Iridium Cancer Network, Antwerp, Belgium
| | - Sofia Spampinato
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Richard Pötter
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University Hospital of Vienna, Vienna, Austria
| | | | - Remi A Nout
- Department of Radiation Oncology, Leiden University Medical Center, Leiden, The Netherlands; Department of Radiotherapy, Erasmus MC Cancer Institute, University Medical Center, Rotterdam, the Netherlands
| | - Cyrus Chargari
- Department of Radiotherapy, Gustave-Roussy, Villejuif, France
| | - Umesh Mahantshetty
- Department of Radiation Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, India; Homi Bhabha Cancer Hospital and Research Centre, Visakhapatnam, India
| | - Alina Sturdza
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University Hospital of Vienna, Vienna, Austria
| | - Barbara Segedin
- Department of Radiotherapy, Institute of Oncology, Ljubljana, Slovenia; Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Kjersti Bruheim
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Peter Hoskin
- Mount Vernon Cancer Centre, Mount Vernon Hospital, Northwood, United Kingdom
| | - Bhavana Rai
- Department of Radiotherapy and Oncology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Fleur Huang
- Department of Oncology, Cross Cancer Institute and University of Alberta, Edmonton, Canada
| | - Rachel Cooper
- Leeds Cancer Centre, St James's University Hospital, Leeds, United Kingdom
| | | | - Marit Sundset
- Clinic of Oncology and Women's Clinic, St. Olavs Hospital, Trondheim, Norway
| | - Erik Van Limbergen
- Department of Radiation Oncology, University Hospital Leuven, Leuven, Belgium
| | - Li Tee Tan
- Oncology Centre, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Ludy C H W Lutgens
- Maastricht Radiation Oncology (MAASTRO) clinic, Maastricht, The Netherlands
| | - Elena Villafranca
- Department of Radiation Oncology, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - Bradley R Pieters
- Department of Radiation Oncology, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands
| | - Kari Tanderup
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Kathrin Kirchheiner
- Department of Radiation Oncology, Comprehensive Cancer Center, Medical University Hospital of Vienna, Vienna, Austria.
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Deek M, Lilleby W, Vaage V, Hole KH, DeWeese T, Stensvold A, Tran P, Seierstad T. Impact of radiation dose on recurrence in high-risk prostate cancer patients. Prostate 2020; 80:1322-1327. [PMID: 33258482 DOI: 10.1002/pros.24059] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 08/04/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Dose escalated radiation therapy (RT) combined with long-term androgen deprivation therapy (ADT) is a standard of care option for men with high-risk and locally advanced prostate cancer (PCa). However, the optimal dose of escalated RT and ADT is not known. Here we assessed the impact of radiation dose and length of ADT on biochemical recurrence in a multi-institutional cohort stratified by the Cambridge prognostic group (CPG). We hypothesized that radiation dose and length of ADT would impact outcome in similar risk groups of our patients. METHODS Two-hundred and forty-four patients were included, 132 from Oslo University Hospital, Department of Oncology and 112 from Johns Hopkins Hospital, Department of Radiation Oncology. Biochemical recurrence was defined as prostate-specific antigen (PSA) nadir +2 ng/mL. Time to recurrence was estimated using Kaplan-Meier analysis and when stratified by CPG the log-rank test was used. Cox regression analysis was performed to identify factors associated with risk of recurrence. Site of recurrence was investigated. RESULTS The median follow-up time was 7.4 years. The vast majority (71%) of patients were classified as high-risk (CPG 4) or very high-risk features (CPG 5). Significantly more PSA recurrences occurred in CPG 5 (41%) compared with CPG 4 (25%) (P = .04) and five-year cumulative recurrence-free survival was lower for CPG 4 and 5 (89% and 68%) compared with CPG 1, 2, and 3 (100%, 100%, and 93%). The recurrence-free survival for CPG 5 was significantly higher for prostate irradiation of 80 Gy as compared with 74 Gy (P = .011). For CPG 4 and 5 no local recurrences were detected in patients receiving 80 Gy. On stepwise Cox regression analysis neither age nor length of ADT were independent prognostic factors for recurrence free survival. CONCLUSION Prostate dose escalation from 74 to 80 Gy decreases risk of recurrence in high-risk PCa. Further studies are needed to identify the optimal combination of ADT and RT.
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Affiliation(s)
- Matthew Deek
- Department of Radiation Oncology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Wolfgang Lilleby
- Department of Oncology, Oslo University Hospital-Radium Hospital, Oslo, Norway
| | - Victoria Vaage
- Department of Oncology, Oslo University Hospital-Radium Hospital, Oslo, Norway
| | - Knut H Hole
- Department of Radiology, Oslo University Hospital-Radium Hospital, Oslo, Norway
- Faculty of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Theodore DeWeese
- Department of Radiation Oncology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Andreas Stensvold
- Department of Oncology, Østfold Hospital Trust, Kalnes, Østfold, Norway
| | - Phuoc Tran
- Department of Radiation Oncology, Johns Hopkins Hospital, Baltimore, Maryland
| | - Therese Seierstad
- Division for Radiology and Nuclear Medicine, Department of Research and Development, Oslo University Hospital, Oslo, Norway
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Gonzalez-Mercado VJ, Marrero S, Marrero-Falcon MA, Saligan LN. Factors Affecting the Severity of Fatigue during Radiotherapy for Prostate Cancer; an Exploratory Study. UROLOGIC NURSING 2020; 40:129-138. [PMID: 34220179 PMCID: PMC8248518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
INTRODUCTION Limited studies have examined potential risk factors associated with the fatigue experience of a sample of Puerto Rican men treated with radiotherapy for non-metastatic prostate cancer. Identifying these factors may provide initial information about targets for individualized interventions, leading to more effective management of fatigue in this population. PURPOSE To examine the relationship of age, body max index, depressive symptoms, physical activity, and sleep disturbance with fatigue during radiotherapy for prostate cancer. METHODS Twenty six participants completed five inventories: demographic intake, health form, the Functional Assessment of Cancer-Therapy-fatigue, Patient-Reported Outcome Measures Information System-Sleep disturbance, and the International Physical Activity Questionnaire-Short Form before, middle/days 19-21 and completion/days 38-42 of radiotherapy. The principal investigator rated the Hamilton depression scale. Descriptive statistics were performed. Interactions and influence of variables on fatigue were assessed using bivariate correlation and multiple linear regression, respectively. RESULTS At each study time point, sleep disturbance and depressive symptoms were strongly correlated with each other and fatigue. The linear combination of sleep disturbance and depressive symptoms was significantly related to fatigue. CONCLUSION Given the high association of sleep disturbance and depressive symptoms with fatigue, clinicians should assess and develop interventions to manage these symptoms altogether.
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Affiliation(s)
| | - Sara Marrero
- University of South Florida College of Arts and Sciences, Tampa, FL, United States
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Can Comprehensive Geriatric Assessment Predict Tolerance of Radiotherapy for Localized Prostate Cancer in Men Aged 75 Years or Older? Cancers (Basel) 2020; 12:cancers12030635. [PMID: 32182949 PMCID: PMC7139355 DOI: 10.3390/cancers12030635] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 03/02/2020] [Accepted: 03/03/2020] [Indexed: 02/07/2023] Open
Abstract
Curative radiotherapy for prostate cancer is common in the elderly. However, concerns about potential toxicity have inhibited access to radiotherapy for this population, for whom preserving quality of life (QoL) is crucial. The primary endpoint was to identify predictors of impaired QoL in men aged 75 years or older treated with curative intent radiotherapy with or without androgen deprivation therapy (ADT) for localized prostate cancer. We prospectively performed comprehensive geriatric assessment (CGA) and administered QoL questionnaires to 208 elderly (>75 years) patients prior to, plus two and six months after, radiotherapy (NCT 02876237). The median age of the patients was 77 years (range 75–89). At the start of the study, comorbidities were highlighted in 65% of patients: 23% were depressed, 23% had cognitive impairment, and 16% had reduced independence. At six months, 9% of patients had a consistently decreased QoL (>20 points), and a further 16% had a more moderate reduction (10 to 20 points) in QoL. None of the parameters studied (tumor characteristic, treatment, or oncogeriatric parameters) were predictive of a reduced QoL following radiotherapy. Though co-existing geriatric impairment was common, QoL was maintained for 75% of patients six months after radiotherapy. CGA was poorly predictive of tolerance of prostatic radiotherapy. Geriatric assessments dedicated to quality of life following radiotherapy need to be developed.
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Yang TK, Wu CC, Chang CH, Muo CH, Huang CY, Chung CJ. Subsequent risk of acute urinary retention and androgen deprivation therapy in patients with prostate cancer: A population-based retrospective cohort study. Medicine (Baltimore) 2020; 99:e18842. [PMID: 32049786 PMCID: PMC7035125 DOI: 10.1097/md.0000000000018842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Acute urinary retention (AUR) is associated with hormone imbalance in men. However, limited studies focused on exploring the complications of AUR in patients with prostate cancer (PC) who receive androgen deprivation therapy (ADT). Therefore, we aim to evaluate the subsequent risk of AUR in ADT-treated PC patients. We collected data from 24,464 male patients who were newly diagnosed with prostate malignancy from a longitudinal health insurance database of catastrophic illness in 2000 to 2008. All PC patients were categorized into 2 cohorts, namely, ADT cohort and non-ADT cohort, based on whether or not the patient receives ADT. The patients were followed up until the occurrence of AUR. Multivariate Cox proportional hazard regression and Kaplan-Meier analysis were performed. After a 12-year follow-up, the incidence rates of AUR were 12.49 and 9.86 per 1000 person-years in ADT and non-ADT cohorts, respectively. Compared with the non-ADT cohort, the ADT cohort had a 1.21-fold increase in AUR risk based on the adjusted model (95% CI = 1.03-1.43). In addition, PC patients receiving early ADT treatment within 6 months or receiving only luteinizing hormone-releasing hormone treatment also had significantly increased risk of AUR. ADT was positively associated with AUR risk. PC patients receiving ADT should be informed about the risks of bladder outlet obstruction and AUR, and they may benefit from screening for related risk factors. New guidelines and treatments should be proposed in the future to manage ADT-related lower urinary tract symptoms and reduce the risk of AUR.
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Affiliation(s)
- Teng-Kai Yang
- Department of Surgery, Yonghe Cardinal Hospital
- School of Medicine, College of Medicine, Fu-Jen Catholic University
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University
| | - Chia-Chang Wu
- Department of Urology, Shuang-Ho Hospital
- Department of Urology, School of Medicine, College of Medicine, Taipei Medical University
| | | | | | - Chao-Yuan Huang
- Department of Urology, Taipei
- Department of Urology, National Taiwan University Hospital, Hsin Chu Branch, Hsin Chu City
| | - Chi-Jung Chung
- Department of Public Health, College of Public Health, China Medical University
- Department of Medical Research, China Medical University and Hospital, Taichung, Taiwan
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11
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Lilleby O, Hernes E, Lilleby W. Metastatic-directed therapy using PSMA-PET/CT at PSA relapse. Urol Case Rep 2019; 27:100992. [PMID: 31453108 PMCID: PMC6704039 DOI: 10.1016/j.eucr.2019.100992] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2019] [Accepted: 08/09/2019] [Indexed: 11/06/2022] Open
Abstract
The side effects of androgen deprivation therapy (ADT) as general treatment against prostate cancer are known to impair quality of life. However, the optimal onset of ADT at PSA relapse is unknown, especially in patients with normal testosterone. In our case a limited PSMA avid lymph node was detected on PET/CT. Our case highlights the importance of metastasis-directed therapy balancing general versus tailored treatment in the decision making in the era of advanced molecular imaging. By using PSMA-PET/CT and radiation we were able to pinpoint the metastasis prolonging the ADT-free survival, thus sparing the patient the side-effects of continuous ADT.
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12
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Newton RU, Jeffery E, Galvão DA, Peddle-McIntyre CJ, Spry N, Joseph D, Denham JW, Taaffe DR. Body composition, fatigue and exercise in patients with prostate cancer undergoing androgen-deprivation therapy. BJU Int 2018; 122:986-993. [PMID: 29750398 DOI: 10.1111/bju.14384] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
OBJECTIVES To investigate the association between lean mass (LM) and fat mass (FM) with fatigue and vitality before and after exercise in patients with prostate cancer already undergoing androgen-deprivation therapy (ADT). SUBJECTS AND METHODS Cross-sectional associations between LM and FM with fatigue and/or vitality measures were examined in 229 patients (aged 43-90 years). Prospective analysis was undertaken in 129 patients who underwent a supervised 3-6 months exercise programme (predominantly resistance + aerobic). Whole body and appendicular LM, and total and trunk FM were assessed by dual X-ray absorptiometry. Fatigue was assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Questionnaire-Core 30 (EORTC QLQ-30) and vitality using the Short Form-36. RESULTS Based on the EORTC QLQ-30, 19% of patients had clinically relevant fatigue. There was no association between LM and fatigue; however, total (P = 0.013), trunk (P = 0.015) and percentage (P = 0.008) FM were higher in fatigued than not fatigued patients, with total and trunk FM 5.0 and 2.6 kg higher, respectively. For quartiles of vitality, a similar pattern emerged for FM with those in the lowest quartile of vitality having the highest FM values (P = 0.014-0.034). In contrast, following supervised exercise, change in fatigue and vitality were associated with change in total LM (r = -0.182, P = 0.042 and r = 0.309, P = 0.001, respectively) but not FM. Patients fatigued at baseline but not fatigued following the exercise programme gained a median (interquartile range) of 2.1 (0.7-3.2) kg LM. CONCLUSION In patients with prostate cancer treated with ADT, body composition is associated with fatigue, with higher total and trunk FM in those with clinically relevant fatigue. However, following exercise those no longer fatigued had an accompanying substantial increase in LM. Modifying body composition, both LM and FM, in patients with prostate cancer may favourably alter cancer-related fatigue levels and should be a target of exercise medicine in this population.
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Affiliation(s)
- Robert U Newton
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.,School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Qld, Australia
| | - Emily Jeffery
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Daniel A Galvão
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Carolyn J Peddle-McIntyre
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia
| | - Nigel Spry
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.,Genesis Cancer Care, Joondalup, WA, Australia.,Faculty of Medicine, University of Western Australia, Nedlands, WA, Australia
| | - David Joseph
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.,Faculty of Medicine, University of Western Australia, Nedlands, WA, Australia.,Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
| | - James W Denham
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, Australia.,Newcastle Mater Hospital, Newcastle, NSW, Australia
| | - Dennis R Taaffe
- Exercise Medicine Research Institute, Edith Cowan University, Joondalup, WA, Australia.,School of Medical and Health Sciences, Edith Cowan University, Joondalup, WA, Australia.,School of Human Movement and Nutrition Sciences, University of Queensland, Brisbane, Qld, Australia
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Goineau A, Campion L, d’Aillières B, Vié B, Ghesquière A, Béra G, Jaffres D, de Laroche G, Magné N, Artignan X, Chamois J, Bergerot P, Martin E, Créhange G, Deniaud-Alexandre E, Buthaud X, Belkacémi Y, Doré M, de Decker L, Supiot S. Comprehensive Geriatric Assessment and quality of life after localized prostate cancer radiotherapy in elderly patients. PLoS One 2018; 13:e0194173. [PMID: 29630602 PMCID: PMC5890970 DOI: 10.1371/journal.pone.0194173] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2017] [Accepted: 02/26/2018] [Indexed: 02/07/2023] Open
Abstract
Introduction Radiotherapy can diminish quality of life (QoL) for prostate cancer patients. Our objective was to evaluate the effect of radiotherapy on QoL in men aged 75 years or older treated with radiotherapy for a localized prostate cancer, and to identify predictors of reduced QoL. Patients and methods We prospectively administered a battery of geriatric (MNA, GDS, Get up and Go Test, CIRS-G, ADL, IADL, MMSE), toxicity (IPSS; IIEF 5), and QoL (QLQ C30) screening tests in 100 elderly patients before and two months after prostate cancer radiotherapy (NCT 02876237). Patients ≥ 75 years undergoing radiotherapy with a curative intent for localized prostate cancer with or without androgen deprivation therapy (ADL) were eligible for study inclusion. Correlations between patient-assessed QoL and tumor characteristics, radiotherapy treatment or CGA parameters were sought using the Fisher or the Mann and Whitney tests. Changes in QoL parameters over time were analyzed using the Wilcoxon signed-rank test. Results At study entry, scores for IADL impairments were present in 51%, reduced autonomy in activities of daily living in 16%, cognitive impairment found in 20%, depression-related symptoms in 31%, and 66% of patients had significant co-morbidities. Eight percent were judged to be at risk of fall and 2% were found to be undernourished. Severely impaired (IPSS ≥ 20) urinary function was observed in 11.2% and 13.5% of patients before and two months after completion of radiotherapy respectively. Significantly decreased QoL (> 20 points) at two months after treatment was found in 13% of patients and a moderate but clinically relevant reduction (10 to 20 points) in 17% of patients. No tumor characteristic, treatment, or oncogeriatric parameter was predictive of reduced QoL following prostate cancer radiotherapy. Conclusion Despite sometimes markedly diminished oncogeriatric parameters, prostate cancer radiotherapy was generally well tolerated in these elderly patients. We found no predictive factor to determine which patients would experience impaired quality of life following radiotherapy.
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Affiliation(s)
- Aurore Goineau
- Department of Radiation Oncology, Institut de Cancérologie de l’Ouest, Angers, France
- * E-mail:
| | - Loïc Campion
- Department of Statistics, Institut de Cancérologie de l’Ouest, Saint Herblain, France
| | - Bénédicte d’Aillières
- Department of Radiation Oncology, Institut de Cancérologie de l’Ouest, Angers, France
| | - Brigitte Vié
- Department of Radiation Oncology, Clinique Armoricaine de Radiologie, St Brieuc, France
| | - Agnès Ghesquière
- Department of Radiation Oncology, Clinique Armoricaine de Radiologie, St Brieuc, France
| | - Guillaume Béra
- Department of Radiation Oncology, Centre Hospitalier de Bretagne Sud, Lorient, France
| | - Didier Jaffres
- Department of Radiation Oncology, Centre Hospitalier de Bretagne Sud, Lorient, France
| | - Guy de Laroche
- Department of Radiation Oncology, Institut de Cancérologie de Loire, St Priest en Jarez, France
| | - Nicolas Magné
- Department of Radiation Oncology, Institut de Cancérologie de Loire, St Priest en Jarez, France
| | - Xavier Artignan
- Department of Radiation Oncology, CHP St Grégoire, St Grégoire, France
| | - Jérôme Chamois
- Department of Radiation Oncology, CHP St Grégoire, St Grégoire, France
| | - Philippe Bergerot
- Department of Radiation Oncology, Clinique Mutualiste de l’Estuaire, St Nazaire, France
| | - Etienne Martin
- Department of Radiation Oncology, Centre Georges François Leclerc, Dijon, France
| | - Gilles Créhange
- Department of Radiation Oncology, Centre Georges François Leclerc, Dijon, France
| | | | - Xavier Buthaud
- Department of Radiation Oncology, Centre Catherine de Sienne, Nantes, France
| | - Yazid Belkacémi
- Department of Radiation Oncology, CHU Henri Mondor, Créteil, France
| | - Mélanie Doré
- Department of Radiation Oncology, Institut de Cancérologie de l’Ouest, Saint Herblain, France
| | - Laure de Decker
- Department of Radiation Oncology, Institut de Cancérologie de l’Ouest, Saint Herblain, France
| | - Stéphane Supiot
- Department of Radiation Oncology, Institut de Cancérologie de l’Ouest, Saint Herblain, France
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14
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Knipper S, Graefen M. Clinical Case Discussion: Primary Treatment for Prostate Cancer in an Elderly Man—Treatment of the Primary Tumor is Necessary. Eur Urol Focus 2017; 3:326-327. [DOI: 10.1016/j.euf.2017.09.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2017] [Revised: 09/06/2017] [Accepted: 09/15/2017] [Indexed: 10/18/2022]
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