Patient satisfaction with health-related quality of life: implications for prognosis in prostate cancer

Global quality of life and mortality risk in patients with cancer: a systematic review and meta-analysis

PURPOSE

This systematic review and meta-analysis aimed to examine the impact of global quality of life (QOL) on mortality risk in patients with cancer, considering cancer type and timepoint of QOL assessment.

METHODS

A systematic search was conducted using Cumulated Index to Nursing and Allied Health Literature, PubMed/MEDLINE, and Scopus databases from inception to December 2022. Observational studies that assessed QOL and examined mortality risk in patients with cancer were extracted. Subgroup analyses were performed for cancer types and timepoints of QOL assessment.

RESULTS

Overall, global QOL was significantly associated with mortality risk (hazard ratio: 1.06, 95% confidence interval: 1.05-1.07; p < 0.00001). A subgroup analysis based on cancer type demonstrated that lung, head and neck, breast, esophagus, colon, prostate, hematologic, liver, gynecologic, stomach, brain, bladder, bone and soft tissue, and mixed type cancers were significantly associated with mortality risk; however, melanoma and pancreatic cancer were not significantly associated with mortality risk. Additionally, global QOL was associated with mortality risk at all timepoints (pretreatment, posttreatment, and palliative phase); pretreatment QOL had the largest impact, followed by posttreatment QOL.

CONCLUSION

These findings provide evidence that QOL is associated with mortality risk in patients with cancer at any timepoint. These results indicate the importance of evaluating the QOL and supportive interventions to improve QOL in any phase.

Managing postoperative biochemical relapse in prostate cancer, from the perspective of the Francophone group of Urological radiotherapy (GFRU)

Up to 50% of patients treated with radical surgery for localized prostate cancer may experience biochemical recurrence that requires appropriate management. Definitions of biochemical relapse may vary, but, in all cases, consist of an increase in a PSA without clinical or radiological signs of disease. Molecular imaging through to positron emission tomography has taken a preponderant place in relapse diagnosis, progressively replacing bone scan and CT-scan. Prostate bed radiotherapy is currently a key treatment, the action of which should be potentiated by androgen deprivation therapy. Nowadays perspectives consist in determining the best combination therapies, particularly thanks to next-generation hormone therapies, but not exclusively. Several trials are ongoing and should address these issues. We present here a literature review aiming to discuss the current management of biochemical relapse in prostate cancer after radical surgery, in lights of recent findings, as well as future perspectives.

Roles of benefit finding in psychological and inflammatory adjustments in persons with colorectal cancer: a prospective analysis on the multidimensionality of benefit finding

OBJECTIVE

This study examined the unique associations of different dimensions of the resilience factor, benefit finding, on concurrent and prospective psychological and biological adjustment outcomes over the first year after a colorectal cancer diagnosis.

METHODS AND MEASURES

Individuals newly diagnosed with colorectal cancer (n = 133, mean age = 56 years old, 59% female, 46% Hispanic) completed questionnaires assessing the multidimensional aspects of benefit finding around 4 months post-diagnosis (T1). Psychological (depressive symptoms and life satisfaction) and biological [C-reactive protein (CRP) and interleukin-10 (IL-10)] adjustments were assessed at T1 and one-year post-diagnosis (T2).

RESULTS

Structural equation modeling revealed that at T1, greater reprioritization was concurrently related to higher depressive symptoms (p=.020). Lower acceptance, lower empathy, and greater positive self-view predicted higher life satisfaction at T2 (ps<.010). Additionally, lower empathy and greater family valuation predicted higher CRP at T2 (ps<.004), whereas greater positive self-view predicted higher IL-10 at T2 (p=.039). Greater overall benefit finding was associated with lower IL-10 at T1 (p=.013).

CONCLUSION

Various aspects of benefit finding differentially relate to psychological and inflammatory markers during the first year after diagnosis in persons with colorectal cancer. Interventions designed to specifically enhance positive self-view may promote both the psychological and biological health of individuals with cancer.

Prediction Model of the Quality of Life for Patients with Pancreatic Cancer

This study attempted to establish a predictive model that systematically and comprehensively predicts the quality of life (QoL) of patients with pancreatic cancer. The study used a descriptive cross-sectional design. A total of 248 patients was included who were selected via the convenience sampling method. A structured questionnaire was used and the collected data were analyzed for fitness, using the SPSS WIN 25.0 program and AMOS 24.0. The perceived health status of the patients with pancreatic cancer would directly affect their QoL and indirectly influence the QoL through social support, symptoms, functional status, and age. The application of social support intervention programs to relieve specific symptoms and improve the functional status according to the conditions of patients may contribute to improving the QoL of pancreatic cancer patients. This predictive model could be used as the basis for developing a nursing intervention plan and writing evaluation guidelines for practitioners who provide nursing care for patients with pancreatic cancer.

An assessment of the use of patient reported outcome measurements (PROMs) in cancers of the pelvic abdominal cavity: identifying oncologic benefit and an evidence-practice gap in routine clinical practice

BACKGROUND

Patient reported outcome measurements (PROMs) are emerging as an important component of patient management in the cancer setting, providing broad perspectives on patients' quality of life and experience. The use of PROMs is, however, generally limited to the context of randomised control trials, as healthcare services are challenged to sustain high quality of care whilst facing increasing demand and financial shortfalls. We performed a systematic review of the literature to identify any oncological benefit of using PROMs and investigate the wider impact on patient experience, in cancers of the pelvic abdominal cavity specifically.

METHODS

A systematic review of the literature was conducted using MEDLINE (Pubmed) and Ovid Gateway (Embase and Ovid) until April 2020. Studies investigating the oncological outcomes of PROMs were deemed suitable for inclusion.

RESULTS

A total of 21 studies were included from 2167 screened articles. Various domains of quality of life (QoL) were identified as potential prognosticators for oncologic outcomes in cancers of the pelvic abdominal cavity, independent of other clinicopathological features of disease: 3 studies identified global QoL as a prognostic factor, 6 studies identified physical and role functioning, and 2 studies highlighted fatigue. In addition to improved outcomes, a number of included studies also reported that the use of PROMs enhanced both patient-clinician communication and patient satisfaction with care in the clinical setting.

CONCLUSIONS

This review highlights the necessity of routine collection of PROMs within the pelvic abdominal cancer setting to improve patient quality of life and outcomes.

Health-Related Quality of Life and Survival in Prostate Cancer Patients in a Real-World Setting

OBJECTIVE

To analyze the health-related quality of life (HRQoL) and survival of real-world prostate cancer (PC) patients and to calculate quality-adjusted life-years (QALYs) experienced under different treatment strategies.

MATERIALS AND METHODS

PC patients undergoing active surveillance (n = 226), radiation treatment (n = 280), surgery (n = 299), or hormonal treatment (n = 62) responded to the generic 15-dimensional (15D) HRQoL questionnaire at the time of the diagnosis and were followed up 3, 6, 12, and 24 months later. QALYs experienced during the follow-up were calculated for each treatment group, and variables associated with survival were analyzed using Cox proportional hazards models.

RESULTS

HRQoL was stable during the first 2 years after diagnosis in all other treatment groups, except in patients treated with hormonal therapy. The overall survival within 6.5-year follow-up time was 84.4%. The number of QALYs experienced during the 2-year follow-up was similar in patients in active surveillance (1.790), surgery (1.784), and radiation groups (1.767), but significantly lower in the hormonal therapy group (1.665).

CONCLUSIONS

Patients receiving hormonal treatment had significantly impaired HRQoL and survival compared with other treatments. Although the number of QALYs experienced was similar in the 3 other treatment lines, there were marked differences between treatment lines on some 15D dimensions.

Reliability and validity of the Japanese version of the Quality of Life Index for patients with cancer

This study was designed to evaluate the psychometric properties of the newly completed Japanese translation of the Ferrans and Powers Quality of Life Index Cancer Version III (QLI). Using a cross-sectional descriptive design, 136 ambulatory patients with gastrointestinal cancer (55 receiving chemotherapy, 76 with stable health status after treatment, and five status not known) completed a questionnaire at a one-time point, and 26 patients (stable health status) completed the questionnaire again 2 weeks later. Internal consistency reliability was supported by Cronbach's α of .96 for the total scale, with subscales ranging from .83 to .93. A test-retest correlation of 0.76 (total scale) provided evidence of stability reliability over a 2-week period, with subscale retest correlations ranging from 0.70 to 0.83. Confirmatory factor analysis showed the same four domains for the Japanese translation as the original QLI, supporting construct validity. We also assessed construct validity by examining the relationships between the Japanese QLI and six other concepts known to be related to the quality of life. As hypothesized, all correlations were moderate and in the expected direction (pain -0.39, anxiety -0.54, depression -0.63, stress -0.51, pain interfering with functioning -0.52, and general health 0.62). This evidence of the reliability and validity of the Japanese translation of the QLI supports its use in research and clinical practice to evaluate the impact of cancer and treatment. This new translation can be used to assess the patient's perspective of their quality of life, both within Japan and in cross-cultural studies with the QLI in other languages.

Prognostic value of changes in quality of life scores in prostate cancer

Background

Several studies in the oncology literature have demonstrated the prognostic value of baseline quality of life (QoL). We investigated whether changes in QoL could predict survival in prostate cancer patients.

Methods

We evaluated 250 prostate cancer patients treated at our institution between Jan 2001 and Dec 2009 who were available for a minimum follow-up of 3 months. QoL was evaluated at baseline and after 3 months of treatment initiation using EORTC-QLQ-C30. Cox regression evaluated the prognostic significance of baseline and changes in QoL scores after adjusting for relevant clinical and demographic variables.

Results

Median overall survival was 89.1 months (95% CI: 56.5-121.7). Baseline QoL scale predictive of survival upon multivariate analysis was fatigue (p = 0.001). Associations between changes in QoL and survival, upon multivariate analysis, were observed for dyspnea and cognitive functioning. Every 10-point increase (worsening) in dyspnea was associated with a 16% increased risk of death (HR = 1.16; 95% CI = 1.02 to 1.30, p = 0.02), and every 10-point increase (improvement) in cognitive functioning was associated with a 24% decreased risk of death (HR = 0.76; 95% CI = 0.54 to 0.98, p = 0.04).

Conclusions

This study provides preliminary evidence to indicate that prostate cancer patients with better baseline fatigue and patients whose dyspnea and cognitive functioning improves within 3 months of treatment are at a significantly decreased risk of mortality.

Life events, cortisol and levels of prostate specific antigen: a story of synergism

BACKGROUND

Previous studies have tested the relationship between stressful life events (LE) and cancer onset, but inconsistent results have been found. One possibility is that the LE-cancer relation may depend on other biological factors pertinent to stress and cancer.

METHODS

This study examined the relationship between LE and prostate specific antigen (PSA) levels, a tumor marker, and whether cortisol mediates or moderates a LE-PSA relationship. During a voluntary screening for prostate cancer risk, 139 men (mean age=57.3 years) were assessed with the Holmes and Rahe questionnaire about their LE during the past 1-5 years, and their PSA and serum cortisol levels were measured.

RESULTS

LE and cortisol alone were unrelated to PSA. However, statistically controlling for age, body mass index and the ratio of triglycerides to HDL cholesterol, we found evidence for a synergistic interaction between LE and cortisol. Among men with low cortisol, number of LE were inversely and significantly correlated with PSA (r=-0.265, p<0.05), while in men with high cortisol, number of LE were positively and significantly correlated with PSA (r=0.344, p<0.01). These results more consistently stemmed from the effects of uncontrollable LE. Similar results were found, using a clinically significant PSA cut-off.

CONCLUSIONS

These results suggest considering the joint effects of psychosocial and biological factors in relation to possible cancer risk, where the hypothalamic pituitary adrenal axis may moderate stress-cancer risk associations.

Predicting survival in prostate cancer: the role of quality of life assessment

Purpose

While the use of quality of life (QoL) assessment has been increasing in clinical oncology, few studies have examined its prognostic significance in prostate cancer. We investigated the association between QoL at presentation and survival in prostate cancer.

Methods

We retrospectively reviewed 673 patients treated at two single-system cancer centers between January 2001 and December 2008. QoL was evaluated using EORTC-QLQ-C30. Patient survival was defined as the time interval between the date of first patient visit and the date of death/date of last contact. Univariate and multivariate Cox regression was performed to evaluate the prognostic significance of QoL.

Results

Mean age at presentation was 63.2 years. Patient stage of disease at diagnosis was I, 4; II, 464; III, 76; IV, 107; and 22 indeterminate. Median overall survival was 89.1 months (95% CI: 46.1–132.0). QoL scales predictive of survival upon univariate analysis were physical, role, emotional, social, fatigue, nausea/vomiting, pain, dyspnea, insomnia, loss of appetite, and constipation (p < 0.01 for all). Multivariate analyses found fatigue (p = 0.02) and constipation (p = 0.01) to be significantly associated with survival.

Conclusions

Baseline QoL provides useful prognostic information in prostate cancer. These findings have important implications for patient stratification in clinical trials and may aid decision making in clinical practice.

Cancer-specific beliefs and survival in nonmetastatic colorectal cancer patients

BACKGROUND

Colorectal cancer (CRC) is the third leading cause of cancer mortality in the United States. Associations between cancer-specific beliefs (beliefs) and survival have been observed among other cancer populations, but similar research in CRC patients is virtually nonexistent, especially in racially diverse populations. The relationship between beliefs and survival was investigated in a cohort of African Americans and non-Hispanic whites with newly diagnosed nonmetastatic CRC, followed for up to 15 years.

METHODS

The authors analyzed data from a population-based cohort of 286 individuals (115 African Americans and 171 whites, approximately 52% women) diagnosed with nonmetastatic CRC in Connecticut, 1987 to 1991. Cox proportional hazards models were adjusted for sociodemographic (age, sex, race, education, income, occupational status, marital status) and biomedical (stage at diagnosis, histological grade, treatment) variables.

RESULTS

Not believing in the curability of cancer increased the risk of all-cause mortality (hazard ratio [HR], 1.59; 95% confidence interval [CI], 1.06-2.39) and CRC-specific mortality (HR, 1.65; 95% CI, 0.90-3.03; P=.10). These multivariate estimates were not altered by additional adjustment for insurance coverage, obesity, smoking, alcohol consumption, or comorbidity. Furthermore, the association between perceived curability and survival did not vary significantly by key sociodemographic or biomedical factors. Other beliefs were not associated with survival.

CONCLUSIONS

Among a racially diverse cohort of men and women with CRC, believing in the curability of cancer was independently associated with survival over a 15-year period. Confirmation of the role of cancer-specific beliefs on survival and study of the potential biobehavioral mechanisms is needed. Findings may inform the design of interventions for cancer survivors.