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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.
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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
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2
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Robitaille K, Guertin MH, Jamshidi A, Xu HW, Hovington H, Pelletier JF, Beaudoin L, Gevariya N, Lacombe L, Tiguert R, Caumartin Y, Dujardin T, Toren P, Lodde M, Racine É, Trudel D, Perigny M, Duchesne T, Savard J, Julien P, Fradet Y, Fradet V. A phase IIb randomized placebo-controlled trial testing the effect of MAG-EPA long-chain omega-3 fatty acid dietary supplement on prostate cancer proliferation. COMMUNICATIONS MEDICINE 2024; 4:56. [PMID: 38519581 PMCID: PMC10960033 DOI: 10.1038/s43856-024-00456-4] [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: 03/14/2023] [Accepted: 02/07/2024] [Indexed: 03/25/2024] Open
Abstract
BACKGROUND High prostate eicosapentaenoic fatty acid (EPA) levels were associated with a significant reduction of upgrading to grade group (GG) ≥ 2 prostate cancer in men under active surveillance. We aimed to evaluate the effect of MAG-EPA long-chain omega-3 fatty acid dietary supplement on prostate cancer proliferation. METHODS A phase II double-blind randomized placebo-controlled trial was conducted in 130 men diagnosed with GG ≥ 2 prostate cancer and undergoing radical prostatectomy between 2015-2017 (Clinicaltrials.gov: NCT02333435). Participants were randomized to receive 3 g daily of either MAG-EPA (n = 65) or placebo (n = 65) for 7 weeks (range 4-10) prior to radical prostatectomy. The primary outcome was the cancer proliferation index quantified by automated image analysis of tumor nuclear Ki-67 expression using standardized prostatectomy tissue microarrays. Additional planned outcomes at surgery are reported including plasma levels of 27 inflammatory cytokines and fatty acid profiles in circulating red blood cells membranes and prostate tissue. RESULTS Cancer proliferation index measured by Ki-67 expression was not statistically different between the intervention (3.10%) and placebo (2.85%) groups (p = 0.64). In the per protocol analyses, the adjusted estimated effect of MAG-EPA was greater but remained non-significant. Secondary outcome was the changes in plasma levels of 27 cytokines, of which only IL-7 was higher in MAG-EPA group compared to placebo (p = 0.026). Men randomized to MAG-EPA prior to surgery had four-fold higher EPA levels in prostate tissue compared to those on placebo. CONCLUSIONS This MAG-EPA intervention did not affect the primary outcome of prostate cancer proliferation according to nuclear Ki-67 expression. More studies are needed to decipher the effects of long-chain omega-3 fatty acid dietary supplementation in men with prostate cancer.
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Affiliation(s)
- Karine Robitaille
- CHU de Québec-Université Laval Research Center, Québec, QC, G1R 3S1, Canada
- Centre de recherche sur le Cancer de l'Université Laval, Québec, QC, G1R 3S3, Canada
- Institute of nutrition and functional foods (INAF) and NUTRISS Center - Nutrition, health and society of Université Laval, Québec, G1V 0A6, Canada
| | - Marie-Hélène Guertin
- CHU de Québec-Université Laval Research Center, Québec, QC, G1R 3S1, Canada
- Faculty of Medicine, Université Laval, Québec, QC, G1V 0A6, Canada
| | - Afshin Jamshidi
- CHU de Québec-Université Laval Research Center, Québec, QC, G1R 3S1, Canada
- Centre de recherche sur le Cancer de l'Université Laval, Québec, QC, G1R 3S3, Canada
| | - Hui Wen Xu
- Department of Mathematics and Statistics, Université Laval, Québec, QC, G1V 0A6, Canada
| | - Hélène Hovington
- CHU de Québec-Université Laval Research Center, Québec, QC, G1R 3S1, Canada
- Centre de recherche sur le Cancer de l'Université Laval, Québec, QC, G1R 3S3, Canada
| | | | - Lisanne Beaudoin
- CHU de Québec-Université Laval Research Center, Québec, QC, G1R 3S1, Canada
| | - Nikunj Gevariya
- CHU de Québec-Université Laval Research Center, Québec, QC, G1R 3S1, Canada
| | - Louis Lacombe
- CHU de Québec-Université Laval Research Center, Québec, QC, G1R 3S1, Canada
- Centre de recherche sur le Cancer de l'Université Laval, Québec, QC, G1R 3S3, Canada
- Centre de Recherche Clinique et Évaluative en Oncologie de L'Hôtel-Dieu de Québec, CHU de Québec-Université Laval, Québec, QC, G1R 3S1, Canada
- Faculty of Medicine, Université Laval, Québec, QC, G1V 0A6, Canada
| | - Rabi Tiguert
- Centre de Recherche Clinique et Évaluative en Oncologie de L'Hôtel-Dieu de Québec, CHU de Québec-Université Laval, Québec, QC, G1R 3S1, Canada
| | - Yves Caumartin
- Centre de Recherche Clinique et Évaluative en Oncologie de L'Hôtel-Dieu de Québec, CHU de Québec-Université Laval, Québec, QC, G1R 3S1, Canada
| | - Thierry Dujardin
- Centre de Recherche Clinique et Évaluative en Oncologie de L'Hôtel-Dieu de Québec, CHU de Québec-Université Laval, Québec, QC, G1R 3S1, Canada
| | - Paul Toren
- CHU de Québec-Université Laval Research Center, Québec, QC, G1R 3S1, Canada
- Centre de recherche sur le Cancer de l'Université Laval, Québec, QC, G1R 3S3, Canada
- Centre de Recherche Clinique et Évaluative en Oncologie de L'Hôtel-Dieu de Québec, CHU de Québec-Université Laval, Québec, QC, G1R 3S1, Canada
- Faculty of Medicine, Université Laval, Québec, QC, G1V 0A6, Canada
| | - Michele Lodde
- Centre de Recherche Clinique et Évaluative en Oncologie de L'Hôtel-Dieu de Québec, CHU de Québec-Université Laval, Québec, QC, G1R 3S1, Canada
| | - Étienne Racine
- Department of Pathology, CHU de Québec-Université Laval, Québec, QC, G1R 2J6, Canada
| | - Dominique Trudel
- Centre de recherche du Centre Hospitalier de l'Université de Montréal (CRCHUM) et Institut du cancer de Montréal, and Department of Pathology and Cellular Biology, Université de Montréal, Montréal, H3C 3J7, Canada
| | - Martine Perigny
- Department of Pathology, CHU de Québec-Université Laval, Québec, QC, G1R 2J6, Canada
| | - Thierry Duchesne
- Department of Mathematics and Statistics, Université Laval, Québec, QC, G1V 0A6, Canada
| | - Josée Savard
- CHU de Québec-Université Laval Research Center, Québec, QC, G1R 3S1, Canada
- Centre de recherche sur le Cancer de l'Université Laval, Québec, QC, G1R 3S3, Canada
- School of psychology, Université Laval, Montréal, QC, G1R 2J6, Canada
| | - Pierre Julien
- CHU de Québec-Université Laval Research Center, Québec, QC, G1R 3S1, Canada
- Faculty of Medicine, Université Laval, Québec, QC, G1V 0A6, Canada
| | - Yves Fradet
- CHU de Québec-Université Laval Research Center, Québec, QC, G1R 3S1, Canada
- Centre de recherche sur le Cancer de l'Université Laval, Québec, QC, G1R 3S3, Canada
- Centre de Recherche Clinique et Évaluative en Oncologie de L'Hôtel-Dieu de Québec, CHU de Québec-Université Laval, Québec, QC, G1R 3S1, Canada
- Faculty of Medicine, Université Laval, Québec, QC, G1V 0A6, Canada
| | - Vincent Fradet
- CHU de Québec-Université Laval Research Center, Québec, QC, G1R 3S1, Canada.
- Centre de recherche sur le Cancer de l'Université Laval, Québec, QC, G1R 3S3, Canada.
- Institute of nutrition and functional foods (INAF) and NUTRISS Center - Nutrition, health and society of Université Laval, Québec, G1V 0A6, Canada.
- Centre de Recherche Clinique et Évaluative en Oncologie de L'Hôtel-Dieu de Québec, CHU de Québec-Université Laval, Québec, QC, G1R 3S1, Canada.
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3
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Beaudry M, Carignan D, Foster W, Lavallee M, Aubin S, Lacroix F, Poulin E, Lachance B, Després P, Beaulieu L, Vigneault E, Martin A. Comparison of four-year toxicities and local control of ultra-hypofractionated vs moderate-hypofractionated image guided prostate radiation with HDR brachytherapy boost: A phase I-II single institution trial. Clin Transl Radiat Oncol 2023; 40:100593. [PMID: 36875870 PMCID: PMC9974413 DOI: 10.1016/j.ctro.2023.100593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 02/03/2023] [Accepted: 02/05/2023] [Indexed: 02/10/2023] Open
Abstract
Purpose/Objectives To analyze the long term efficacy and safety of an ultra-hypofractionated (UHF) radiation therapy prostate treatment regimen with HDR brachytherapy boost (BB) and compare it to moderate-hypofractionated regimens (MHF). Materials/Methods In this single arm, prospective monocentric study, 28 patients with intermediate risk prostate cancer were recruited in an experimental treatment arm of 25 Gy in 5 fractions plus a 15 Gy HDR BB. They were then compared to two historical control groups, treated with either 36 Gy in 12 fractions or 37.5 Gy in 15 fractions with a similar HDR BB. The control groups included 151 and 311 patients respectively. Patient outcomes were reported using the International Prostate Symptom Score (IPSS) and Expanded Prostate Index Composite (EPIC-26) questionnaires at baseline and at each follow-up visit. Results Median follow-up for the experimental arm was 48.5 months compared to 47 months and 60 months compared to the 36/12 and 37,5/15 groups respectively. The IPSS and EPIC scores did not demonstrate any significant differences in the gastrointestinal or genitourinary domains between the three groups over time. No biochemical recurrence occurred in the UHF arm as defined by the Phoenix criterion. Conclusion The UHF treatment scheme with HDR BB seems equivalent to standard treatment arms in terms of toxicities and local control. Randomized control trials with larger cohorts are ongoing and needed to further confirm our findings.
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Affiliation(s)
- M.M. Beaudry
- CHU de Québec-Université Laval, Service de radio-oncologie, Québec, QC, Canada
| | - D. Carignan
- Centre de recherche sur le cancer, Université Laval, Québec, QC, Canada
| | - W. Foster
- CHU de Québec-Université Laval, Service de radio-oncologie, Québec, QC, Canada
| | - M.C. Lavallee
- CHU de Québec-Université Laval, Service de radio-oncologie, Québec, QC, Canada
| | - S. Aubin
- CHU de Québec-Université Laval, Service de radio-oncologie, Québec, QC, Canada
| | - F. Lacroix
- CHU de Québec-Université Laval, Service de radio-oncologie, Québec, QC, Canada
| | - E. Poulin
- CHU de Québec-Université Laval, Service de radio-oncologie, Québec, QC, Canada
| | - B. Lachance
- CHU de Québec-Université Laval, Service de radio-oncologie, Québec, QC, Canada
| | - P. Després
- CHU de Québec-Université Laval, Service de radio-oncologie, Québec, QC, Canada
- Centre de recherche sur le cancer, Université Laval, Québec, QC, Canada
| | - L. Beaulieu
- CHU de Québec-Université Laval, Service de radio-oncologie, Québec, QC, Canada
- Centre de recherche sur le cancer, Université Laval, Québec, QC, Canada
| | - E. Vigneault
- CHU de Québec-Université Laval, Service de radio-oncologie, Québec, QC, Canada
- Centre de recherche sur le cancer, Université Laval, Québec, QC, Canada
| | - A.G. Martin
- CHU de Québec-Université Laval, Service de radio-oncologie, Québec, QC, Canada
- Centre de recherche sur le cancer, Université Laval, Québec, QC, Canada
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4
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Awad MA, Hallgarth L, Barayan GA, Shahait M, Abu-Hijlih R, Farkouh A, Azhar RA, Alghamdi MM, Bugis A, Yaiesh S, Aldousari S, Barham A, Saed M, Moussa A, Hassen W, Naud S, Plante MK, Grunert R. Creation and validation of the harmonized Arabic version of the Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP). Arab J Urol 2021; 20:88-93. [PMID: 35530568 PMCID: PMC9067989 DOI: 10.1080/2090598x.2021.2002636] [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] [Indexed: 11/23/2022] Open
Abstract
Objectives Tocreate and validate a translated Arabic version of the Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP), a validated patient-reported outcome (PRO) widely used for assessing the quality of life in patients with prostate cancer (PCa). Patients and Methods Using the established protocol as defined by the Professional Society for the Health Economics and Outcomes Research (ISPOR) for translating patient care questionnaires, a harmonised translated Arabic version of EPIC-CP was created. The questionnaire was tested in native Arabic speakers from four different Arabic countries (Saudi Arabia, United Arab Emirates, Jordan, and Kuwait). Cronbach’s alpha and interclass coefficient correlation (ICC) analyses were used to test the internal consistency and test–retest reliability, respectively. In addition, PCa characteristics were collected for participants. Results In total, 168 patients with PCa participated in the study (39 from Saudi Arabia, 23 from United Arab Emirates, 65 from Jordan, and 41 from Kuwait). In all, 52 (31%) participants repeated the questionnaire for test–retest reliability analysis. The median (interquartile range [IQR]) age of patients included in the study was 66 (61–71) years. The median (IQR) PSA level was 9.8 (6–19) ng/mL. Most patients had Grade Group 2 PCa at diagnosis (31%), clinical stage cT1 (42%), managed primarily by urology (79%), and the primary treatment was radical prostatectomy (71%). The total Cronbach’s alpha coefficient was 0.84 demonstrating an acceptable internal consistency. The total ICC was also acceptable at 0.64. Conclusion The Arabic version of the EPIC-CP is a reliable and valid tool for assessing health-related quality of life for Arabic patients with PCa.
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Affiliation(s)
- Mohannad A. Awad
- Department of Surgery, Division of Urology, University of Vermont Medical Center, Burlington, VT, USA
- Department of Surgery, King Abdulaziz University, Rabigh, Saudi Arabia
| | - Luke Hallgarth
- Department of Surgery, Division of Urology, University of Vermont Medical Center, Burlington, VT, USA
| | - Ghassan A. Barayan
- Department of Surgery, Division of Urology, University of Vermont Medical Center, Burlington, VT, USA
- Department of Surgery, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Mohammed Shahait
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Ramiz Abu-Hijlih
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Ala’a Farkouh
- Department of Surgery, King Hussein Cancer Center, Amman, Jordan
| | - Raed A. Azhar
- Department of Surgery, Division of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Musab M. Alghamdi
- Department of Surgery, Division of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Ahmad Bugis
- Department of Surgery, Division of Urology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Said Yaiesh
- Urology Unit, Department of Surgery, Mubarak Al-Kabeer Hospital, Kuwait, Kuwait
| | - Saad Aldousari
- Department of Surgery (Urology Division), Faculty of Medicine, Kuwait University, Kuwait, Kuwait
- Department of Urology, MD Anderson Cancer Center, Houston, TX, USA
| | - Alaeddin Barham
- Urology, Surgical Subspecialties Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Mohamed Saed
- Urology, Surgical Subspecialties Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Ayman Moussa
- Urology, Surgical Subspecialties Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
| | - Waleed Hassen
- Urology, Surgical Subspecialties Institute, Cleveland Clinic, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Lerner College of Medicine of Case Western University, Cleveland, OH, USA
| | - Shelly Naud
- Medical Biostatistics, Larner College of Medicine, University of Vermont, Burlington, VT, USA
| | - Mark K. Plante
- Department of Surgery, Division of Urology, University of Vermont Medical Center, Burlington, VT, USA
| | - Richard Grunert
- Department of Surgery, Division of Urology, University of Vermont Medical Center, Burlington, VT, USA
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Reynaud T, Hathout L, Carignan D, Barkati M, Martin AG, Foster W, Lacroix F, Delouya G, Taussky D, Morton G, Vigneault E. PSA outcomes and late toxicity of single-fraction HDR brachytherapy and LDR brachytherapy as monotherapy in localized prostate cancer: A phase 2 randomized pilot study. Brachytherapy 2021; 20:1090-1098. [PMID: 34238688 DOI: 10.1016/j.brachy.2021.05.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 04/16/2021] [Accepted: 05/19/2021] [Indexed: 12/21/2022]
Abstract
PURPOSE To evaluate the PSA outcomes and the late patient's reported health related quality of life (HRQOL) and toxicity after single-fraction High-Dose-Rate brachytherapy (HDRB) and Low-Dose-Rate brachytherapy (LDRB) for prostate cancer. METHODS Men with low and favorable intermediate-risk prostate cancer across 3 centres were randomized between monotherapy brachytherapy with either Iodine-125 LDRB or 19 Gy single-fraction HDRB. Biochemical outcomes were evaluated using the Phoenix definition, PSA nadir and absolute PSA value <0.4 ng/mL. Toxicities and HRQOL were recorded at 24 and 36 months. RESULTS A total of 31 patients were randomized, 15 in the LDRB arm and 16 patients in the HDRB arm. After a median follow-up of 45(36-53) months, 3 patients in the HDRB arm experienced biochemical failure (p = 0.092). Nineteen Gy single-fraction HDRB was associated with significantly higher PSA nadir compared to LDRB (1.02 ± 0.66vs 0.25 ± 0.39, p < 0.0001). Moreover, a significantly larger proportion of patients in the LDRB group had a PSA <0.4 ng/mL (13/15 vs 2/16, p < 0.0001). For late Genito-Urinary, Gastro-Intestinal, and sexual toxicities at 24 and 36 months, no significant differences were found between the 2 arms. As for HRQOL, the IPSS and EPIC-26 urinary irritative score were significantly better for patients treated with HDRB over the first 36 months post-treatment (p = 0.001 and p = 0.01, respectively), reflecting superior HRQOL. CONCLUSION HDRB resulted in superior HRQOL in the irritative urinary domain compared to LDRB. PSA nadir was significantly lower in the LDRB group and a higher proportion of patients in the LDRB group reached PSA <0.4 ng/mL.
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Affiliation(s)
- Thomas Reynaud
- Department of Radiation Oncology, CHU de Québec-Université Laval, Québec, Canada; Research Centre CHU de Québec-Université Laval, Québec, Canada
| | - Lara Hathout
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, NJ
| | - Damien Carignan
- Research Centre CHU de Québec-Université Laval, Québec, Canada
| | - Maroie Barkati
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - André-Guy Martin
- Department of Radiation Oncology, CHU de Québec-Université Laval, Québec, Canada; Research Centre CHU de Québec-Université Laval, Québec, Canada
| | - William Foster
- Department of Radiation Oncology, CHU de Québec-Université Laval, Québec, Canada
| | - Frédéric Lacroix
- Department of Radiation Oncology, CHU de Québec-Université Laval, Québec, Canada
| | - Guila Delouya
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Daniel Taussky
- Department of Radiation Oncology, Centre Hospitalier de l'Université de Montréal, Montréal, Canada
| | - Gerard Morton
- Department of Radiation Oncology, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, Ontario, Canada
| | - Eric Vigneault
- Department of Radiation Oncology, CHU de Québec-Université Laval, Québec, Canada; Research Centre CHU de Québec-Université Laval, Québec, Canada.
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Sibert NT, Dieng S, Oesterle A, Feick G, Carl G, Steiner T, Minner J, Roghmann F, Kaftan B, Zengerling F, Hinkel A, Beyer B, Heidenreich A, Harke N, Brehmer B, Pfitzenmaier J, Fichtner J, Neisius A, Hammerer P, Wesselmann S, Kowalski C. Psychometric validation of the German version of the EPIC-26 questionnaire for patients with localized and locally advanced prostate cancer. World J Urol 2019; 39:11-25. [PMID: 31552467 DOI: 10.1007/s00345-019-02949-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Accepted: 09/04/2019] [Indexed: 10/26/2022] Open
Abstract
PURPOSE For patients with prostate cancer, validated and reliable instruments are essential for measuring patient-reported outcomes. The aim of this study was to validate the German version of the widely established Expanded Prostate Cancer Index Composite with 26 items (EPIC-26). METHODS A German translation of the original questionnaire was tested in 3094 patients with localized or locally advanced (any T, any N and M0) prostate cancer with treatment intent (including radical prostatectomy, brachytherapy, active surveillance, watchful waiting). They completed the EPIC-26 questionnaire before treatment. A total of 521 of them also completed a questionnaire 12 months afterward. Internal consistency, sensitivity to change, and construct validity were assessed. RESULTS The internal consistency of all domains was sufficient (Cronbach's alpha between 0.64 and 0.93). Item-to-scale correlation coefficients showed acceptable associations between items and their domain score (all > 0.30), with the lowest scores for "bloody stools" (r = 0.37) and "breast problems" (r = 0.32). Confirmatory and exploratory factor analysis confirmed the five-dimension structure of the EPIC-26 (comparative fit index 0.95). CONCLUSIONS Psychometric evaluation suggests that the German version of the EPIC-26 is a well-constructed instrument for measuring patient-reported health-related symptoms in patients with prostate cancer.
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Affiliation(s)
- Nora Tabea Sibert
- German Cancer Society, Kuno-Fischer-Strasse 8, Berlin, 14057, Germany.
| | | | | | - Günter Feick
- Federal Association of German Prostate Cancer Patient Support Groups, Bonn, Germany
| | - Günther Carl
- Help for Prostate Cancer Patients (Förderverein Hilfe bei Prostatakrebs e.V.-FHbP), Tornesch, Germany
| | | | - Jörg Minner
- Hegau-Bodensee-Klinikum Singen, Singen, Germany
| | | | - Björn Kaftan
- Städtisches Klinikum Lüneburg, Lüneburg, Germany
| | | | | | - Burkhard Beyer
- Martini-Klinik Prostate Cancer Center Hamburg, Hamburg, Germany
| | | | - Nina Harke
- University Hospital Essen, Essen, Germany
| | | | | | - Jan Fichtner
- Johanniter Krankenhaus Oberhausen, Oberhausen, Germany
| | | | | | - Simone Wesselmann
- German Cancer Society, Kuno-Fischer-Strasse 8, Berlin, 14057, Germany
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Marzorati C, Monzani D, Mazzocco K, Masiero M, Pavan F, Monturano M, Pravettoni G. Validation of the Italian version of the abbreviated expanded prostate Cancer index composite (EPIC-26) in men with prostate Cancer. Health Qual Life Outcomes 2019; 17:147. [PMID: 31464649 PMCID: PMC6716830 DOI: 10.1186/s12955-019-1214-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2018] [Accepted: 08/16/2019] [Indexed: 12/18/2022] Open
Abstract
Background This study aims to validate and evaluate the psychometric properties and reliability of the Italian version of the Expanded Prostate Cancer Index Composite – Short Form (EPIC-26), a measure of quality of life (QoL) for prostate cancer patients. Methods Two hundred and eighty-four prostate cancer patients completed the Italian version of the EPIC-26 questionnaire at 45 days (T1) and 3 months (T2) after robot-assisted radical prostatectomy (RARP). Psychometric properties were evaluated using structural equation modeling: the goodness of fit of the correlated five-factor model (CFFM) for the EPIC-26 was assessed using the confirmatory factor analysis (CFA), while longitudinal invariance was conducted to assess the ability of the EPIC-26 to measure QoL construct over time. Test-retest reliability was assessed as well by considering intraclass correlations. Results At T1, the CFFM model displayed a good fit to data. Similarly, the model showed an adequate fit also at T2. Results of the reliability analysis attested the acceptable internal consistency and test-retest reliability of each dimension: all Cronbach’s alphas could be classified as acceptable (i.e., above .65) except for low Cronbach’s alpha for hormonal dysfunction at T1 (i.e., .638) and urinary irritation at both waves. (i.e., respectively .585 and .518). Finally, psychometric properties were invariant over time and each of the five dimensions of QoL displayed from moderate (all ICCs above .500) to good test-retest reliability (i.e. ICC for urinary incontinence = .764). Conclusions Results of the CFA and the measurement invariance analysis demonstrated the validity of the Italian version of the EPIC-26 to assess QoL in prostate cancer patients. Its reliability and good psychometric qualities are well-supported, thus providing a valid tool to assess health-related quality of life and its change over time in prostate cancer patients.
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Affiliation(s)
- Chiara Marzorati
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy. .,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy.
| | - Dario Monzani
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Ketti Mazzocco
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
| | - Marianna Masiero
- Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy.,Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Francesca Pavan
- Patient Safety & Risk Management Service, European Institute of Oncology IRCCS, Milan, Italy
| | - Massimo Monturano
- Patient Safety & Risk Management Service, European Institute of Oncology IRCCS, Milan, Italy
| | - Gabriella Pravettoni
- Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.,Applied Research Division for Cognitive and Psychological Science, European Institute of Oncology IRCCS, Milan, Italy
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Hathout L, Mahmoud O, Wang Y, Vergalasova I, Barkati M, Després P, Martin AG, Foster W, Lacroix F, Delouya G, Taussky D, Morton G, Vigneault E. A Phase 2 Randomized Pilot Study Comparing High-Dose-Rate Brachytherapy and Low-Dose-Rate Brachytherapy as Monotherapy in Localized Prostate Cancer. Adv Radiat Oncol 2019; 4:631-640. [PMID: 31673656 PMCID: PMC6817536 DOI: 10.1016/j.adro.2019.04.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 04/08/2019] [Accepted: 04/09/2019] [Indexed: 01/30/2023] Open
Abstract
Purpose To compare health-related quality of life (HRQOL) of high-dose-rate brachytherapy (HDRB) versus low dose-rate brachytherapy (LDRB) for localized prostate cancer in a multi-institutional phase 2 randomized trial. Methods and Materials Men with favorable-risk prostate cancer were randomized between monotherapy brachytherapy with either Iodine-125 LDRB to 144 Gy or single-fraction Iridium-192 HDRB to 19 Gy. HRQOL and urinary toxicity were recorded at baseline and at 1, 3, 6, and 12 months using the Expanded Prostate Cancer Index Composite (EPIC)-26 scoring and the International Prostate Symptom Score (IPSS). Independent samples t test and mixed effects modeling were performed for continuous variables. Time to IPSS resolution, defined as return to its baseline score ±5 points, was calculated using Kaplan-Meier estimator curves with the log-rank test. A multiple-comparison adjusted P value of ≤.05 was considered significant. Results LDRB and HDRB were performed in 15 and 16 patients, respectively, for a total of 31 patients. At 3 months, patients treated with LDRB had a higher IPSS score (mean, 15.5 vs 6.0, respectively; P = .003) and lower EPIC urinary irritative score (mean, 69.2 vs 85.3, respectively; P = .037) compared with those who received HDRB. On repeated measures at 1, 3, 6, and 12 months, the IPSS (P = .003) and EPIC urinary irritative scores (P = .019) were significantly better in the HDR arm, translating into a lower urinary toxicity profile. There were no significant differences in the EPIC urinary incontinence, sexual, or bowel habit scores between the 2 groups at any measured time point. Time to IPSS resolution was significantly shorter in the HDRB group (mean, 2.0 months) compared with the LDRB group (mean, 6.0 months; P = .028). Conclusions HDRB monotherapy is a promising modality associated with a lower urinary toxicity profile and higher HRQOL in the first 12 months compared with LDRB.
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Affiliation(s)
- Lara Hathout
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey
| | - Omar Mahmoud
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey
| | - Yaqun Wang
- Department of Biostatistics, School of Public Health, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey
| | - Irina Vergalasova
- Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey
| | - Maroie Barkati
- Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Philippe Després
- Department of Radiation Oncology and Research Centre CHU de Québec-Université Laval, Québec City, QC, Canada
| | - André-Guy Martin
- Department of Radiation Oncology and Research Centre CHU de Québec-Université Laval, Québec City, QC, Canada
| | - William Foster
- Department of Radiation Oncology and Research Centre CHU de Québec-Université Laval, Québec City, QC, Canada
| | - Frédéric Lacroix
- Department of Radiation Oncology and Research Centre CHU de Québec-Université Laval, Québec City, QC, Canada
| | - Guila Delouya
- Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Daniel Taussky
- Department of Radiation Oncology, Centre hospitalier de l'Université de Montréal, Montréal, QC, Canada
| | - Gerard Morton
- Department of Radiation Oncology, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Eric Vigneault
- Department of Radiation Oncology and Research Centre CHU de Québec-Université Laval, Québec City, QC, Canada
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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.
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Early toxicity and health-related quality of life results of high-dose-rate brachytherapy as monotherapy for low and intermediate-risk prostate cancer. Brachytherapy 2018; 17:524-529. [DOI: 10.1016/j.brachy.2018.01.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 01/14/2018] [Accepted: 01/18/2018] [Indexed: 12/20/2022]
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Guertin MH, Robitaille K, Pelletier JF, Duchesne T, Julien P, Savard J, Bairati I, Fradet V. Effects of concentrated long-chain omega-3 polyunsaturated fatty acid supplementation before radical prostatectomy on prostate cancer proliferation, inflammation, and quality of life: study protocol for a phase IIb, randomized, double-blind, placebo-controlled trial. BMC Cancer 2018; 18:64. [PMID: 29321047 PMCID: PMC5763552 DOI: 10.1186/s12885-017-3979-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 12/22/2017] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Prostate cancer is the most commonly diagnosed cancer in north-American men. Few dietary or lifestyle interventions have been tested to prevent prostate cancer progression. Omega-3 fatty acid supplementation represents a promising intervention for prostate cancer patients. The aim of the study is to evaluate the effects of long-chain omega-3 polyunsaturated fatty acids (LCn3), more precisely eicosapentaenoic acid monoacylglyceride (MAG-EPA) supplementation, on prostate cancer proliferation, inflammation mediators and quality of life among men who will undergo radical prostatectomy. METHODS/DESIGN We propose a phase IIb, randomized, double-blind placebo-controlled trial of MAG-EPA supplementation for 130 men who will undergo radical prostatectomy as treatment for a prostate cancer of Gleason score ≥ 7 in an academic cancer center in Quebec City. Participants will be randomized to 6 capsules of 625 mg of fish oil (MAG-EPA) per capsule containing 500 mg of EPA daily or to identically looking capsules of high oleic acid sunflower oil (HOSO) as placebo. The intervention begins 4 to 10 weeks prior to radical prostatectomy (baseline) and continues for one year after surgery. The primary endpoint is the proliferative index (Ki-67) measured in prostate cancer cells at radical prostatectomy. A secondary endpoint includes prostate tissue levels of inflammatory mediators (cytokines and proteins) at time of radical prostatectomy. Changes in blood levels of inflammatory mediators, relative to baseline levels, at time of radical prostatectomy and 12 months after radical prostatectomy will also be evaluated. Secondary endpoints also include important aspects of psychosocial functioning and quality of life such as depression, anxiety, sleep disturbances, fatigue, cognitive complaints and prostate cancer-specific quality of life domains. The changes in these outcomes, relative to baseline levels, will be evaluated at 3, 6, 9 and 12 months after radical prostatectomy. DISCUSSION The results from this trial will provide crucial information to clarify the role of omega-3 supplementation on prostate cancer proliferation, inflammation and quality of life. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT02333435. Registered on December 17, 2014. Last updated September 6, 2016.
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Affiliation(s)
- Marie-Hélène Guertin
- Oncology Unit, Centre de recherche du CHU de Québec – Université Laval - L’Hôtel-Dieu de Québec, 6 rue McMahon, Québec, QC Canada
| | - Karine Robitaille
- Oncology Unit, Centre de recherche du CHU de Québec – Université Laval - L’Hôtel-Dieu de Québec, 6 rue McMahon, Québec, QC Canada
| | - Jean-François Pelletier
- Oncology Unit, Centre de recherche du CHU de Québec – Université Laval - L’Hôtel-Dieu de Québec, 6 rue McMahon, Québec, QC Canada
| | - Thierry Duchesne
- Mathematics and Statistics Department, Université Laval, 1045 avenue de la médecine, Bureau, Québec, QC 1056 Canada
| | - Pierre Julien
- Endocrinology and Nephrology Unit, Centre de recherche du CHU de Québec – Université Laval - CHUL, 2705, boulevard Laurier, Québec, QC Canada
| | - Josée Savard
- Oncology Unit, Centre de recherche du CHU de Québec – Université Laval - L’Hôtel-Dieu de Québec, 6 rue McMahon, Québec, QC Canada
| | - Isabelle Bairati
- Oncology Unit, Centre de recherche du CHU de Québec – Université Laval - L’Hôtel-Dieu de Québec, 6 rue McMahon, Québec, QC Canada
| | - Vincent Fradet
- Oncology Unit, Centre de recherche du CHU de Québec – Université Laval - L’Hôtel-Dieu de Québec, 6 rue McMahon, Québec, QC Canada
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