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Pasalic D, Barocas DA, Huang LC, Zhao Z, Koyama T, Tang C, Conwill R, Goodman M, Hamilton AS, Wu XC, Paddock LE, Stroup AM, Cooperberg MR, Hashibe M, O'Neil BB, Kaplan SH, Greenfield S, Penson DF, Hoffman KE. Five-year outcomes from a prospective comparative effectiveness study evaluating external-beam radiotherapy with or without low-dose-rate brachytherapy boost for localized prostate cancer. Cancer 2021; 127:1912-1925. [PMID: 33595853 DOI: 10.1002/cncr.33388] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/14/2020] [Accepted: 11/30/2020] [Indexed: 11/08/2022]
Abstract
BACKGROUND To inform patients who are in the process of selecting prostate cancer treatment, the authors compared disease-specific function after external-beam radiotherapy (EBRT) alone versus EBRT plus a low-dose-rate (LDR) brachytherapy boost (EBRT-LDR). METHODS For this prospective study, men who had localized prostate cancer in 2011 and 2012 were enrolled. Assessments at baseline, 0.5, 1, 3, and 5 years included the patient-reported Expanded Prostate Index Composite, the 36-item Medical Outcomes Study Short-Form Health Survey, and treatment-related regret. Regression models were adjusted for baseline function and for patient and treatment characteristics. The minimum clinically important difference in scores on the Expanded Prostate Index Composite 26-item instrument was from 5 to 7 for urinary irritation and from 4 to 6 for bowel function. RESULTS Six-hundred ninety-five men met inclusion criteria and received either EBRT (n = 583) or EBRT-LDR (n = 112). Patients in the EBRT-LDR group were younger (median age, 66 years [interquartile range [IQR], 60-71 years] vs 69 years [IQR, 64-74 years]; P < .001), were less likely to receive pelvic radiotherapy (10% vs 18%; P = .040), and had higher baseline 36-item Medical Outcomes Study Short-Form Health Survey physical function scores (median score, 95 [IQR, 86-100] vs 90 [IQR, 70-100]; P < .001). Over a 3-year period, compared with EBRT, EBRT-LDR was associated with worse urinary irritative scores (adjusted mean difference at 3 years, -5.4; 95% CI, -9.3, -1.6) and bowel function scores (-4.1; 95% CI, -7.6, -0.5). The differences were no longer clinically meaningful at 5 years (difference in urinary irritative scores: -4.5; 95% CI, -8.4, -0.5; difference in bowel function scores: -2.1; 95% CI, -5.7, -1.4). However, men who received EBRT-LDR were more likely to report moderate or big problems with urinary function bother (adjusted odds ratio, 3.5; 95% CI, 1.5-8.2) and frequent urination (adjusted odds ratio, 2.6; 95% CI, 1.2-5.6) through 5 years. There were no differences in survival or treatment-related regret between treatment groups. CONCLUSIONS Compared with EBRT alone, EBRT-LDR was associated with clinically meaningful worse urinary irritative and bowel function over 3 years after treatment and more urinary bother at 5 years. LAY SUMMARY In men with prostate cancer who received external-beam radiation therapy (EBRT) with or without a brachytherapy boost (EBRT-LDR), EBRT-LDR was associated with clinically worse urinary irritation and bowel function through 3 years but resolved after 5 years. Men who received EBRT-LDR continued to report moderate-to-big problems with urinary function bother and frequent urination through 5 years. There was no difference in treatment-related regret or survival between patients who received EBRT and those who received EBRT-LDR. These intermediate-term estimates of function may facilitate counseling for men who are selecting treatment.
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Affiliation(s)
- Dario Pasalic
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Daniel A Barocas
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Li-Ching Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Zhiguo Zhao
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tatsuki Koyama
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Chad Tang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Ralph Conwill
- Patient Advocacy Program, Office of Patient and Community Education, Vanderbilt University Medical Center, Vanderbilt Ingram Cancer Center, Nashville, Tennessee
| | - Michael Goodman
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, Georgia
| | - Ann S Hamilton
- Department of Preventative Medicine, Keck School of Medicine at the University of Southern California, Los Angeles, California
| | - Xiao-Cheng Wu
- Department of Epidemiology, Louisiana State University New Orleans School of Public Health, New Orleans, Louisiana
| | - Lisa E Paddock
- Department of Epidemiology, Cancer Institute of New Jersey, Rutgers Health, New Brunswick, New Jersey
| | - Antoinette M Stroup
- Department of Epidemiology, Cancer Institute of New Jersey, Rutgers Health, New Brunswick, New Jersey
| | - Matthew R Cooperberg
- Department of Urology, University of California San Francisco, San Francisco, California
| | - Mia Hashibe
- Department of Family and Preventative Medicine, University of Utah School of Medicine, Salt Lake City, Utah
| | - Brock B O'Neil
- Department of Urology, University of Utah Health, Salt Lake City, Utah
| | - Sherrie H Kaplan
- Department of Medicine, University of California Irvine, Irvine, California
| | - Sheldon Greenfield
- Department of Medicine, University of California Irvine, Irvine, California
| | - David F Penson
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Karen E Hoffman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Gross MD, Al Hussein Al Awamlh B, Hu JC. Assessing Treatment-Related Toxicity Using Administrative Data, Patient-Reported Outcomes, or Physician-Graded Toxicity: Where Is the Truth? Semin Radiat Oncol 2019; 29:333-337. [DOI: 10.1016/j.semradonc.2019.05.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Patient Reported Comparative Effectiveness of Contemporary Intensity Modulated Radiation Therapy Versus External Beam Radiation Therapy of the Mid 1990s for Localized Prostate Cancer. UROLOGY PRACTICE 2018. [DOI: 10.1016/j.urpr.2017.09.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Lee DJ, Barocas DA, Zhao Z, Huang LC, Resnick MJ, Koyoma T, Conwill R, McCollum D, Cooperberg MR, Goodman M, Greenfield S, Hamilton AS, Hashibe M, Kaplan SH, Paddock LE, Stroup AM, Wu XC, Penson DF, Hoffman KE. Comparison of Patient-reported Outcomes After External Beam Radiation Therapy and Combined External Beam With Low-dose-rate Brachytherapy Boost in Men With Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2018; 102:116-126. [PMID: 30102188 DOI: 10.1016/j.ijrobp.2018.05.043] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2018] [Revised: 05/14/2018] [Accepted: 05/16/2018] [Indexed: 10/14/2022]
Abstract
PURPOSE To compare patient-reported disease-specific functional outcomes after external beam radiation therapy (EBRT) and EBRT combined with low-dose-rate brachytherapy prostate boost (EB-LDR) among men with localized prostate cancer. METHODS AND MATERIALS The prospective, population-based Comparative Effectiveness Analysis of Surgery and Radiation study enrolled men with localized prostate cancer in 2011 to 2012. The 26-item Expanded Prostate Cancer Index Composite measured patient-reported disease-specific function at baseline and at 6, 12, and 36 months. Higher domain scores indicate better function. Minimal clinically important difference was defined as 6 for urinary incontinence, 5 for urinary irritative function, 4 for bowel function, 12 for sexual function, and 4 for hormonal function. Multivariable linear and logistic regression models were fit to estimate the effect of treatment on patient-reported outcomes. RESULTS Five-hundred seventy-eight men received EBRT and 109 received EB-LDR. Median patient age was 69 years, and 70% had intermediate- or high-risk disease. Men in the EB-LDR group were younger (P < .001) and less likely to receive androgen deprivation therapy (P < .001). Baseline urinary, bowel, sexual, and hormonal function was similar between treatment groups (P > .05). On multivariable analyses, men receiving EB-LDR reported worse urinary irritative function at 6 months (adjusted mean difference [AMD] -14.4, P < .001), 12 months (AMD -12.9, P < .001), and 36 months (AMD -4.7, P = .034) than men receiving EBRT. At 12 months, men receiving EB-LDR reported worse bowel function (AMD -5.8, P = .002), but these differences were not seen at 36 months. There were no significant differences in sexual or hormone function between treatment groups. CONCLUSIONS Men treated with EB-LDR report worse bowel function at 1 year and worse urinary irritative function through 3 years compared with men treated with EBRT alone. These side effect profiles should be discussed with patients when considering EB-LDR versus EBRT treatment.
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Affiliation(s)
- Daniel J Lee
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee.
| | - Daniel A Barocas
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Zhiguo Zhao
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Li-Ching Huang
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matthew J Resnick
- Department of Urology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Tatsuki Koyoma
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ralph Conwill
- Prostate Cancer Patient Advocate, Vanderbilt Ingram Cancer Center, Nashville, Tennessee
| | - Dan McCollum
- Prostate Cancer Patient Advocate, Vanderbilt Ingram Cancer Center, Nashville, Tennessee
| | - Matthew R Cooperberg
- Department of Urology, University of California, San Francisco Medical Center, San Francisco, California
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Sheldon Greenfield
- Center for Health Policy Research and Department of Medicine, University of California, Irvine, Irvine, California
| | - Ann S Hamilton
- Department of Preventative Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Mia Hashibe
- Department of Family and Preventative Medicine, University of Utah, Salt Lake City, Utah
| | - Sherrie H Kaplan
- Health Policy Research Institute, University of California, Irvine, Irvine, California
| | - Lisa E Paddock
- Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey
| | - Antoinette M Stroup
- Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick, New Jersey
| | - Xiao-Cheng Wu
- School of Public Health, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - David F Penson
- Tennessee Valley Veterans Administration Health System, Nashville, Tennessee
| | - Karen E Hoffman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
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Long-term Psychological and Quality-of-life Effects of Active Surveillance and Watchful Waiting After Diagnosis of Low-risk Localised Prostate Cancer. Eur Urol 2018; 73:859-867. [DOI: 10.1016/j.eururo.2017.08.013] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2017] [Accepted: 08/11/2017] [Indexed: 11/20/2022]
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Hoffman RM, Lo M, Clark JA, Albertsen PC, Barry MJ, Goodman M, Penson DF, Stanford JL, Stroup AM, Hamilton AS. Treatment Decision Regret Among Long-Term Survivors of Localized Prostate Cancer: Results From the Prostate Cancer Outcomes Study. J Clin Oncol 2017; 35:2306-2314. [PMID: 28493812 PMCID: PMC5501361 DOI: 10.1200/jco.2016.70.6317] [Citation(s) in RCA: 76] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Purpose To determine the demographic, clinical, decision-making, and quality-of-life factors that are associated with treatment decision regret among long-term survivors of localized prostate cancer. Patients and Methods We evaluated men who were age ≤ 75 years when diagnosed with localized prostate cancer between October 1994 and October 1995 in one of six SEER tumor registries and who completed a 15-year follow-up survey. The survey obtained demographic, socioeconomic, and clinical data and measured treatment decision regret, informed decision making, general- and disease-specific quality of life, health worry, prostate-specific antigen (PSA) concern, and outlook on life. We used multivariable logistic regression analyses to identify factors associated with regret. Results We surveyed 934 participants, 69.3% of known survivors. Among the cohort, 59.1% had low-risk tumor characteristics (PSA < 10 ng/mL and Gleason score < 7), and 89.2% underwent active treatment. Overall, 14.6% expressed treatment decision regret: 8.2% of those whose disease was managed conservatively, 15.0% of those who received surgery, and 16.6% of those who underwent radiotherapy. Factors associated with regret on multivariable analysis included reporting moderate or big sexual function bother (reported by 39.0%; OR, 2.77; 95% CI, 1.51 to 5.0), moderate or big bowel function bother (reported by 7.7%; OR, 2.32; 95% CI, 1.04 to 5.15), and PSA concern (mean score 52.8; OR, 1.01 per point change; 95% CI, 1.00 to 1.02). Increasing age at diagnosis and report of having made an informed treatment decision were inversely associated with regret. Conclusion Regret was a relatively infrequently reported outcome among long-term survivors of localized prostate cancer; however, our results suggest that better informing men about treatment options, in particular, conservative treatment, might help mitigate long-term regret. These findings are timely for men with low-risk cancers who are being encouraged to consider active surveillance.
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Affiliation(s)
- Richard M. Hoffman
- Richard M. Hoffman, University of Iowa Carver College of Medicine; Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA; Mary Lo and Ann S. Hamilton, Keck School of Medicine of the University of Southern California, Los Angeles, CA; Jack A. Clark, Edith Nourse Rogers Veterans Affairs Memorial Hospital, Bedford; Boston University School of Public Health; Michael J. Barry, Massachusetts General Hospital; Harvard Medical School, Boston, MA; Peter C. Albertsen, University of Connecticut Health Center, Farmington, CT; Michael Goodman, Emory University, Atlanta, GA; David F. Penson, Vanderbilt University, Nashville, TN; Janet L. Stanford, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antoinette M. Stroup, Rutgers School of Public Health, Piscataway; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Mary Lo
- Richard M. Hoffman, University of Iowa Carver College of Medicine; Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA; Mary Lo and Ann S. Hamilton, Keck School of Medicine of the University of Southern California, Los Angeles, CA; Jack A. Clark, Edith Nourse Rogers Veterans Affairs Memorial Hospital, Bedford; Boston University School of Public Health; Michael J. Barry, Massachusetts General Hospital; Harvard Medical School, Boston, MA; Peter C. Albertsen, University of Connecticut Health Center, Farmington, CT; Michael Goodman, Emory University, Atlanta, GA; David F. Penson, Vanderbilt University, Nashville, TN; Janet L. Stanford, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antoinette M. Stroup, Rutgers School of Public Health, Piscataway; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Jack A. Clark
- Richard M. Hoffman, University of Iowa Carver College of Medicine; Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA; Mary Lo and Ann S. Hamilton, Keck School of Medicine of the University of Southern California, Los Angeles, CA; Jack A. Clark, Edith Nourse Rogers Veterans Affairs Memorial Hospital, Bedford; Boston University School of Public Health; Michael J. Barry, Massachusetts General Hospital; Harvard Medical School, Boston, MA; Peter C. Albertsen, University of Connecticut Health Center, Farmington, CT; Michael Goodman, Emory University, Atlanta, GA; David F. Penson, Vanderbilt University, Nashville, TN; Janet L. Stanford, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antoinette M. Stroup, Rutgers School of Public Health, Piscataway; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Peter C. Albertsen
- Richard M. Hoffman, University of Iowa Carver College of Medicine; Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA; Mary Lo and Ann S. Hamilton, Keck School of Medicine of the University of Southern California, Los Angeles, CA; Jack A. Clark, Edith Nourse Rogers Veterans Affairs Memorial Hospital, Bedford; Boston University School of Public Health; Michael J. Barry, Massachusetts General Hospital; Harvard Medical School, Boston, MA; Peter C. Albertsen, University of Connecticut Health Center, Farmington, CT; Michael Goodman, Emory University, Atlanta, GA; David F. Penson, Vanderbilt University, Nashville, TN; Janet L. Stanford, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antoinette M. Stroup, Rutgers School of Public Health, Piscataway; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Michael J. Barry
- Richard M. Hoffman, University of Iowa Carver College of Medicine; Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA; Mary Lo and Ann S. Hamilton, Keck School of Medicine of the University of Southern California, Los Angeles, CA; Jack A. Clark, Edith Nourse Rogers Veterans Affairs Memorial Hospital, Bedford; Boston University School of Public Health; Michael J. Barry, Massachusetts General Hospital; Harvard Medical School, Boston, MA; Peter C. Albertsen, University of Connecticut Health Center, Farmington, CT; Michael Goodman, Emory University, Atlanta, GA; David F. Penson, Vanderbilt University, Nashville, TN; Janet L. Stanford, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antoinette M. Stroup, Rutgers School of Public Health, Piscataway; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Michael Goodman
- Richard M. Hoffman, University of Iowa Carver College of Medicine; Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA; Mary Lo and Ann S. Hamilton, Keck School of Medicine of the University of Southern California, Los Angeles, CA; Jack A. Clark, Edith Nourse Rogers Veterans Affairs Memorial Hospital, Bedford; Boston University School of Public Health; Michael J. Barry, Massachusetts General Hospital; Harvard Medical School, Boston, MA; Peter C. Albertsen, University of Connecticut Health Center, Farmington, CT; Michael Goodman, Emory University, Atlanta, GA; David F. Penson, Vanderbilt University, Nashville, TN; Janet L. Stanford, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antoinette M. Stroup, Rutgers School of Public Health, Piscataway; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - David F. Penson
- Richard M. Hoffman, University of Iowa Carver College of Medicine; Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA; Mary Lo and Ann S. Hamilton, Keck School of Medicine of the University of Southern California, Los Angeles, CA; Jack A. Clark, Edith Nourse Rogers Veterans Affairs Memorial Hospital, Bedford; Boston University School of Public Health; Michael J. Barry, Massachusetts General Hospital; Harvard Medical School, Boston, MA; Peter C. Albertsen, University of Connecticut Health Center, Farmington, CT; Michael Goodman, Emory University, Atlanta, GA; David F. Penson, Vanderbilt University, Nashville, TN; Janet L. Stanford, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antoinette M. Stroup, Rutgers School of Public Health, Piscataway; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Janet L. Stanford
- Richard M. Hoffman, University of Iowa Carver College of Medicine; Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA; Mary Lo and Ann S. Hamilton, Keck School of Medicine of the University of Southern California, Los Angeles, CA; Jack A. Clark, Edith Nourse Rogers Veterans Affairs Memorial Hospital, Bedford; Boston University School of Public Health; Michael J. Barry, Massachusetts General Hospital; Harvard Medical School, Boston, MA; Peter C. Albertsen, University of Connecticut Health Center, Farmington, CT; Michael Goodman, Emory University, Atlanta, GA; David F. Penson, Vanderbilt University, Nashville, TN; Janet L. Stanford, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antoinette M. Stroup, Rutgers School of Public Health, Piscataway; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Antoinette M. Stroup
- Richard M. Hoffman, University of Iowa Carver College of Medicine; Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA; Mary Lo and Ann S. Hamilton, Keck School of Medicine of the University of Southern California, Los Angeles, CA; Jack A. Clark, Edith Nourse Rogers Veterans Affairs Memorial Hospital, Bedford; Boston University School of Public Health; Michael J. Barry, Massachusetts General Hospital; Harvard Medical School, Boston, MA; Peter C. Albertsen, University of Connecticut Health Center, Farmington, CT; Michael Goodman, Emory University, Atlanta, GA; David F. Penson, Vanderbilt University, Nashville, TN; Janet L. Stanford, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antoinette M. Stroup, Rutgers School of Public Health, Piscataway; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
| | - Ann S. Hamilton
- Richard M. Hoffman, University of Iowa Carver College of Medicine; Holden Comprehensive Cancer Center, University of Iowa, Iowa City, IA; Mary Lo and Ann S. Hamilton, Keck School of Medicine of the University of Southern California, Los Angeles, CA; Jack A. Clark, Edith Nourse Rogers Veterans Affairs Memorial Hospital, Bedford; Boston University School of Public Health; Michael J. Barry, Massachusetts General Hospital; Harvard Medical School, Boston, MA; Peter C. Albertsen, University of Connecticut Health Center, Farmington, CT; Michael Goodman, Emory University, Atlanta, GA; David F. Penson, Vanderbilt University, Nashville, TN; Janet L. Stanford, Fred Hutchinson Cancer Research Center, Seattle, WA; and Antoinette M. Stroup, Rutgers School of Public Health, Piscataway; Rutgers Cancer Institute of New Jersey, New Brunswick, NJ
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The Evolution of Self-Reported Urinary and Sexual Dysfunction over the Last Two Decades: Implications for Comparative Effectiveness Research. Eur Urol 2014; 67:1019-1025. [PMID: 25174325 DOI: 10.1016/j.eururo.2014.08.035] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Accepted: 08/14/2014] [Indexed: 11/22/2022]
Abstract
BACKGROUND Despite the paramount importance of patient-reported outcomes, little is known about the evolution of patient-reported urinary and sexual function over time. OBJECTIVE To evaluate differences in pretreatment urinary and sexual function in two population-based cohorts of men with prostate cancer enrolled nearly 20 yr apart. DESIGN, SETTING, AND PARTICIPANTS Patients were enrolled in the Prostate Cancer Outcomes Study (PCOS) or the Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study, two population-based cohorts that enrolled patients with incident prostate cancer from 1994 to 1995 and from 2011 to 2012, respectively. Participants completed surveys at baseline and various time points thereafter. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS We performed multivariable logistic and linear regression analysis to investigate differences in pretreatment function between studies. RESULTS AND LIMITATIONS The study comprised 5469 men of whom 2334 (43%) were enrolled in PCOS and 3135 (57%) were enrolled in CEASAR. Self-reported urinary incontinence was higher in CEASAR compared with PCOS (7.7% vs 4.7%; adjusted odds ratio [OR]: 1.83; 95% confidence interval [CI], 1.39-2.43). Similarly, self-reported erectile dysfunction was more common among CEASAR participants (44.7% vs 24.0%) with an adjusted OR of 3.12 (95% CI, 2.68-3.64). Multivariable linear regression models revealed less favorable self-reported baseline function among CEASAR participants in the urinary incontinence and sexual function domains. The study is limited by its observational design and possibility of unmeasured confounding. CONCLUSIONS Reporting of pretreatment urinary incontinence and erectile dysfunction has increased over the past two decades. These findings may reflect sociological changes including heightened media attention and direct-to-consumer marketing, among other potential explanations. PATIENT SUMMARY Patient reporting of urinary and sexual function has evolved and is likely contingent on continually changing societal norms. Recognizing the evolving nature of patient reporting is essential in efforts to conduct high-quality, impactful comparative effectiveness research.
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McDougall GJ, Oliver JS, Scogin F. Memory and cancer: a review of the literature. Arch Psychiatr Nurs 2014; 28:180-6. [PMID: 24856270 PMCID: PMC4033831 DOI: 10.1016/j.apnu.2013.12.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Accepted: 12/30/2013] [Indexed: 12/31/2022]
Abstract
The mental health of cancer survivors has not always been the primary emphasis of treatment protocols since physical health outcomes have taken precedence. Older cancer survivors experience a double jeopardy since they are at risk for memory impairments and mild cognitive impairment and because they are greater than 55 years of age. Of the 9.6 million cancer survivors in the US who have completed active treatment, many report cognitive difficulties, with labels such as "chemo brain," "not as sharp," "woolly-headedness," or the "mind does not work as quickly". To date, most of our knowledge of cognitive impairment in cancer survivors comes from female breast cancer survivors. Studies indicate that these survivors have diminished executive function, verbal memory, and motor function. Cancer survivors want to live independently in the community for as long as possible however, these cognitive deficits may prevent this desired lifestyle. To broaden our understanding this paper reviews the literature on the cognitive impairment and memory deficits experienced by three groups of cancer survivors breast, colorectal, and prostate cancer, that make up 60% of all survivors nationally. Even though mental health declined after a cancer diagnosis, the long-term outcomes of cancer survivors did not differ from persons without cancer in depression or cognitive function.
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Affiliation(s)
| | - JoAnn S Oliver
- The University of Alabama, Capstone College of Nursing, Tuscaloosa, AL
| | - Forrest Scogin
- The University of Alabama, Department of Psychology, Tuscaloosa, AL
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Resnick MJ, Barocas DA, Morgans AK, Phillips SE, Chen VW, Cooperberg MR, Goodman M, Greenfield S, Hamilton AS, Hoffman KE, Kaplan SH, Paddock LE, Stroup AM, Wu XC, Koyama T, Penson DF. Contemporary prevalence of pretreatment urinary, sexual, hormonal, and bowel dysfunction: Defining the population at risk for harms of prostate cancer treatment. Cancer 2014; 120:1263-71. [PMID: 24510400 PMCID: PMC4930672 DOI: 10.1002/cncr.28563] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2013] [Revised: 12/06/2013] [Accepted: 12/11/2013] [Indexed: 01/22/2023]
Abstract
BACKGROUND The authors investigated the prevalence of pretreatment urinary, sexual, hormonal, and bowel dysfunction in a contemporary, population-based prostate cancer cohort. They also explored the associations between baseline function and age, comorbidity, and timing of baseline survey completion with respect to treatment. METHODS The Comparative Effectiveness Analysis of Surgery and Radiation (CEASAR) study is a population-based, prospective cohort study that enrolled 3691 men with incident prostate cancer during 2011 and 2012. Pretreatment function was ascertained using the Expanded Prostate Cancer Index-26 (EPIC-26). Data were stratified by age, comorbidity, and timing of baseline survey completion with respect to treatment. Unadjusted and multivariable linear regression analyses were performed to evaluate the relations between exposures and pretreatment function. RESULTS After applying exclusion criteria, the study cohort comprised 3072 men. A strikingly high proportion of men reported inability to obtain erections satisfactory for intercourse (45%) and some degree of urinary incontinence (17%) at baseline. Sexual function was particularly age-sensitive, with patients aged ≤60 years reporting summary scores in excess of 30 points higher than patients aged ≥75 years (P < .001). Compared with the healthiest men, highly comorbid patients reported less favorable function in each domain, including urinary incontinence (summary score, 89.5 vs 74.1; P < .001) and sexual function (summary score, 70.8 vs 32.9; P < .001). Although statistically significant differences in summary scores were identified between patients who completed the baseline questionnaire before treatment (52%) versus after treatment (48%), the absolute differences were small (range, 1-3 points). CONCLUSIONS Patients with newly diagnosed prostate cancer exhibit a wide distribution of pretreatment function. The current data may be used to redefine the population "at risk" for treatment-related harms.
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Affiliation(s)
- Matthew J. Resnick
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Geriatric Research Education and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Daniel A. Barocas
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Alicia K. Morgans
- Department of Medical Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Sharon E. Phillips
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Vivien W. Chen
- Department of Epidemiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Matthew R. Cooperberg
- Department of Urology, University of California San Francisco Medical Center, San Francisco, California
| | - Michael Goodman
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Sheldon Greenfield
- Center for Health Policy Research and Department of Medicine, University of California Irvine, Irvine, California
| | - Ann S. Hamilton
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Karen E. Hoffman
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Sherri H. Kaplan
- Health Policy Research Institute, University of California Irvine, Irvine, California
| | | | | | - Xiao-Cheng Wu
- Department of Epidemiology, Louisiana State University Health Sciences Center, New Orleans, Louisiana
| | - Tatsuki Koyama
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David F. Penson
- Department of Urologic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
- Geriatric Research Education and Clinical Center, Veterans Affairs Tennessee Valley Healthcare System, Nashville, Tennessee
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Resnick MJ, Koyama T, Fan KH, Albertsen PC, Goodman M, Hamilton AS, Hoffman RM, Potosky AL, Stanford JL, Stroup AM, Van Horn RL, Penson DF. Long-term functional outcomes after treatment for localized prostate cancer. N Engl J Med 2013; 368:436-45. [PMID: 23363497 PMCID: PMC3742365 DOI: 10.1056/nejmoa1209978] [Citation(s) in RCA: 670] [Impact Index Per Article: 60.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND The purpose of this analysis was to compare long-term urinary, bowel, and sexual function after radical prostatectomy or external-beam radiation therapy. METHODS The Prostate Cancer Outcomes Study (PCOS) enrolled 3533 men in whom prostate cancer had been diagnosed in 1994 or 1995. The current cohort comprised 1655 men in whom localized prostate cancer had been diagnosed between the ages of 55 and 74 years and who had undergone either surgery (1164 men) or radiotherapy (491 men). Functional status was assessed at baseline and at 2, 5, and 15 years after diagnosis. We used multivariable propensity scoring to compare functional outcomes according to treatment. RESULTS Patients undergoing prostatectomy were more likely to have urinary incontinence than were those undergoing radiotherapy at 2 years (odds ratio, 6.22; 95% confidence interval [CI], 1.92 to 20.29) and 5 years (odds ratio, 5.10; 95% CI, 2.29 to 11.36). However, no significant between-group difference in the odds of urinary incontinence was noted at 15 years. Similarly, although patients undergoing prostatectomy were more likely to have erectile dysfunction at 2 years (odds ratio, 3.46; 95% CI, 1.93 to 6.17) and 5 years (odds ratio, 1.96; 95% CI, 1.05 to 3.63), no significant between-group difference was noted at 15 years. Patients undergoing prostatectomy were less likely to have bowel urgency at 2 years (odds ratio, 0.39; 95% CI, 0.22 to 0.68) and 5 years (odds ratio, 0.47; 95% CI, 0.26 to 0.84), again with no significant between-group difference in the odds of bowel urgency at 15 years. CONCLUSIONS At 15 years, no significant relative differences in disease-specific functional outcomes were observed among men undergoing prostatectomy or radiotherapy. Nonetheless, men treated for localized prostate cancer commonly had declines in all functional domains during 15 years of follow-up. (Funded by the National Cancer Institute.).
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Affiliation(s)
- Matthew J Resnick
- Department of Urologic Surgery and the Center for Surgical Quality and Outcomes Research, Vanderbilt University, Nashville, TN 37203, USA
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Kim DS, Chung YG, Kim DJ, Park KK, Chung MS, Lee DH, Lee SH, Mah SY, Chung BH. Optimal Timing to Evaluate Prediagnostic Baseline Erectile Function in Patients Undergoing Robot‐Assisted Radical Prostatectomy. J Sex Med 2012; 9:602-7. [DOI: 10.1111/j.1743-6109.2011.02465.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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12
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Letts C, Tamlyn K, Byers ES. Exploring the Impact of Prostate Cancer on Men's Sexual Well-Being. J Psychosoc Oncol 2010; 28:490-510. [DOI: 10.1080/07347332.2010.498457] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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13
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Helfand BT, Fought A, Manvar AM, McVary KT. Determining the Utility of Recalled Lower Urinary Tract Symptoms. Urology 2010; 76:442-7. [DOI: 10.1016/j.urology.2009.12.052] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2009] [Revised: 11/30/2009] [Accepted: 12/22/2009] [Indexed: 11/28/2022]
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Gray AM, Papanicolas IN. Impact of symptoms on quality of life before and after diagnosis of coeliac disease: results from a UK population survey. BMC Health Serv Res 2010; 10:105. [PMID: 20423498 PMCID: PMC2907763 DOI: 10.1186/1472-6963-10-105] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2010] [Accepted: 04/27/2010] [Indexed: 11/15/2022] Open
Abstract
Background Coeliac disease is a common chronic autoimmune disorder. Underdiagnosis is common and the quality of life impact of symptoms may be severe. We report a study of symptom duration and quality of life before and after diagnosis in a representative sample of people with diagnosed coeliac disease in the UK. Methods Postal questionnaire of 2000 people with diagnosed coeliac disease, requesting information on date of diagnosis, type and duration of symptoms, and quality of life before and after diagnosis using the EQ-5D instrument. Results The survey response rate was 40% (788/2000). Mean duration of symptoms prior to diagnosis was 13.2 years, with some evidence of shorter duration in recent years. Respondents reported a mean of 13 consultations with their GP about their symptoms prior to diagnosis. The mean utility value of pre-diagnosis quality of life was 0.56, compared to 0.84 at time of survey, a highly statistically significant improvement of 0.27 (95% c.i. 0.25, 0.30). Conclusions The symptoms of undiagnosed coeliac disease are associated with a prolonged and substantial decrement to quality of life. These results strengthen the case for detailed examination of the cost-effectiveness of improved methods of detection and diagnosis, including population screening.
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Affiliation(s)
- Alastair M Gray
- Health Economics Research Centre, Department of Public Health, University of Oxford, Old Road Campus, Oxford, UK.
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Smith DP, King MT, Egger S, Berry MP, Stricker PD, Cozzi P, Ward J, O'Connell DL, Armstrong BK. Quality of life three years after diagnosis of localised prostate cancer: population based cohort study. BMJ 2009; 339:b4817. [PMID: 19945997 PMCID: PMC2784818 DOI: 10.1136/bmj.b4817] [Citation(s) in RCA: 195] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To quantify the risk and severity of negative effects of treatment for localised prostate cancer on long term quality of life. DESIGN Population based, prospective cohort study with follow-up over three years. SETTING New South Wales, Australia. PARTICIPANTS Men with localised prostate cancer were eligible if aged less than 70 years, diagnosed between October 2000 and October 2002, and notified to the New South Wales central cancer registry. Controls were randomly selected from the New South Wales electoral roll and matched to cases by age and postcode. MAIN OUTCOME MEASURES General health specific and disease specific function up to three years after diagnosis, according to the 12 item short form health survey and the University of California, Los Angeles prostate cancer index. RESULTS 1642 (64%) cases and 495 (63%) eligible and contacted controls took part in the study. After adjustment for confounders, all active treatment groups had low odds of having better sexual function than controls, in particular men on androgen deprivation therapy (adjusted odds ratio (OR) 0.02, 95% CI 0.01 to 0.07). Men treated surgically reported the worst urinary function (adjusted OR 0.17, 95% CI 0.13 to 0.22). Bowel function was poorest in cases who had external beam radiotherapy (adjusted OR 0.44, 95% CI 0.30 to 0.64). General physical and mental health scores were similar across treatment groups, but poorest in men who had androgen deprivation therapy. CONCLUSIONS The various treatments for localised prostate cancer each have persistent effects on quality of life. Sexual dysfunction three years after diagnosis was common in all treatment groups, whereas poor urinary function was less common. Bowel function was most compromised in those who had external beam radiotherapy. Men with prostate cancer and the clinicians who treat them should be aware of the effects of treatment on quality of life, and weigh them up against the patient's age and the risk of progression of prostate cancer if untreated to make informed decisions about treatment.
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Affiliation(s)
- David P Smith
- Cancer Council, Kings Cross, New South Wales 1340, Australia.
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Abstract
There is a justified assumption that the patient outcome is in large part determined by the quality of the care they receive. For certain procedures outside of the field of urology, it has been demonstrated that higher surgical volume, either at the hospital or surgeon level is a proxy for higher quality of care. Multiple studies have followed this line of inquiry and attempted to show that volume may also predict outcome for certain urologic procedures. Review of the published studies shows that the association appears quite weak. However, the real weakness of this line of study is not so much in the findings, but in the universally used and critically flawed study methodology. This article demonstrates how a simple study design flaw has proved to be the Achilles heal of this entire line of research.
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Accuracy of recall in quality-of-life assessment among women operated on for stress urinary incontinence. Int Urogynecol J 2009; 20:1233-41. [PMID: 19513575 DOI: 10.1007/s00192-009-0917-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2009] [Accepted: 05/15/2009] [Indexed: 10/20/2022]
Abstract
INTRODUCTION AND HYPOTHESIS The purpose of this study is to assess the validity and reliability of a retrospective quality-of-life (QOL) assessment. METHODS The Incontinence Impact Questionnaire (IIQ-30) and the Short-Form Health Survey (SF-12) were self-administered pre-operatively. At 3 months post-op, the IIQ-30 and SF-12 surveys were mailed to patients to reassess their pre-operative QOL status. Pearson's correlation coefficient (r) and the intraclass correlation coefficient (ICC) were used to test the validity and reliability of the recalled IIQ and SF-12 scores. RESULTS Recall validity was excellent for the IIQ-30 (r = 0.64) and moderate for the SF-12 (r = 0.46 (physical component summary or PCS) and 0.42 (mental component summary or MCS)). Recall reliability was moderate with the IIQ-30 (ICC = 0.62) and poor with the SF-12 (ICC = 0.44 (PCS) and 0.49 (MCS)). CONCLUSIONS The IIQ-30 can be reliably used in a retrospective manner among women who have undergone surgery for SUI 3 months earlier.
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Zeliadt SB, Ramsey SD, Potosky AL, Arora NK, Blough DK, Oakley-Girvan I, Hamilton AS, Van Den Eeden SK, Penson DF. Association of Preexisting Symptoms with Treatment Decisions among Newly Diagnosed Prostate Cancer Patients. PATIENT-PATIENT CENTERED OUTCOMES RESEARCH 2008; 1:189. [PMID: 20119493 DOI: 10.2165/1312067-200801030-00006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND: The choice between surgical versus non-surgical treatment options is a fundamental decision for men with local stage prostate cancer because of differences in risks of genitourinary side effects among available treatments. OBJECTIVES: We assessed whether preexisting genitourinary symptoms at the time of diagnosis influenced men's preferences for surgery versus other management options. METHODS: We recruited 593 patients with newly diagnosed local stage prostate cancer prior to initiating treatment from an integrated health care system, an academic urology center, and community urology clinics. Using logistic regression we compared whether men had a preference for non-surgical options or only preferred surgery. RESULTS: Nearly 60% indicated they were considering non-surgical options. Age and clinical characteristics but not preexisting genitourinary symptoms influenced the decision between preferences for surgical or non-surgical options. A total of 62% of men reported side effects as a main factor in their treatment decision. Men with more aggressive tumor types were less likely to consider side effects, however, men who reported poor ability to have an erection were more likely to consider side effects (p<0.001). CONCLUSION: Sexual dysfunction at time of diagnosis, but not other genitourinary symptoms, is associated with men considering treatment-related side effects when considering surgery versus other options. Men who are not experiencing sexual dysfunction at diagnosis may discount the risks of side effects in the decision making process.
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5-year urinary and sexual outcomes after radical prostatectomy: results from the Prostate Cancer Outcomes Study. J Urol 2008; 179:S40-4. [PMID: 18405749 DOI: 10.1016/j.juro.2008.03.136] [Citation(s) in RCA: 97] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2004] [Indexed: 11/24/2022]
Abstract
PURPOSE Prior studies of postoperative outcomes following radical prostatectomy have been limited by selection bias and short-term followup. In this study we assessed temporal changes in urinary and sexual function up to 5 years following radical prostatectomy in a population based cohort. MATERIALS AND METHODS A sample of 1,288 men with localized prostate cancer who underwent radical prostatectomy and completed a baseline survey within 6 to 12 months of diagnosis were included in the analysis. Two and 5-year functional and quality of life data were collected, as was information on the use of erectile aids. Temporal functional changes and potentially confounding or modifying factors were assessed using longitudinal regression models. RESULTS Of these men 14% reported frequent urinary leakage or no urinary control 60 months after diagnosis, which was slightly higher than the 10% reporting incontinence at 24 months (p = 0.007). At 60 months 28% of the men had erections firm enough for intercourse compared with 22% at 24 months (p = 0.003). Sildenafil was the most commonly used erectile aid (43% ever used) and 45% of users reported that it helped "somewhat" or "a lot." CONCLUSIONS Urinary and sexual dysfunction were common 5 years following radical prostatectomy in this large, community based cohort of prostate cancer survivors. While a small minority of subjects experienced changes in urinary or sexual function between years 2 and 5 after prostatectomy, functional outcomes remained relatively stable in the majority of participants.
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20
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Litwin MS. Commentary on urinary and sexual outcomes after radical prostatectomy. J Urol 2008; 179:S45-6. [PMID: 18405750 DOI: 10.1016/j.juro.2008.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Karakiewicz PI, Bhojani N, Neugut A, Shariat SF, Jeldres C, Graefen M, Perrotte P, Peloquin F, Kattan MW. The effect of comorbidity and socioeconomic status on sexual and urinary function and on general health-related quality of life in men treated with radical prostatectomy for localized prostate cancer. J Sex Med 2008; 5:919-927. [PMID: 18371045 DOI: 10.1111/j.1743-6109.2007.00741.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Different treatments for localized prostate cancer (PCa) may be associated with similar overall survival but may demonstrate important differences in health-related quality of life (HRQOL). Therefore, valid interpretation of cancer control outcomes requires adjustment for HRQOL. AIM To assess the effect of comorbidity and socioeconomic status (SES) on sexual and urinary function as well as general HRQOL in men treated with radical prostatectomy (RP) for PCa. METHODS We sent a self-addressed mail survey, composed of the research and development short form 36-item health survey, the PCa-specific University of California at Los Angeles (UCLA) Prostate Cancer Index (PCI), as well as a battery of items addressing SES and lifetime prevalence of comorbidity, to 4,546 men treated with RP in Quebec between 1988 and 1996. MAIN OUTCOME MEASURES The association between comorbidity, SES, and HRQOL was tested and quantified using univariable and multivariable linear regression models. RESULTS Survey responses from 2,415 participants demonstrated that comorbidity and SES are strongly related to sexual, urinary, and general HRQOL in univariable and multivariable analyses. In multivariable models, the presence of comorbid conditions was associated with significantly worse HRQOL, as evidenced by lower scale scores by as much as 17/100 points in general domains, and by as much as 10/100 points in PCa-specific domains. Favorable SES characteristics were related to higher general (up to 9/100 points) and higher PCa-specific (up to 8/100 points) HRQOL scale scores. CONCLUSIONS Comorbidity and SES are strongly associated with sexual, urinary and general HRQOL.
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Affiliation(s)
- Pierre I Karakiewicz
- University of Montreal Health Center (CHUM)-Cancer Prognostics and Health Outcomes Unit, Montreal, Canada;.
| | | | - Alfred Neugut
- Columbia University-The Departments of Medicine and Epidemiology, New York, NY, USA
| | | | | | | | - Paul Perrotte
- University of Montreal Health Center (CHUM)-Cancer Prognostics and Health Outcomes Unit, Montreal, Canada
| | | | - Michael W Kattan
- Cleveland Clinic Foundation-Department of Biostatistics and Epidemiology, Cleveland, OH, USA
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Hodges LD, Kirby M, Solanki J, O'Donnell J, Brodie DA. The temporal relationship between erectile dysfunction and cardiovascular disease. Int J Clin Pract 2007; 61:2019-25. [PMID: 17997808 DOI: 10.1111/j.1742-1241.2007.01629.x] [Citation(s) in RCA: 101] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Erectile dysfunction (ED) and cardiovascular disease (CVD) share similar risk factors, and ED may be a marker of CVD progression. The study assessed: (i) the temporal relationship between ED and CVD and (ii) the UK incidence of ED, in patients with CVD and an age-matched control group. DESIGN After ethics approval, 207 patients (CVD group) attending cardiovascular rehabilitation programmes and 165 age-matched subjects (control group), from GP practices across the UK, completed up to four questionnaires [ED details, The International Index of Erectile Function (IIEF) (before and after a cardiovascular event) and ED related Quality of Life]. A health professional also completed a medical details questionnaire. RESULTS Erectile dysfunction was reported by 66% of individuals with CVD, with a mean duration of 5 +/- 5.3 years. The control group was significantly different (p < 0.05) in both incidence (37%) and mean duration (6.6 +/- 6.8 years). Only 53% of the CVD group and 43% of the control group had discussed their symptoms of ED with a health professional. The IIEF demonstrated that ED became significantly worse (p < 0.05) after a cardiovascular event, changing from moderate to severe (13-10). CONCLUSIONS From these data, it is now evident that ED may precede a cardiovascular event by as much as 5 years. In almost half of the men with ED, there were missed opportunities to undertake a CVD risk assessment and provide an intervention, because the men did not acknowledge the problem. Men with ED should be specifically targeted for CVD preventative strategies in terms of lifestyle changes, and appropriate pharmacological treatments.
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Affiliation(s)
- L D Hodges
- Research Centre for Society and Health, Buckinghamshire Chilterns University College, Buckinghamshire, UK.
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Watson WL, Ozanne-Smith J, Richardson J. Retrospective baseline measurement of self-reported health status and health-related quality of life versus population norms in the evaluation of post-injury losses. Inj Prev 2007; 13:45-50. [PMID: 17296689 PMCID: PMC2610562 DOI: 10.1136/ip.2005.010157] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Owing to the difficulty in prospectively measuring pre-injury health status and health-related quality of life (HRQL) in an injured cohort, population norms or retrospective baseline scores are often used as comparators for evaluating post-injury losses. However, there has been little discussion in the literature or research into the soundness of these approaches for this purpose. OBJECTIVES To investigate the appropriateness of the retrospectively measured baseline health status and HRQL in an injured population for the purpose of evaluating post-injury losses. METHODS A cohort of injured admitted to hospital (n=186) was followed up for 12 months after injury. Retrospectively measured pre-injury health status and HRQL scores were compared with those at 12 months after injury for participants who reported complete recovery (n=61) and those who did not. Retrospective baseline scores for the whole cohort were also compared with Australian population norms. RESULTS For participants who completely recovered, no significant difference was observed between scores at baseline (measured retrospectively) and those at 12 months after injury (36-item Short Form Questionnaire physical component summary z=-1.274, p=0.203; 36-item Short Form Questionnaire mental component summary z=-1.634, p=0.102; Short Form 6 Dimensions: z=-1.405, p=0.296). A borderline significant difference was observed in HRQL as measured by the Assessment of Quality of Life (z=-1.970, p=0.049). Retrospectively measured pre-injury scores were consistently higher than Australian norms for all measures. CONCLUSIONS The injured population may not be representative of the general population. Consequently, retrospective baseline measurement of pre-injury health states may be more appropriate than general population norms for the purpose of evaluating post-injury losses in this population.
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Affiliation(s)
- W L Watson
- Monash University Accident Research Centre, Melbourne, Victoria, Australia.
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Schroeder JC, Bensen JT, Su LJ, Mishel M, Ivanova A, Smith GJ, Godley PA, Fontham ETH, Mohler JL. The North Carolina-Louisiana Prostate Cancer Project (PCaP): methods and design of a multidisciplinary population-based cohort study of racial differences in prostate cancer outcomes. Prostate 2006; 66:1162-76. [PMID: 16676364 DOI: 10.1002/pros.20449] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The North Carolina-Louisiana Prostate Cancer Project (PCaP) is a multidisciplinary study of social, individual, and tumor-level causes of racial differences in prostate cancer aggressiveness. METHODS A population-based sample of incident prostate cancer cases from North Carolina and Louisiana will include 1,000 African Americans and 1,000 Caucasian Americans. Study nurses administer structured questionnaires and collect blood, adipose tissue, urine, and toenail samples during an in-home visit. Clinical data are abstracted from medical records, diagnostic biopsies are reviewed and assayed, and tissue microarrays are constructed from prostatectomy samples. Prostate cancer aggressiveness is classified based on PSA, clinical stage, and Gleason grade. RESULTS Preliminary data demonstrate between- and within-group differences in patient characteristics, screening, and treatment by race and state. Participation exceeds 70% in all groups. CONCLUSIONS Preliminary data support the feasibility of this comprehensive study to help determine the focus of public health efforts to reduce racial disparities in prostate cancer mortality.
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Affiliation(s)
- Jane C Schroeder
- Department of Epidemiology, UNC Linebarger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 1700 Airport Road, Chapel Hill, NC 27599, USA
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Malone KJ, Magnell TD, Freeman DC, Boyer MI, Placzek JD. Surgical correction of dorsally angulated distal radius malunions with fixed angle volar plating: a case series. J Hand Surg Am 2006; 31:366-72. [PMID: 16516729 DOI: 10.1016/j.jhsa.2005.10.017] [Citation(s) in RCA: 49] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2004] [Revised: 10/03/2005] [Accepted: 10/03/2005] [Indexed: 02/02/2023]
Abstract
PURPOSE To report our experience using a fixed-angle volar plate in conjunction with a corrective osteotomy and cancellous bone graft for the treatment of distal radius malunions with dorsal angulation in 4 patients. METHODS Four consecutive patients had a volarly based opening wedge osteotomy with a fixed angle volar plate and cancellous bone grafting for the treatment of a dorsally angulated distal radius malunion. Data collected retrospectively included a visual analog pain scale, grip strength, range of motion, radiographic parameters, and each patient's subjective functional outcomes as measured by the Disabilities of the Arm, Shoulder, and Hand questionnaire. Motion, strength, and radiographic values were compared with the contralateral arm for each patient. RESULTS The average time from initial fracture to corrective osteotomy was 346 days. The average length of follow-up evaluation was 13.5 months. The flexion-extension arc of motion increased an average of 21 degrees to a value of 84% of the contralateral side; the pronation-supination arc of motion increased an average of 20 degrees to a value of 98% of the contralateral side. The average tilt of the radius improved from 26 degrees extension to 2 degrees extension; the average radial inclination improved from 22 degrees to 24 degrees; the average ulnar variance excluding the 1 patient who had a distal ulna resection improved from 5 mm to 1 mm. The average retrospective Disabilities of the Arm, Shoulder, and Hand score improved from 30 to 7; the average retrospective visual analog pain scale score improved from 4.5 to 1. The average grip strength increased from 20 to 29 kg, which corresponded to 73% of the contralateral extremity. CONCLUSIONS The rigid characteristics of fixed angle volar plates can provide an alternative to the traditional techniques of distal radius osteotomy including structural bone grafting and dorsal plate fixation or external fixation. In addition these plates are strong enough to allow for early postoperative motion. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic, Level IV.
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Affiliation(s)
- Kevin J Malone
- Department of Orthopaedic Surgery, William Beaumont Hospital, Royal Oak, MI, USA.
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Stephenson RA, Mori M, Hsieh YC, Beer TM, Stanford JL, Gilliland FD, Hoffman RM, Potosky AL. TREATMENT OF ERECTILE DYSFUNCTION FOLLOWING THERAPY FOR CLINICALLY LOCALIZED PROSTATE CANCER: PATIENT REPORTED USE AND OUTCOMES FROM THE SURVEILLANCE, EPIDEMIOLOGY, AND END RESULTS PROSTATE CANCER OUTCOMES STUDY. J Urol 2005; 174:646-50; discussion 650. [PMID: 16006930 DOI: 10.1097/01.ju.0000165342.85300.14] [Citation(s) in RCA: 89] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Erectile dysfunction (ED) persists for years following curative therapies for clinically localized prostate cancer. We report use and treatment outcomes in a 5-year interval in a population based cohort from the Surveillance, Epidemiology, and End Results Prostate Cancer Outcomes Study. MATERIALS AND METHODS A sample of 1,977 men with localized prostate cancer who received external beam radiation therapy or radical prostatectomy in 1994 to 1995 were surveyed for 5 outcome measures of ED treatment, namely treatment, perceived helpfulness, erectile sufficiency, sexual activity frequency and erection maintenance. Subjects were surveyed 6, 12, 24 and 60 months after prostate cancer diagnosis. RESULTS Overall 50.5% of men ever used ED treatment. The use of ED treatments increased during the study course. Subject age, regular sexual partner and baseline sexual activity were factors positively associated with ED treatments. While it was used uncommonly (1.9%), a penile prosthesis was perceived as the most helpful ED treatment (helped a lot in 52% of respondents). Sildenafil helped a lot in 12% of respondents. Erectile fullness, erection maintenance and sexual activity frequency were modestly improved in men using ED treatment compared with those in men not using ED treatment. CONCLUSIONS Approximately half of the patients in this population based cohort of men used ED treatment during the 5 years following prostate cancer diagnosis. Men using ED treatments had modest improvement in sexual function compared with men that in who did not receive ED treatment at 60 months. More effective treatments for ED following local therapy for prostate cancer are needed.
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Affiliation(s)
- Robert A Stephenson
- From the Division of Urology, University of Utah School of Medicine, Salt Lake City, Utah 8411132, USA.
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Penson DF, McLerran D, Feng Z, Li L, Albertsen PC, Gilliland FD, Hamilton A, Hoffman RM, Stephenson RA, Potosky AL, Stanford JL. 5-year urinary and sexual outcomes after radical prostatectomy: results from the prostate cancer outcomes study. J Urol 2005; 173:1701-5. [PMID: 15821561 DOI: 10.1097/01.ju.0000154637.38262.3a] [Citation(s) in RCA: 285] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Prior studies of postoperative outcomes following radical prostatectomy have been limited by selection bias and short-term followup. In this study we assessed temporal changes in urinary and sexual function up to 5 years following radical prostatectomy in a population based cohort. MATERIALS AND METHODS A sample of 1,288 men with localized prostate cancer who underwent radical prostatectomy and completed a baseline survey within 6 to 12 months of diagnosis were included in the analysis. Two and 5-year functional and quality of life data were collected, as was information on the use of erectile aids. Temporal functional changes and potentially confounding or modifying factors were assessed using longitudinal regression models. RESULTS Of these men 14% reported frequent urinary leakage or no urinary control 60 months after diagnosis, which was slightly higher than the 10% reporting incontinence at 24 months (p = 0.007). At 60 months 28% of the men had erections firm enough for intercourse compared with 22% at 24 months (p = 0.003). Sildenafil was the most commonly used erectile aid (43% ever used) and 45% of users reported that it helped "somewhat" or "a lot." CONCLUSIONS Urinary and sexual dysfunction were common 5 years following radical prostatectomy in this large, community based cohort of prostate cancer survivors. While a small minority of subjects experienced changes in urinary or sexual function between years 2 and 5 after prostatectomy, functional outcomes remained relatively stable in the majority of participants.
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Affiliation(s)
- David F Penson
- Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, California 90089, USA.
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Differences between men with screening-detected versus clinically diagnosed prostate cancers in the USA. BMC Cancer 2005; 5:27. [PMID: 15755329 PMCID: PMC555747 DOI: 10.1186/1471-2407-5-27] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2004] [Accepted: 03/08/2005] [Indexed: 11/13/2022] Open
Abstract
Background The advent of prostate specific antigen (PSA) testing in the United States of America (USA) has led to a dramatic increase in the incidence of prostate cancer in the United States as well as the number of men undergoing aggressive treatment with radical prostatectomy and radiation therapy. We compared patient characteristics and treatment selection between American men with screening-detected versus clinically diagnosed prostate cancers. Methods We evaluated 3,173 men with prostate cancer in the USA. Surveys and medical records provided information on demographics, socioeconomic status, comorbidities, symptoms, tumor characteristics, and treatment. We classified men presenting with symptoms of advanced cancer – bone pain, weight loss, or hematuria – as "clinically diagnosed"; asymptomatic men and those with only lower urinary tract symptoms were considered "screening-detected." We used multivariate analyses to determine whether screening predicted receiving aggressive treatment for a clinically localized cancer. Results We classified 11% of cancers as being clinically diagnosed. Men with screening-detected cancers were more often non-Hispanic white (77% vs. 65%, P < 0.01), younger (36% < 65 years vs. 25%, P ≤ 0.01), better educated (80% ≥ high school vs. 67%, P < 0.01), healthier (18% excellent health vs. 10%, P < 0.01), and diagnosed with localized disease (90% vs. 75%, P < 0.01). Men with screening-detected localized cancers more often underwent aggressive treatment, 76% vs. 70%, P = 0.05. Conclusion Most cancers were detected by screening in this American cohort. Appropriately, younger, healthier men were more likely to be diagnosed by screening. Minority status and lower socio-economic status appeared to be screening barriers. Screening detected earlier-stage cancers and was associated with receiving aggressive treatment.
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Karakiewicz P, Shariat SF, Naderi A, Kadmon D, Slawin KM. Reliability of remembered International Index of Erectile Function domain scores in men with localized prostate cancer. Urology 2005; 65:131-5. [PMID: 15667878 DOI: 10.1016/j.urology.2004.08.054] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2004] [Accepted: 08/27/2004] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To test the reliability of recollected International Index of Erectile Function (IIEF) domain scores before and after radical prostatectomy. Recall reliability can be affected by several biases. In men with localized prostate cancer (PCa), conflicting results have been reported. METHODS Thirty-nine men, aged 44 to 69 years, were invited to participate in a prospectively administered IIEF questionnaire. The survey was administered before and 6 and 12 months after radical prostatectomy. Several months later, a recall IIEF survey targeted the prospectively gathered IIEF data. The independent sample t test, Pearson correlation coefficient, partial correlation, and intraclass correlation coefficient tested the reliability of the recalled IIEF scores versus the prospective ratings. RESULTS All 39 men completed the prospective and recalled IIEF surveys addressing preoperative erectile function. Surveys targeting function at 6 and 12 months after surgery were completed by 85% and 51% of the participants, respectively. The erectile function domain demonstrated the greatest recall reliability (intraclass correlation coefficient 0.65 to 0.73). Erectile function and sexual desire scale recall reliability was greatest for pretreatment function or function 12 months after surgery. The orgasmic function domain had the lowest recall reliability (intraclass correlation coefficient 0.37 to 0.54). CONCLUSIONS When restricted to before surgery and 12 months after surgery, most IIEF domains may be reliably used in a retrospective fashion. The erectile function and sexual desire domains appear to be most reliable, possibly because they address more objective areas of men's sexual function.
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Affiliation(s)
- Pierre Karakiewicz
- Department of Urology and Outcomes Research Unit, University of Montreal, Montreal, Quebec, Canada
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Placzek JD, Boyer MI, Gelberman RH, Sopp B, Goldfarb CA. Nerve decompression for complex regional pain syndrome type II following upper extremity surgery. J Hand Surg Am 2005; 30:69-74. [PMID: 15680558 DOI: 10.1016/j.jhsa.2004.08.006] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2004] [Accepted: 08/30/2004] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the results of nerve decompression for the symptoms of complex regional pain syndrome that developed after upper-extremity surgery. METHODS Eight patients (5 men, 3 women) developed worsening severe pain, swelling, and loss of range of motion after an upper-extremity surgery. The diagnosis of complex regional pain syndrome was made at an average of 6 weeks (range, 1-10 weeks) after the surgical procedure. A clinical diagnosis of either median or combined median and ulnar nerve compression at the wrist was confirmed in all patients with electrophysiologic testing. Nerve decompression was performed at a mean of 13 weeks after the procedure. Subjective (Disabilities of the Arm, Shoulder, and Hand questionnaire; visual analog pain scale) and objective (forearm, wrist, and finger range of motion; grip strength) data from before and after nerve decompression were reviewed. RESULTS The average score on the Disabilities of the Arm, Shoulder, and Hand questionnaire decreased from 71 to 30 (p < .05). The mean visual analog pain score decreased from 7.5 to 1.8. (p < .05) There was immediate and near-complete resolution of all somatic complaints including hypersensitivity to touch, hyperhydrosis, swelling, and cold sensitivity. Range of motion and grip strength improved. CONCLUSIONS Traditionally surgical treatment has been avoided in patients with complex regional pain syndrome; however, in the setting of clinical and electrophysiologic evidence of nerve compression surgical intervention may hasten recovery in these patients.
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Affiliation(s)
- Jeffrey D Placzek
- Department of Orthopaedic Surgery, Washington University, One Barnes-Jewish Plaza, St Louis, MO 63110, USA
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Hoffman RM, Gilliland FD, Penson DF, Stone SN, Hunt WC, Potosky AL. Cross-sectional and longitudinal comparisons of health-related quality of life between patients with prostate carcinoma and matched controls. Cancer 2004; 101:2011-9. [PMID: 15452835 DOI: 10.1002/cncr.20608] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Prostate carcinoma and treatments affect health-related quality of life (HRQOL). The authors prospectively compared prostate and general HRQOL between prostate carcinoma cases and an age-matched and ethnicity-matched control group. METHODS The case cohort consisted of 293 men with localized prostate carcinoma who were selected randomly from the population-based New Mexico Tumor Registry, and the control cohort consisted of 618 men who were selected randomly from administrative databases and matched for age and ethnicity. Subjects completed a baseline survey of demographics, socioeconomic status, comorbidity, and prostate and general HRQOL. Also, 210 cases (71.7%) and 421 controls (67.8%) completed a follow-up survey 5 years later. Multinomial logistic regression models compared baseline characteristics as well as 5-year general HRQOL outcomes measured by selected domains of the Medical Outcomes Study SF-36. The authors used a mixed-model repeated-measures analysis of variance and multinomial regression analyses to compare longitudinal changes in urinary, bowel, and sexual function between groups. RESULTS At baseline, patients with prostate carcinoma had better urinary control and sexual function than controls. Over 5 years, sexual function declined significantly among controls, although urinary function remained stable. However, patients with cancer subsequently reported significant declines in both domains and were left with much worse function and more bother than controls. Bowel function and general HRQOL were similar for both groups at follow-up. CONCLUSIONS Prostate carcinoma treatment led to significant 5-year declines in urinary and sexual function that far exceeded age-related changes in controls. Patients with cancer had significantly worse function and more bother than controls for these disease-specific domains of HRQOL. Bowel function and general HRQOL were not affected by cancer status.
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Affiliation(s)
- Richard M Hoffman
- Medicine Service, New Mexico Veterans Affairs Health Care System, Albuquerque, NM 87108, USA.
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Johnson TK, Gilliland FD, Hoffman RM, Deapen D, Penson DF, Stanford JL, Albertsen PC, Hamilton AS. Racial/Ethnic differences in functional outcomes in the 5 years after diagnosis of localized prostate cancer. J Clin Oncol 2004; 22:4193-201. [PMID: 15483030 DOI: 10.1200/jco.2004.09.127] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023] Open
Abstract
PURPOSE We investigated racial/ethnic differences in functional outcomes up to 5 years after diagnosis among men with aggressively treated localized prostate cancer. PATIENTS AND METHODS Patients were from the Prostate Cancer Outcomes Study, a population-based cohort study that surveyed patients at 6, 12, 24, and 60 months after diagnosis. Analyses were stratified by primary treatment. Racial/ethnic differences at each time point were assessed using Generalized Estimating Equations, adjusting for pretreatment function, age at diagnosis, secondary treatment, and other confounders. An adjusted summary score for each functional domain was calculated for each time period. RESULTS Patients included 1,475 non-Hispanic white, 321 African-American, and 279 Hispanic prostate cancer patients. After 60 months, among prostatectomy patients, African-Americans had significantly higher sexual function scores than non-Hispanic whites (43.9 v 36.1; P = .02), but were more likely to have a moderate to big problem with sexual function (50.6% v 44.4%; P = .04). African-Americans also had higher urinary function scores at 5 years than non-Hispanic whites (78.5 v 72.4; P = .04) and were less likely to have problems with incontinence. Changes in sexual and bowel function after radiotherapy showed no significant racial/ethnic differences. CONCLUSION This long-term cohort study found that, among prostatectomy patients, African-Americans had better recovery of sexual and urinary function at 60 months after diagnosis that was likely to be of mild clinical significance, despite reporting more problems with sexual function than non-Hispanic whites. More study is necessary to understand reasons for these differences. In contrast, no racial/ethnic differences in recovery from radiotherapy were found.
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Affiliation(s)
- Terri Kang Johnson
- University of Southern California Keck School of Medicine, Dept of Preventive Medicine, 1441 Eastlake Ave, Rm 3427A, MC9175, Los Angeles, CA 90089-9175, USA.
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Potosky AL, Davis WW, Hoffman RM, Stanford JL, Stephenson RA, Penson DF, Harlan LC. Five-year outcomes after prostatectomy or radiotherapy for prostate cancer: the prostate cancer outcomes study. J Natl Cancer Inst 2004; 96:1358-67. [PMID: 15367568 DOI: 10.1093/jnci/djh259] [Citation(s) in RCA: 431] [Impact Index Per Article: 21.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Men treated for clinically localized prostate cancer with either radical prostatectomy or external beam radiotherapy usually survive many years with the side effects of these treatments. We present treatment-specific quality-of-life outcomes for prostate cancer patients 5 years after initial diagnosis. METHODS The cohort consisted of men aged 55-74 years who were newly diagnosed with clinically localized prostate cancer in 1994-1995 and were treated with radical prostatectomy (n = 901) or external beam radiotherapy (n = 286). We used clinical and quality-of-life data previously collected at the time of diagnosis (i.e., baseline) and at the 2-year follow-up and data newly collected at 5 years after diagnosis to compare urinary, bowel, and sexual function and to examine temporal changes in those functions. Odds ratios (ORs) and adjusted percentages were calculated by logistic regression. All statistical tests were two-sided. RESULTS At 5 years after diagnosis, overall sexual function declined in both groups to approximately the same level. However, at 5 years after diagnosis, erectile dysfunction was more prevalent in the radical prostatectomy group than in the external beam radiotherapy group (79.3% versus 63.5%; OR = 2.5, 95% confidence interval [CI] = 1.6 to 3.8). Approximately 14%-16% of radical prostatectomy and 4% of external beam radiotherapy patients were incontinent at 5 years (OR = 4.4, 95% CI = 2.2 to 8.6). Bowel urgency and painful hemorrhoids were more common in the external beam radiotherapy group than in the radical prostatectomy group. All of these differences remained statistically significant after adjustment for confounders and for differences between treatment groups in some baseline characteristics. CONCLUSIONS At 5 years after diagnosis, men treated with radical prostatectomy for localized prostate cancer continue to experience worse urinary incontinence than men treated with external beam radiotherapy. However, the two treatment groups were more similar to each other with respect to overall sexual function, mostly because of a continuing decline in erectile function among the external beam radiotherapy patients between years 2 and 5.
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Affiliation(s)
- Arnold L Potosky
- Division of Cancer Control and Population Sciences, National Cancer Institute, EPN Rm. 4005, 6130 Executive Blvd., MSC 7344, Bethesda, MD 20892-7344, USA.
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Maly RC, Umezawa Y, Leake B, Silliman RA. Determinants of participation in treatment decision-making by older breast cancer patients. Breast Cancer Res Treat 2004; 85:201-9. [PMID: 15111757 DOI: 10.1023/b:brea.0000025408.46234.66] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
PURPOSE To identify the impact of patient age and patient-physician communication on older breast cancer patients' participation in treatment decision-making. METHODS We conducted a cross-sectional survey of breast cancer patients aged 55 years or older (n = 222) in Los Angeles County. Patients received a breast cancer diagnosis between 1998 and 2000, and were interviewed on average 7.1 months (SD = 2.9) from diagnosis. All patient-physician communication variables were measured by patient self-report. Patient participation in treatment decision-making was defined by (1) questioning the surgeon about treatment, and (2) perception of self as the final decision-maker. RESULTS In multiple logistic regression analyses, surgeons' specific solicitation of patients' input about treatment preferences had positive relationships with both dimensions of patient participation in decision-making, that is, questioning the surgeon (adjusted odds ratio [OR] = 2.09, 95% confidence interval [CI] = 1.05-4.16) and perceiving oneself to be the final decision-maker (OR = 2.38, CI = 1.08-5.28), controlling for patients' sociodemographic and case-mix characteristics and social support. Greater emotional support from surgeons was negatively associated with patient perception of being the final decision-maker. Physicians' information-giving and patient age were not associated with the participation measures. However, greater patient-perceived self-efficacy in patient-physician interactions was related to participation. CONCLUSION In breast cancer patients aged 55 years and older, surgeons' solicitation of patients' treatment preferences was a powerful independent predictor of patient participation in treatment decision-making, as was patient's self-efficacy in interacting with physicians. Increasing both physicians' and patients' partnership-building skills might enhance the quality of treatment decision-making and treatment outcomes in this burgeoning patient population.
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Affiliation(s)
- Rose C Maly
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA 90024-2933, USA.
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Staff I, Salner A, Bohannon R, Panatieri P, Maljanian R. Disease-specific symptoms and general quality of life of patients with prostate carcinoma before and after primary three-dimensional conformal radiotherapy. Cancer 2003; 98:2335-43. [PMID: 14635067 DOI: 10.1002/cncr.11805] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Approximately 189,000 men are diagnosed with prostate carcinoma each year and more than 1 million are living with the disease. Good prognoses and undesirable sequelae accompany each of several available primary and adjuvant treatment options. The current study explored the effects of primary three-dimensional conformal radiotherapy with or without neoadjuvant hormonal therapy on urinary, bowel, and sexual symptoms and health-related quality of life (HRQOL). METHODS A prospective, repeated-measures design study included 100 patients. Data from the Medical Outcomes Study Short Form Health Survey (a measure of general HRQOL) and a 12-item symptom questionnaire were collected before the start of radiotherapy, approximately 1-3 months after completion of treatment, and again approximately 5-10 months after completion of treatment for follow-up. RESULTS Patients reported few urinary symptoms after treatment. Bowel frequency and urgency were reported more frequently posttreatment and at follow-up. Erectile difficulties, which were common pretreatment, were reported with increased frequency posttreatment and at follow-up. General HRQOL scores were higher than age-related general population norms for men at all three data collection times, but there were significant losses posttreatment for patients' physical functioning and vitality. At the 5-10-month follow-up, physical functioning remained lower but vitality scores regained some of the losses. A more extended follow-up is needed. Neoadjuvant therapy, which was received before the pretreatment data collection, had a deleterious effect on erectile functioning but no interactive effects with the radiotherapy on symptoms or HRQOL. CONCLUSIONS Although patients with a diagnosis of prostate carcinoma experienced increased bowel and sexual dysfunction and decreased vitality after radiotherapy, their HRQOL scores remained at or above age-related general population norms.
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Affiliation(s)
- Ilene Staff
- Institute for Outcomes Research and Evaluation, Hartford Hospital, Hartford, Connecticut 06106, USA.
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Hoffman RM, Harlan LC, Klabunde CN, Gilliland FD, Stephenson RA, Hunt WC, Potosky AL. Racial differences in initial treatment for clinically localized prostate cancer. Results from the prostate cancer outcomes study. J Gen Intern Med 2003; 18:845-53. [PMID: 14521648 PMCID: PMC1494937 DOI: 10.1046/j.1525-1497.2003.21105.x] [Citation(s) in RCA: 78] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
OBJECTIVE We examined whether there were racial differences in initial treatment for clinically localized prostate cancer and investigated whether demographic, socioeconomic, clinical, or tumor characteristics could explain any racial differences. DESIGN Prospective cohort study. SETTING Population-based tumor registries in Connecticut, Los Angeles, and Atlanta. PARTICIPANTS We evaluated 1144 African-American and non-Hispanic white men, aged 50 to 74 years, with clinically localized cancer diagnosed between October 1994 and October 1995. MEASUREMENTS AND MAIN RESULTS We obtained demographic, socioeconomic, and clinical data from patient surveys and medical record abstractions. We reported adjusted percentages for receiving treatment derived from multinomial logistic regression. We found an interaction between race and tumor aggressiveness. Among men with more aggressive cancers (PSA > or = 20 ng/mL or Gleason score > or = 8), African Americans were less likely to undergo radical prostatectomy than non-Hispanic whites (35.2% vs 52.0%), but more likely to receive conservative management (38.9% vs 16.3%, P=.003). Among the 71% of subjects with less aggressive cancers, African Americans and non-Hispanic whites were equally likely to receive either radical prostatectomy or radiation therapy (80.0% vs 84.5%, P=.2). CONCLUSIONS African Americans with more aggressive cancers were less likely to undergo radical prostatectomy and more likely to be treated conservatively. These treatment differences may reflect African Americans' greater likelihood for presenting with pathologically advanced cancer for which surgery has limited effectiveness. Among men with less aggressive cancers-the majority of cases-there were no racial differences in undergoing radical prostatectomy or radiation therapy.
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Affiliation(s)
- Richard M Hoffman
- Medicine Service, New Mexico VA Health Care System, Albuquerque, NM 87108, USA.
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Maly RC, Leake B, Silliman RA. Health care disparities in older patients with breast carcinoma: informational support from physicians. Cancer 2003; 97:1517-27. [PMID: 12627517 DOI: 10.1002/cncr.11211] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND Little is known about how disparities in the treatment of patients with breast carcinoma based on patient age and ethnicity are effected or mitigated at the patient-physician interaction level. The objectives of this study were to document physician provision of informational support to patients at the time of a new diagnosis of breast carcinoma and to assess differences according to patient age and ethnic group in terms of the information received and desired. METHODS Participants were 222 patients with breast carcinoma in Los Angeles County, California, age >/= 55 years who were interviewed within 6 months of their diagnosis of breast carcinoma and/or within 1 month posttreatment. Respondents were asked about receipt and helpfulness of 10 tangible informational support items (e.g., whether booklets, videotapes, medical records, etc. were provided by physicians) and 15 interactive informational support items (e.g., whether physicians discussed breast cancer topics, such as risk of recurrence or treatment options). An index of the tangible informational support items and a scale of the interactive informational support items received were created for summary analyses. Patients' medical records were abstracted for breast carcinoma stage and treatment type; surgeons also were surveyed about sociodemographic and practice characteristics. RESULTS In multiple linear regression analyses, older age (beta coefficient [beta] +/- standard error [SE], - 0.08 +/- 0.02; P = 0.001) and Latina ethnicity (beta +/- SE, - 1.21 +/- 0.40; P = 0.003) had a negative association with physician provision of interactive informational support, controlling for patient and physician sociodemographic characteristics, practice characteristics, breast carcinoma stage, comorbidity, number of physicians seen, visit length, social support, and patient self-efficacy in interacting with physicians (adjusted correlation coefficient [R(2)] for the model, 0.33; P < 0.00001). Both older patients and ethnic minority patients, as well as their respective comparison groups, rated most breast cancer information as at least as helpful. Both groups preferred interpersonal sources of information to written sources, although they received interpersonal sources less frequently. CONCLUSIONS Older patients and Latina patients with breast carcinoma received less interactive informational support from their physicians compared with younger patients, differences that persisted after controlling for a wide range of sociodemographic, psychosocial, and physician factors. Improving the quality of communication at the patient-physician interaction level may be an important avenue to reducing age and ethnic group treatment disparities among patients with breast carcinoma.
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Affiliation(s)
- Rose C Maly
- Department of Family Medicine, David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, California 90024, USA.
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Penson DF, Feng Z, Kuniyuki A, McClerran D, Albertsen PC, Deapen D, Gilliland F, Hoffman R, Stephenson RA, Potosky AL, Stanford JL. General quality of life 2 years following treatment for prostate cancer: what influences outcomes? Results from the prostate cancer outcomes study. J Clin Oncol 2003; 21:1147-54. [PMID: 12637483 DOI: 10.1200/jco.2003.07.139] [Citation(s) in RCA: 151] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE The goal of this study was to determine the relationship between primary treatment, urinary dysfunction, sexual dysfunction, and general health-related quality of life (HRQOL) in prostate cancer. METHODS A sample of men with newly diagnosed prostate cancer between 1994 and 1995 was randomly selected from six population-based Surveillance, Epidemiology, and End Results registries. A baseline survey was completed by 2,306 men within 6 to 12 months of diagnosis, and these men also completed a follow-up HRQOL survey 2 years after diagnosis. Logistic regression models were used to determine whether primary treatment, urinary dysfunction, and sexual dysfunction were independently associated with general HRQOL outcomes approximately 2 years after diagnosis as measured by the Medical Outcomes Study 36-item Short Form Health Survey. The magnitude of this effect was estimated using least square means models. RESULTS After adjustment for potential confounders, primary treatment was not associated with 2-year general HRQOL outcomes in men with prostate cancer. Urinary function and bother were independently associated with worse general HRQOL in all domains. Sexual function and bother were also independently associated with worse general HRQOL, although the relationship was not as strong as in the urinary domains. CONCLUSION Primary treatment is not associated with 2-year general HRQOL outcomes in prostate cancer. Although both sexual and urinary function and bother are associated with quality of life, men who are more bothered by their urination or impotence are more likely to report worse quality of life. This implies that future research should be directed toward finding ways to improve treatment-related outcomes or help patients better cope with their posttreatment urinary or sexual dysfunction.
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Affiliation(s)
- David F Penson
- Section of Urology, VA Puget Sound Health Care System and the Department of Urology, University of Washington, Seattle, WA 98108, USA.
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Schover LR, Fouladi RT, Warneke CL, Neese L, Klein EA, Zippe C, Kupelian PA. Defining sexual outcomes after treatment for localized prostate carcinoma. Cancer 2002; 95:1773-85. [PMID: 12365027 DOI: 10.1002/cncr.10848] [Citation(s) in RCA: 222] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND The objective of this survey was to identify factors associated with good sexual outcomes in a large group of survivors of localized prostate carcinoma. METHODS A postal survey was sent to 2636 men in the Cleveland Clinic Foundation's Prostate Cancer Registry who either were treated with definitive radiotherapy or underwent prostatectomy for localized prostate carcinoma. The survey asked about demographic items, past and current sexual functioning, partner's sexual function and health, and a number of factors hypothesized to affect sexual satisfaction. Standardized questionnaires included the Sexual Self-Schema Scale-Male Version, the International Index of Erectile Function (IIEF), urinary and bowel symptom scales from the Los Angeles Prostate Cancer Index, and the Short Form Health Survey (SF-36). RESULTS The return rate was 49%, yielding a sample of 1236 men at an average of 4.3 years post-treatment. Comparing responders with nonresponders suggested that the sample may have been somewhat biased toward men who were more interested in maintaining sexual function. At the time they were diagnosed with prostate carcinoma, 36% of men had erectile dysfunction (ED). Within the past 6 months, however, 85% of men reported having ED. Only 13% of men were having reliable, firm erections spontaneously, and another 8% of men were having erections with the aid of a medical treatment. Men were as distressed about loss of desire and trouble having satisfying orgasms as they were about ED. Of the 84% of men who reported having a current sexual partner, 66% indicated that she had a sexual problem. Younger age was associated strongly with better sexual outcome (global IIEF score). With demographic factors taken into account, better sexual outcome was related significantly to medical factors, including not having neoadjuvant or current antiandrogen therapy, undergoing bilateral nerve-sparing prostatectomy or brachytherapy, and having better mental and physical health composite scores on the SF-36. Sexual factors that were associated with a better outcome included having normal erections before treatment for prostate carcinoma, choosing a treatment based on the hope that it would preserve sexual function, having more sexual partners in the past year, and having a sexually functional partner. CONCLUSIONS The great majority of men who survive prostate carcinoma do not achieve a return to functional sexual activity in the years after treatment. The priorities a man places on sexuality and on having a sexually functional partner are important factors in sexual satisfaction at follow-up, over and above the influence of age and medical factors.
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Affiliation(s)
- Leslie R Schover
- Department of Behavioral Science, The University of Texas M. D. Anderson Cancer Center, Houston, Texas77030-4009, USA.
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Schwartz K, Bunner S, Bearer R, Severson RK. Complications from treatment for prostate carcinoma among men in the Detroit area. Cancer 2002; 95:82-9. [PMID: 12115320 DOI: 10.1002/cncr.10650] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
BACKGROUND Aggressive treatment of early stage prostate carcinoma (PC) is limited primarily to two modalities: radical prostatectomy (RP) and external beam radiation therapy (RT). The authors conducted a population-based study of Detroit area men with localized PC to determine the outcome of bowel, urinary, and sexual function after aggressive treatment. METHODS Men with PC were identified through the Metropolitan Detroit Cancer Surveillance System, a member of the National Cancer Institute Surveillance, Epidemiology, and End Results Program. Patients participated in interviews about their pretreatment bowel, urinary, and sexual function approximately 9 months after treatment. The same men were asked identical questions about their function an average of 2 years after treatment. Treatment outcomes were compared for men who underwent RP and men who received RT. RESULTS Of 501 men, 398 (79.4%) participated in both interviews, 304 of whom (76.4%) had localized PC and had been treated at least 1 year previously (median, 688 days). One hundred thirty men underwent RP, and 115 men received RT. The proportion of men in the RP group who reported an increase in incontinence symptoms was significant (53.8% compared with 19.2% in the RT group; P < 0.001). Men in the RT group reported increased loose stools between the pretreatment and post-treatment interviews (5.2% vs. 29.6%; P < 0.001). Men in both the RT group and the RP group reported increases in impotence from 40% to > 75% (P < 0.001 for both). Men in the RT group were 3.6 times more likely to have bowel incontinence compared with men in the RP group (odds ratio [OR], 3.61; 95% confidence interval [95% CI], 1.54-8.47). Urinary incontinence (OR, 2.87; 95% CI, 1.52-5.44) and erection difficulty (OR, 3.98; 95% CI, 1.35-11.70) were more likely among men in the RP group. CONCLUSIONS Although patients may have recalled their baseline function as better than it was, the current results are consistent with other population-based studies of treatment outcomes among men with localized PC. They indicate that the side effects associated with treatment are greater than those based on case series. Physicians and patients should be aware of these population-based outcomes and should use them as part of the decision-making process regarding the treatment options for men with PC.
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Affiliation(s)
- Kendra Schwartz
- Karmanos Cancer Institute and Department of Family Medicine, Wayne State University, Detroit, Michigan 48201, USA.
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Kahn KL, Malin JL, Adams J, Ganz PA. Developing a reliable, valid, and feasible plan for quality-of-care measurement for cancer: how should we measure? Med Care 2002; 40:III73-85. [PMID: 12064761 DOI: 10.1097/00005650-200206001-00011] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recent changes in the US health care delivery system have raised expectations that the medical marketplace will compete on quality and cost of care. This effort will require a systematic evaluation of the measurement of quality of care as it applies to cancer and other critical conditions. OBJECTIVES To articulate the components of the design of quality-of-care measurement systems that must be considered and optimally manipulated to generate feasible, reliable, and valid data pertinent to patients with cancer. RESEARCH DESIGN A synthesis of information obtained from literature reviews and experience. MEASURES Four key areas of design that influence quality-of-care measurement scores are discussed: case identification, data source, data-collection strategies, and the quality of the care-measurement model. RESULTS Challenges associated with these design and measurement strategies are defined and discussed. CONCLUSIONS Policy analyses vary as a function of measurement domains. The design of a quality-of-care measurement system should consider trade-offs between validity and burden by considering the intricate relations between domains of measurement.
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Fransson P, Bergström P, Löfroth PO, Widmark A. Prospective evaluation of urinary and intestinal side effects after BeamCath stereotactic dose-escalated radiotherapy of prostate cancer. Radiother Oncol 2002; 63:239-48. [PMID: 12142087 DOI: 10.1016/s0167-8140(02)00107-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND New data suggest that a higher radiation dose will improve outcome in treatment of localized prostate cancer. External beam radiotherapy (EBRT) may on the other hand induce disturbances in the patient's urinary and intestinal function. Since 1997, 195 patients have been treated with a stereotactic boost of 4-8 Gy added to conventional 70 Gy EBRT. Late side effects were prospectively evaluated 3 years after dose-escalated EBRT. METHODS Urinary and intestinal problems were prospectively evaluated with a validated self-assessment questionnaire, the Prostate Cancer Symptom Scale (PCSS). Two hundred and eighty-seven patients completed the questionnaire at the 1 year follow-up, and 153 at 3 years after treatment. Pre-treatment mean age was 66 years. One hundred and sixty-eight patients were treated with the conformal technique and 195 were treated with the dose-escalated stereotactic BeamCath technique. Mean total dose in the conformal group (< or =70 Gy) was 66 Gy (60.8-70.4 Gy). The dose-escalated group consists of three dose levels, 74 Gy (n = 68), 76 Gy (n = 74), and 78 Gy (n = 53). RESULTS Analyzing the whole population 3 years after treatment, urgency and starting problems decreased in comparison to pre-treatment. A minor increase in urinary incontinence was reported 3 years after treatment in comparison to pre-treatment. No increases in other urinary symptoms were reported. Intestinal symptoms were slightly increased during the follow-up period in comparison to pre-treatment. Dose escalation with stereotactic EBRT (74-78 Gy) did not increase gastrointestinal or genitourinary late side effects at 1 year or 3 years in comparison to doses < or =70 Gy. CONCLUSIONS The stereotactic BeamCath EBRT technique facilitates safe dose escalation of patients with prostate cancer.
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Affiliation(s)
- Per Fransson
- Department of Radiation Sciences, Oncology, Umeå University, S-901 85 Umeå, Sweden
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Harlan LC, Potosky A, Gilliland FD, Hoffman R, Albertsen PC, Hamilton AS, Eley JW, Stanford JL, Stephenson RA. Factors associated with initial therapy for clinically localized prostate cancer: prostate cancer outcomes study. J Natl Cancer Inst 2001; 93:1864-71. [PMID: 11752011 DOI: 10.1093/jnci/93.24.1864] [Citation(s) in RCA: 152] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Because of the lack of results from randomized clinical trials comparing the efficacy of aggressive therapies with that of more conservative therapies for clinically localized prostate cancer, men and their physicians may select treatments based on other criteria. We examined the association of sociodemographic and clinical characteristics with four management options: radical prostatectomy, radiation therapy, hormonal therapy, and watchful waiting. METHODS We studied 3073 participants of the Prostate Cancer Outcomes Study diagnosed from October 1, 1994, through October 31, 1995, with clinically localized disease (T1 or T2). Participants completed a baseline survey, and diagnostic and treatment information was abstracted from medical records. Multiple logistic regression analysis identified factors associated with initial treatment. All statistical tests were two-sided. RESULTS Patients with clinically localized disease received the following treatments: radical prostatectomy (47.6%), radiation therapy (23.4%), hormonal therapy (10.5%), or watchful waiting (18.5%). Men aged 75 years or older more often received conservative treatment (i.e., hormonal therapy alone or watchful waiting; 57.9% of men aged 75-79 years and 82.1% of men aged 80 years and older) than aggressive treatment (i.e., radical prostatectomy or radiation therapy) (for all age groups, P</=.001). After adjustment for age, clinical stage, baseline prostate-specific antigen level, and histologic grade, the following factors were associated with conservative treatment: history of a heart attack, being unmarried, geographic region, poor pretreatment bladder control, and impotence. In men younger than 60 years, use of aggressive treatment was similar by race/ethnicity (adjusted percentages = 85.5%, 88.1%, and 85.3% for white, African-American, and Hispanic men, respectively). However, among men 60 years old and older, African-American men underwent aggressive treatment less often than did white men or Hispanic men (adjusted percentages for men aged 60-64 years = 67.1%, 84.7%, and 79.2%, respectively; 65-74 years = 64.8%, 73.4%, and 79.5%, respectively; and 75 years old and older = 25.2%, 45.7%, and 36.6%, respectively). CONCLUSIONS The association of nonclinical factors with treatment suggests that, in the absence of definitive information regarding treatment effectiveness, men diagnosed with prostate cancer should be better informed of the risks and benefits of all treatment options.
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Affiliation(s)
- L C Harlan
- Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, National Institutes of Health, Bethesda, MD 20892, USA.
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Potosky AL, Knopf K, Clegg LX, Albertsen PC, Stanford JL, Hamilton AS, Gilliland FD, Eley JW, Stephenson RA, Hoffman RM. Quality-of-life outcomes after primary androgen deprivation therapy: results from the Prostate Cancer Outcomes Study. J Clin Oncol 2001; 19:3750-7. [PMID: 11533098 DOI: 10.1200/jco.2001.19.17.3750] [Citation(s) in RCA: 199] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE To compare health-related quality-of-life outcomes after primary androgen deprivation (AD) therapy with orchiectomy versus luteinizing hormone-releasing hormone (LHRH) agonists for patients with prostate cancer. PATIENTS AND METHODS Men (n = 431) newly diagnosed with all stages of prostate cancer from six geographic regions who participated in the Prostate Cancer Outcomes Study and who received primary AD therapy but no other treatments within 12 months of initial diagnosis were included in a study of health outcomes. Comparisons were statistically adjusted for patient sociodemographic and clinical characteristics, timing of therapy, and use of combined androgen blockade. RESULTS More than half of the patients receiving primary AD therapy had been initially diagnosed with clinically localized prostate cancer. Among these patients, almost two thirds were at high risk of progression on the basis of prognostic factors. Sexual function outcomes were similar by treatment group both before and after implementation of AD therapy. LHRH patients reported more breast swelling than did orchiectomy patients (24.9% v 9.7%, P <.01). LHRH patients reported more physical discomfort and worry because of cancer or its treatment than did orchiectomy patients. LHRH patients assessed their overall health as fair or poor more frequently than did orchiectomy patients (35.4% v 28.1%, P =.01) and also were less likely to consider themselves free of prostate cancer after treatment. CONCLUSION Most endocrine-related health outcomes are similar after surgical versus medical primary hormonal therapy. Stage at diagnosis had little effect on outcomes. These results provide representative information comparing surgical and medical AD therapy that may be used by physicians and patients to inform treatment decisions.
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Affiliation(s)
- A L Potosky
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, MD, USA.
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Hamilton AS, Stanford JL, Gilliland FD, Albertsen PC, Stephenson RA, Hoffman RM, Eley JW, Harlan LC, Potosky AL. Health outcomes after external-beam radiation therapy for clinically localized prostate cancer: results from the Prostate Cancer Outcomes Study. J Clin Oncol 2001; 19:2517-26. [PMID: 11331331 DOI: 10.1200/jco.2001.19.9.2517] [Citation(s) in RCA: 97] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Studies reporting effects of radiotherapy for prostate cancer on sexual, bowel, and urinary function have been conducted primarily in referral centers or academic institutions. Effects of external-beam radiotherapy for prostate cancer among a population-based cohort were assessed. PATIENTS AND METHODS The study population included 497 white, Hispanic, and African-American men with localized prostate cancer from six US cancer registries who were diagnosed between October 1, 1994, and October 31, 1995, and treated initially with external-beam radiotherapy. They were interviewed at regular intervals, and medical records were reviewed. Distributions of responses for bowel-, urinary-, and sexual-related functions at 6, 12, and 24 months after diagnosis and adjusted mean composite change scores for each domain were analyzed. RESULTS Declines of 28.9% in the sexual function score and 5.4% in the bowel function score occurred by 24 months, whereas at this time, the urinary function score was relatively unchanged. A total of 43% of those who were potent before diagnosis became impotent after 24 months. More than two thirds of the men were satisfied with their treatment and would make the same decision again. CONCLUSION Sexual function was the most adversely affected quality-of-life domain, with problems continuing to increase between 12 and 24 months. Bowel function problems increased at 6 months, with partial resolution observed by 24 months. Despite the side effects, satisfaction with therapy was high. These results are representative of men in community practice settings and may be of assistance to men and to clinicians when making treatment decisions.
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Affiliation(s)
- A S Hamilton
- Keck School of Medicine of the University of Southern California, Department of Preventive Medicine, Los Angeles, CA 90089-9175, USA.
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Potosky AL, Legler J, Hoffman RM, Gilliland FD. RESPONSE: Re: Health Outcomes After Prostatectomy or Radiotherapy for Prostate Cancer: Results From the Prostate Cancer Outcomes Study. J Natl Cancer Inst 2001. [DOI: 10.1093/jnci/93.5.401-a] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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