The Association of Long-term Treatment-related Side Effects With Cancer-specific and General Quality of Life Among Prostate Cancer Survivors

doi:10.1016/j.urology.2014.04.036

Urology

Volume 84, Issue 2, August 2014, Pages 300-306

https://doi.org/10.1016/j.urology.2014.04.036 Get rights and content

Objective

To examine the association between treatment-related side effects and cancer-specific and general quality of life (QOL) among long-term prostate cancer survivors.

Materials and Methods

Within the Prostate, Lung, Colorectal and Ovarian Cancer Screening Trial, we conducted telephone interviews with prostate cancer survivors (N = 518) who were 5-10 years after diagnosis. We assessed demographic and clinical information, sexual, urinary, and bowel treatment-related side effects (Expanded Prostate Cancer Index Composite), cancer-specific QOL (Functional Assessment of Cancer Therapy—total score), and general QOL (the Medical Outcomes Study Short Form 12's physical and mental subscales).

Results

Participants were aged 74.6 years on average, primarily White (88.4%), and married (81.7%). Pearson correlation coefficients between the 3 treatment-related side effect domains (urinary, sexual, and bowel) and QOL ranged between 0.14 and 0.42 (P <.0001). Multivariable linear regression analyses revealed that poorer urinary and sexual functioning and greater bowel side effects were independently associated with poorer cancer-specific QOL (P <.0001). Bowel and urinary functions were also associated with poorer general QOL on the Medical Outcomes Study Short Form 12's physical component summary and mental component summary (P <.05). Bowel side effects demonstrated the strongest association with all QOL outcomes.

Conclusion

Treatment-related side effects persisted for up to 10 years after diagnosis and continued to be associated with men's QOL. These results suggest that each of the treatment-related side effects was independently associated with cancer-specific QOL. Compared with the other Expanded Prostate Cancer Index Composite domains, bowel side effects had the strongest association with cancer-specific and general QOL. These associations emphasize the tremendous impact that bowel side effects continue to have for men many years after their initial diagnosis.

Section snippets

Overview of the PLCO Trial

From 1993 to 2001, the PLCO trial22, 23 enrolled 76,705 men aged 55-74 years at 10 screening sites in the United States. PLCO exclusion criteria for male participants were: (1) history of prostate, lung, or colorectal cancer, (2) current cancer treatment, (3) prior surgical removal of the prostate, lung, colon, or rectum, (4) current finasteride use, (5) ≥1 prostate-specific antigen (PSA) test ≤3 years ago, (6) colon cancer screening ≤3 years ago, (7) enrollment in another cancer screening or

Demographic and Clinical Information

Demographic and clinical characteristics are presented in Table 1. Participants had a mean age of 74.6 years and their average time since initial PCa diagnosis was 7.4 years (with a range from 5.0 to 9.9 years since diagnosis). Participants were mostly White (88.4%), married (81.7%), retired (77.1%), and had at least some college education (71.9%). Regarding clinical information, at diagnosis most men had stage-II disease (87.8%), a Gleason score of 3-6 (68.0%), and a PSA level ≤10 (82.2%).

Associations Between Treatment-related Side Effects and QOL

Comment

While most studies on QOL and PCa have focused on the short-term influence of treatment-related side effects, this study examined the long-term (5-10 years after diagnosis) association between PCa-related treatment side effects and cancer-specific and general QOL. The relationships between cancer-specific and general QOL measures and the EPIC domains were similar to those found by Wei et al.²⁰

After adjusting for demographic and clinical variables, our results suggest that the urinary, sexual,

Conclusion

In summary, treatment-related side effects persisted up to 10-years after diagnosis and were associated with both cancer-specific and general QOL. These associations were particularly strong for the cancer-specific QOL measure, as evidenced by the larger point estimates and statistical significance of the treatment side effects. The 3 EPIC domains were all independently associated with cancer-specific QOL, with bowel side effects exhibiting the strongest association of the 3 domains. These

Acknowledgments

The authors appreciate the time and effort of the participants, the interviewers who conducted the interviews, and Susan Marx for administrative support.

References (30)

A.J. Lim et al.
Quality of life: radical prostatectomy versus radiation therapy for prostate cancer
J Urol
(1995)
M.S. Litwin et al.
Bowel function and bother after treatment for early stage prostate cancer: a longitudinal quality of life analysis from CaPSURE
J Urol
(2004)
P. Chang et al.
Expanded prostate cancer index composite for clinical practice: development and validation of a practical health related quality of life instrument for use in the routine clinical care of patients with prostate cancer
J Urol
(2011)
C.H. Halbert et al.
Racial differences in quality of life following prostate cancer diagnosis
Urology
(2010)
S.D. Ramsey et al.
On the importance of race, socioeconomic status and comorbidity when evaluating quality of life in men with prostate cancer
J Urol
(2007)
K.M. Szymanski et al.
Development and validation of an abbreviated version of the expanded prostate cancer index composite instrument for measuring health-related quality of life among prostate cancer survivors
Urology
(2010)
J.T. Wei et al.
Development and validation of the expanded prostate cancer index composite (EPIC) for comprehensive assessment of health-related quality of life in men with prostate cancer
Urology
(2000)
D. Rao et al.
Racial/Ethnic differences in the health-related quality of life of cancer patients
J Pain Symptom Manage
(2008)
G.A. Sonn et al.
Differing perceptions of quality of life in patients with prostate cancer and their doctors
J Urol
(2013)
M.S. Litwin et al.
Quality-of-life outcomes in men treated for localized prostate cancer
JAMA
(1995)

A.L. Potosky et al.

Health outcomes after prostatectomy or radiotherapy for prostate cancer: results from the Prostate Cancer Outcomes Study

J Natl Cancer Inst

(2000)

J.L. Gore et al.

Survivorship beyond convalescence: 48-month quality-of-life outcomes after treatment for localized prostate cancer

J Natl Cancer Inst

(2009)

A.L. Potosky et al.

Five-year outcomes after prostatectomy or radiotherapy for prostate cancer: the prostate cancer outcomes study

J Natl Cancer Inst

(2004)

M.G. Sanda et al.

Quality of life and satisfaction with outcome among prostate-cancer survivors

N Engl J Med

(2008)

D.C. Miller et al.

Long-term outcomes among localized prostate cancer survivors: health-related quality-of-life changes after radical prostatectomy, external radiation, and brachytherapy

J Clin Oncol

(2005)

Cited by (52)

Outcomes of Active Surveillance for Men With Intermediate Risk Prostate Cancer: A Population-Based Analysis
2021, Urology
To assesses if active surveillance (AS) is an appropriate treatment modality for patients with intermediate risk (IR) prostate cancer (PCa) utilizing population-level data to compare the survival outcomes of men with low risk (LR) and IR PCa initially treated with AS, watchful waiting (WW) or active treatment (AT).
In total, 166,244 patients were initially identified in the surveillance, epidemiology, and end results database using biopsy Gleason grade group (GG) alone—GG1 and GG2. In total, 94,891 patients with GG1 and GG2 disease were further stratified by National Comprehensive Cancer Network risk categories—LR, favorable IR (fIR), and unfavorable IR (uIR). Predictors of cancer-specific (CSS) and overall survival (OS) were analyzed, stratified by risk classification and initial treatment—AT (first-line curative surgery or radiotherapy), AS or WW, utilizing the new “Watchful waiting recode (2010+)” variable.
We found GG2 patients on AS had worse CSS and OS than GG2 patients who received AT and GG1 patients treated with AS or AT; these trends persist within the National Comprehensive Cancer Network fIR and uIR cohorts. WW patients (GG1, GG2, LR, fIR, and uIR) had the worst survival outcomes of any cohort (log-rank tests P < .05).
We demonstrate a significantly worse 5-year CSS and OS for men with GG2, fIR, and uIR PCa treated with AS compared to AT. Our analysis suggests that AS should not be the preferred treatment modality for IR PCa.
Characteristics of Participation in Patient-Reported Outcomes and Electronic Data Capture Components of NRG Oncology Clinical Trials
2020, International Journal of Radiation Oncology Biology Physics
Citation Excerpt :
Patient-reported quality of life has been shown to differ on the basis of education level. Davis et al21 reported an adjusted analysis showing that men with prostate cancer who had less than or equal to a high school education had significantly worse patient-reported cancer-specific quality of life, whereas Popovic et al30 found a positive correlation between amount of education and improved scores on functional and social quality-of-life scales in patients with early-stage cancers. These results highlight the effects on the trial’s results if patients with less education are not represented appropriately.
To assess the reasons why patients do not consent to patient-reported outcome (PRO) and electronic PRO data capture components of clinical trials and potential selection bias by having a separate consent.
Selected NRG Oncology trials were included based on disease site and inclusion of PROs and electronic PRO data capture via VisionTree Optimal Care as separate consent questions. Reasons for not participating were assessed. Pretreatment characteristics between patients who did and did not consent were tested using χ² and t tests for univariate comparisons and logistic regression for multivariable analyses.
Ten trials were selected in head and neck, prostate, gynecologic, breast, lung, and gastrointestinal cancers, with 4 of these trials having electronic PRO data capture. Most patients consented to the PRO component (75.3%) but not electronic PRO data capture (37.8%). More white patients consented to PROs than nonwhite patients across all trials (odds ratio [OR], 0.53; 95% confidence interval [CI], 0.45-0.63; P < .001), and more patients with education after high school consented compared with those with less education (OR, 1.71; 95% CI, 1.46-2.02; P < .001). Patients who are younger (OR, 0.63; 95% CI, 0.47-0.85; P = .002), white (OR, 0.60; 95% CI, 0.44-0.82; P = .001), and a never or former smoker (OR, 0.57; 95% CI, 0.41-0.78; P = .001) are more likely to participate in electronic PRO data capture.
These results suggest that a patient’s race, age, and education can affect whether a patient chooses to consent or is offered to participate in PRO or electronic PRO data capture components. More investigation is needed, but this analysis provides support for making PROs integrated in the trial.
Quality of Life Changes >10 Years After Postoperative Radiation Therapy After Radical Prostatectomy for Prostate Cancer
2019, International Journal of Radiation Oncology Biology Physics
To analyze long-term quality-of-life (QoL) changes related to postoperative radiation therapy (RT) after radical prostatectomy.
Patients who received postoperative 3-dimensional conformal RT in the years 2003 to 2008 with 1.8 to 2.0 Gy fractions up to 66.0 to 66.6 Gy (n = 181) were surveyed using the Expanded Prostate Cancer Index Composite questionnaire before the beginning of RT (A); on the last day (B); and 2 months (C), 1 to 3 years (D), 6 to 9 years (E), and 10 to 13 years (F) after RT.
Mean urinary bother, urinary incontinence bother, and bowel bother score changes (in relation to baseline at time A) of 13, 14, and 7 and 14, 15, and 7 were found at times E and F, respectively (P < .01 for all comparisons). Sexual function scores decreased 6 and 8 points on average (P < .01). Patient age at the time of RT had a considerable impact on urinary bother and urinary incontinence bother, with increasing differences over time when comparing patients aged <68 versus ≥68 years: 0 versus 7 and 0 versus 7 points at time D and 8 versus 23 and 6 versus 35 points at time F, respectively. Patients who did not respond to RT with a decreasing prostate-specific antigen level had greater urinary and urinary incontinence bother and bowel bother score changes >10 years after treatment (25 vs 12; P = .04, 36 vs 10; P = .03, and 20 vs 5; P = .07, respectively). A higher rectal dose was associated with greater acute and long-term bowel bother score decrease. No correlation was found between the dose to the bladder and QoL changes.
In contrast to early evaluations in the first years, significantly decreasing QoL in the urinary, bowel, and sexual domains was found >5 years after RT. Aging is likely to be a major factor. Younger patients who responded to the treatment had the most favorable long-term QoL results. As 3-dimensional conformal RT was used in this study, intensity modulated concepts could result in improved outcomes.
Study design and protocol for a culturally adapted cognitive behavioral stress and self-management intervention for localized prostate cancer: The Encuentros de Salud study
2018, Contemporary Clinical Trials
Citation Excerpt :
Almost 2.8 million men in the U.S. are living with prostate cancer (PC), and approximately 80% of PC cases are diagnosed as non-metastatic with a 5-year relative survival rate of 100% [1]. Despite high survival, treatment side effects, including sexual and urinary dysfunction, pain and fatigue are common and chronic [2–4]. Side effects also lead to poor psychosocial functioning, including mood disturbance, impaired intimacy and social functioning, and concerns about body image and masculinity [5].
Almost 2.8 million men in the U.S. are living with prostate cancer (PC), accounting for 40% of all male cancer survivors. Men diagnosed with prostate cancer may experience chronic and debilitating treatment side effects, including sexual and urinary dysfunction, pain and fatigue. Side effects can be stressful and can also lead to poor psychosocial functioning. Prior trials reveal that group-based cognitive behavioral stress and self-management (CBSM) is effective in reducing stress and mitigating some of these symptoms, yet little is known about the effects of culturally-translated CBSM among Spanish-speaking men with PC. This manuscript describes the rationale and study design of a multi-site, randomized controlled trial to determine whether participation in a culturally adapted cognitive behavioral stress management (C-CBSM) intervention leads to significantly greater reductions in symptom burden and improvements in health-related quality of life relative to participation in a non-culturally adapted cognitive behavioral stress management (CBSM) intervention. Participants (N = 260) will be Spanish-speaking Hispanic/Latino men randomized to the standard, non-culturally adapted CBSM intervention (e.g., cognitive behavioral strategies, stress management, and health maintenance) or the culturally adapted C-CBSM intervention (e.g., content adapted to be compatible with Hispanic/Latino cultural patterns and belief systems, meanings, values and social context) for 10 weeks. Primary outcomes (i.e., disease-specific symptom burden and health-related quality of life) will be assessed across time. We hypothesize that a culturally adapted C-CBSM intervention will be more efficacious in reducing symptom burden and improving health-related quality of life among Hispanic/Latino men when compared to a non-culturally adapted CBSM intervention.
Predictive factors of long-term rectal toxicity following permanent iodine-125 prostate brachytherapy with or without supplemental external beam radiation therapy in 2216 patients
2018, Brachytherapy
Citation Excerpt :
Rectal toxicity is one of the primary concerns after prostate BT. Among long-term prostate cancer survivors, bowel side effects had the strongest association with cancer-specific and general QOL (7). Although the incidence of late Grade 2 or higher (G2+) rectal toxicity following BT is typically on the order of 5–7% (8), this risk may be increased when BT is combined with EBRT (9, 10).
We analyzed factors associated with rectal toxicity after iodine-125 prostate brachytherapy (BT) with or without external beam radiation therapy (EBRT).
In total, 2216 prostate cancer patients underwent iodine-125 BT with or without EBRT between 2003 and 2013. The median followup was 6.9 years. Cox proportional hazards modeling was used for univariate and multivariate analyses to assess clinical and dosimetric factors associated with rectal toxicity. Dosimetric parameters from 1 day after implantation (Day 1) and 1 month after implantation (Day 30) were included in the analyses.
The 7-year cumulative incidence of Grade 2 or higher rectal toxicity was 5.7% in all patients. The multivariate analysis revealed that antiplatelet or anticoagulant therapy, neoadjuvant androgen deprivation therapy, treatment modality, Day 1 rectal volume receiving 100% of the prescribed dose (RV₁₀₀), and the Day 30 minimal percent of the prescribed dose delivered to 30% of the rectum (RD₃₀) were associated with rectal toxicity. Day 1 RV₁₀₀ was a common predictor in both BT-alone and the BT + EBRT groups. The 5-year cumulative incidence of Grade 2 or higher rectal toxicity was 12.6%, 5.9%, and 1.7% for BT + 3-dimensional conformal radiation therapy, BT + intensity-modulated radiation therapy, and the BT-alone groups, respectively (p < 0.001).
Rectal dosimetric parameters in BT were associated with late rectal toxicity. Although the risk of rectal toxicity was higher when EBRT was combined with BT, with proper and achievable rectal dose constraints intensity-modulated radiation therapy yielded less toxicity than 3-dimensional conformal radiation therapy.
Familism, family cohesion, and health-related quality of life in Hispanic prostate cancer survivors
2024, Journal of Behavioral Medicine

View all citing articles on Scopus

: Financial Disclosure: The authors declare that they have no relevant financial interests.

: Funding Support: This work was supported by the Midwest Division of the American Cancer Society, (grant number 113173-RSGPB-07-099-01-CPPB to Kathryn L.Taylor). This project was supported in part by the Biostatistics and Bioinformatics Shared Resource at the Lombardi Comprehensive Cancer Center by Award Number P30CA051008 from the National Cancer Institute.

View full text

Health Services ResearchThe Association of Long-term Treatment-related Side Effects With Cancer-specific and General Quality of Life Among Prostate Cancer Survivors

Objective

Materials and Methods

Results

Conclusion

Section snippets

Overview of the PLCO Trial

Demographic and Clinical Information

Associations Between Treatment-related Side Effects and QOL

Comment

Conclusion

Acknowledgments

J Urol

J Urol

J Urol

Urology

J Urol

Urology

Urology

J Pain Symptom Manage

J Urol

Quality-of-life outcomes in men treated for localized prostate cancer

JAMA

Health outcomes after prostatectomy or radiotherapy for prostate cancer: results from the Prostate Cancer Outcomes Study

J Natl Cancer Inst

Survivorship beyond convalescence: 48-month quality-of-life outcomes after treatment for localized prostate cancer

J Natl Cancer Inst

Five-year outcomes after prostatectomy or radiotherapy for prostate cancer: the prostate cancer outcomes study

J Natl Cancer Inst

Quality of life and satisfaction with outcome among prostate-cancer survivors

N Engl J Med

Long-term outcomes among localized prostate cancer survivors: health-related quality-of-life changes after radical prostatectomy, external radiation, and brachytherapy

J Clin Oncol

Health Services Research
The Association of Long-term Treatment-related Side Effects With Cancer-specific and General Quality of Life Among Prostate Cancer Survivors