ORIGINAL RESEARCH
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

https://doi.org/10.1111/j.1743-6109.2007.00741.xGet rights and content

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. Karakiewicz PI, Bhojani N, Neugut A, Shariat SF, Jeldres C, Graefen M, Perrotte P, Peloquin F, and 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.

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) 1, 2, 3. Therefore, valid interpretation of cancer control outcomes requires adjustment for HRQOL, which is the case in methodologically sound studies 2, 4. Unfortunately, the majority of HRQOL do not adjust their HRQOL scores for population characteristics or case mix 5, 6, 7. Unadjusted HRQOL scale score comparisons might be confounded by effects stemming from population differences, such as comorbidity and socioeconomic status (SES). In many cancers, including PCa, comorbidity has been shown to affect survival 8, 9, 10. Similarly, SES has been shown to represent a predictor of outcome 8, 11, 12. In this study, we explored and tested the strength of the effect of comorbidity and SES on sexual, urinary, and general HRQOL scales in men treated with radical prostatectomy (RP) for PCa in the Province of Quebec between 1988 and 1996.

Section snippets

Aims

This study aimed to assess the effect of comorbidity and SES on sexual and urinary function as well as general HRQOL in men treated with RP for localized PCa.

Methods

The patient population included 4,997 men treated with RP in the Province of Quebec, between January 1, 1988 and January 16, 1996. They were identified from the Quebec Health Care Plan Database using the RP-specific billing code. The Quebec Health Plan represents the exclusive medical insurer in the Province; therefore, the billing code-based identification results in virtually complete ascertainment of RP. The Quebec Health Care Plan Database contains no clinical, surgical, or pathological

Main Outcome Measures

The relationships between comorbid conditions, SES, and three outcomes, namely sexual, urinary, and general HRQOL were assessed using linear regression analyses and were quantified using regression coefficients. Comorbid conditions and SES characteristics (Table 1) represented predictor variables, and each of the HRQOL domains (sexual, urinary, and general) represented an outcome variable in univariable, and subsequently multivariable models. For brevity, analyses targeting general HRQOL focused

Results

Of 4,546 eligible men, 2,415 (53.1%) participated in the survey and no further exclusions were made. Table 1 displays the mean age at surgery and age at survey administration as well as the prevalence of comorbid conditions and the SES characteristics of survey participants. The mean scores for the SF-36 PF, MH, and SocF scales were 80.95 (standard deviation [SD]; 24.05), 74.15 (SD; 18.86), and 82.13 (SD; 23.12), respectively. The mean scores for the PCI SexF, SexB, UF, and UB were 21.47 (SD;

Discussion

The goal of this study was to explore and test the strength of the effect of comorbid conditions and SES on patient reported sexual, urinary, and general HRQOL after RP. Its rationale stems from the documented association between comorbidity, SES, and survival in the setting of PCa, as well as from a concomitant lack of data quantifying the relation between these variables and HRQOL 8, 9, 10. Although several analyses have addressed sexual, urinary, and general HRQOL in men with localized PCa

Conclusion

Our data suggest that comorbidity and SES represent important intervening variables in the relation between PCa treatment and HRQOL outcomes. In consequence, these variables require consideration when HRQOL data are reported and interpreted. Failure to account for the contribution of case-mix heterogeneity stemming from comorbidity and/or SES may result in an incorrect interpretation of generic and PCa-specific HRQOL outcomes.

Category 1

  • (a)

    Conception and Design

  • Pierre Karakiewicz; Naeem Bhojani; Alfred Neugut; Michael Kattan

  • (b)

    Acquisition of Data

  • Claudio Jeldres; Naeem Bhojani; Paul Perrotte; Francois Peloquin

  • (c)

    Analysis and Interpretation of Data

  • Naeem Bhojani; Alfred Neugut; Michael Kattan; Pierre Karakiewicz

Category 2

  • (a)

    Drafting the Article

  • Pierre Karakiewicz; Naeem Bhojani; Paul Perrotte; Michael Kattan

  • (b)

    Revising It for Intellectual Content

  • Pierre Karakiewicz; Paul Perrotte; Francois Peloquin; Michael Kattan

Category 3

  • (a)

    Final Approval of the Completed Article

References (26)

Cited by (41)

  • Changes in Sexual Roles and Quality of Life for Gay Men after Prostate Cancer: Challenges for Sexual Health Providers

    2014, Journal of Sexual Medicine
    Citation Excerpt :

    Given their generally worse HRQOL, it may not be surprising that men in our sample reported lower satisfaction with PCa medical care compared with other PCa survivors. However, comorbidity rates in this sample were comparable with other samples [28]. In addition, HIV rates were relatively low at 7%; slightly lower than the U.S. incidence rate of 11% for men aged over 50 years [29].

View all citing articles on Scopus
View full text