ORIGINAL RESEARCHThe 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
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