Predictors of preferences, utilities and quality of life in men treated with 3DCRT for prostate cancer

Predictors of preferences, utilities and quality of life in men treated with 3DCRT for prostate cancer

Proceedings of the 44th Annual ASTRO Meeting 76 47 Predictors of Preferences, Utilities and Quality of Life in Men Treated with 3DCRT for Prostate ...

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Proceedings of the 44th Annual ASTRO Meeting

76

47

Predictors of Preferences, Utilities and Quality of Life in Men Treated with 3DCRT for Prostate Cancer

D.W. Bruner, A.L. Hanlon, S. Mazzoni, T. Sargent, G.E. Hanks Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA Purpose/Objective: Patient decision-making is enhanced with knowledge of what others going through similar treatments prefer and what the impact on quality of life (QL) is with different treatment alternatives. This study assessed the preferences, utilities and QL in patients treated with 3DCRT for prostate cancer, as well as predictors of these variables. Materials/Methods: Patients participating in a prostate cancer risk registry recruited through the Department of Radiation Therapy were analyzed. Preferences for health states of impotence (IP) and incontinence (IC) associated with prostate cancer therapies were elicited using a modified Time Trade-off (TTO) interview. Utility (a number between 0, death and 1, best possible health) for health states were calculated from stated preferences. QL (using the Functional Assessment of Cancer Therapy–Prostate, FACT-P; made up of a general QL scale, FACT-G and a prostate specific subscale), sexual adjustment (via a modified Sexual Adjustment Questionnaire, SAQ), and urinary function (using the AUA-Symptom Problem Index, SPI) were evaluated in patients with prostate cancer receiving 3DCRT. Stepwise multiple regressions were used to assess predictors (sociodemographics and pretx and treatment characteristics) of utilities and QL. Results: Fifty-six men (mean age 63 yrs.) treated between 12/90 and 2/99 with 3DCRT (mean dose 73 Gy) and a mean follow-up of 55 mos (range 17-131) completed the TTO. 83% were stage T1-T2 and 30% were on hormones. 33/56 (59%) pts completed the FACT and 38-39/56 (68%) pts completed the SAQ & SPI. Utilities followed a linear trend with declining scores for increasing risk of poorer health states. Men showed an increased preference and higher utility for health states associated with radiotherapy as compared to surgery or hormone therapy (Table 1). Global QL scores were higher than reports of a population of 466 mixed cancer patients (Cella, ’94). SAQ scores were low but urinary function scores were excellent. Predictors of utilities for IP included marital status with being married associated with higher utilities, and for IC younger age and higher income were associated with higher utilities. The only treatment variable that predicted utilities for either IP or IC was RT dose, with higher dose associated with higher utilities. QL scores did not predict utilities. Predictors of sexual function included hormone therapy, while higher RT dose predicted worse urinary function, higher income predicted better global QL and higher tumor grade predicted worse FACT-P subscale scores. Conclusions: Men in this study treated with 3DCRT had relatively high utility for health states associated with treatment and higher utilities for health states associated with RT than hypothetical health states associated with surgery or hormonal therapy. All aspects of QL were quite good with the exception of sexual function. Predictors of both utilities and QL can assist in identifying patients at risk for poorer outcomes. Table 1. Utility Values for Prostate Cancer Treatment Related Health States and QL Scores of Men Treated with 3DCRT Utilities Health State % Risk of Health State Utility Value, Mean (SD) Qualtiy of Life Instrument Possible Score Range QL Score Mean (SD)

Incontinence

(IC)

Impotence

(IP)

(IP)

10% Risk .9321 (.21)

30% Risk .8961 (.22)

40% Risk .9415 (.14)

80% Risk .9043 (.15)

99% Risk .8750 (.16)

FACT- GGlobal QL# 0-112 97 (13.2)

FACT-P Subscale# 0-48 37.8 (8.1)

FACT-P Total# 0-160 134.8 (19.5)

SAQ# 8-100 39.5 (15.8)

SPI* 28-0 4.28 (5.66)

#higher scores are better; *lower scores are better

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Health-Related Quality Of Life (HRQOL) in Men Treated with Prostate Brachytherapy Alone on Radiation Therapy Oncology Group (RTOG) Trial 98-05

W.R. Lee1, C. Scott2, C. Lawton3, G. Morton4, T. Pisansky5, M. Baikadi6, D. Bruner7, H. Sandler8 1

Wake Forest University, Winston-Salem, NC, 2RTOG, Philadelphia, PA, 3Medical College of Wisconsin, Milwaukee, WI, Toronto Sunnybrook, Toronto, ON, Canada, 5Mayo Clinic, Rochester, MN, 6Mercy Hospital, Scranton, PA, 7Fox Chase Cancer Center, Philadelphia, PA, 8University of Michigan, Ann Arbor, MI

4

Purpose/Objective: To prospectively assess health-related quality of life (HRQOL) during the first year after treatment with prostate brachytherapy (PB) alone for T1c-2a prostate cancer. Materials/Methods: Ninety-eight patients from 24 institutions were eligible and properly entered on this study. All patients were treated with PB alone using I-125 (Amersham Model 6711). The prescription dose was 145 Gy. Three separate HRQOL questionnaires (Functional Assessment of Cancer Therapy-Prostate: FACT-P, Sexual Adjustment Questionnaire: SAQ and International Prostate Symptom Score: IPSS) were self-administered before and after PB (baseline; 3, 6, 9 and 12 months following PB). The Standard Error of Measurement (SEM) was used to analyze changes in HRQOL scores over time. Patients that improved greater than the SEM were categorized as Improved; patients that declined greater than the SEM were categorized as Declined; patients were otherwise categorized as Stable. All changes are measured using the pretreatment HRQOL score as baseline. Results: The percentage of men who reported the ability to have an erection decreased from 73% at baseline (65% unassisted, 8% assisted) to 57% at one year (36% unassisted, 21% assisted). The rate of urinary incontinence increased to 14% at six months but had decreased to 1% at the 12-month follow-up. At one year after PB, 80% of men reported decreased sexual