Quality of Life in Men Living With Advanced and Localized Prostate Cancer
In a population-based study reported in The Lancet Oncology, Downing et al found little difference in health-related quality of life (HRQOL) between men with advanced vs localized prostate cancer. Sexual function problems were common among all patients—and often not addressed—and use of androgen-deprivation therapy (ADT) was associated with greater toxicity.
Study Details
The study involved 35,823 survey respondents (of 58,930 mailed surveys) among men in the U.K. living 18 to 42 months after diagnosis of prostate cancer who were identified through cancer registration data. Among 30,733 with known disease stage, 19,599 (63.8%) had stage I or II, 7,209 (23.4%) stage III, and 3,925 (12.8%) stage IV disease. The survey contained measures to assess functional outcomes (urinary incontinence; urinary irritation and obstruction; bowel, sexual, and vitality and hormonal function) measured with the Expanded Prostate Cancer Index Composite short form (EPIC-26), questions regarding use of interventions for sexual dysfunction, and generic HRQOL assessed with the 5-level EuroQol five dimensions questionnaire (EQ-5D) measuring mobility, self-care, usual activities, pain or discomfort, and anxiety or depression, plus a rating of self-assessed health. Models comparing outcomes were adjusted for age, socioeconomic deprivation, and number of other long-term conditions.
HRQOL Outcomes
Mean adjusted EPIC-26 domain scores were high among all patients, indicating good function, except for sexual function scores, which were markedly lower among all patients. Compared with men who did not receive ADT, those who received ADT more frequently reported moderate to big problems with hot flushes (30.7% vs 5.4%), low energy (29.4% vs 14.7%), and weight gain (22.5% vs 6.9%). Overall, poor sexual function was reported by 81.0% of patients, with similar proportions of men reporting poor function irrespective of stage; 55.8% of those reporting poor function reported being offered no intervention for the condition. Overall, self-assessed health was similar in men with stage I and II and stage III disease. Although self-assessed health was reported as somewhat poorer in men with stage IV disease, 23.5% of men with stage IV disease reported no problems in any EQ-5D dimension.
The investigators concluded, “Men diagnosed with advanced disease do not report substantially different HRQOL outcomes to those diagnosed with localized disease, although considerable problems with hormonal function and fatigue are reported in men treated with androgen deprivation therapy. Sexual dysfunction is common and most men are not offered helpful intervention or support. Service improvements around sexual rehabilitation and measures to reduce the effects of androgen deprivation therapy are required.”
Amy Downing, PhD, of Leeds Institute for Data Analytics, University of Leeds, is the corresponding author for The Lancet Oncology article.
Disclosure: The study was funded by The Movember Foundation in partnership with Prostate Cancer UK. The study authors' full disclosures can be found at thelancet.com.
The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.
