Survivors of prostate cancer originally diagnosed with metastatic disease may experience significantly worse health-related quality of life than those diagnosed with early-stage disease and individuals without a cancer history across all domains, according to a new study by Zheng et al published in the Journal of Clinical Oncology. The study was also presented at the 2022 ASCO Quality Care Symposium (Abstract 205).
Study Methodology
Researchers, led by lead study author Zhiyuan “Jason” Zheng, PhD, a senior principal scientist and health economist at the American Cancer Society, used Surveillance, Epidemiology, and End Results (SEER) and Medicare Health Outcomes Survey (MHOS) data linkage to identify prostate cancer survivors and individuals without a cancer history who enrolled in Medicare Advantage plans. Prostate cancer survivors diagnosed from 1988 to 2017 who completed the SEER-MHOS baseline survey between 1998 and 2019—up to 10 years after their cancer diagnosis—were included in the analyses. Survey records were clustered at the person level for those who completed multiple survey waves.
In total, 27,829 survivors of prostate cancer with 40,611 survey records were identified (n = 752 for those with metastatic disease, with 1,040 survey records). Medicare Advantage enrollees living in SEER regions (n = 784,305) without a cancer history had about 1.15 million survey records. Multilevel linear regressions were used to compare health-related quality of life outcomes (ie, the Veterans RAND 12-Item Health Survey) between survivors of metastatic disease and survivors of other stages of disease and individuals without a cancer history. The Veterans RAND-12 Item Health Survey scores consist of eight principal health domains—general health perceptions, physical functioning, role limitations as a result of physical and emotional problems, bodily pain, energy and fatigue, social functioning, and mental health. All analyses were adjusted for age at the time of the survey, disease stage, number of comorbid conditions, body mass index, race and ethnicity, marital status, educational attainment, home ownership, SEER region, and survey era.
Key Results
Compared with those who did not have a cancer history, prostate cancer survivors were older, more likely to be overweight, racial and ethnic minorities, married, and had higher socioeconomic status. Compared with men who did not have a cancer history, metastatic prostate cancer survivors were most likely to report worse general health (T-score difference: –6.26, 95% confidence internal [CI] = –7.14 to –5.38, P < .001), physical component summary (T-score difference: –4.33, 95% CI = –5.18 to –3.48, P < .001), and mental component summary (T-score difference: –2.64, 95% CI = –3.40 to –1.88, P < .001), followed by survivors with early-stage disease in adjusted analyses. Results were similar for other health-related quality-of-life Veterans RAND 12-Item Health Survey measures.
Researchers suggested a need for better symptom management and palliative care as part of treatment for patients diagnosed with metastatic prostate cancer.
Disclosure: This study was supported by the Centers for Disease Control and Prevention Special Interest Project. For full disclosures of the study authors, visit ascopubs.org.
