Effect of investigation intensity and treatment differences on prostate cancer survivor's physical symptoms, psychological well-being and health-related quality of life: a two country cross-sectional study

Anna T Gavin, David Donnelly, Conan Donnelly, Frances J Drummond, Eileen Morgan, Gerard J Gormley, Linda Sharp, Anna T Gavin, David Donnelly, Conan Donnelly, Frances J Drummond, Eileen Morgan, Gerard J Gormley, Linda Sharp

Abstract

Aim: To investigate effects on men's health and well-being of higher prostate cancer (PCa) investigation and treatment levels in similar populations.

Participants: PCa survivors in Ireland where the Republic of Ireland (RoI) has a 50% higher PCa incidence than Northern Ireland (NI).

Method: A cross-sectional postal questionnaire was sent to PCa survivors 2-18 years post-treatment, seeking information about current physical effects of treatment, health-related quality of life (HRQoL; EORTC QLQ-C30; EQ-5D-5L) and psychological well-being (21 question version of the Depression, Anxiety and Stress Scale, DASS-21). Outcomes in RoI and NI survivors were compared, stratifying into 'late disease' (stage III/IV and any Gleason grade (GG) at diagnosis) and 'early disease' (stage I/II and GG 2-7). Responses were weighted by age, jurisdiction and time since diagnosis. Between-country differences were investigated using multivariate logistic and linear regression.

Results: 3348 men responded (RoI n=2567; NI n=781; reflecting population sizes, response rate 54%). RoI responders were younger; less often had comorbidities (45% vs 38%); were more likely to present asymptomatically (66%; 41%) or with early disease (56%; 35%); and less often currently used androgen deprivation therapy (ADT; 2%; 28%). Current prevalence of incontinence (16%) and impotence (56% early disease, 67% late disease) did not differ between RoI and NI. In early disease, only current bowel problems (RoI 12%; NI 21%) differed significantly in multivariate analysis. In late disease, NI men reported significantly higher levels of gynaecomastia (23% vs 9%) and hot flashes(41% vs 19%), but when ADT users were analysed separately, differences disappeared. For HRQoL, in multivariate analysis, only pain (early disease: RoI 11.1, NI 19.4) and financial difficulties (late disease: RoI 10.4, NI 7.9) differed significantly between countries. There were no significant between-country differences in DASS-21 or index ED-5D-5L score.

Conclusions: Treatment side effects were commonly reported and increased PCa detection in RoI has left more men with these side effects. We recommended that men be offered a PSA test only after informed discussion.

Keywords: PSA Testing; Patient Reported Outcomes; Prostate Cancer; Survivors.

Conflict of interest statement

LS received an unrestricted grant 2011–2012 from Sanofi-aventis for research into predictors of treatment receipt and survival in prostate cancer.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

References

    1. Mc David K, Lee J, Fulton JP et al. . Prostate cancer incidence and mortality rates and trends in the United States and Canada. Public Health Rep 2004;119:174–86.
    1. Globocan 2012. Estimated cancer incidence, mortality and prevalence worldwide in 2012, International Agency for Research on Cancer. World health organisation; accessed 2016.
    1. Harvey P, Basuita A, Edersby D et al. . A systematic review of the diagnostic accuracy of prostate specific antigen. BMC Urol 2009;9:14 10.1186/1471-2490-9-14
    1. Schröder FH, Hugosson J, Roobol MJ et al. . Screening and prostate cancer mortality: results of the European Randomised Study of Screening for Prostate Cancer (ERSPC) at 13 years of follow-up. Lancet 2014;384:2027–35. 10.1016/S0140-6736(14)60525-0
    1. O'Dowd A. Offer men in 40s access to PSA test. BMJ 2016;352:i1802.
    1. Carsin AE, Drummond FJ, Black A et al. . Impact of PSA testing and prostatic biopsy on cancer incidence and mortality: comparative study between the Republic of Ireland and Northern-Ireland. Cancer Causes Control 2010;21:1523–31. 10.1007/s10552-010-9581-y
    1. O'Brien K, Comber H, Sharp L. Completeness of case ascertainment at the Irish National Cancer Registry. Ir J Med Sci 2014;183:219–24. 10.1007/s11845-013-0993-z
    1. Kearney TM, Donnelly C, Kelly JM et al. . Validation of completeness and accuracy of the Northern Ireland Cancer Registry. Cancer Epidemiol 2015;39:401–44. 10.1016/j.canep.2015.02.005
    1. Drummond FJ, Barrett E, Burns R et al. . The number of tPSA tests continues to rise and variation in testing practice persists: a survey of laboratory services in Ireland 2008_2010. Ir J Med Sci 2014;183:369–75. 10.1007/s11845-013-1022-y
    1. UK national screening committee first report of The National screening committee. London: Department of Health, 2002.
    1. NHS cancer screening programmes. Prostate cancer risk management 2008.
    1. Gavin A, McCarron P, Middleton RJ et al. . Evidence of prostate cancer screening in a UK region. BJU Int 2004;93:730–4. 10.1111/j.1464-410X.2003.04716.x
    1. Drummond FJ, Kinnear H, Donnelly C et al. . Establishing a population-based patient-reported outcomes study (PROMs) using national cancer registries across two jurisdictions; the Prostate Cancer Treatment, your experience (PiCTure) Study. BMJ Open 2015;5:e006851 10.1136/bmjopen-2014-006851
    1. The EuroQol Group. EuroQol-a new facility for the measurement of health-related quality of life. Health Policy 1990;16:199–208.
    1. Aaronson NK, Ahmedzai S, Bergman B et al. . The European Organisation for Research and Treatment of Cancer QLQ-C30: a quality of life instrument for use in international clinical trials in oncology. J Natl Cancer Inst 1993;85:365–76.
    1. .
    1. Lovibond SH, Lovibond PF. Manual for the depression anxiety stress scales. 2nd edn Sydney: Psychology Foundation of Australia, 1995.
    1. Sharp L, O'Leary E, Kinnear H et al. . Cancer-related symptoms predict psychological wellbeing among prostate cancer survivors: results from the PICTure study. Psychooncology 2016;25:282–91. 10.1002/pon.3909
    1. Litwin MS, Pasta DJ, Yu J et al. . Urinary function and bother after radical prostatectomy or radiation for prostate cancer: a longitudinal, multivariate quality of life analysis from the Cancer of the Prostate Strategic Urologic Research Endeavor. J Urol 2000;164:1973–7.
    1. Korfage IJ, Essink-Bot ML, Borsboom GJ et al. . Five-year follow-up of health-related quality of life after primary treatment of localized prostate cancer. Int J Cancer 2005;116:291–6. 10.1002/ijc.21043
    1. Gavin AT, Drummond FJ, Donnelly C et al. . Patient reported “ever had” and “current” long term physical symptoms following prostate cancer treatments. BJU Int 2015;116:397–406. 10.1111/bju.13036
    1. Potosky AL, Legler J, Albertsen PC et al. . Health outcomes after prostatectomy or radiotherapy for prostate cancer: results from the prostate cancer outcomes study. J Natl Cancer Inst 2000;92:1582–92.
    1. Litwin MS, Sadetsky N, Pasta DJ et al. . Bowel function and bother after treatment for early stage prostate cancer: a longitudinal quality of life analysis from CaPSURE. J Urol 2004;172:515–19. 10.1097/01.ju.0000129236.56712.e7
    1. Donnelly DW, Gavin AT, Comber H. Cancer in Ireland 1994–2004. A comprehensive report. Northern Ireland Cancer Registry/National Cancer Registry of Ireland, 2009.
    1. Osoba D, Rodriques G, Myles J et al. . Interpreting the significance of changes in health-related quality of life scores. J Clin Oncol 1998;16:139–44. 10.1200/jco.1998.16.1.139
    1. Sharp L, Timmons A. Pre-diagnosis employment status and financial circumstances predict cancer-related financial stress and strain among breast and prostate cancer survivors Supportive Care in Cancer. Support Care Cancer 2016;24:699–709. 10.1007/s00520-015-2832-4
    1. Sharp L, Carsin AE, Timmons A. Association between cancer related financial stress and strain and psychological wellbeing among individuals living with cancer. Psychooncology 2013;22:745–55. 10.1002/pon.3055

Source: PubMed

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