Comprehensive Quality-of-life Outcomes in the Setting of a Multidisciplinary, Equal Access Prostate Cancer Clinic
Comprehensive Quality-of-life Outcomes in the Setting of a Multidisciplinary, Equal Access Prostate Cancer Clinic
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DOI：
10.1016/j.urology.2010.03.087
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发表时间：
2010-11-01
期刊：
影响因子：
2.1
通讯作者：
Brassell, Stephen
中科院分区：
文献类型：
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作者：
Rice, Kevin;Hudak, Jane;Brassell, Stephen
目的确定影响前列腺癌患者治疗选择的种族和人口学因素及其对健康相关生活质量(HRQL)的影响。使用的工具是扩展前列腺癌综合指数(EPIC)、EPIC人口统计学和医学结果研究简表36。治疗前和治疗后每3个月进行一次评估。结果研究组共665例患者。高加索人选择手术(根治性前列腺切除术[RP])的可能性是外照射疗法(EBRT)的3倍。年收入超过10万美元的患者不成比例地选择了RP(P<；.0001)。同样，那些拥有研究生学位的人不成比例地选择了RP(P<；.0001)。接受RP治疗的患者发生排尿功能下降(P<；.0001)和性功能障碍(P=.0003)的风险最大。非裔美国人(AA)无论选择何种治疗方式，尿路功能下降的风险都更大。接受EBRT的患者在12个月时的排尿功能与预期治疗(EM)相同(P<；.0001)。与EM相比，近距离放射治疗是唯一一种增加了尿路障碍减少风险的治疗方法(P=.0217)。与EM相比，单纯EBRT并未显示出明显的性功能减退。结论尽管提供了最大的HRQOL下降风险，但高加索人种患者和收入和教育水平较高的患者选择了RP。EBRT在12个月时对排尿功能、性功能或性障碍评分没有显著影响。EBRT可提供给年龄较大的患者，对HRQOL的影响最小。治疗前的HRQL结果咨询对前列腺癌的整体治疗至关重要。泌尿外科76：1231-1239,2010。由爱思唯尔公司出版。
OBJECTIVES To identify racial and demographic factors that influence treatment choice and its resulting impact on health-related quality of life (HRQoL) for prostate cancer patients.METHODS Patients presenting to an equal access, military, multidisciplinary prostate cancer clinic composed the study group. The Expanded Prostate Cancer Index Composite (EPIC), EPIC Demographic, and Medical Outcomes Study Short Form 36 were the instruments used. Evaluation was performed before treatment and every 3 months after treatment.RESULTS The study group comprised 665 patients. Caucasians were 3-fold more likely to choose surgery (radical prostatectomy [ RP]) over external beam radiation therapy (EBRT). Patients who earned more than $100 000 annually disproportionately chose RP (P < .0001). Similarly, those having a graduate school degree disproportionally chose RP (P < .0001). Patients undergoing RP had the greatest risk of urinary function decline (P < .0001) and sexual bother (P = .0003). African Americans (AA) had a greater risk of urinary function decline irrespective of treatment choice. Patients undergoing EBRT had equivalent urinary function to expectant management (EM) at 12 months (P < .0001). Brachytherapy was the only treatment that posed an increased risk of urinary bother decline when compared with EM (P = .0217). EBRT alone did not show significant decrement in sexual function when compared with EM.CONCLUSIONS RP was chosen by patients of Caucasian ethnicity and patients with higher income and education level, despite providing the greatest risk of HRQoL decline. EBRT had no significant impact on urinary function, sexual function, or sexual bother scores at 12 months. EBRT may be offered to older patients with minimal HRQoL impact. Pretreatment counseling of HRQoL outcomes is essential to overall prostate cancer management. UROLOGY 76: 1231-1239, 2010. Published by Elsevier Inc.