Patient-reported Outcomes Following Treatment of Localised Prostate Cancer and Their Association with Regret About Treatment Choices
Patient-reported Outcomes Following Treatment of Localised Prostate Cancer and Their Association with Regret About Treatment Choices
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DOI：
10.1016/j.euo.2018.12.004
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发表时间：
2020-02-01
影响因子：
8.2
通讯作者：
van der Poel, Henk G.
中科院分区：
文献类型：
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作者：
van Stam, Marie-Anne;Aaronson, Neil K.;van der Poel, Henk G.
背景资料：对于帮助局限性前列腺癌（LPC）患者在可用的治疗方案中进行选择而言，有充分记录的患者不同治疗经验的报告非常重要。目的：记录根治性乳腺癌切除术（RP）、外射束放疗（EBRT）、近距离放射治疗（BT）和主动监测（AS）后患者报告结局（PRO）的差异，并评估这些PRO和其他因素如何与治疗决定后悔相关。设计、设置和参与者：一项对诊断为LPC的男性的前瞻性、观察性、多中心研究（cT 1 -2阶段）。结局测量和统计分析：完成经验证PRO指标的患者（生活质量问卷核心30 [QLQ-C30]，生活质量问卷前列腺癌特异性模块[QLQ-PR 25]，决策后悔量表，和前列腺癌记忆焦虑量表）。混合效应模型被用来描述不同的PRO patterns.Results和局限性：分析队列包括434名男性（AS = 32%; RP = 45%; EBRT = 12%; BT = 10%）。随访应答率在90%以上。在1年的随访中，（1）接受RP的男性报告显著（p < 0.01）尿失禁、性功能障碍、激素/男性气质相关症状更多，情绪困扰较少;（2）接受EBRT的患者报告性功能障碍、激素/男性气质相关症状和身体困扰更多;（3）BT组患者的尿路梗阻和刺激症状较AS组多。不考虑治疗方式，23%的患者报告了临床相关的治疗后悔（99%置信区间，17-28%）。决定后悔的多变量相关因素包括荷尔蒙/男性相关症状、教育水平和手术切缘阳性。结论：治疗后身体和心理社会功能与特定治疗方式和治疗前功能显着相关。后悔是相对频繁的患者经历了不必要的身体，心理和肿瘤的结果。应作出更大的努力，以了解是否仔细教育患者的可能后果和有效性的治疗可能有助于限制治疗regret.Patient摘要的感觉：在男性与局限性前列腺癌，后悔的治疗选择是更常见的那些谁经历了更多的治疗相关的症状在治疗后的一年。(C)2018年欧洲泌尿外科协会。Elsevier B. V.出版，保留所有权利。
Background: Well-documented reports of patients' experiences with different treatments are important for helping localised prostate cancer (LPC) patients choose among the available treatment options.Objective: To document differences in patient-reported outcomes (PROs) following radical prostatectomy (RP), external beam radiotherapy (EBRT), brachytherapy (BT), and active surveillance (AS), and to evaluate how these PROs and other factors are associated with treatment decision regret.Design, setting, and participants: A prospective, observational, multicentre study of men diagnosed with LPC (stage cT1-2) during 2014-2016.Outcome measurements and statistical analysis: Patients completed validated PRO measures (Quality of Life Questionnaire Core 30 [QLQ-C30], Quality of Life Questionnaire prostate cancer-specific module [QLQ-PR25], Decision Regret Scale, and the Memorial Anxiety Scale for Prostate Cancer) before treatment and at 3, 6, and 12 mo after treatment. Mixed-effect models were used to describe different PRO patterns.Results and limitations: The analytic cohort included 434 men (AS = 32%; RP = 45%; EBRT = 12%; BT = 10%). Follow-up response rates were above 90%. At 1-yr follow-up, (1) men who had received RP reported significantly (p < 0.01) more urinary incontinence, sexual dysfunction, hormonal/masculinity-related symptoms, and less emotional distress; (2) those having received EBRT reported more sexual dysfunction, hormonal/masculinity-related symptoms, and physical distress; and (3) those having received BT reported more urinary obstruction and irritation symptoms, compared with patients under AS. Irrespective of the treatment modality, 23% of the patients reported clinically relevant treatment regret (99% confidence interval, 17-28%). Multivariate correlates of decision regret were hormonal/masculinity-related symptoms, educational level, and positive surgical margins.Conclusions: Post-treatment physical and psychosocial functioning was significantly associated with specific treatment modalities and pretreatment functioning. Regret was relatively frequently reported by patients who experienced unwanted physical, psychosocial, and oncological outcomes. Greater efforts should be made to understand whether carefully educating patients about the possible consequences and effectiveness of treatments may help limit the feeling of treatment regret.Patient summary: In men with localised prostate cancer, regret about the treatment choice was more common among those who experienced more treatment-related symptoms during the year after treatment. (C) 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.