QUALITY-OF-LIFE OUTCOMES IN MEN FOR LOCALIZED PROSTATE-CANCER
QUALITY-OF-LIFE OUTCOMES IN MEN FOR LOCALIZED PROSTATE-CANCER
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DOI：
10.1001/jama.273.2.129
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发表时间：
1995-01-11
影响因子：
120.7
通讯作者：
BROOK, RH
中科院分区：
文献类型：
--
作者：
LITWIN, MS;HAYS, RD;BROOK, RH
客观。-评估临床局限性前列腺癌患者的健康相关生活质量（HRQOL）。临床局限性前列腺腺癌经根治性前列腺切除术、盆腔放疗或单独观察治疗后HRQOL的横断面分析，以及年龄匹配的对照患者。在加利福尼亚州的一个大型管理护理人口。共有528名男性，包括214名接受临床局限性前列腺癌治疗的患者（41名有转移性疾病证据的患者被排除在该分析之外）和273名年龄匹配、ZIP码匹配的无前列腺癌的对照患者。癌症患者分为三个治疗组进行分析：根治性盆腔切除术（n=98），原发性盆腔照射（n=56）和单独观察（n=60）。一般HRQOL采用兰德36项健康调查1.0进行测量。癌症特异性HRQOL用癌症康复评估系统-简表和癌症治疗功能评估-一般形式测量，疾病靶向生活质量用评估三个器官系统的功能和困扰的新仪器测量：性，泌尿和肠道。在一般HRQOL比较中，未观察到治疗组间差异。治疗组间在前列腺靶向性、泌尿和肠道领域的功能和困扰方面存在显著差异。当将癌症患者与年龄相仿的无前列腺癌男性进行比较时，在性、泌尿和肠道功能和困扰方面存在差异，但在一般HRQOL指标方面没有差异。虽然没有癌症的男性被发现没有完全的能力或能力，但接受手术或放射治疗的前列腺癌患者报告的性功能，泌尿功能和bower功能比没有癌症的男性明显更差。谁经历了神经保留脊髓切除术的男性没有从那些谁经历了标准脊髓切除术不同，但检测差异的能力是低的。虽然在总体HRQOL方面没有观察到差异，但发现治疗组和对照患者之间的三个疾病靶向领域存在显著差异。即使在控制了没有癌症的老年男性所经历的性功能和泌尿功能障碍之后，那些接受前列腺癌治疗干预的人也被发现具有较差的疾病靶向HRQOL。我们的结论是，除了一般HRQOL，疾病有针对性的措施，必须用于评估结果的护理男性治疗局限性前列腺癌。
Objective.-To assess health-related quality of life (HRQOL) in men treated for clinically localized prostate cancer.Design.-A cross-sectional analysis of HRQOL after treatment with radical prostatectomy, pelvic irradiation, or observation alone for clinically localized prostatic adenocarcinoma, and in age-matched comparison patients.Setting.-A large managed care population in California.Subjects.-A total of 528 men, including 214 treated for clinically localized prostate cancer (41 with evidence of metastatic disease were excluded from this analysis) and 273 age-matched, ZIP code-matched comparison patients without prostate cancer. Cancer patients were analyzed in three treatment groups: radical prostatectomy (n=98), primary pelvic irradiation (n=56), and observation alone (n=60).Main Outcome Measures.-General HRQOL was measured with the RAND 36-item Health Survey 1.0. Cancer-specific HRQOL was measured with the CAncer Rehabilitation Evaluation System-Short Form and the Functional Assessment of Cancer Therapy-General form, Disease-targeted quality of life was measured with a new instrument assessing function and bother in three organ systems: sexual, urinary, and bowel.Resuls.-No differences among treatment groups were seen in comparisons of general HRQOL. Significant differences among treatment groups were seen in both function and bother in the prostate-targeted measures of sexual, urinary, and bowel domains, When cancer patients were compared with men of similar age without prostate cancer, differences were seen in the sexual, urinary, and bowel function and bother but not in general HRQOL measures. Although cancer-free men were found not to have full potency or continence, prostate cancer patients treated with surgery or radiation reported significantly worse sexual, urinary, and bower function than men without cancer. Men who had undergone nerve-sparing prostatectomy did not differ from those who had undergone standard prostatectomy, but the power to detect a difference was low.Conclusions.-Although no differences were seen in general HRQOL, three disease-targeted domains were found to differ significantly among the treatment groups and comparison patients. Even after controlling for the sexual and urinary dysfunction experienced by older men without cancer, those receiving therapeutic interventions for their prostate cancer were found to have poorer disease-targeted HRQOL. We conclude that in addition to general HRQOL, disease-targeted measures must be used to assess outcomes of care in men treated for localized prostate cancer.