Individualizing Quality-of-Life Outcomes Reporting: How Localized Prostate Cancer Treatments Affect Patients With Different Levels of Baseline Urinary, Bowel, and Sexual Function
Individualizing Quality-of-Life Outcomes Reporting: How Localized Prostate Cancer Treatments Affect Patients With Different Levels of Baseline Urinary, Bowel, and Sexual Function
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DOI：
10.1200/jco.2008.18.6486
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发表时间：
2009-08-20
影响因子：
45.3
通讯作者：
Talcott, James A.
中科院分区：
文献类型：
--
作者：
Chen, Ronald C.;Clark, Jack A.;Talcott, James A.
尽管它是早期前列腺癌治疗相关并发症和生活质量(QOL)结果的最有力的预测因子，但大多数研究并没有根据基线功能对结果进行分层。此外，将功能结果报告为平均数值结果可能会掩盖信息上不同的过程。使用与治疗相关的功能障碍水平，我们解决了这些问题，并展示了我们对早期前列腺癌患者进行的前瞻性队列研究的最终生活质量结果。方法我们创建性功能、肠道功能和尿路功能的类别，使用经验证的前列腺癌症状指数的数字分数来衡量，并通过结合患者报告的症状和痛苦信息将其分层为“正常”、“中等”和“较差”的功能水平。我们报告了409名患者在根治性前列腺切除术、外照射和近距离放射治疗36个月后的生活质量结果。结果从基线到36个月，不同的基准性、肠道和尿路功能水平导致了与治疗相关的显著变化。总体而言，在基线功能正常的患者中，功能障碍的平均量表增幅最大，尽管基线功能正常和中等基线功能的患者在性功能障碍方面的增幅相似。对于基线尿路梗阻/刺激较差的患者，平均量表评分和大多数患者的功能水平在治疗后都有所改善，尤其是在手术后。结论使用功能水平根据治疗前的功能状态对与治疗相关的结果进行分层，并显示治疗后功能改善、稳定或恶化的患者的比例，为前列腺癌局部治疗方案的选择提供了更具体的信息。
PurposeAlthough it is the most powerful predictor of early prostate cancer treatment-related complications and quality-of-life (QOL) outcomes, most studies do not stratify results by baseline function. Further, reporting functional outcomes as averaged numerical results may obscure informatively disparate courses. Using levels of treatment-related dysfunction, we address these problems and present the final QOL outcomes of our prospective cohort study of patients with early prostate cancer.MethodsWe created categories for sexual, bowel, and urinary function, measured using numerical scores of the validated Prostate Cancer Symptom Indices and stratified into "normal," "intermediate" and "poor" levels of function by incorporating patient-reported symptom and distress information. We present QOL outcomes for 409 patients 36 months after radical prostatectomy, external-beam radiation therapy, and brachytherapy.ResultsDifferent levels of baseline sexual, bowel, and urinary function produced distinctive treatment-related changes from baseline to 36 months. In general, the average scale increases in dysfunction were greatest among patients with normal baseline function, although patients with normal and intermediate baseline function had similar increases in sexual dysfunction. For patients whose baseline urinary obstruction/irritation was poor, both average scale scores and most patients' level of function improved after treatment, particularly after surgery.ConclusionThe use of functional levels to stratify treatment-related outcomes by pretreatment functional status and to display the proportions of patients with improved, stable, or worsened function after treatment provides information that more specifically conveys the expected impact of treatment to patients choosing among localized prostate cancer treatments.