Reassessing the Quality of Life Burden of Prostate Cancer Survivorship

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DESCRIPTION (provided by applicant): Men with non-metastatic prostate cancer live many years with their disease, often coping with long-term consequences of treatment including bowel and urinary incontinence, sexual dysfunction, fatigue and mental and emotional difficulties. The burdens of treatment are often dismissed or downplayed by men who feel fortunate to have found and treated their cancer. Existing measures of quality of life among prostate cancer survivors focus on immediate or partial outcomes and do not address the extent to which men downplay treatment consequences, creating a gap in our knowledge of the true burdens of survivorship. This study proposes to explore the feasibility of willingness-to-pay methods for quantifying the burden of prostate cancer survivorship. The goal of this work is to estimate the integrated probabilities of survivorship - multiple sources of benefit and loss associated with health outcomes - enabling overall outcomes to be assessed. Through a series of dialogues with prostate cancer survivor groups, we will explore relevant domains and introduce survey items for initial feedback. These items will then be tested and validated in a sample of 100 prostate cancer survivors from a prior study of pre-treatment decision making. This sample includes a racially diverse cohort of men who are 2 years out from diagnosis from Washington State, California and South Carolina. This pilot study will lay the foundation for a comprehensive evaluation of quality of life gaining insight into the overall value of prostate cancer screening and treatment and will help establish the PI as a leader in quality of life assessment in prostate cancer. This project will develop a comprehensive instrument to quantify neglected and undervalued burdens of quality of life (QOL) among prostate cancer survivors using economic willingness-to-pay methods. Current estimates of QOL find men report high levels of side effects and burdens yet no diminished QOL, suggesting that existing measures do not account for the psychological consequences of a cancer diagnosis and the hope instilled by aggressive therapies that allow subjects to unconditionally accept the consequences of treatment. This work will explore new methods for evaluating QOL among prostate cancer survivors that more appropriately balance the benefits and burdens of treatment. The results of this study will aid patients, physicians, and policy makers in decisions related to prostate cancer management.