Trajectories of QOL in Prostate Cancer Survivors using Growth Curve Modeling

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DESCRIPTION: This proposal is in response to PA-04-034 "Exploratory Grants for Behavioral Research in Cancer Control." We propose to apply Growth Curve Analyses (GCA) to an existing dataset with longitudinal assessments of disease-specific and general quality of life (QOL) domains and psychological functioning of patients diagnosed with localized prostate cancer. Compared to a conventional multivariate approach, GCA provides a better way to examine individual change, explore correlates of change, and detect group differences in the process of change. GCA will identify trajectories of urinary and sexual functioning, general QOL, and psychological responses over time. These trajectories of functioning will provide a close approximation of a patient's actual experience following treatment. Such information can be used by clinicians to realistically prepare patients for possible treatment related side-effects including the timeframe when such side-effects might occur or subside. Ultimately, results can be used to identify at-risk patients for dysfunction, who then can be targeted for preparatory interventions. The three-year data set (N = 986 at baseline; n = 664 at 36 months; 67.3% retention) consists of six assessments of urinary and sexual functioning, general QOL(FACT-P) and extensive assessments of depression, anxiety, negative moods, and intrusive and avoidant ideation. Sensitivity analyses and imputation methods will be used to address potential biases in the data due to patient drop-out and missing data. The specific aims are: 1) To quantify trajectories of individual change in urinary and sexual functioning, QOL, and psychological functioning among prostate cancer survivors over 36 months; 2) to examine how these trajectories correlate with time invariant factors (e.g., treatment received, Gleason score, age); 3) to examine how trajectories of change in sexual and urinary function are associated with trajectories of change in QOL and psychological functioning; 4) to identify subgroups of patients with similar trajectories of sexual and urinary functioning. We hypothesize 1) that urinary and sexual dysfunction will be associated with lower levels of general QOL and psychological functioning over time; and 2) that subgroups of patients with similar trajectories of functioning exhibit distinct profiles or signatures characterized by clinical (i.e., urinary and sexual functioning) and psychological functioning (i.e., depression, intrusive and avoidant ideation). The proposed research is clinically significant in two ways: 1) identifying trajectories of functioning provides new information to health care providers of how urinary and sexual symptoms might develop over time; and 2) subgroups with similar demographic, clinical, and psychological profiles might be targets for interventions designed to prepare patients to anticipate treatment related side effects. PUBLIC HEALTH RELEVANCE: The proposed project is significant to public health for four main reasons: 1) The examination of trajectories of symptom experience and quality of life over time among prostate cancer patients is an unexplored area. 2) The information gained from the analyses can be used by clinicians to realistically prepare patients for possible treatment related side-effects including the time frame when such side-effects might occur or subside. 3) Results can be used to identify patients who might be at risk for dysfunction, who subsequently might be targeted for preparatory interventions. 4) The proposed analyses use data from an already existing data set, thus making this application a cost-effective approach to obtain new information and knowledge.