Trajectories of QOL in Prostate Cancer Survivors using Growth Curve Modeling

使用生长曲线模型研究前列腺癌幸存者的生活质量轨迹

• 批准号: 7476125
• 负责人: Michael A Diefenbach
• 金额: $ 17.2万
• 依托单位: ICAHN SCHOOL OF MEDICINE AT MOUNT SINAI
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-05-01 至 2010-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7476125
• 关键词: Accounting; Address; Adverse effects; Affect; Affective; Age; Analysis of Variance; Anxiety; Area; Behavioral Research; Cancer Control; Cancer Patient; Cancer Survivor; Cancer Survivorship; Characteristics; Clinical; Consultations; Cross-Sectional Studies; Data; Data Set; Development; Diagnosis; Diagnostic; Disease; Doctor of Philosophy; Drops; Emotional; Exhibits; Fatigue; Feeling; Functional disorder; Gleason Grade for Prostate Cancer; Goals; Grant; Group Identifications; Growth; Health Personnel; Individual; Individual Differences; Intercept; Interdisciplinary Study; Intervention; Intestines; Investigation; Knowledge; Lead; Literature; Living Wills; Localized; Localized Disease; Malignant neoplasm of prostate; Marital Status; Masks; Measures; Mental Depression; Methodology; Methods; Modeling; Moods; Multivariate Analysis; Pain; Parents; Patients; Persons; Physicians; Population; Principal Investigator; Process; Prostatectomy; Psychologist; Public Health; Quality of life; Recovery; Regrets; Research; Review Literature; Risk; Score; Sex Functioning; Sexual Dysfunction; Shapes; Subgroup; Symptoms; Techniques; Thinking; Time; Treatment outcome; Urologist; base; cancer therapy; clinically significant; cognitive function; cost; experience; ideation; man; negative mood; programs; psychologic; research clinical testing; response; social; therapy design; urinary

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.

描述：本提案是对 PA-04-034“癌症控制行为研究探索性拨款”的回应。我们建议将生长曲线分析（GCA）应用于现有数据集，对诊断为局限性前列腺癌的患者的疾病特异性和一般生活质量（QOL）领域以及心理功能进行纵向评估。与传统的多变量方法相比，GCA 提供了一种更好的方法来检查个体变化， 探索变化的相关性，并发现变化过程中的群体差异。 GCA 将确定泌尿和性功能、一般生活质量和心理反应随时间的变化轨迹。这些功能轨迹将非常接近患者治疗后的实际体验。临床医生可以使用此类信息，让患者切实做好应对可能的治疗相关副作用的准备，包括此类副作用可能发生或消退的时间范围。最终，结果可用于识别存在功能障碍风险的患者，然后针对这些患者进行准备干预。三年数据集（基线时 N = 986；36 个月时 n = 664；保留率为 67.3%）包括泌尿和性功能、一般生活质量 (FACT-P) 的六项评估以及对抑郁、焦虑、消极情绪以及侵入性和回避观念的广泛评估。将使用敏感性分析和插补方法来解决由于患者退出和数据缺失而导致的数据潜在偏差。具体目标是： 1) 量化前列腺癌幸存者 36 个月内泌尿和性功能、生活质量和心理功能的个体变化轨迹； 2）检查这些轨迹如何与时间不变因素（例如接受的治疗、格里森评分、年龄）相关； 3）检查性和泌尿功能的变化轨迹如何与生活质量和心理功能的变化轨迹相关； 4) 识别性功能和泌尿功能相似轨迹的患者亚组。我们假设 1) 随着时间的推移，泌尿和性功能障碍将与较低水平的总体生活质量和心理功能相关； 2) 患者亚组 具有相似功能轨迹的个体表现出不同的特征或特征，以临床（即泌尿和性功能）和心理功能（即抑郁、侵入性和回避观念）为特征。拟议的研究在两个方面具有临床意义：1）确定功能轨迹为医疗保健提供者提供了关于泌尿和性症状如何随着时间的推移而发展的新信息； 2) 具有相似人口统计学、临床和心理特征的亚组可能是干预措施的目标，旨在帮助患者做好预见治疗相关副作用的准备。公共健康相关性：拟议的项目对公共健康具有重要意义，主要有四个原因：1）检查前列腺癌患者随时间的推移症状经历和生活质量的轨迹是一个尚未探索的领域。 2) 临床医生可以利用从分析中获得的信息，让患者切实做好准备，应对可能出现的治疗相关副作用，包括此类副作用可能发生或消退的时间范围。 3) 结果可用于识别可能存在功能障碍风险的患者，随后可能成为准备干预的目标。 4) 所提出的分析使用来自现有数据集的数据，从而使该应用程序成为获取新信息和知识的具有成本效益的方法。