Trajectories of QOL in Prostate Cancer Survivors using Growth Curve Modeling

描述：这项建议是对PA-04-034“癌症控制行为研究的探索性资助”的响应。我们建议将生长曲线分析(GCA)应用于现有的数据集，对被诊断为局限性前列腺癌的患者的特定疾病和一般生活质量(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提供了一种检验个体变化的更好的方法， 探索变化的相关性，并检测变化过程中的群体差异。GCA将确定随时间推移的尿路和性功能、一般生活质量和心理反应的轨迹。这些功能轨迹将提供与患者在治疗后的实际体验非常接近的情况。临床医生可以使用这些信息来切实地让患者为可能的治疗相关副作用做好准备，包括这些副作用可能发生或消退的时间框架。最终，结果可以用来识别有功能障碍的高危患者，然后他们可以成为准备干预的目标。为期三年的数据集(基线时N=986；36个月时n=664；保留率67.3%)包括6项尿性功能评估、一般生活质量(FACT-P)以及对抑郁、焦虑、负面情绪、侵入性和回避性思维的广泛评估。将使用敏感性分析和归罪方法来解决由于患者遗漏和丢失数据而导致的数据中的潜在偏差。具体目标是：1)量化前列腺癌幸存者36个月的尿性功能、生活质量和心理功能的个体变化轨迹；2)检查这些轨迹与时间不变因素(例如，接受的治疗、格里森评分、年龄)之间的关系；3)检验性功能和尿路功能的变化轨迹与生活质量和心理功能的变化轨迹之间的关系；4)确定具有相似的性功能和尿路功能轨迹的患者亚群。我们假设1)随着时间的推移，尿液和性功能障碍将与一般生活质量和心理功能水平降低相关；2)患者亚组 类似的功能轨迹表现出不同的特征或特征，表现为临床功能(即尿路和性功能)和心理功能(即抑郁、侵入性和回避性意念)。这项拟议的研究在两个方面具有临床意义：1)识别功能轨迹为卫生保健提供者提供了有关尿路和性症状如何随时间发展的新信息；2)具有相似人口统计、临床和心理特征的亚组可能成为干预措施的目标，旨在为患者预期治疗相关的副作用做好准备。公共卫生相关性：拟议的项目对公共卫生具有重要意义，主要有四个原因：1)前列腺癌患者症状、经验和生活质量随时间的轨迹检查是一个未被探索的领域。2)从分析中获得的信息可以被临床医生用来实际地为患者准备好应对可能的治疗相关副作用，包括这些副作用可能发生或消退的时间框架。3)结果可以用来确定哪些患者可能有功能障碍的风险，这些患者随后可能成为预备干预的目标。4)拟议的分析使用来自现有数据集的数据，从而使这一应用成为获得新信息和知识的一种具有成本效益的方法。

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.