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When Antiandrogens Work, Patients Have Normal Quality of Life

When Antiandrogens Work, Patients Have Normal Quality of Life

FARMINGTON, Conn--Men with advanced prostate cancer who are in remission while on treatment with an LHRH agonist and flutamide (Eulexin) have a quality of life (QOL) that is similar to an equivalent norm for a matched population of US men without prostate cancer, say Peter C. Albertsen, MD, and his colleagues from Connecticut, Am-sterdam, and Boston.

These men in remission had a significantly better quality of life than prostate cancer patients who were no longer responding to antiandrogen therapy.

Dr. Albertsen, of the Division of Urology, University of Connecticut Health Center, says that issues surrounding health-related quality of life "have become more relevant as our society faces the mounting pressure of health care cost containment."

Health care payers are increasingly reluctant to pay for interventions that have not been shown to lead to patient improvement, Dr. Albertsen notes, and patients themselves are more likely to demand quantitative evidence of treatment efficacy.

The Connecticut study, funded by Schering-Plough, included 113 patients with stage D2 prostate cancer (60 in remission and 53 with disease progression).

Patients were administered the EORTC Quality of Life Questionniare-C30 (a cancer-specific instrument); the more general Medical Outcomes Study Short Form Health Survey SF-36; and a prostate cancer-specific module developed specifically for the project.

Analysis of the EORTC and prostate cancer-specific module showed that patients in remission had a significantly higher overall quality of life than patients with disease progression. Patients in remission had a significantly higher level of physical function, and had less fatigue, pain, appetite loss, and weight gain (Urology 49:207-217, 1997).

Results of the SF-36 scale were similar: Patients in remission had significantly higher levels of vitality, social functioning, and mental health, and suffered less pain.

"Among patients who respond to total androgen ablation, flutamide and an LHRH agonist provide meaningful benefits to recipients independent of any possible improvement in longevity," Dr. Albertsen concluded.

Editorial Comment

In an editorial comment, Michael O. Koch, MD, of Vanderbilt University, noted that the study findings "are highly predictable," ie, patients who are responding to therapy have a better quality of life than those who are not.

Dr. Koch pointed out that some of the differences in quality of life seen in this study may be due to the more extensive disease volume in those with androgen-insensitive disease. However, a separate analysis of patients with minimal versus extensive disease found that "a significant difference still exists in those patients who are responding to therapy as compared with those patients who are not responding to therapy."

Dr. Koch cautioned that the study lacked a control arm and cannot be used to make any conclusions about the efficacy of androgen ablation with LHRH agonists and flutamide, "other than to say that when maximal androgen ablation does work, patients appear to have a normal quality of life, as measured by the tools used in this study."

He went on to call the article "very important," since it shows that by using several different quality of life instruments, very significant differences in quality of life can be demonstrated, "giving us new tools to measure treatment effectiveness."

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