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
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
"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.
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."