LOS ANGELES--A survey of men with and without prostate cancer used four different instruments (see below) to get a clear picture of how treatment decisions affect quality of life, and found some surprising results, Mark S. Litwin, MD, MPH, told Oncology News International.
Quality of life should be considered an important medical outcome, on a par with quantity of life, when making treatment decisions in prostate cancer, said Dr. Litwin, of the UCLA School of Medicine. Yet in most studies, outcome measures of various treatments are no more sensitive than "alive versus dead."
Researchers from UCLA and the RAND Corporation measured quality of life in 214 men treated for clinically localized prostate cancer and 273 age-matched controls who had never had prostate cancer diagnosed. The patients were treated with either radical prosta-tectomy (98 patients), external-beam irradiation (56), or observation alone (60). Patients completed a questionnaire at home, without assistance.
Surprisingly, responses to the parts of the survey reflecting general health and well-being showed no differences between patients and controls, Dr. Litwin said (JAMA 273:129-135, 1995). One exception was that observation patients reported greater role limitations due to emotional problems, which may be caused by anxiety and uncertainty concerning the future course of their prostate cancer.
Day-to-Day Life Not Compromised
A cancer-specific questionnaire also showed no differences in general health (excluding sexual function), "implying that the major activities in patients' day-to-day lives are not compromised after prostate cancer therapy, regardless of which treatment is chosen," he said.
However, a prostate-specific instrument revealed significant differences between patients and controls in bowel symptoms, urinary incontinence, and sexual dysfunction. Surgery and radiation patients were worse off functionally than observation or comparison patients. The surprising finding was that many were not very bothered by their dysfunctions.