Downing A, et al. - In men with all stages of prostate cancer, researchers assessed population-wide functional outcomes and health-related quality of life (HRQOL) as well as suggestions for health-care delivery. They found that HRQOL outcomes were not substantially different between men diagnosed with advanced disease vs those diagnosed with localized disease, though men treated with androgen deprivation therapy had substantial problems with hormonal function and fatigue. Participants were commonly found to have sexual dysfunction and helpful intervention or support was not offered to most. A need for service improvements around sexual rehabilitation and measures to reduce the effects of androgen deprivation therapy was seen.

Methods

• In this population-based study, cancer registration data was used to identify men in the UK living 18–42 months after diagnosis of prostate cancer.
• Using validated measures to assess functional outcomes (urinary incontinence, urinary irritation and obstruction, bowel, sexual, and vitality and hormonal function), a postal survey was administered.
• Assessments were made using the Expanded Prostate Cancer Index Composite short form (EPIC-26), plus questions about use of interventions for sexual dysfunction and generic HRQOL (assessed with the 5-level EuroQol five dimensions questionnaire [EQ-5D-5L] measuring mobility, self-care, usual activities, pain or discomfort, and anxiety or depression, plus a rating of self-assessed health).
• Comparisons were made for functional outcomes and HRQOL across diagnostic stages and self-reported treatment groups by using log-linear and binary logistic regression models.
• Adjustment for age, socioeconomic deprivation, and number of other long-term conditions were included in each model.

Results

• Out of overall 58,930 participants, 35,823 (60.8%) men responded to the survey.
• For 30,733 (85.8%) out of 35,823 men, disease stage was recognized; 19,599 (63.8%), 7,209 (23.4%), and 3,925 (12.8%) had stage I or II, stage III, and stage IV disease, respectively.
• Good function was demonstrated by high mean adjusted EPIC-26 domain scores, except for sexual function, for which scores were much lower.
• Compared with men who did not receive androgen deprivation therapy, moderate to big problems with hot flushes (30.7% [95% CI 29.8–31.6]vs 5.4% [5.0–5.8]), low energy (29.4% [95% CI 28.6–30.3] vs 14.7% [14.2–15.3]), and weight gain (22.5%, 21.7–23.3) vs 6.9% [6.5–7.3]) were reported more by men who received the therapy.
• Irrespective of stage, poor sexual function was commonly reported (81.0%; 95% CI 80.6–81.5); no intervention was offered to more than half of men (n=18,782 [55.8%]) to help with this condition.
• Men with stage I–III disease demonstrated similar self-assessed health, it was slightly attenuated in those with stage IV cancer but no problems on any EQ-5D dimension was reported by 23.5% of men with metastatic disease.