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Quality of life and side effects in patients with localized prostate cancer: evaluation with self-assessment questionnaires
Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
2000 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Localized prostate cancer (LPC) is predominantly a tumor among older men, and few patients will get symptoms from the disease. All methods to treat LPC with a curative intent have different types and degrees of side effects. It is therefore very important to evaluate the side effects thoroughly to make sure that treatment complications will not decrease the quality of life more than the disease would have done. In search for new and better treatments, complications has to be registered and evaluated in relation to quality of life (QOL) for the patients. Few validated self-assessment questionnaires for evaluation of external radiotherapy (EBRT) induced side effects has yet been developed. The present project focus on the development of the PC-specific questionnaire, QUFW94, and evaluation of symptoms in patients treated with EBRT and un-treated (watchful waiting) patients with a LPC.

In the newly developed LPC-specific questionnaire a reliability and responsiveness test was performed. Both the inter-rater test and the test-retest show high correlation coefficients (ICC), above 0.60 for all scales. The internal reliability exceeded the lower acceptable limit (Cronbach a >0.70). The questionnaire was proven to be valid for the evaluations of EBRT side effects in LPC patients.

Late side effects were evaluated 4 years after treatment in 181 LPC patients, treated with conventional large field EBRT, and compared with 141 age-matched PC disease free men. The most prominent urinary side effects were urgency and leakage which were doubled in the patient group. A ten fold increase was seen in comparison to controls at the most prominent intestinal problems, blood, mucus and leakage. The results support the use 3-D conformai therapy to decrease irradiation dose to the rectum and the bladder and thereby decreased side effects. A prospective additional evaluation 8 years after EBRT did not show any changes in urinary problems between 4 and 8-yr follow-up in the patients or the controls.

EBRT of LPC is also accompanied by disturbances in sexual function. These problems were therefore evaluated, 4 years after EBRT, in relation to the function in PC free men. Patients treated with EBRT indicated higher levels of sexual dysfunction than age-matched controls. No erection was reported from 12% of the control subjects, 56% of the patients who had only received radiotherapy (RT) and 87% of the RT+castration (RT+A) patients. The extended evaluation 8 years after EBRT show similar sexual function in all groups.

QOL and late side effects/symptoms were evaluated in the first and only randomized trial between RT and deferred treatment (DT) and compared to age-matched controls. QOL was evaluated with the general QOL formula, EORTC's QLQ-C30 (+3), and LPC specific side effects with QUFW94 in 108 randomized patients with LPC 3 years after diagnosis. Social functioning was the only QOL scale where a significant difference was found between the two patient groups and in comparison with the control group. Multivariate regression analysis showed that hematuria, incontinence, mucus, and planning of the daily activities due to intestinal problems caused this decrease in QOL in the RT group. In conclusion, the LPC specific QUFW94 questionnaire was proven to be valid for evaluation of side effects and showed increased intestinal problems in the patients treated with conventional large field EBRT in comparison to untreated LPC patients. No difference in urinary and intestinal late side effects or sexual function was seen between a 4 year vs. 8 year follow-up.

Place, publisher, year, edition, pages
Umeå: Umeå universitet , 2000. , 70 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 701
Keyword [en]
prostate cancer, radiotherapy, complications, self assessment, questionnaires, validation, deferred treatment, quality of life
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:umu:diva-66906ISBN: 91-7191-924-4 (print)OAI: oai:DiVA.org:umu-66906DiVA: diva2:610503
Public defence
2000-11-24, Norrlands universitetssjukhus, byggnad 7, sal 244, Umeå universitet, Umeå, 10:00
Opponent
Projects
digitalisering@umu
Available from: 2013-03-11 Created: 2013-03-06 Last updated: 2013-03-11Bibliographically approved
List of papers
1. Reliability and responsiveness of a prostate cancer questionnaire for radiotherapy-induced side effects
Open this publication in new window or tab >>Reliability and responsiveness of a prostate cancer questionnaire for radiotherapy-induced side effects
2001 (English)In: Supportive Care in Cancer, ISSN 0941-4355, E-ISSN 1433-7339, Vol. 9, no 3, 187-198 p.Article in journal (Refereed) Published
Abstract [en]

Few self-assessment cancer-specific questionnaires / modules have yet been developed for radiotherapy-induced side effects. The aim of the present study was to test the reliability and responsiveness of a prostate cancer (PC)specific questionnaire. Thirty-one patients with PC graded their urinary and intestinal symptoms and their sexual function on the questionnaire. A doctor and a nurse performed a structured interview and graded the patient's symptoms with the same questions. The procedure was performed at both the start and the end of the treatment. A high concordance regarding symptom detection was seen between the patient, nurse and the doctor. The inter-rater test shows intraclass correlation coefficient (ICC) values above 0.60 in all scales. The internal reliability exceeded the lower limit (Cronbach alpha > 0.70) for all scales. The test-retest gave acceptable reliability for all scales (ICC greater than or equal to 0.60). All scales indicated increased problems during radiotherapy. The questionnaire was proven to be valid for the evaluations of urinary and intestinal problems and for sexual function in PC patients.

Place, publisher, year, edition, pages
Springer, 2001
Keyword
prostatic cancer, questionnaire, self-assessment, reliability, responsiveness
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-66902 (URN)10.1007/s005200000146 (DOI)000168843700008 ()
Projects
digitalisering@umu
Available from: 2013-03-11 Created: 2013-03-06 Last updated: 2017-12-06Bibliographically approved
2. Self-assessment questionnaire for evaluating urinary and intestinal late side effects after pelvic radiotherapy in patients with prostate cancer compared with an age-matched control population
Open this publication in new window or tab >>Self-assessment questionnaire for evaluating urinary and intestinal late side effects after pelvic radiotherapy in patients with prostate cancer compared with an age-matched control population
1994 (English)In: Cancer, ISSN 1097-0142, Vol. 74, no 9, 2520-2532 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Pelvic irradiation to patients with prostate cancer is accompanied by urinary and intestinal reactions. In men older than 60 years, treatment-induced problems should be evaluated in relation to problems in an age-matched nonirradiated population.

METHODS: In the present study, problems in the urinary tract and intestine were evaluated with a self-assessment questionnaire using the linear-analogue scale. The questionnaire was mailed out to 200 patients and to an age-matched population 24-56 months after irradiation.

RESULTS: Twenty-five percent of the control group and 50% of the patient group reported some kind of problem in the urinary tract. The most common urinary problems in the control group and in the patient group, respectively, were urgency (19 and 42%), starting problems (22 and 33%), and leakage (11 and 32%). In the control and patient groups, 14 and 59%, respectively, reported some kind of gastrointestinal problems. The most common intestinal problems in the control and patient groups were respectively, mucus (4 and 38%), cramp (5 and 14%), leakage (2 and 27%), and blood (2 and 36%). Ninety percent of the patients' problems were minor.

CONCLUSION: Pelvic irradiation induced a relatively large number of minor problems, evaluated with a self-assessment questionnaire and compared with an age-matched population of men, of approximately similar magnitude as with a physician's systematic evaluation. The most important urinary factors were urgency and leakage. The most important intestinal factors were blood, mucus, and leakage. The results support the ongoing efforts to use 3-D computed tomography-based conformal therapy to decrease irradiation dose to the rectum and bladder.

National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-67024 (URN)10.1002/1097-0142(19941101)74:9<2520::AID-CNCR2820740921>3.0.CO;2-Q (DOI)7923010 (PubMedID)
Projects
digitalisering@umu
Available from: 2013-03-11 Created: 2013-03-11 Last updated: 2013-04-17Bibliographically approved
3. Self-assessed sexual function after pelvic irradiation for prostate carcinoma: Comparison with an age-matched control group
Open this publication in new window or tab >>Self-assessed sexual function after pelvic irradiation for prostate carcinoma: Comparison with an age-matched control group
1996 (English)In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 78, no 5, 1066-1078 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND. Treatment of localized prostate carcinoma is often accompanied by disturbances in sexual function. The patient's own opinion and experience with these problems can be of great importance for his quality of life. In men older than 50 years, disturbances in sexual function are common. Treatment such as radiotherapy (RT), which can induce sexual dysfunction, should be evaluated in relation to the problems in an age-matched population without prostate carcinoma. METHODS. Sexual function was evaluated with a self-assessment questionnaire using linear-analogue scales. The questionnaire was sent to 199 patients with prostate carcinoma, median age 71 years (range, 51-86 years), who had received pelvic RT with curative intent and to 200 age-matched men in northern Sweden. Mean follow-up time after RT was 48 months (range, 24-56 months). RESULTS. The response rate was high: 141 (71%) and 181 (91%) in the control and patient groups, respectively. Field reduction and treatment pause during RT was not associated with decreased problems in the patient groups. A failure to achieve erection was indicated in 12% of the control subjects, 56% of the patients who had received (RT only) and 87% of the RT + castration (RT + A) patients. In general, patients < 70 years treated with RT + A indicated more sexual problems than the RT only patients < 70 years. There was a strong negative correlation between age and sexual problems in the RT 9 A < 70 years group. However, in patients < 70 years, sexual activity after RT only, was not significantly different from the age-matched control population. CONCLUSIONS. Patients with prostate carcinoma treated with RT only indicated higher levels of sexual dysfunction than age-matched controls. This was most obvious in patients younger than 70 years, although their sexual activity was comparable to age-matched controls. The addition of castration to RT tended to increase sexual problems, especially in patients < 70 years. In men between 70 and 74 years, the maintenance of sexual function seems to be very susceptible to disturbances. For patients older than 74 years, decreased sexual function was not perceived as such a significant problem, despite abolished desire and erection. (C) 1996 American Cancer Society.

Place, publisher, year, edition, pages
John Wiley & Sons, 1996
Keyword
prostate carcinoma, irradiation, complications, sexual function, self-assessment, questionnaire, control group
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-66904 (URN)10.1002/(SICI)1097-0142(19960901)78:5<1066::AID-CNCR17>3.0.CO;2-0 (DOI)A1996VD62400017 ()
Projects
digitalisering@umu
Available from: 2013-03-11 Created: 2013-03-06 Last updated: 2017-12-06Bibliographically approved
4. Late side effects unchanged 4-8 years after radiotherapy for prostate carcinoma: A comparison with age-matched controls
Open this publication in new window or tab >>Late side effects unchanged 4-8 years after radiotherapy for prostate carcinoma: A comparison with age-matched controls
1999 (English)In: Cancer, ISSN 0008-543X, E-ISSN 1097-0142, Vol. 85, no 3, 678-688 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND. The authors of this study previously evaluated pelvic irradiation-induced late side effects in patients with localized prostatic carcinoma 4 years after external irradiation by administering a validated self-assessment questionnaire (QUFW94), and compared the results with those of age-matched controls. The current study was designed to evaluate prospectively the patients' problems 8 years after radiotherapy and to compare them with those reported by the same controls. METHODS. The questionnaire was sent out at a mean of 8 years (range, 72-104 months) after irradiation to 120 patients and 125 controls. For analysis of sexual function, the patient group was divided into two subgroups, one treated with radiotherapy only (RT) and one group treated with radiotherapy plus castration (RT+A). A value of >1 on a 0-10 scale indicated that the patient was having a problem. RESULTS, The mean age was 73 years for both patients and controls. No changes in urinary problems were seen between the 4-year and the 8-year follow-up in the 2 groups. Sixty percent and 54% of the patients (P = 0.096) and 24% and 31% of the controls (P = 0.988) reported urinary problems at the 4-year and 8-year follow-ups, respectively. No changes in gastrointestinal late side effects in the patient group were seen between the 4-year (65%) and the 8-year (62%) follow-ups (P = 0.490). However, there was a decrease in intestinal problems in the control group between the 4-year (12%) and the 8-year (9%) follow-ups (P = 0.001). The sexual problems did not change during the two periods, in the patient groups or in the control groups. Fifty-six percent and 65% of the RT group (P = 0.052), 67% and 54% of the RT + A group (P = 0.555), and 27% and 33% of the control group (P = 0.243) indicated some kind of sexual problem at the 4-year and 8-year follow-ups, respectively. CONCLUSIONS. The amount of pelvic irradiation-induced urinary late side effects, intestinal late side effects, and sexual function, evaluated with a self-assessment questionnaire, did not change between 4 and 8 years after RT. The age-matched controls reported no change in urinary or sexual problems despite advanced age, but there was a reported decrease in intestinal problems, Cancer 1999;85:678-88. (C) 1999 American Cancer Society.

Place, publisher, year, edition, pages
John Wiley & Sons, 1999
National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-66903 (URN)10.1002/(SICI)1097-0142(19990201)85:3<678::AID-CNCR18>3.0.CO;2-E (DOI)000078390100018 ()
Projects
digitalisering@umu
Available from: 2013-03-11 Created: 2013-03-06 Last updated: 2017-12-06Bibliographically approved
5. Quality of life and symptoms in a randomized trial of radiotherapy versus deferred treatment of localized prostate carcinoma
Open this publication in new window or tab >>Quality of life and symptoms in a randomized trial of radiotherapy versus deferred treatment of localized prostate carcinoma
Show others...
2001 (English)In: Cancer, ISSN 0918-1989, Vol. 92, no 12, 3111-3119 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Treatment of localized prostate carcinoma (LPC) using radiotherapy (RT) can induce disturbances in a patient's quality of life (QOL) and urinary and intestinal function. Late symptoms and QOL were evaluated in a randomized trial between RT and deferred treatment (DT).

METHODS: Quality of life was evaluated with European Organization for Research and Treatment of Cancer's QLQ-C30 (+3) formula. Urinary and intestinal problems were evaluated with a validated symptom specific self-assessment questionnaire, QUFW94. The questionnaires were sent to 108 randomized patients with LPC and to an age-matched control group (n = 68). Mean age was 72 years. Mean total dose was 65 grays (Gy; 62.3-70 Gy). The median follow-up time from randomization was 40.6 months for the RT group and 30.4 months for the DT group.

RESULTS: Social functioning was the only QOL scale in which a significant difference was found between the two patient groups and compared with the control group. Multivariate regression analysis showed that hematuria, incontinence, mucus, and planning of daily activities in response to intestinal problems caused this decrease in QOL in the RT group. A significant increase of intestinal problems was observed in the RT versus DT groups regarding mucus, stool leakage, intestinal blood, and planning of daily activity in response to intestinal problems.

CONCLUSIONS: The RT patients showed increased levels of minor intestinal side effects compared with the DT patients and the controls, but the RT patients reported no decreased QOL except for decreased social functioning. This could be because this group developed coping skills or because of a low magnitude of side effects to influence the QOL.

National Category
Cancer and Oncology
Identifiers
urn:nbn:se:umu:diva-67025 (URN)11753990 (PubMedID)
Projects
digitalisering@umu
Note

Manuskriptet står i avhandlingen med titeln: Evaluation of quality of life and symptoms in a randomized trial of radiotherapy versus deferred treatment in patients with localized prostate cancer.

Available from: 2013-03-11 Created: 2013-03-11 Last updated: 2013-03-11Bibliographically approved

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