Impact of treatment on quality of life: two sets of data
Posted Sep 28 2008 7:03pm
Two studies published in recent weeks provide interesting insights into the impact of treatment for localized prostate cancer on the men receiving treatment (and in one study their spouses/partners too).
Sanda et al. report data from over 1,200 men treated at a variety of major US institutions. In contrast, Namiki et al. compared the social impact and “bother” of urinary and bowel dysfunction post-treatment on men treated in Sendai, Japan, and Los Angeles, California. The two studies offer instructive insights.
Sanda and his colleagues tried to identify critical issues affecting quality of life after treatment of prostate cancer and “to measure the effects of such determinants on satisfaction with the outcome of treatment in patients and their spouses or partners.” In this prospective, multi-center study, they measured outcomes reported by 1201 patients and 625 spouses or partners before and after radical prostatectomy, brachytherapy, or external-beam radiotherapy.
They report the following specific results:
Adjuvant hormone therapy was associated with worse quality-of-life outcomes among patients receiving brachytherapy or radiotherapy.
Patients in the brachytherapy group reported long-lasting urinary irritation, bowel and sexual symptoms, and transient problems with vitality or hormonal function.
Adverse effects of prostatectomy on sexual function were mitigated by nerve-sparing procedures.
After prostatectomy, urinary incontinence was observed, but urinary irritation and obstruction improved, particularly in patients with large prostates.
They state further that, “Treatment-related symptoms were exacerbated by obesity, a large prostate size, a high prostate-specific antigen score, and older age. Black patients reported lower satisfaction with the degree of overall treatment outcomes. Changes in quality of life were significantly associated with the degree of outcome satisfaction among patients and their spouses or partners.”
The study by Namiki et al. involved fewer patients, but is of interest because of possible cultural differences in attitude to post-surgical effects of treatment.
The authors ”assessed the impact of bother with urinary and bowel dysfunction on social activities among men in Japan and the United States following primary therapy for localized prostate cancer” in 400 Japanese and 427 American men who underwent radical prostatectomy or brachytherapy for localized prostate cancer. Participants completed questionnaires before treatment and at 1, 12 and 24 months after treatment. Of the 161 men who reported any urinary “bother,” the Japanese men had slightly better urinary function than the American men (84 vs 77, P<0.01).
Among the patients receiving brachytherapy, urinary bother was associated with social function in both countries (but only weakly); after brachytherapy, urinary bother was strongly correlated with social function in American men but not Japanese men. After brachytherapy, bowel dysfunction was also more strongly associated with social function in American men than in Japanese men (P<0.05).
Namiki et al conclude that, “The bother associated with urinary and bowel dysfunction after surgery or brachytherapy for prostate cancer has a greater impact on social function in American men than in Japanese men.”