Side-effects of treatment for localized prostate cancer

It seems plausible that prostate cancer (CaP) patients might value health states associated with side-effects of treatment for localized CaP as less detrimental than men with no CaP.

Not so, reports Dr. Korfage and research collaborators from Erasmus University in the Netherlands. The study appears in the BJU International online version and addresses the fact that CaP patients report high generic HRQoL scores that do not decrease after treatment despite side-effects.

The study compared a group of men with long-lasting side effects to a group with no CaP. The participants valued description of health states associated with the side-effects of treatment of localized CaP. The format of the EuroQoL-5D classification of health was used as a framework for the descriptions from which five specific ones were generated. The descriptions were; Man 1 with severe ED, Man 2 some urinary leakage, moderate ED, moderately anxious, Man 3 some bowl problems, moderate ED, Man 4 serious urinary leakage, and Man 5 serious bowel problems, severe ED. The descriptions were presented without the mention of cancer or cancer treatment and the participants in an interactive, Internet-enabled self-reported questionnaire performed the valuations tasks. The questionnaire consisted of four parts; respondent's functioning, ranking of the health state descriptions, valuation of the description of Man 1 to Man 5 on a visual analogue scale (VAS), and valuation of descriptions of Man 1 to Man 5 by time trade-off (TTO).

A total of 53 CaP patients and 52 controls had evaluable data. Controls were younger than patients (63 vs. 67 years) and had significantly better urinary bowel and sexual function than the patients, and rated their health as better. Interestingly, insignificant differences between healthy controls and patients were found for Man 1, 3, 4 and 5. Only the mean VAS scores for Man 2 differed between patients and controls. Differences for mean TTO scores were insignificant for all five health states. Both groups ranked Man 3 best when they applied TTO, but as third (patients) or second (controls) when based on the VAS score.

Serious ED was regard as less bad than serious urinary leakage. The authors suggest that the lack of difference between controls and patients is possibly explained by a response shift in the patients or insensitivity of generic HRQoL measures.

Ida J. Korfage Harry J. de Koning J. Dik F. Habbema Fritz H. Schröder Marie-Louise Essink-Bot

BJU Int 2007;epub

By Christopher P. Evans, MD