Impact of Prostate Cancer Diagnosis, Treatment Choice on Quality of Life
Both curative therapy and active surveillance can affect quality of life for patients with prostate cancer.
Patients with newly diagnosed prostate cancer (PCa) who undergo the treatment planning process experience a reduction in their health-related quality of life (HRQoL), particularly if they decide to receive curative therapy, according to a study published in Supportive Care in Cancer.
The negative HRQoL outcomes related to prostate cancer treatment are well documented; patients experience a variety of physical and psychological adverse events after undergoing curative therapy (eg, surgery and radiotherapy) and active surveillance. The impact of prostate cancer on the HRQoL of patients prior to receiving treatment is unclear.
For this study, researchers assessed the results of 377 patients who filled out a questionnaire evaluating HRQoL (EORTC QLQ-C30 and PR25), self-efficacy (Decision Self-efficacy scale), optimism (LOT-r), and personality traits (BFI-10), prior to undergoing a biopsy to confirm a diagnosis of prostate cancer (baseline, t0).
Of the 377 patients, 126 patients with biopsies positive for prostate cancer completed a follow-up survey regarding HRQoL 2 weeks after selecting but not having initiated a course of treatment (t1).
There were no differences in HRQoL between patients with or without prostate cancer at t0, but patients with positive diagnosis who made treatment decisions began to experience worse role and cognitive functioning (fatigue, urinary, bowel, constipation, hormonal) by t1.
Sexual dysfunction and activity improved upon choosing treatment (P <.05).
At t0, symptoms and functioning were not found to be associated with treatment decisions, but patients with prostate cancer experienced a greater deterioration of functioning and more symptoms if they decided to undergo curative treatment compared with active surveillance at t1.
Patients who had had high scores on the LOT-r assessment measuring optimism had better HRQoL at baseline (P <.001), whereas patients who had high marks on the Decision Self-efficacy scale had better HRQoL at follow-up (P =.04).
The authors concluded, “[d]uring clinical counseling, managing optimism when PCa is suspected (before and after biopsy) and (decisional) self-efficacy when PCa is confirmed could help to reduce the pretreatment impact on HRQoL.”
Cuypers M, Lamers RED, Cornel EB, van de Poll-Franse LV, de Vries M, Kil PJM. The impact of prostate cancer diagnosis and treatment decision-making on health-related quality of life before treatment onset [published online November 10, 2017]. Support Care Cancer. doi: 10.1007/s00520-017-3953-8