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Quality of life in men living with advanced and localised prostate cancer in the UK: a population-based study

Quality of life in men living with advanced and localised prostate cancer in the UK: a population-based study
Quality of life in men living with advanced and localised prostate cancer in the UK: a population-based study

Background: Little is known about the health-related quality of life (HRQOL) of men living with advanced prostate cancer. We report population-wide functional outcomes and HRQOL in men with all stages of prostate cancer and identify implications for health-care delivery. Methods: For this population-based study, men in the UK living 18–42 months after diagnosis of prostate cancer were identified through cancer registration data. A postal survey was administered, which contained validated measures to assess functional outcomes (urinary incontinence, urinary irritation and obstruction, bowel, sexual, and vitality and hormonal function), measured with 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). Log-linear and binary logistic regression models were used to compare functional outcomes and HRQOL across diagnostic stages and self-reported treatment groups. Each model included adjustment for age, socioeconomic deprivation, and number of other long-term conditions. Findings: 35 823 (60·8%) of 58 930 men responded to the survey. Disease stage was known for 30 733 (85·8%) of 35 823 men; 19 599 (63·8%) had stage I or II, 7209 (23·4%) stage III, and 3925 (12·8%) stage IV disease. Mean adjusted EPIC-26 domain scores were high, indicating good function, except for sexual function, for which scores were much lower. Compared with men who did not receive androgen deprivation therapy, more men who received the therapy reported 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]). Poor sexual function was common (81·0%; 95% CI 80·6–81·5), regardless of stage, and more than half of men (n=18 782 [55·8%]) were not offered any intervention to help with this condition. Overall, self-assessed health was similar in men with stage I–III disease, and although slightly reduced in those with stage IV cancer, 23·5% of men with metastatic disease reported no problems on any EQ-5D dimension. Interpretation: Men diagnosed with advanced disease do not report substantially different HRQOL outcomes to those diagnosed with localised disease, although considerable problems with hormonal function and fatigue are reported in men treated with androgen deprivation therapy. Sexual dysfunction is common and most men are not offered helpful intervention or support. Service improvements around sexual rehabilitation and measures to reduce the effects of androgen deprivation therapy are required. Funding: The Movember Foundation, in partnership with Prostate Cancer UK.

1470-2045
436-447
Downing, Amy
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Wright, Penny
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Hounsome, Luke
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Selby, Peter
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Wilding, Sarah
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Watson, Eila
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Wagland, Richard
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Kind, Paul
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Donnelly, David W.
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Butcher, Hugh
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Catto, James W.F.
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Cross, William
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Mason, Malcolm
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Sharp, Linda
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Weller, David
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Velikova, Galina
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McCaughan, Eilis
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Mottram, Rebecca
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Allen, Majorie
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Kearney, Therese
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McSorley, Oonagh
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Huws, Dyfed W.
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Brewster, David H.
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McNair, Emma
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Gavin, Anna
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Glaser, Adam W.
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Downing, Amy
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Wright, Penny
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Hounsome, Luke
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Selby, Peter
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Wilding, Sarah
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Watson, Eila
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Wagland, Richard
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Kind, Paul
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Donnelly, David W.
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Butcher, Hugh
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Catto, James W.F.
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Cross, William
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Mason, Malcolm
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Sharp, Linda
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Weller, David
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Velikova, Galina
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McCaughan, Eilis
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Mottram, Rebecca
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Allen, Majorie
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Kearney, Therese
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McSorley, Oonagh
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Huws, Dyfed W.
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Brewster, David H.
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McNair, Emma
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Gavin, Anna
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Glaser, Adam W.
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Downing, Amy, Wright, Penny, Hounsome, Luke, Selby, Peter, Wilding, Sarah, Watson, Eila, Wagland, Richard, Kind, Paul, Donnelly, David W., Butcher, Hugh, Catto, James W.F., Cross, William, Mason, Malcolm, Sharp, Linda, Weller, David, Velikova, Galina, McCaughan, Eilis, Mottram, Rebecca, Allen, Majorie, Kearney, Therese, McSorley, Oonagh, Huws, Dyfed W., Brewster, David H., McNair, Emma, Gavin, Anna and Glaser, Adam W. (2019) Quality of life in men living with advanced and localised prostate cancer in the UK: a population-based study. The Lancet Oncology, 20 (3), 436-447. (doi:10.1016/S1470-2045(18)30780-0).

Record type: Article

Abstract

Background: Little is known about the health-related quality of life (HRQOL) of men living with advanced prostate cancer. We report population-wide functional outcomes and HRQOL in men with all stages of prostate cancer and identify implications for health-care delivery. Methods: For this population-based study, men in the UK living 18–42 months after diagnosis of prostate cancer were identified through cancer registration data. A postal survey was administered, which contained validated measures to assess functional outcomes (urinary incontinence, urinary irritation and obstruction, bowel, sexual, and vitality and hormonal function), measured with 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). Log-linear and binary logistic regression models were used to compare functional outcomes and HRQOL across diagnostic stages and self-reported treatment groups. Each model included adjustment for age, socioeconomic deprivation, and number of other long-term conditions. Findings: 35 823 (60·8%) of 58 930 men responded to the survey. Disease stage was known for 30 733 (85·8%) of 35 823 men; 19 599 (63·8%) had stage I or II, 7209 (23·4%) stage III, and 3925 (12·8%) stage IV disease. Mean adjusted EPIC-26 domain scores were high, indicating good function, except for sexual function, for which scores were much lower. Compared with men who did not receive androgen deprivation therapy, more men who received the therapy reported 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]). Poor sexual function was common (81·0%; 95% CI 80·6–81·5), regardless of stage, and more than half of men (n=18 782 [55·8%]) were not offered any intervention to help with this condition. Overall, self-assessed health was similar in men with stage I–III disease, and although slightly reduced in those with stage IV cancer, 23·5% of men with metastatic disease reported no problems on any EQ-5D dimension. Interpretation: Men diagnosed with advanced disease do not report substantially different HRQOL outcomes to those diagnosed with localised disease, although considerable problems with hormonal function and fatigue are reported in men treated with androgen deprivation therapy. Sexual dysfunction is common and most men are not offered helpful intervention or support. Service improvements around sexual rehabilitation and measures to reduce the effects of androgen deprivation therapy are required. Funding: The Movember Foundation, in partnership with Prostate Cancer UK.

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e-pub ahead of print date: 31 January 2019
Published date: 1 March 2019

Identifiers

Local EPrints ID: 430583
URI: http://eprints.soton.ac.uk/id/eprint/430583
ISSN: 1470-2045
PURE UUID: bd7481cc-f65c-49c5-a398-cf4fcb0836fc
ORCID for Richard Wagland: ORCID iD orcid.org/0000-0003-1825-7587

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Date deposited: 03 May 2019 16:30
Last modified: 28 Apr 2022 02:03

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Contributors

Author: Amy Downing
Author: Penny Wright
Author: Luke Hounsome
Author: Peter Selby
Author: Sarah Wilding
Author: Eila Watson
Author: Richard Wagland ORCID iD
Author: Paul Kind
Author: David W. Donnelly
Author: Hugh Butcher
Author: James W.F. Catto
Author: William Cross
Author: Malcolm Mason
Author: Linda Sharp
Author: David Weller
Author: Galina Velikova
Author: Eilis McCaughan
Author: Rebecca Mottram
Author: Majorie Allen
Author: Therese Kearney
Author: Oonagh McSorley
Author: Dyfed W. Huws
Author: David H. Brewster
Author: Emma McNair
Author: Anna Gavin
Author: Adam W. Glaser

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