Patient reported quality of life during and after primary radiotherapy for prostate cancer
OC-0592
Abstract
Patient reported quality of life during and after primary radiotherapy for prostate cancer
Authors: Tina Siersbaek1, Mette Sandfeld Svenson2, Martin Berg3, Christine Vestergaard Madsen1, Lars Fokdal4, Henrik Dahl Nissen3
1Lillebaelt University Hospital of Southern Denmark, Vejle, Department of Oncology, Vejle, Denmark; 2 Lillebaelt University Hospital of Southern Denmark, Vejle, Department of Oncology, Vejle, Denmark; 3Lillebaelt University Hospital of Southern Denmark, Vejle, Radiotherapy Research Team, Department of Oncology, Vejle, Denmark; 4Lillebaelt University Hospital of Southern Denmark, Vejle, Department of Oncology, Department of Regional Health Research, University Hospital of Southern Denmark, Odense, Vejle, Denmark
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Purpose or Objective
Radiotherapy (RT) with or without androgen deprivation therapy (ADT) for prostate cancer is associated with side effects that may have a large impact on the quality of life (QoL) . To explore QoL from the patients’ perspective several patient reported outcome measures have been developed and validated for clinical use.
Assessment of patient-reported outcomes (PROs) after RT for prostate cancer has been done within a prospective observational study with 5 years follow-up using the Expanded Prostate Cancer Index Composite (EPIC-26) and EORTC QLQ-C30. Additionally, patients were asked to describe in their own words the two factors or symptoms that at each time point had the largest negative impact on QoL. This work provides a descriptive analysis of these individual sentences to gain more knowledge about the factors that had the most influence on QoL during and after the radiotherapy trajectory.
Material and Methods
In total, 273 patients participated in the study from October 2017 until June 2022. Patients received PRO questionnaires at multiple timepoints from baseline till 5 years of follow-up. Here we present data from the first 24 months.
The analysis of patient’s individual comments included several steps. First, all individual answers were discussed in a study group comprising of two RT nurses, one doctor and one medical physicist. Second, all answers were categorized according to cause. Initially 20 categories were defined but after new discussions in the study group we ended up with 13 categories covering all symptoms. Descriptive analysis of all categories was done by calculation of prevalence rates at baseline and at each follow-up.
Results
Patients had a median age of 70 (50-78) years and were generally in good performance status (PS 0 = 84.5%). A total of 231 (85%) patients were treated with RT to the prostate, seminal vesicles (SV) and elective lymph nodes. The remaining patients were treated with RT to the prostate alone (22 pts, 8%) or to the prostate and SV (20pts, 7%). ADT was prescribed in 245 (90%) of the patients.
Analysis of symptoms shoved that patients especially were bothered by symptoms related to ADT with sexual dysfunction, hot flashes and fatigue. During RT fatique, urinary and bowel side effects increased. 6 months after RT urinary symptoms decreased to near baseline level. Bowel symptoms remain elevated. Increased fatique continue until 12 month after RT. Finally, almost 20% of the patients reported that comorbidity had a large impact on QoL during and after RT (figure 1).
Conclusion
The systematic use of PROs with the possibility to add individual information about the most bothersome symptoms has expanded our understanding of the factors that influence QoL. The results from our study can be used directly in future counselling during and after RT where health care professionals should focus on side effects related to ADT. Furthermore, with this knowledge, pre-habilitation strategies with management of comorbidities may play a role in a subset of patients.