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Basic Research

Long-term quality of life in disadvantaged men with prostate cancer on androgen-deprivation therapy

Prostate Cancer and Prostatic Diseases volume 15, pages 237–243 (2012)Cite this article

Subjects

Abstract

Background:

To explore the effects of androgen-deprivation therapy (ADT) on general, disease-specific and hormone-specific health-related quality of life (HRQOL) among minority men.

Methods:

Men enrolled in a state-funded program, providing free prostate cancer treatment for underserved men, were recruited, if they had received at least 3 months of continuous ADT and/or other forms of primary treatment. HRQOL was assessed with validated measures including the RAND Medical Outcomes Study 12-item Health Short Form Survey (SF-12), the UCLA Prostate Cancer Index Survey and the Expanded Prostate Cancer Index Composite Survey. Repeated measures analysis was performed to evaluate the association between clinical and sociodemographic covariates with HRQOL.

Results:

We enrolled 322 men, including 94 on ADT and 228 who received other forms of treatment. When controlling for patient characteristics, men receiving ADT had poorer outcomes relative to sexual function (P<0.01), sexual bother (P<0.01), hormonal function (P<0.01) and hormonal bother (P=0.02). ADT use was significantly associated with worsening sexual function (P<0.01) and sexual bother (P=0.01) over two years compared with non-ADT users. Analysis also demonstrated significant differences between whites, Hispanics and Others (African American (n=43, 16%), Asian (n=13, 5%), multiracial (n=1, 0.4%), Native American (n=1, 0.4%) and other (n=9, 3%)) relative to urinary bother (P=0.01), urinary function (P=0.01) and hormonal bother (P=0.03). ADT users had better urinary function and less bother than non-ADT users among the Other group, while the opposite was true for whites and Hispanics. For hormonal bother, ADT use was associated with worse outcomes across all three race/ethnicity groups; however, Hispanics were less bothered by their hormonal symptoms than whites or Others.

Conclusion:

Men of disadvantaged backgrounds on hormone therapy for prostate cancer experience declines in sexual and hormonal HRQOL. Whites and non-whites on ADT have significantly different HRQOL outcomes.

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References

  1. US Census Bureau 2012 Statistical Abstracts: Population Estimates and Projections by Age, Sex, Race/Ethnicity. http://www.census.gov/compendia/statab/cats/population/estimates_and_projections_by_age_sex_raceethnicity.html (2012).

  2. American Cancer Society: Cancer Facts and Figures 2012. http://www.cancer.org/Research/CancerFactsFigures/CancerFactsFigures/cancer-facts-figures-2012 (2012).

  3. Hoffman RM, Gilliland FD, Eley JW, Harlan LC, Stephenson RA, Stanford JL et al. Racial and ethnic differences in advanced-stage prostate cancer: the Prostate Cancer Outcomes Study. J Natl Cancer Inst 2001; 93: 388–395.

    Article  CAS  Google Scholar 

  4. Cooperberg MR, Grossfeld GD, Lubeck DP, Carroll PR . National practice patterns and time trends in androgen ablation for localized prostate cancer. J Natl Cancer Inst 2003; 95: 981–989.

    Article  Google Scholar 

  5. Efstathiou JA, Bae K, Shipley WU, Hanks GE, Pilepich MV, Sandler HM et al. Cardiovascular mortality after androgen deprivation therapy for locally advanced prostate cancer: RTOG 85-31. J Clin Oncol 2009; 27: 92–99.

    Article  Google Scholar 

  6. Krupski TL, Fink A, Kwan L, Maliski S, Connor SE, Clerkin B et al. Health-related quality-of-life in low-income, uninsured men with prostate cancer. J Health Care Poor Underserved 2005; 16: 375–390.

    Article  Google Scholar 

  7. Maliski SL, Kwan L, Orecklin JR, Saigal CS, Litwin MS . Predictors of fatigue after treatment for prostate cancer. Urology 2005; 65: 101–108.

    Article  Google Scholar 

  8. Shahinian VB, Kuo YF, Freeman JL, Goodwin JS . Risk of the ‘androgen deprivation syndrome’ in men receiving androgen deprivation for prostate cancer. Arch Intern Med 2006; 166: 465–471.

    PubMed  PubMed Central  Google Scholar 

  9. Maliski SL, Rivera S, Connor S, Lopez G, Litwin MS . Renegotiating masculine identity after prostate cancer treatment. Qual Health Res 2008; 18: 1609–1620.

    Article  Google Scholar 

  10. Zavala MW, Maliski SL, Kwan L, Miller DC, Fink A, Litwin MS . Longitudinal quality of life in low-income men in a state-funded prostate cancer treatment program. J Health Care Poor Underserved 2008; 19: 200–214.

    Article  Google Scholar 

  11. Klein JB, Nguyen CT, Saffore L, Modlin III C, Modlin Jr CS . Racial disparities in urologic health care. J Natl Med Assoc 2010; 102: 108–117.

    Article  Google Scholar 

  12. Modlin CS . Culture, race, and disparities in health care. Cleve Clin J Med 2003; 70: 283, 287-288.

    Article  Google Scholar 

  13. Blacksher E . On being poor and feeling poor: low socioeconomic status and the moral self. Theor Med Bioeth 2002; 23: 455–470.

    Article  Google Scholar 

  14. Maliski SL, Kwan L, Krupski T, Fink A, Orecklin JR, Litwin MS . Confidence in the ability to communicate with physicians among low-income patients with prostate cancer. Urology 2004; 64: 329–334.

    Article  Google Scholar 

  15. Maliski SL, Clerkin B, Litwin MS . Describing a nurse case manager intervention to empower low-income men with prostate cancer. Oncol Nurs Forum 2004; 31: 57–64.

    Article  Google Scholar 

  16. Ware JE KM, Turner-Bowker DM . How to Score the Version 2 of the SF-12 Health Survey. Quality Metric Incorporated and Health Assessment Lab: Boston, 2002.

    Google Scholar 

  17. Ware Jr J, Kosinski M, Keller SD . A 12-Item Short-Form Health Survey: construction of scales and preliminary tests of reliability and validity. Med Care 1996; 34: 220–233.

    Article  Google Scholar 

  18. Krongrad A, Perczek RE, Burke MA, Granville LJ, Lai H, Lai S . Reliability of Spanish translations of select urological quality of life instruments. J Urol 1997; 158: 493–496.

    Article  CAS  Google Scholar 

  19. Litwin MS, Hays RD, Fink A, Ganz PA, Leake B, Brook RH . The UCLA Prostate Cancer Index: development, reliability, and validity of a health-related quality of life measure. Med Care 1998; 36: 1002–1012.

    Article  CAS  Google Scholar 

  20. Wei JT, Dunn RL, Litwin MS, Sandler HM, Sanda MG . Development and validation of the expanded prostate cancer index composite (EPIC) for comprehensive assessment of health-related quality of life in men with prostate cancer. Urology 2000; 56: 899–905.

    Article  CAS  Google Scholar 

  21. Dacal K, Sereika SM, Greenspan SL . Quality of life in prostate cancer patients taking androgen deprivation therapy. J Am Geriatr Soc 2006; 54: 85–90.

    Article  Google Scholar 

  22. Krahn MD, Bremner KE, Tomlinson G, Naglie G . Utility and health-related quality of life in prostate cancer patients 12 months after radical prostatectomy or radiation therapy. Prostate Cancer Prostatic Dis 2009; 12: 361–368.

    Article  CAS  Google Scholar 

  23. Wu AK, Cooperberg MR, Sadetsky N, Carroll PR . Health related quality of life in patients treated with multimodal therapy for prostate cancer. J Urol 2008; 180: 2415–2422; discussion 2422.

    Article  Google Scholar 

  24. Sharifi N, Gulley JL, Dahut WL . Androgen deprivation therapy for prostate cancer. JAMA 2005; 294: 238–244.

    Article  CAS  Google Scholar 

  25. Potosky AL, Reeve BB, Clegg LX, Hoffman RM, Stephenson RA, Albertsen PC et al. Quality of life following localized prostate cancer treated initially with androgen deprivation therapy or no therapy. J Natl Cancer Inst 2002; 94: 430–437.

    Article  Google Scholar 

  26. Basaria S, Lieb II J, Tang AM, DeWeese T, Carducci M, Eisenberger M et al. Long-term effects of androgen deprivation therapy in prostate cancer patients. Clin Endocrinol (Oxf) 2002; 56: 779–786.

    Article  CAS  Google Scholar 

  27. Joly F, Alibhai SM, Galica J, Park A, Yi QL, Wagner L et al. Impact of androgen deprivation therapy on physical and cognitive function, as well as quality of life of patients with nonmetastatic prostate cancer. J Urol 2006; 176 (6 Pt 1): 2443–2447.

    Article  CAS  Google Scholar 

  28. Alibhai SM, Breunis H, Timilshina N, Johnston C, Tomlinson G, Tannock I et al. Impact of androgen-deprivation therapy on physical function and quality of life in men with nonmetastatic prostate cancer. J Clin Oncol 2010; 28: 5038–5045.

    Article  CAS  Google Scholar 

  29. Pirl WF, Siegel GI, Goode MJ, Smith MR . Depression in men receiving androgen deprivation therapy for prostate cancer: a pilot study. Psychooncology 2002; 11: 518–523.

    Article  Google Scholar 

  30. Holzbeierlein JM . Managing complications of androgen deprivation therapy for prostate cancer. Urol Clin North Am 2006; 33: 181–190, vi.

    Article  Google Scholar 

  31. Higano C . Androgen deprivation therapy: monitoring and managing the complications. Hematol Oncol Clin North Am 2006; 20: 909–923.

    Article  Google Scholar 

  32. Huang GJ, Sadetsky N, Penson DF . Health related quality of life for men treated for localized prostate cancer with long-term followup. J Urol 2010; 183: 2206–2212.

    Article  Google Scholar 

  33. Interian A, Martinez IE, Guarnaccia PJ, Vega WA, Escobar JI . A qualitative analysis of the perception of stigma among Latinos receiving antidepressants. Psychiatr Serv 2007; 58: 1591–1594.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA

    C Sevilla, L Kwan, S E Connor & M S Litwin

  2. School of Nursing, University of California, Los Angeles, Los Angeles, CA, USA

    S L Maliski

  3. Division of Cancer Prevention and Control, Jonsson Comprehensive Cancer Center, University of California, Los Angeles, Los Angeles, CA, USA

    L Kwan & M S Litwin

  4. Department of Health Services, School of Public Health, University of California, Los Angeles, Los Angeles, CA, USA

    M S Litwin

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  1. C Sevilla
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  4. S E Connor
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Correspondence to M S Litwin.

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Sevilla, C., Maliski, S., Kwan, L. et al. Long-term quality of life in disadvantaged men with prostate cancer on androgen-deprivation therapy. Prostate Cancer Prostatic Dis 15, 237–243 (2012). https://doi.org/10.1038/pcan.2011.71

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