局部或轉移性攝護腺癌治療後一般生活品質變化趨勢
高耀臨1、蔡育賢1、林宗瑩2、歐建慧1、楊文宏1、鄭鴻琳1、蔡宗欣1、王榮德2
國立成功大學附設醫院 1泌尿部、2公共衛生研究所
Trend of global quality of life in localized or metastatic prostate cancer patients after treatment
Yao-Lin Kao1,Yuh-Shyan Tsai11, Zong-Ying Lin2, Chien-Hui Ou1, Wen-Horng Yang1, Hong-Lin Chen1, Tzong-Shin Tzai1, Jung-Der Wang2
Department of 1Urology and 2Public Health, Medical College and Hospital, National Cheng Kung University, Tainan, Taiwan
Purpose: Quality of life (QoL) is an important concern in prostate cancer (PC) treatment, particularly facing with selection of any optimal therapy. The trend of global QoL may help physician and patients in decision making for treatment strategy. The aim of the study is to explore the trend of global QoL after standard treatments in PC patients with localized or metastatic diseases.
Materials and Methods: From January 2013 to April 2015, self-reported questionnaires, World Health Organization Quality of Life-BREF (WHOQOL-BREF) serving as a tool for global QoL assessment with good validity and reliability, were randomly obtained from prostate cancer patients at urologic outpatient clinic. Repeated measurements in same individuals were obtained from some individuals at different times during follow-up. The mix-effect model was used for analyzing the determinant of global QoL and a Kernel smoothing curve fitting was used for analyzing the trend of global QoL in the initial 5-year follow-up.
Results: A total of 287 patients and 526 person-times completed the WHOQOL-BREF questionnaire with a mean age of 72.7 years, including localized disease (n=156) and metastatic disease (n=131). The analysis of the Kernel smooth curve showed decreases of global QoL in physical, psychological and social domains in localized disease patients after receiving radical prostatectomy or radiotherapy compare to active surveillance group, both of which gradually recovered in one and half a year. In contrast, metastatic patients exhibited both increases of global QoL in physical and psychological domains after androgen deprivation therapy or palliative radiotherapy as compared with watchful and supportive groups (Figure 1). Moreover, radiotherapy is an independent risk factor for sexual life impairment (p values, 3 months after radiotherapy and > 3 months after radiotherapy, 0.017 and 0.004, respectively). There were some limitations in this study, including single-institute and outpatient alone.
Conclusions: During the initial 5-year follow-up, both radical prostatectomy and radiotherapy had one-to-two year negative impacts on global QoL in localized patients . Both hormonal therapy and palliative radiotherapy had one-to-two year positive impacts on global QoL in metastatic patients. Radiotherapy had a profound long-term decrease in sexual life performance. These results can help physicians and patients in decision making for optimal therapy.