Jayadevappa Ravishankar, Chhatre Sumedha, Whittington Richard, Bloom Bernard S, Wein Alan J, Malkowicz S Bruce
Department of Psychiatry, University of Pennsylvania, Philadelphia, PA 19104-2676, USA.
BJU Int. 2006 May;97(5):955-62. doi: 10.1111/j.1464-410X.2006.06128.x.
To analyse health-related quality of life (HRQoL) and satisfaction with care across potential curative treatments for older patients newly diagnosed with prostate cancer.
In a prospective cohort study we recruited 115 older patients (> or =65 years) newly diagnosed with prostate cancer from the urology clinics of an urban academic and a Veterans' Administration (VA) hospital. Patients completed generic (Short Form-36), prostate-specific (University of California Los Angeles Prostate Cancer Index) HRQoL, and Client Satisfaction with Care (CSQ-8) surveys before treatment with either radical prostatectomy (RP) or external beam irradiation (EBRT) and at 3, 6 and 12 months afterward. Clinical and demographic data were obtained via medical chart review. A repeated-measures analysis of variance was used to examine changes in generic and prostate cancer-specific HRQoL between treatments. Log-linear regression was used to analyse the factors associated with 12-month HRQoL scores, and Kaplan-Meier survival curves were used to compare the return to baseline values for HRQoL.
The RP group had significantly higher income, education and better general health than the EBRT group. Age (odds ratio 0.5, 95% confidence interval 0.32-0.82), non-VA hospital (28.8, 2-402) and prostate-specific antigen level at diagnosis (2.8, 1.05-7.5) were associated with RP. The analysis results indicated that the RP group had higher scores for generic HRQoL subscales of physical function (P = 0.019), role emotional (P = 0.037), vitality (P = 0.033) and general health (P = 0.05) than the EBRT group. A log-linear regression model for predicting the 12-month scores showed that RP was associated with higher scores for most of the generic HRQoL and bowel function (odds ratio 1.12, P = 0.03), urinary bother (1.6, P = 0.014) and bowel bother (1.5, P = 0.013). Being older was associated with a lower score on bowel function (0.98, P = 0.05) and sexual function (0.92, P = 0.05). Satisfaction with care was comparable between treatment groups at baseline and at the follow-up.
Older patients tolerate RP well from the HRQoL perspective and thus decisions for therapy in this age cohort should not be based primarily on age.
分析新诊断前列腺癌老年患者在各种潜在根治性治疗中的健康相关生活质量（HRQoL）及对治疗的满意度。
在一项前瞻性队列研究中，我们从一家城市学术性泌尿科诊所和一家退伍军人管理局（VA）医院招募了115名新诊断为前列腺癌的老年患者（≥65岁）。患者在接受根治性前列腺切除术（RP）或外照射放疗（EBRT）治疗前以及治疗后3、6和12个月完成了通用（简短健康调查问卷-36）、前列腺特异性（加利福尼亚大学洛杉矶分校前列腺癌指数）HRQoL以及患者对治疗的满意度（CSQ-8）调查。通过查阅病历获取临床和人口统计学数据。采用重复测量方差分析来检验不同治疗方法之间通用和前列腺癌特异性HRQoL的变化。采用对数线性回归分析与12个月HRQoL评分相关的因素，并使用Kaplan-Meier生存曲线比较HRQoL恢复到基线值的情况。
RP组患者的收入、受教育程度显著高于EBRT组，总体健康状况也更好。年龄（比值比0.5，95%置信区间0.32 - 0.82）、非VA医院（28.8，2 - 402）以及诊断时的前列腺特异性抗原水平（2.8，1.05 - 7.5）与接受RP治疗相关。分析结果表明，RP组在身体功能（P = 0.019）、角色情感（P = 0.037）、活力（P = 0.033）和总体健康（P = 0.05）等通用HRQoL子量表上的得分高于EBRT组。预测12个月评分的对数线性回归模型显示，RP与大多数通用HRQoL以及肠道功能（比值比1.12，P = 0.03）、尿路困扰（1.6，P = 0.014）和肠道困扰（1.5，P = 0.013）得分较高相关。年龄较大与肠道功能得分较低（0.98，P = 0.05）和性功能得分较低（0.92，P = 0.05）相关。治疗组在基线和随访时对治疗的满意度相当。
从HRQoL角度来看，老年患者对RP耐受性良好，因此该年龄组的治疗决策不应主要基于年龄。
