362 Dissatisfaction with information provision and patient reported outcomes in prostate cancer survivors

e18531 Background: Prostate cancer patients generally have good survival outcomes, but some survivors have poor functional outcomes with persisting symptoms and poor quality of life (QoL). Socio-economic status (SES), access to specialist care and place of residence (including rural, remote areas) are associated with poor survival. These variables may also impact survivorship outcomes, including QoL. This study aimed to identify and visualise geographical disparities in QoL outcomes for prostate cancer survivors. Methods: We extracted complete data for 7690 patients, including patient-reported EPIC-26 QoL questionnaire results (12 months post-treatment), from the Prostate Cancer Outcomes Registry–Victoria (PCOR-VIC), a population-based clinical quality outcomes registry. Patient-matched geographic coordinates were obtained through the Victorian Cancer Registry. Scores from each of the 5 EPIC-26 functional domains were visualised using geospatial maps and correlated to the Index of Relative Socio-economic Advantage and Disadvantage (IRSAD) and geographical remoteness. A composite score condensing all 5 domains into a single number (range 5 – 20) was created for succinct visualisation of functional outcomes. We analysed hotspots using the Getis-Ord Gi* statistic. Results: Scores in all 5 functional domains were positively correlated to IRSAD, which remained an independent predictor of low functional score when controlling for age, disease stage, treatment modality and geographical remoteness (p < 0.001 for all). Geographical remoteness predicted low functional score in all domains (p < 0.05) except Urinary Irritative but was not statistically significant when adjusted for IRSAD. The constructed composite score was significantly correlated to IRSAD and remoteness in a univariate model (p < 0.001). In a multivariate model, remoteness was not an independent predictor of outcome, but the composite score rose by 0.13 for each IRSAD decile (p < 0.001), with patients in the bottom decile of IRSAD more likely to have composite scores below median ( < 14) than those in the top decile (OR 1.8 CI 1.4-2.2 p < 0.001). The composite score allowed visualisation of functional outcomes in a single figure and identification of geographic hotspots with poor outcome. Conclusions: Systematic collection of long-term patient-reported outcomes is feasible. Geographical disparities in QoL outcome following prostate cancer treatment correlated with SES and remoteness, and we note the relative importance of SES over remoteness. A single composite score for EPIC-26 showed face-validity. Our results will allow targeted efforts to further understand the drivers of these findings and improve equity in survivorship outcomes for prostate cancer survivors. The methods developed in this study can be extended and re-deployed to evaluate outcomes in other jurisdictions and cancer types.

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Comment on: Radiation Dose to the Penile Structures and Patient-Reported Sexual Dysfunction in Long-Term Prostate Cancer Survivors

Journal of Sexual Medicine ◽

10.1111/jsm.13064 ◽

2015 ◽

Vol 12 (12) ◽

pp. 2398-2399

Author(s):

Marco Oderda ◽

Paolo Gontero

Keyword(s):

Prostate Cancer ◽

Sexual Dysfunction ◽

Radiation Dose ◽

Cancer Survivors ◽

Prostate Cancer Survivors ◽

Patient Reported

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Quality of life among symptomatic compared to PSA-detected prostate cancer survivors - results from a UK wide patient-reported outcomes study

BMC Cancer ◽

10.1186/s12885-019-6164-5 ◽

2019 ◽

Vol 19 (1) ◽

Author(s):

David W. Donnelly ◽

Linda C. Vis ◽

Therese Kearney ◽

Linda Sharp ◽

Damien Bennett ◽

...

Keyword(s):

Quality Of Life ◽

Prostate Cancer ◽

Cancer Survivors ◽

Functional Outcomes ◽

Multivariable Analysis ◽

Cross Sectional ◽

Prostate Cancer Survivors ◽

Treatment Type ◽

Patient Reported

Abstract Background Quality of life among prostate cancer survivors varies by socio-demographic factors and treatment type received; however, less in known about differences in functional outcomes by method of presentation. We investigate differences in reported urinary, bowel, sexual and hormone-related problems between symptomatic and PSA-detected prostate cancer survivors. Methods A UK wide cross-sectional postal survey of prostate cancer survivors conducted 18-42 months post-diagnosis. Questions were included on presentation method and treatment. Functional outcome was determined using the EPIC-26 questionnaire. Reported outcomes were compared for symptomatic and PSA-detected survivors using ANOVA and multivariable log-linear regression. Results Thirty-five thousand eight hundred twenty-three men responded (response rate: 60.8%). Of these, 31.3% reported presenting via PSA test and 59.7% symptomatically. In multivariable analysis, symptomatic men reported more difficulty with urinary incontinence (Adjusted mean ratio (AMR): 0.96, 95% CI: 0.96-0.97), urinary irritation (AMR: 0.95, 95% CI: 0.95-0.96), bowel function (AMR: 0.97, 95% CI: 0.97-0.98), sexual function (AMR: 0.90, 95% CI: 0.88-0.92), and vitality/hormonal function (AMR: 0.96, 95% CI: 0.96-0.96) than PSA-detected men. Differences were consistent across respondents of differing age, stage, Gleason score and treatment type. Conclusion Prostate cancer survivors presenting symptomatically report poorer functional outcomes than PSA-detected survivors. Differences were not explained by socio-demographic or clinical factors. Clinicians should be aware that men presenting with symptoms are more likely to report functional difficulties after prostate cancer treatment and may need additional aftercare if these difficulties persist. Method of presentation should be considered as a covariate in patient-reported outcome studies of prostate cancer.

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