Health-Related Quality of Life and Survival in Prostate Cancer Patients in a Real-World Setting.

OBJECTIVE: To analyze the health-related quality of life (HRQoL) and survival of real-world prostate cancer (PC) patients and to calculate quality-adjusted life-years (QALYs) experienced under different treatment strategies. MATERIALS AND METHODS: PC patients undergoing active surveillance (n = 226), radiation treatment (n = 280), surgery (n = 299), or hormonal treatment (n = 62) responded to the generic 15-dimensional (15D) HRQoL questionnaire at the time of the diagnosis and were followed up 3, 6, 12, and 24 months later. QALYs experienced during the follow-up were calculated for each treatment group, and variables associated with survival were analyzed using Cox proportional hazards models. RESULTS: HRQoL was stable during the first 2 years after diagnosis in all other treatment groups, except in patients treated with hormonal therapy. The overall survival within 6.5-year follow-up time was 84.4%. The number of QALYs experienced during the 2-year follow-up was similar in patients in active surveillance (1.790), surgery (1.784), and radiation groups (1.767), but significantly lower in the hormonal therapy group (1.665). CONCLUSIONS: Patients receiving hormonal treatment had significantly impaired HRQoL and survival compared with other treatments. Although the number of QALYs experienced was similar in the 3 other treatment lines, there were marked differences between treatment lines on some 15D dimensions.

USE OF PATIENT ASSESSED HEALTH-RELATED QUALITY OF LIFE INSTRUMENTS IN PROSTATE CANCER RESEARCH: A SYSTEMATIC REVIEW OF THE LITERATURE 2002-15.

OBJECTIVES: The objectives of this study were to identify and qualitatively describe, in a systematic literature review, published studies that collected prostate cancer patients' health-related quality of life (HRQoL) estimates by using validated, generic instruments. METHODS: Systematic searches of the literature were made using the Medline, Cochrane Library, PsycINFO, and CINAHL electronic databases from 2002 to 2015. RESULTS: The search identified 2,171 references, of which 237 were obtained for full-text assessment; thirty-three of these articles were deemed relevant and included in the systematic review. An indirect valuation method was used in 73 percent (n = 24) of the studies. The most commonly used HRQoL instrument with an indirect valuation method was the EuroQol (EQ-5D; n = 21), and the second most common was the 15D (n = 5). A direct valuation method was used in 48 percent (n = 16) of the studies. Of these, the Visual Analogue Scale (VAS) was the most often used (n = 10), followed by the Time-Trade-Off (n = 6). HRQoL scores varied in localized and early stage disease between 0.63 and 0.91, and in advanced or metastatic disease stage between 0.50 and 0.87. There was also variance in the HRQoL instruments and study methods used, which explains the large variance in HRQoL scores between the various disease stages. CONCLUSIONS: Although utility and quality-adjusted life-years gained are considered important measures of effectiveness in health care, the number of studies in which utilities of prostate cancer patients have been estimated using generic HRQoL instruments, based on either direct or indirect measurement of HRQoL, is fairly small.

Cardiovascular event rates increase after each recurrence and associate with poor statin adherence.

AIMS: The study evaluated the quality of cardiovascular prevention in real-world clinical practice. The recurrence of up to five cardiovascular events was assessed, as data on recurrence beyond the first event and interindividual variations in event rates past the second event have been sparse. Low-density lipoprotein cholesterol concentrations and lipid-lowering therapy use were investigated. METHODS: This retrospective register-based study included adult patients with an incident cardiovascular event between 2004 and 2016 treated in the hospital district of southwest Finland. Patients were followed for consecutive cardiovascular events or cardiovascular death, low-density lipoprotein cholesterol and statin purchases. The timing of event recurrence was evaluated, and predictive factors were assessed. RESULTS: A wide interindividual variation in cardiovascular event recurrence was observed, each additional event caused an increased risk, the median time of recurrence decreased from 7 to one year for the second and fifth event. Event rates increased correspondingly from 12 to 43/100 patient-years and were most pronounced in the first years following the previous event. The low-density lipoprotein cholesterol goal (<1.8 mmol/l) was reached by 18% in the year after the event and statin underuse was associated with an increased risk of recurrence. Six months after the index event high intensity statins were used by only 22% of the cohort. CONCLUSION: The study provides new perspectives on individual risk assessment showing that event rates are not stable for all patients but increase 1.2-1.9-fold per consecutive event. The underuse of statins and poor adherence support the identification of these patients for intensified multifactorial preventive measures.

Health-related quality of life among prostate cancer patients: real-life situation at the beginning of treatment.

OBJECTIVE: The aims of this study were to measure the real-life health-related quality of life (HRQoL) of newly diagnosed prostate cancer (PCa) patients, to compare it with that of the general male population and to explore factors affecting HRQoL. METHODS: All newly diagnosed PCa patients in the Helsinki University Hospital were asked to fill in 15D and EORTC QLQ-C30 questionnaires. Clinical background information was collected retrospectively from patient charts. Patients were categorized into three mutually exclusive groups based on the disease stage: Local, Locally advanced and Metastatic groups. Multivariate linear regression analysis was conducted to explore which factors explained variance in 15D scores. A regression model was built to map the EORTC QLQ-C30 to 15D in a random sample of 50% of patients and the model was tested in the other half of the patients. RESULTS: In total, 1050 men with a mean age of 67 years responded to the questionnaires. The mean ± SD 15D score of patients was slightly lower than that of the age-standardized general male population: 0.905 ± 0.089 vs 0.915 ± 0.082 (p = .057). The mean ± SD 15D utility scores were 0.912 ± 0.084, 0.897 ± 0.102 and 0.855 ± 0.109 for Local, Locally advanced and Metastatic groups, respectively. The mapping model of EORTC QLQ-C30 to 15D was robust and fitted well (root mean square error = 0.042, adjusted R² = .79). CONCLUSIONS: The HRQoL of PCa patients entering treatment was similar to that of the general population. HRQoL was most impaired among patients with metastatic disease, whereas the difference between patients with localized PCa and the general population was minor. Mapping indicated that the 15D score aggregates quite accurately the information from the EORTC QLQ-C30.