Quality of life and treatment outcomes: prostate carcinoma patients' perspectives after prostatectomy or radiation therapy.

BACKGROUND: Of the estimated 317,000 men in the United States diagnosed with prostate carcinoma in 1996, 57% will have localized disease, and their 5-year relative survival rate will be 98%. Limited information exists on patient-reported quality of life (QOL) and the incidence and severity of treatment-related side effects. The purpose of this study was to identify and compare patients' self-reported QOL and treatment side effects 1-5 years after radical prostatectomy or radiotherapy. METHODS: Data collection for this cross-sectional study included a mailed, self-administered survey with three parts: a demographic survey, the Functional Assessment of Cancer Therapy-General (FACT-G), and a newly developed Prostate Cancer Treatment Outcome Questionnaire (PCTO-Q). The FACT-G measured the effect of prostate carcinoma on overall QOL in the two treatment groups. The PCTO-Q assessed the patients' perceptions of the incidence and severity of specific changes in bowel, urinary, and sexual functions. The test-retest reliability of the PCTO-Q in a pilot study was 91.2%. RESULTS: Two hundred seventy-four eligible men completed the questionnaires; 132 (48%) reported having undergone prostatectomy and 142 (52%) reported having undergone radiotherapy. After age adjustment, the radiotherapy group reported more bowel dysfunction (P = 0.001), whereas the prostatectomy group reported more urinary problems (P = 0.03) and more sexual dysfunction (P = 0.001). Scores for the FACT-G were similar in the two treatment groups. CONCLUSIONS: Men undergoing treatment for clinically localized prostate carcinoma continue to experience difficulty long after treatment. In this study, the prostatectomy group fared worse in regard to sexual and urinary functions, whereas the radiotherapy group experienced more bowel dysfunction. Survivor-reported QOL and treatment outcomes can assist physicians in counseling patients in the selection of the preferred course of treatment.

Identifying patient symptoms after radiotherapy using a nurse-managed telephone interview.

PURPOSE/OBJECTIVES: To identify patients' symptoms following completion of radiotherapy for common cancers by a nurse-managed telephone interview. DESIGN: Quality assurance project. SETTING: Radiation therapy department in a community hospital in a large midwestern city. SAMPLE: One hundred eleven patients treated by radiotherapy for primary cancer of the prostate, head/neck, lung, and breast. METHODS: Two time points of data collection: nurses completed an end-of-treatment symptom evaluation within the last five days of treatment and conducted telephone interviews 14-21 days post-therapy. Interview questions were based on each individual's end-of-treatment symptoms and common site-specific side effects. MAIN RESEARCH VARIABLES: Symptoms at end of treatment and 14-21 days after therapy completion, nursing assessments and interventions, and length of telephone interview. FINDINGS: At the end of treatment, 104 (94%) patients were experiencing symptoms. Nurses contacted 106 (95%) patients by telephone 14-21 days after therapy completion and assessed symptoms in 84 (79%) patients. Nineteen (18%) patients reported the development of a new symptom. Nurses independently managed 95% of the calls. CONCLUSIONS: The majority of patients experienced symptoms in the immediate post-therapy period. Telephone follow-up interviews served as a mechanism for evaluating short-term morbidity and provided the opportunity for nurses to intervene with many patients. IMPLICATIONS FOR NURSING PRACTICE: A nurse-managed telephone follow-up program can be used as a component of a quality improvement process in radiation centers to assess patients' post-treatment symptoms and provide education and support.