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Multi-institutional prospective evaluation of bowel quality of life after prostate external beam radiation therapy identifies patient and treatment factors associated with patient-reported outcomes: the PROSTQA experience.

AbstractPURPOSE:
To evaluate patients treated with external beam radiation therapy as part of the multicenter Prostate Cancer Outcomes and Satisfaction with Treatment Quality Assessment (PROSTQA), to identify factors associated with posttreatment patient-reported bowel health-related quality of life (HRQOL).
METHODS AND MATERIALS:
Pretreatment characteristics and treatment details among 292 men were evaluated using a general linear mixed model for their association with measured HRQOL by the Expanded Prostate Cancer Index Composite instrument through 2 years after enrollment.
RESULTS:
Bowel HRQOL had a median score of 100 (interquartile range 91.7-100) pretreatment and 95.8 (interquartile range 83.3-100) at 2 years, representing new moderate/big problems in 11% for urgency, 7% for frequency, 4% for bloody stools, and 8% for an overall bowel problems. Baseline bowel score was the strongest predictor for all 2-year endpoints. In multivariable models, a volume of rectum ≥25% treated to 70 Gy (V70) yielded a clinically significant 9.3-point lower bowel score (95% confidence interval [CI] 16.8-1.7, P=.015) and predicted increased risks for moderate to big fecal incontinence (P=.0008). No other radiation therapy treatment-related variables influenced moderate to big changes in rectal HRQOL. However, on multivariate analyses V70 ≥25% was associated with increases in small, moderate, or big problems with the following: incontinence (3.9-fold; 95% CI 1.1-13.4, P=.03), rectal bleeding (3.6-fold; 95% CI 1.3-10.2, P=.018), and bowel urgency (2.9-fold; 95% CI 1.1-7.6, P=.026). Aspirin use correlated with a clinically significant 4.7-point lower bowel summary score (95% CI 9.0-0.4, P=.03) and an increase in small, moderate, or big problems with bloody stools (2.8-fold; 95% CI 1.2-6.4, P=.018). Intensity modulated radiation therapy was associated with higher radiation therapy doses to the prostate and lower doses to the rectum but did not independently correlate with bowel HRQOL.
CONCLUSION:
After contemporary dose-escalated external beam radiation therapy up to 11% of patients have newly identified moderate/big problems with bowel HRQOL 2 years after treatment. Bowel HRQOL is related to baseline function, rectal V70, and aspirin use. Finally, our findings validate the commonly utilized cut-point of rectal V70 ≥25% as having significant impact on patient-reported outcomes.
AuthorsDaniel A Hamstra, Anna S C Conlon, Stephanie Daignault, Rodney L Dunn, Howard M Sandler, A Larry Hembroff, Anthony L Zietman, Irving Kaplan, Jay Ciezki, Deborah A Kuban, John T Wei, Martin G Sanda, Jeff M Michalski,
JournalInternational journal of radiation oncology, biology, physics (Int J Radiat Oncol Biol Phys) Vol. 86 Issue 3 Pg. 546-53 (Jul 1 2013) ISSN: 1879-355X [Electronic] United States
PMID23561651 (Publication Type: Journal Article, Multicenter Study, Research Support, N.I.H., Extramural)
CopyrightCopyright © 2013 Elsevier Inc. All rights reserved.
Chemical References
  • Anti-Inflammatory Agents, Non-Steroidal
  • Aspirin
Topics
  • Aged
  • Aged, 80 and over
  • Analysis of Variance
  • Anti-Inflammatory Agents, Non-Steroidal
  • Aspirin (administration & dosage)
  • Confidence Intervals
  • Fecal Incontinence (etiology)
  • Gastrointestinal Hemorrhage (etiology)
  • Humans
  • Male
  • Middle Aged
  • Patient Satisfaction
  • Prospective Studies
  • Prostate (radiation effects)
  • Prostatic Neoplasms (psychology, radiotherapy)
  • Quality of Life (psychology)
  • Radiotherapy Dosage
  • Radiotherapy, Intensity-Modulated (adverse effects)
  • Rectal Diseases (etiology)
  • Rectum (radiation effects)
  • Severity of Illness Index
  • United States

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