Actual and expected treatment-related side-effects predict low health related quality-of-life in prostate cancer survivors

Introduction: Prostate cancer (PCa) treatments may be associated with side-effects. The impact of these on health-related quality-of-life (HRQoL) longer term is poorly understood.

Objectives: To investigate associations between treatment-related side-effects and HRQoL in a population-based sample of long-term PCa survivors. 

Methods: 6,937 PCa (ICD10 C61) survivors, 1.5-15 years post-diagnosis, identified from the National Cancer Registry Ireland and Northern Ireland Cancer Registry were invited to complete a postal questionnaire. This included questions on: socio-demographic characteristics; treatment(s) received; side-effects expected and experienced (including incontinence, impotence, bowel problems, hot flushes, fatigue); and HRQoL.  An EORTC QLQ30 global health score in the lowest quartile (<38.1) was considered low HRQoL.  Predictors of low HRQoL were investigated using multivariate logistic regression. 

Results: 3,802 men participated (response rate=55%). In analysis of the first 1,344 respondents, the significant socio-demographic predictors of low HRQoL were age, marital status, educational level and employment status at diagnosis. Risk of low HRQoL was: higher in men with comorbidities; varied by treatment received; and increased with time since diagnosis.  Men who currently experienced treatment-related incontinence had increased risk of low HRQoL (OR=2.90, 95%CI 1.90-4.43). Risk was also increased in men whose side-effects were worse than expected (OR=1.82, 95%CI 1.17-2.84), and reduced in those whose side-effects were not as bad as expected (OR=0.54, 95%CI 0.34-0.86).

Conclusions:   Actual and expected side-effects predicted risk of low HRQoL.  If confirmed in the full dataset, these results suggest that men with PCa may benefit from realistic information pre-treatment on risk of side-effects and long-term support in managing side-effects.