Changes in health utilities and health-related quality of life over 12 months following radical prostatectomy

Authors

  • Jennifer Ku University of Waterloo, University Health Network, University of Toronto, Toronto Health Economics and Technology Assessment Collaborative (THETA)
  • Murray Krahn University of Waterloo, University Health Network, University of Toronto, Toronto Health Economics and Technology Assessment Collaborative (THETA)
  • John Trachtenberg University of Waterloo, University Health Network, University of Toronto, Toronto Health Economics and Technology Assessment Collaborative (THETA)
  • Michael Nesbitt University of Waterloo, University Health Network, University of Toronto, Toronto Health Economics and Technology Assessment Collaborative (THETA)
  • Robin Kalnin University of Waterloo, University Health Network, University of Toronto, Toronto Health Economics and Technology Assessment Collaborative (THETA)
  • Gina Lockwood University of Waterloo, University Health Network, University of Toronto, Toronto Health Economics and Technology Assessment Collaborative (THETA)
  • Shabbir M.H. Alibhai University of Waterloo, University Health Network, University of Toronto, Toronto Health Economics and Technology Assessment Collaborative (THETA)

DOI:

https://doi.org/10.5489/cuaj.1171

Abstract

Introduction: Although radical prostatectomy (RP) is an effective
treatment for prostate cancer, it has potentially deleterious effects
on health-related quality of life (HRQoL). Utility is an important
global measure of HRQoL. This utility is also used in decisionmaking
models and economic evaluations. There are no published
prospective data characterizing men’s utilities for health
outcomes post-RP.

Methods: From July 2003 to June 2006, patients undergoing RP at
the University Health Network in Toronto, Ontario, Canada, completed
the Patient-Oriented Prostate Utility Scale (PORPUS), a
disease-specific HRQoL and utility instrument. Men were included
if they had clinically localized prostate cancer and had completed
HRQoL measures prior to surgery and at least once within
9 to 18 months after the RP. Health-related quality of life was
measured prior to surgery and at 4 stages after surgery: 0 to 3
months, 3 to 9 months, 9 to 18 months, and 18 to 30 months.
Statistical analyses included pairwise t-tests and multivariable linear
regression comparing changes in scores between baseline and
the 9- to 18-month range.

Results: Two hundred and thirteen men (mean age 60.9, median
Gleason score 7) met the inclusion criteria. At baseline, HRQoL
was high (mean PORPUS-P [psychometric] = 83.8). Scores declined
sharply by 3 months (65.5, p < 0.001) and improved but did not
reach baseline by 9-18 months (75.1, p < 0.001). Utility scores
(PORPUS-U[utility]) showed the same pattern: 0.94 at baseline;
0.81 at 3 months (p < 0.001); and 0.88 at 9 to 18 months (p <
0.001). Predictors of HRQoL, including baseline PORPUS score,
nerve-sparing surgery and smoking status, decline after RP.

Conclusion: Symptom scores are known to be affected up to
12 months after RP. Our study demonstrates that global health
status also declines and remains affected 1 year after surgery.

Introduction : La prostatectomie radicale est un traitement efficace
contre le cancer de la prostate, mais elle présente des effets indési -
rables potentiels ayant un impact sur la qualité de vie liée à la
santé (QdVS), dont l’état de santé est une importante mesure glo -
bale. Cette mesure est aussi utilisée dans les modèles décisionnels
et les évaluations économiques. Aucune donnée prospective n’a
été publiée concernant l’état de santé des patients après une PR.

Méthodologie : Entre juillet 2003 et juin 2006, des patients ayant
subi une PR au sein du University Health Network à Toronto (Ontario)
au Canada ont rempli le questionnaire PORPUS d’auto-évaluation,
un instrument de mesure de la qualité de vie reliée à la santé et de
l’état de santé. Étaient inclus les hommes atteints d’un cancer de la
prostate cliniquement localisé et ayant été évalués à l’aide d’ins -
truments de mesure de la QdVS avant l’intervention chirurgicale et
au moins une fois dans les 9 à 18 mois suivant la PR. La qualité de
vie reliée à la santé a été mesurée avant la chirurgie et à 4 reprises
par la suite : après 0 à 3 mois, 3 à 9 mois, 9 à 18 mois et 18 à 30
mois. Les analyses statistiques incluaient des tests t par paires et
une analyse de régression linéaire multivariée afin de comparer les
changements dans les scores entre les valeurs de départ et les valeurs
obtenues 9 à 18 mois après l’intervention.

Résultats : Deux cent treize hommes (âge moyen, 60,9 ans, score
de Gleason médian, 7) répondaient aux critères d’inclusion. Au
départ, les scores de QdVS étaient élevés (score PORPUS-P [psychométrique]
moyen = 83,8). Les scores avaient chuté dramatiquement
après 3 mois (65,5, p < 0,001); ils ont ensuite remonté,
mais n’avaient pas atteint le niveau de départ après 9 à
18 mois (75,1, p < 0,001). Les scores d’état de santé (PORPUS-U)
ont suivi la même tendance : 0,94 au départ; 0,81 après
3 mois (p < 0,001), et 0,88 après 9 à 18 mois (p < 0.001). Les
facteurs de prédiction du score de QdVS qui diminuent sont le
score PORPUS au départ, le recours à une technique chirurgicale
préservant les filets nerveux et le tabagisme.

Conclusion : Il est reconnu que les scores des symptômes sont affectés
jusqu’à 12 mois après la PR. Notre étude montre que l’état de
santé global diminue également et demeure affecté un an après
l’intervention chirurgicale.

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Author Biographies

Jennifer Ku, University of Waterloo, University Health Network, University of Toronto, Toronto Health Economics and Technology Assessment Collaborative (THETA)

Murray Krahn, University of Waterloo, University Health Network, University of Toronto, Toronto Health Economics and Technology Assessment Collaborative (THETA)

John Trachtenberg, University of Waterloo, University Health Network, University of Toronto, Toronto Health Economics and Technology Assessment Collaborative (THETA)

Michael Nesbitt, University of Waterloo, University Health Network, University of Toronto, Toronto Health Economics and Technology Assessment Collaborative (THETA)

Robin Kalnin, University of Waterloo, University Health Network, University of Toronto, Toronto Health Economics and Technology Assessment Collaborative (THETA)

Gina Lockwood, University of Waterloo, University Health Network, University of Toronto, Toronto Health Economics and Technology Assessment Collaborative (THETA)

Shabbir M.H. Alibhai, University of Waterloo, University Health Network, University of Toronto, Toronto Health Economics and Technology Assessment Collaborative (THETA)

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How to Cite

Ku, J., Krahn, M., Trachtenberg, J., Nesbitt, M., Kalnin, R., Lockwood, G., & Alibhai, S. M. (2013). Changes in health utilities and health-related quality of life over 12 months following radical prostatectomy. Canadian Urological Association Journal, 3(6), 445–52. https://doi.org/10.5489/cuaj.1171

Issue

Vol. 3 No. 6 (2009): CUAJ December

Section

Original Research

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