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Changes in Health-Related Quality of Life Among Older Adults with Prostate Cancer: A Case-Control Study

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Sources of Funding: none

Introduction

The objective of our study was to assess health-related quality of life (HRQOL) changes before and after cancer diagnosis in older adults with prostate cancer and compare changes to non-cancer controls.

Methods

We used the Surveillance, Epidemiology, and End Results linked to Medicare Health Outcomes Survey (SEER MHOS) dataset. The MHOS included the SF-36 from 1998-2005 and replaced it with the VR-12 from 2006-2013. Adults 65 years and older who were diagnosed with prostate cancer between two MHOS surveys from 1998-2013 were included. Cases were matched to 5 non-cancer controls using propensity score matching. Linear mixed models were used to estimate HRQOL changes over time and factors associated with changes.

Results

We identified 1,764 prostate cases and 8,820 non-cancer matched controls. Among cases, 1,040 had Gleason 6-7 (low/intermediate risk) and 724 Gleason 8-10 (high-risk). Compared to controls, cases (low/intermediate and high-risk) were more likely to have significant decrements in Role Physical (-2 and -1.7 points vs. -0.5 point) and General Health (-1.9 and -2.0 vs. -0.3). Compared to controls, high-risk cases had additional significant decrements in Physical Component Score (-1.4 vs. -0.4 points), Mental Component Score (-1.7 vs. -0.5 points), and Role Emotional (-1.2 vs. -0.1 points). When stratified by time since diagnosis, immediate declines were observed across HRQOL measures (Figure1). Most HRQOL measures improved over time with the exception of Role Emotional, which deteriorated. We observed no significant differences in HRQOL changes across treatment modalities.

Conclusions

Following diagnosis, older men with prostate cancer experienced significant declines in physical, mental and social HRQOL relative to controls. Declines were most pronounced in the first 6 months after diagnosis and among men with high-risk disease. Understanding factors associated with HRQOL declines may inform more comprehensive HRQOL management for prostate cancer patients.

Funding

none

Authors
Angela Smith
Byron Jaeger
Laura Pinheiro
Lloyd Edwards
Bryce Reeve
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