Original ResearchLong-term quality of life among localised prostate cancer survivors: QALIPRO population-based study
Introduction
Prostate cancer (PCa) is one of the most frequent cancers in developed countries and represents nearly a quarter of all cancers diagnosed in men in France [1]. Improvements in cancer treatments and early diagnosis have led to an increased number of long-term PCa survivors.
Patients with localised prostate cancer (LPCa) have different curative treatment options such as radical prostatectomy (RP), radiotherapy (RT) or both. Androgen deprivation therapy can also be proposed in combination with the others treatments [2]. LPCa patients have a long-term survival and treatments often induce acute and delayed toxicities and sequelae that impact quality of life (QoL). Toxicities may differ according to the treatment used [2].
While many studies have identified adverse effects of PCa treatments, some focused on short (1–3 years) or intermediate-term follow-up (4–5 years) and most of them focused only on symptoms. Some have assessed the impact of treatments in the long-term (>5 years) [3], [4], [5], [6], [7], [8], [9] but few of them included assessment of different domains of QoL and fatigue, that could be impacted. Moreover, only three studies compared QoL and/or symptoms of patients to those of healthy controls [3], [4], [5]. Since the 10-year net survival rate is equal to 71% [10], a careful evaluation of long-term QoL and sequelae in LPCa patients in comparison to those of healthy men of the same age is crucial. This allows to better understand the issues involved and inform patients of the potential long-term consequences of the different treatments. This French population-based study evaluated QoL and sequelae 10 years after treatments for LPCa in comparison with those of aged-matched controls.
Section snippets
Study design and participants
QALIPRO is a population-based case-control study conducted in 2011 among long-term PCa patients survivors initially enrolled in a large cohort from the French network of cancer registries including 2181 patients with a diagnosis of PCa in 2001 from 11 French cancer registries [11]. Inclusion criteria were as follows: i) age >40 at diagnosis, ii) LPCa, low or intermediate D'Amico risk classification, iii) alive but no clinical or radiological relapse (except isolated rising PSA), iv) no history
Study population
We identified 646 eligible patients. Of these, 317 completed the questionnaire. Among the 2855 controls contacted, 683 completed the questionnaire (Fig. 1). The participation rate of all eligible subjects was 49.1% for patients and 23.9% for controls. After exclusions due to relapse or other cancer, 287 questionnaires of patients and 287 questionnaires of aged-matched controls were exploited in the final analyses.
Among patients, participants (n = 317) were younger than non-participants
Discussion
To our knowledge, this is one of the first large population-based studies to analyse all the aspects of long-term QoL and symptoms 10 years after treatments among a group of patients with LPCa in comparison to the general population. Our results obtained from registry data better reflect reality than hospital series. The patients had a global QoL similar to that of aged-matched controls. Nevertheless, they presented severe persistent urinary, bowel and sexual adverse effects, especially those
Funding
This work was co-supported by grants from the ‘French National Institute of Cancer (INCa)’, the ‘Ligue Nationale Contre le Cancer’ and the ‘Fondation ARC’, (PAIR PROSTATE 2011, n°2010-176).
Conflict of interest statement
None declared.
Role of the funding source
The funding sources had no role in the study design, in the collection, analysis and interpretation of data, in the writing of the report, or in the decision to submit the article for publication.
Acknowledgements
The authors thank the physicians, the urologists and the pathologists from the 11 departments in the study. They thank the patients and controls who agreed to participate in the study.
References (39)
- et al.
Cancer incidence and mortality in France over the 1980-2012 period: solid tumors
Rev Epidemiol Sante Publique
(2014) - et al.
EAU guidelines on prostate cancer. Part 1: screening, diagnosis, and local treatment with curative intent-update 2013
Eur Urol
(2014) - et al.
Long-term quality-of-life outcomes after radical prostatectomy or watchful waiting: the Scandinavian Prostate Cancer Group-4 randomised trial
Lancet Oncol
(2011) - et al.
The association of long-term treatment-related side effects with cancer-specific and general quality of life among prostate cancer survivors
Urology
(2014) - et al.
Prostate cancer management and factors associated with radical prostatectomy in France in 2001
Prog Urol
(2010) - et al.
Development and validation of the expanded prostate cancer index composite (EPIC) for comprehensive assessment of health-related quality of life in men with prostate cancer
Urology
(2000) - et al.
The multidimensional fatigue inventory (MFI) psychometric qualities of an instrument to assess fatigue
J Psychosom Res
(1995) - et al.
Three-dimensional structure of the hospital anxiety and depression scale in a large French primary care population suffering from major depression
Psychiatry Res
(2001) - et al.
Quality of life in long-term cervical cancer survivors: a population-based study
Gynecol Oncol
(2013) - et al.
Bowel, urinary, and sexual problems among long-term prostate cancer survivors: a population-based study
Int J Radiat Oncol Biol Phys
(2009)
Health related quality of life in patients treated with multimodal therapy for prostate cancer
J Urol
Update on impact of moderate dose of adjuvant radiation on urinary continence and sexual potency in prostate cancer patients treated with nerve-sparing prostatectomy
Urology
Long-term disease-specific functioning among prostate cancer survivors and noncancer controls in the prostate, lung, colorectal, and ovarian cancer screening trial
J Clin Oncol
Health-related quality of life 10 years after external beam radiotherapy or watchful waiting in patients with localized prostate cancer
Scand J Urol Nephrol
Long-term functional outcomes after treatment for localized prostate cancer
N Engl J Med
Long-term quality of life among Dutch prostate cancer survivors: results of a population-based study
Cancer
Long-term health-related quality of life after primary treatment for localized prostate cancer: results from the CaPSURE registry
Eur Urol
Unbiased estimates of long-term net survival of solid cancers in France
Int J Cancer
The European Organization for Research and Treatment of Cancer QLQ-C30: a quality-of-life instrument for use in international clinical trials in oncology
J Natl Cancer Inst
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- 1
French Network of Cancer Registries (FRANCIM): Anne-Sophie Woronoff (Doubs CR); Brigitte Trétarre (Hérault CR); Patricia Delafosse (Isère CR); Florence Molinié (Loire-Atlantique CR); Simona Bara (Manche CR); Michel Velten (Bas-Rhin CR); Emilie Marrer (Haut Rhin CR); Bénédicte Lapôtre-Ledoux (Somme CR); Anne Cowppli-Bony (Vendée CR). Note: CR = Cancer Registry.