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Predictors of multidomain decline in health‐related quality of life after stereotactic body radiation therapy (SBRT) for prostate cancer
Author(s) -
Dess Robert T.,
Jackson William C.,
Suy Simeng,
Soni Payal D.,
Lee Jae Y.,
Abugharib Ahmed E.,
Zumsteg Zachary S.,
Feng Felix Y.,
Hamstra Daniel A.,
Collins Sean P.,
Spratt Daniel E.
Publication year - 2017
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/cncr.30519
Subject(s) - medicine , prostate cancer , confidence interval , odds ratio , androgen deprivation therapy , quality of life (healthcare) , prostate , clinical endpoint , cancer , radiation therapy , prospective cohort study , urology , clinical trial , nursing
BACKGROUND Stereotactic body radiation therapy (SBRT) for localized prostate cancer involves high‐dose‐per‐fraction radiation treatments. Its use is increasing, but concerns remain about treatment‐related toxicity. The authors assessed the incidence and predictors of a global decline in health‐related quality of life (HRQOL) after prostate SBRT. METHODS From 2008 to 2014, 713 consecutive men with localized prostate cancer received treatment with SBRT according to a prospective institutional protocol. Expanded Prostate Cancer Index Composite (EPIC‐26) HRQOL data were collected at baseline and longitudinally for 5 years. EPIC‐26 is comprised of 5 domains. The primary endpoint was defined as a decline exceeding the clinically detectable threshold in ≥4 EPIC‐26 domains, termed multidomain decline . RESULTS The median age was 69 years, 46% of patients had unfavorable intermediate‐risk or high‐risk disease, and 20% received androgen‐deprivation therapy. During 1 to 3 months and 6 to 60 months after SBRT, 8% to 15% and 10% to 11% of patients had multidomain declines, respectively. On multivariable analysis, lower baseline bowel HRQOL (odds ratio, 1.8; 95% confidence interval, 1.2‐2.7; P < .01) and baseline depression (odds ratio, 5.7; 95% confidence interval, 1.3‐24.3; P = .02) independently predicted for multidomain decline. Only 3% to 4% of patients had long‐term multidomain declines exceeding twice the clinical threshold, and 30% of such declines appeared to be related to prostate cancer treatment or progression of disease. CONCLUSIONS Prostate SBRT has minimal long‐term impact on multidomain decline, and the majority of more significant multidomain declines appear to be unrelated to treatment. This emphasizes the importance of focusing not only on the side effects of prostate cancer treatment but also on other comorbid illnesses that contribute to overall HRQOL. Cancer 2017;123:1635–1642. © 2017 American Cancer Society .