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Query: UMLS:C0376358 (prostate cancer)
 59,338 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

As a first effort to introduce quality-of-life assessment in prostatic cancer clinical trials, the European Organization for Research and Treatment of Cancer Genitourinary Group, in cooperation with European Organization for Research and Treatment Quality of Life Group, initiated protocol 30853, coordinated by Louis Denis. This protocol compared the efficacy of treatment with orchiectomy alone to that with Zoladex (Zeneca Pharmaceuticals, Alderley Macclesfield, Cheshire, UK) plus flutamide in previously untreated patients with metastatic cancer. The use of patient-administered quality-of-life questionnaires was optional, and of 327 patients, only 22% had pretreatment assessments. This trial revealed many clinician's considerable reluctance to perform quality of life research, partly because of feasibility problems and partly because of doctors' doubts about the value of such efforts. Psychologic distress, fatigue, issues of social and family life, and pain were found to be the most important concerns on a subjective basis, and this finding was confirmed by objective parameters. There was a discrepancy between doctors' evaluations and patients' opinions about subjective morbidity, namely sexual status and pain. Quality of life assessment should become a mandatory part of clinical trials in prostate cancer.
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PMID:Quality of life in prostatic cancer patients. 825 94

Subjective quality-of-life assessments obtained from investigators and patients were compared in a subset of 76 patients from an EORTC study (protocol 30853) on metastatic prostatic carcinoma. In this study the therapeutic effect of orchiectomy was compared with a luteinizing hormone-releasing hormone analogue depot preparation and flutamide in 327 patients in total. Pretreatment, 6- and 12-month quality-of-life assessments revealed large variations between the patients' and the investigators' evaluation of performance status and sexual status (potency). Correlation analysis showed that reduced social life, impaired sexual potency and fatigue played important roles in overall psychological well-being. It was concluded that quality-of-life assessments obtained by self-administration questionnaires is a feasible approach and provides a tool to evaluate the benefits of treatment in prostate cancer.
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PMID:Quality of life in prostatic carcinoma. 826 15

Assessing the QOL in cancer clinical trials is becoming increasingly important. However, a suitable device of assessment of QOL has not been developed yet for prostate cancer patients in Japan. We tried to assess the QOL of prostate cancer patients using the EORTC questionnaire translated in Japanese, and examined its validity and reliability. Thirty-six patients filled in a questionnaire. The reliability of this device was confirmed by the results of test-retest reproducibility. Good correlation was shown between the results and patients performance status, and between the results and clinical stages, which support the validity of the device. As for the results of assessment of QOL, these patients were severely damaged in sexuality. Those factors of functional status, physical symptoms and fatigue/malaise were closely related to disease activity and clinical stage.
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PMID:[Assessment of the quality of life of prostate cancer patients]. 841 17

This study was undertaken to evaluate the quality of life (QoL) of previously untreated patients with M1 prostate cancer before and during androgen-suppressive treatment. Assessment of QoL was included as an optimal component of EORTC protocol 30853, a phase III trial comparing LH-RH (luteinising hormone-releasing hormone) analogue combined with a non-steroidal anti-androgen versus orchiectomy in patients with M1 prostate cancer. At pretreatment and during the follow-up period, patients were asked to complete a questionnaire assessing their physical and psychosocial functioning, and their symptom levels. Physicians rated the patients' performance status, pain, urological symptoms and erectile function. Due to its optional nature, only a minority of the patients in the trial were recruited for the QoL investigation. 63 patients completed a pretreatment questionnaire, of whom 49 completed a second questionnaire at least once during the initial 15 month follow-up period. While statistically significant correlations were observed between patients' and physicians' ratings of physical functioning and pain, these were of only a moderate magnitude (r = 0.43 and 0.30, respectively). No significant association was observed between physicians' and patients' ratings of micturation problems or of erectile function. Before treatment, fatigue, pain and decreased social role and sexual functioning were the problems most frequently reported by patients. With an average of approximately 1 year follow-up, statistically significant improvements were observed in patients' self-reported urological symptoms and metastatic pain. No significant changes were noted for the other QoL domains assessed. The results of this study confirm earlier findings that physicians' ratings may not reflect accurately the functional health and symptom experience of their patients. Patient-based QoL questionnaires offer the most direct means of evaluating the subjective morbidity associated with prostate cancer and its treatment. To increase participation and compliance rates in future studies, it is recommended that QoL assessment be made mandatory in those clinical trials in which QoL is considered to be an important study endpoint.
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PMID:The quality of life of patients with newly diagnosed M1 prostate cancer: experience with EORTC clinical trial 30853. 869 46

Palliation is the principal aim of treatment for patients with advanced prostate cancer. In a strict sense, "palliation" means reduction of existing symptoms, but in clinical practice a further goal is to prolong the symptom-free interval in asymptomatic patients and to prevent distressing problems, such as pain and fatigue, with the overall aim of improving quality of life. In patients with advanced prostate cancer, quality of life parameters represent an important endpoint in clinical routine and in clinical trials. Evaluation of quality of life issues also provides independent prognostic information. A feasible approach for regular quality of life assessment is the use of a questionnaire developed for cancer patients together with psychometrically tested disease-specific and treatment-specific modules designed to evaluate the various factors, such as micturition, sexuality, vitality, and intestinal problems for localized prostate cancer, and bone pain, micturition, sexuality, hot flashes, gynecomastia, and gastrointestinal problems for metastatic prostate cancer.
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PMID:Quality of life in advanced prostate cancer. 899 83

Clinical evaluation in oncology has typically focused on outcome indicators, while less attention has been paid to how treatment affects quality of life (QOL) of the patient. In this article some general aspects of quality of life are discussed, a short review of published data on QOL in patients with prostate cancer is given and results of a QOL study executed by the authors on patients with lymph node positive prostatic cancer are presented. The purpose of the study was to examine the impact of immediate or delayed treatment (after objective progression) in patients with prostatic carcinoma (T1-3 N1-3 M0) on quality of life parameters. To this end an extended questionnaire was constructed. Fifty-five patients participated. Assessment was performed twice, in 1994 and 1995. The comparison between patients with and patients without treatment showed in 1994 as well as in 1995 significant differences for hormonal treatment side effects such as sexual functioning and hot flushes, all of which were experienced more frequently by treated patients. In 1994 the treated patients experienced more psychological distress while in 1995 they showed worse physical function, less energy and more fatigue when compared to patients under surveillance. The premise that active treatment would improve the psychological quality of life was not sustained. In addition global health status and quality of life were identified as independent factors for progression in untreated patients with lymph node positive prostate cancer. Finally, an increase in prostate-specific antigen (PSA) in hormonally treated patients not only indicated hormonal escape but also a decrease in QOL.
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PMID:Quality of life in patients with prostatic carcinoma: a review and results of a study in N+ disease. Prostate-specific antigen as predictor of quality of life. 914 92

This synthesis of the literature on the quality of life in relation to radiotherapy is based on 78 scientific articles, including 12 randomized studies, 25 prospective studies, and 20 retrospective studies. These studies involve 9884 patients. Radiotherapy is often organ-preserving, which inherently promotes a better quality of life. Many quality of life aspects related to radiotherapy have been studied, but seldom by prospective randomized studies that compare radiotherapy to other treatment (eg, surgery or chemotherapy). Radiotherapy involves numerous physical and psychological symptoms, mainly during the course of treatment. Examples include skin irritation and fatigue. Radiotherapy directed at the brain has delayed effects, in children treatment carries a substantial risk for lowering the IQ. The risk for encephalopathy in adults is probably underestimated. Patients with cancer in the head and neck may experience adverse side effects in the irradiated area long after the conclusion of radiotherapy. There are no confirmed differences in quality of life between breast cancer patients receiving adjuvant radiotherapy and those receiving chemotherapy. Impotency problems and urinary incontinence appear following radical surgery and radiotherapy for prostate cancer. The risk for delayed complications is low after radiotherapy for testicular cancer. Patients receiving radiotherapy for gynecologic cancers are often troubled by local side effects long after the conclusion of treatment.
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PMID:Radiotherapy for cancer. Quality of life. 915 7

The antineoplastic agent mitoxantrone in combination with a corticosteroid (either prednisone or hydrocortisone) has shown clinical efficacy as palliative treatment for a proportion of patients (about 35 to 40%) with hormone-resistant advanced prostate cancer, a disease which predominantly affects elderly men and for which few systemic treatment options are available. Palliative end-points including pain relief, decreased analgesic use and reduced prostate specific antigen levels (a marker of tumour response) are reached in a greater percentage of patients receiving combination therapy than corticosteroid alone. In addition, there are generally greater improvements in quality-of-life parameters in mitoxantrone recipients. However, combined treatment offers no survival advantage over corticosteroid monotherapy. Neutropenia is the most common toxicity associated with mitoxantone therapy and may necessitate dosage reduction in some patients. Otherwise, mitoxantrone generally has a more favourable tolerability profile than has been established for other cytotoxic agents such as doxorubicin with regard to acute adverse events (e.g. nausea/vomiting, anorexia, constipation, alopecia, malaise/ fatigue, oedema) and cardiac toxicity. In conclusion, administration of mitoxantrone plus a corticosteroid can provide palliation for some elderly patients with hormone-resistant advanced prostate cancer, and is thus a valuable first-line treatment for this indication.
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PMID:Mitoxantrone. A review of its pharmacology and clinical efficacy in the management of hormone-resistant advanced prostate cancer. 920 52

Eleven men with prostate cancer were randomly chosen and interviewed during an in-patient period at a southern Swedish hospital. The interview focused on functional health status in relation to daily life and life quality. In addition the sense of coherence scale was used, as well as the European Organization or Research and Treatment of Cancer (EORTC) QLQ C-30 questionnaire. The interview findings were analysed from a phenomenological-hermeneutic perspective and interpreted within the concept of transition. The entry to transition was marked by the men when experiencing an altered life continuum in terms of physical and existential fatigue, pain, micturition problems and an altered sex life. The passage phase was marked by descriptions of a new lifestyle where hope was a central internal resource, creating a positive illusion of life in order to endure. Their external resources were wives and family who supported physically (household matters, gardening) and psycho-logically (comfort, encouragement). The exit phase meant continuously adapting to a new life style, living with a slowly deteriorating functional health status, a new sense of dependency on others, daily life routine broken by in-patient hospital periods and contacts with primary health care. Thus the findings pointed more at continuously facing new passages than a stable exit, i.e. an ongoing transition. The areas of life imbalance described may serve as a basis for care assessment and intervention as well as supplying support of the transitional process.
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PMID:Experiences of daily life and life quality in men with prostate cancer. An explorative study. Part I. 923 61

The so-called andropause is an ill-defined collection of symptoms in a group of men who may have low but may also have normal androgen levels. Unlike the proven benefits of hormone replacement therapy in women, the effects of testosterone supplementation in men are equivocal. It may increase sexual interest, but rarely to a level thought adequate by the patient. It has no proven beneficial effect on erectile dysfunction and other possible beneficial effects on haemopoesis, bone metabolism, lipids and fibrinolysis have yet to be demonstrated. With the availability of the testosterone patch, sustained increases in the serum testosterone levels will be readily achieved and could theoretically significantly affect the behaviour of subclinical prostate cancer. At the present time, testosterone replacement therapy in hypogonadal men is of proven clinical benefit; this is not the case, however, for eugonadal men with symptoms attributed to the andropause. The symptoms of the andropause fatigue can readily be explained by stress and there is no scientifically valid, placebo-controlled study that shows any benefit for testosterone supplements in this not uncommon group of patients.
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PMID:The andropause: fact or fiction? 937 94


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