Abstract CN03-03: Disparities in quality of life and satisfaction with outcome among prostate cancer survivors and their spouses

Background: We sought to identify determinants of health-related quality of life (HRQOL) after primary prostate cancer treatment, to measure HRQOL effects on patient or spouse satisfaction with treatment outcome, and to determine whether race is associated with differences in HRQOL outcome or Satisfaction with Cancer Care.

Methods: Outcomes reported by patients and spouses were measured prospectively at multiple centers before and after radical prostatectomy, brachytherapy, or external radiotherapy among 1201 patients and 625 spouses. Patient and treatment factors associated with HRQOL changes were evaluated within treatment groups, and HRQOL effects on satisfaction with treatment outcome were determined.

Results: Adjuvant hormone therapy was associated with worse outcomes across multiple HRQOL domains. Brachytherapy patients reported durable urinary irritative, incontinence, bowel, or sexual symptoms, and transient vitality or hormonal symptoms, compared to pretreatment. Adverse sexual effects of prostatectomy were mitigated by nerve-sparing. After prostatectomy, urinary incontinence was observed, but urinary irritative or obstructive symptoms improved compared to pre-treatment, particularly in patients with larger prostates. No treatment-related deaths occurred; serious adverse events were rare. Obesity, large prostate size, higher PSA, and older age exacerbated treatment-related symptoms; African-Americans reported lower satisfaction with overall treatment outcome. HRQOL changes were significantly associated with outcome satisfaction among patients and their spouse-partners.

Conclusions: Each prostate cancer treatment showed a distinct pattern of changes in urinary, sexual, bowel or vitality/hormonal HRQOL domains that influenced satisfaction with treatment outcome among patients and their spouses. Whereas nerve-sparing mitigated sexual side effects of prostatectomy, adjuvant hormonal therapy magnified the adverse effects of radiotherapy or brachytherapy. African Americans reported less favorable outcomes than did other subjects (despite ostensibly similar care settings), suggesting possibilities of race-associated differences in care quality, patient expectations, or cancer biology; to discern these possibilities will require further study.