title: Impact of age and comorbidities on health-related quality of life for patients with prostate cancer: evaluation before a curative treatment.
abstract: BACKGROUND
  Interpretation of comparative health-related quality of life (HRQOL) studies following different prostate cancer treatments is often difficult due to differing patient ages. Furthermore, age-related changes can hardly be discriminated from therapy-related changes. The evaluation of age-and comorbidity-related changes was in focus of this study.
  
  
  METHODS
  HRQOL of 528 prostate cancer patients was analysed using a validated questionnaire (Expanded Prostate Cancer Index Composite) before a curative treatment. Patients were divided into age groups <or=65, 6670, 7175 and >75 years. The impact of specific comorbidities and the Charlson Comorbidity Index (CCI) were evaluated. The questionnaire comprises 50 items concerning the urinary, bowel, sexual and hormonal domains for function and bother. For assessment of sexual and hormonal domains, only patients without prior hormonal treatment were included (n = 336).
  
  
  RESULTS
  Urinary incontinence was observed increasingly with higher age (mean function scores of 92/88/85/87 for patients <or=65, 6670, 7175 and >75 years) complete urinary control in 78%/72%/64%/58% (p < 0.01). Sexual function scores decreased particularly (48/43/35/30), with erections sufficient for intercourse in 68%/50%/36%/32% (p < 0.01) a decrease of more than a third comparing patients <or=65 vs. 6670 (36%) and 6670 vs. 7175 years (39%). The percentage of patients with comorbidities was lowest in the youngest group (48% vs. 66%/68%/63% for ages 6670/7175/>75 years; p < 0.05). A multivariate analysis revealed an independent influence of both age and comorbidities on urinary incontinence, specifically diabetes on urinary bother, and both age and diabetes on sexual function/bother. Rectal domain scores were not significantly influenced by age or comorbidities. A CCI>5 particularly predisposed for lower urinary and sexual HRQOL scores.
  
  
  CONCLUSIONS
  Urinary continence and sexual function are the crucial HRQOL domains with age-related and independently comorbidity-related decreasing scores. The results need to be considered for the interpretation of comparative studies or longitudinal changes after a curative treatment.
authors.affiliation: Department of Radiation Oncology, RWTH Aachen University, Aachen, Germany. mpinkawa@ukaachen.de
authors.forename: Michael
authors.initials: M
authors.lastname: Pinkawa
authors.forename: Karin
authors.initials: K
authors.lastname: Fischedick
authors.forename: Bernd
authors.initials: B
authors.lastname: Gagel
authors.forename: Marc D
authors.initials: MD
authors.lastname: Piroth
authors.forename: Branka
authors.initials: B
authors.lastname: Asadpour
authors.forename: Jens
authors.initials: J
authors.lastname: Klotz
authors.forename: Holger
authors.initials: H
authors.lastname: Borchers
authors.forename: Gerhard
authors.initials: G
authors.lastname: Jakse
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Eble
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000523:psychology* / Q000532:radiotherapy; D011788:Quality of Life; D012725:Sexual Behavior; D011795:Surveys and Questionnaires
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