title: Association between utility and treatment among patients with prostate cancer.
abstract: OBJECTIVE
  To analyze the association between utility, treatment, and generic and prostate-specific health-related quality of life (HRQoL) among patients with prostate cancer.
  
  
  METHODS
  In this longitudinal cohort study, we recruited 201 (>or=45 years) newly diagnosed patients with prostate cancer from urology clinics of an urban academic hospital. Participants completed Quality of Wellbeing (QWB-SA), generic (SF-36), and prostate-specific (UCLA-PCI) HRQoL surveys prior to treatment and up to 24 months post-treatment. Clinical and demographic data were obtained via medical chart review, and utility scores were computed using QWB-SA. To analyze the relationship between treatment and utility, we used linear mixed effects models, after adjusting for covariates and propensity score. Similar models were used to examine the association between generic and prostate-specific HRQoL and utility.
  
  
  RESULTS
  Mean baseline utility was comparable between radical prostatectomy (RP) and external beam radiation therapy (EBRT) groups (0.73 vs. 0.69, P=0.1750). Mixed effects models indicated that RP was associated with higher utility at 24 month (OR=1.12, P=0.027), after controlling for covariates. RP was associated with improved functioning for role physical, role emotional, vitality, mental health and bodily pain, and impaired urinary function. Higher scores on generic health subscales were indicative of higher utility. Also, for prostate-specific HRQoL, higher scores on bowl function, sexual function, urinary bother, and bowel bother were associated with higher utility.
  
  
  CONCLUSIONS
  Treatment appears to have significant association with post-treatment utility. Thus, utility assessment provides an important quantitative tool to support patient and physician clinical treatment decision-making process in prostate cancer care.
authors.affiliation: Department of Medicine, University of Pennsylvania, 224, 3615 Chestnut Street, Philadelphia, PA 19104-2676, USA. jravi@mail.med.upenn.edu
authors.forename: Ravishankar
authors.initials: R
authors.lastname: Jayadevappa
authors.forename: J Sanford
authors.initials: JS
authors.lastname: Schwartz
authors.forename: Sumedha
authors.initials: S
authors.lastname: Chhatre
authors.forename: Alan J
authors.initials: AJ
authors.lastname: Wein
authors.forename: S Bruce
authors.initials: SB
authors.lastname: Malkowicz
mesh_terms: D000223:Adaptation, Psychological; D001741:Black or African American; D000368:Aged; D016001:Confidence Intervals; D006304:Health Status; D006305:Health Status Indicators; D006306:Health Surveys; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011446:Prospective Studies; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000523:psychology* / Q000532:radiotherapy / Q000601:surgery; D011594:Psychometrics; D011787:Quality of Health Care; D011788:Quality of Life / Q000523:psychology*; D013315:Stress, Psychological; D016896:Treatment Outcome; D014481:United States