title: From bad to worse: comorbidity severity and quality of life after treatment for early-stage prostate cancer.
abstract: Commonly used measures of comorbidity assess comorbidity number and type but not severity. We sought to evaluate the impact of comorbidity severity on longitudinal health-related quality of life (HRQOL) in men treated with radical prostatectomy (RP) or radiation therapy (RT) using the Total Illness Burden Index for prostate cancer (TIBI-CaP). We sampled 738 men with non-metastatic prostate cancer treated with RP or RT from the Cancer of the Prostate Strategic Urologic Research Endeavor registry. We examined the impact of comorbidity severity on generic and disease-specific HRQOL at baseline and at 6, 12, 18 and 24 months post-treatment. Men with worse TIBI-CaP comorbidity had significantly lower baseline and post-treatment HRQOL in all domains at all time points. In a multivariate model, men with moderate or severe TIBI-CaP comorbidity had significantly worse HRQOL scores at 12 and 24 months after treatment in all domains except sexual and urinary function (P<0.05); in these domains, severe comorbidity was predictive of lower HRQOL (P<0.05). Comorbidity groups had similar absolute declines in HRQOL from baseline to 6 and 24 months after treatment. Although comorbidity groups experienced similar long-term declines from baseline HRQOL after treatment, men with more severe comorbidity had significantly lower baseline scores and therefore poorer long-term HRQOL.
authors.affiliation: Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095-1738, USA. tdaskivich@mednet.ucla.edu
authors.forename: T J
authors.initials: TJ
authors.lastname: Daskivich
authors.forename: L V
authors.initials: LV
authors.lastname: van de Poll-Franse
authors.forename: L
authors.initials: L
authors.lastname: Kwan
authors.forename: N
authors.initials: N
authors.lastname: Sadetsky
authors.forename: D M
authors.initials: DM
authors.lastname: Stein
authors.forename: M S
authors.initials: MS
authors.lastname: Litwin
mesh_terms: D000368:Aged; D002277:Carcinoma / Q000453:epidemiology* / Q000473:pathology / Q000534:rehabilitation / Q000628:therapy*; D015897:Comorbidity; D018450:Disease Progression; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000453:epidemiology; D008875:Middle Aged; D009367:Neoplasm Staging; D011468:Prostatectomy / Q000534:rehabilitation / Q000706:statistics & numerical data; D011471:Prostatic Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000534:rehabilitation / Q000628:therapy*; D011788:Quality of Life; D011878:Radiotherapy / Q000706:statistics & numerical data; D012107:Research Design; D012720:Severity of Illness Index; D012735:Sexual Dysfunction, Physiological / Q000453:epidemiology; D013997:Time Factors; D014555:Urination Disorders / Q000453:epidemiology