From bad to worse: comorbidity severity and quality of life after treatment for early-stage prostate cancer.
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.
Daskivich
T J
TJ
Department of Urology, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA 90095-1738, USA. tdaskivich@mednet.ucla.edu
van de Poll-Franse
L V
LV
Kwan
L
L
Sadetsky
N
N
Stein
D M
DM
Litwin
M S
MS
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