title: Predictors of multidomain decline in health-related quality of life after stereotactic body radiation therapy (SBRT) for prostate cancer.
abstract: Stereotactic body radiation therapy (SBRT) for localized prostate cancer involves high-dose-per-fraction radiation treatments. Its use is increasing, but concerns remain about treatment-related toxicity. The authors assessed the incidence and predictors of a global decline in health-related quality of life (HRQOL) after prostate SBRT.
  
  
  
  From 2008 to 2014, 713 consecutive men with localized prostate cancer received treatment with SBRT according to a prospective institutional protocol. Expanded Prostate Cancer Index Composite (EPIC-26) HRQOL data were collected at baseline and longitudinally for 5 years. EPIC-26 is comprised of 5 domains. The primary endpoint was defined as a decline exceeding the clinically detectable threshold in ≥4 EPIC-26 domains, termed multidomain decline.
  
  
  
  The median age was 69 years, 46% of patients had unfavorable intermediate-risk or high-risk disease, and 20% received androgen-deprivation therapy. During 1 to 3 months and 6 to 60 months after SBRT, 8% to 15% and 10% to 11% of patients had multidomain declines, respectively. On multivariable analysis, lower baseline bowel HRQOL (odds ratio, 1.8; 95% confidence interval, 1.2-2.7; P < .01) and baseline depression (odds ratio, 5.7; 95% confidence interval, 1.3-24.3; P = .02) independently predicted for multidomain decline. Only 3% to 4% of patients had long-term multidomain declines exceeding twice the clinical threshold, and 30% of such declines appeared to be related to prostate cancer treatment or progression of disease.
  
  
  
  Prostate SBRT has minimal long-term impact on multidomain decline, and the majority of more significant multidomain declines appear to be unrelated to treatment. This emphasizes the importance of focusing not only on the side effects of prostate cancer treatment but also on other comorbid illnesses that contribute to overall HRQOL. Cancer 2017;123:1635-1642. © 2017 American Cancer Society.
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Robert T
authors.identifier: 0000-0003-2331-3758
authors.initials: RT
authors.lastname: Dess
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
authors.forename: William C
authors.initials: WC
authors.lastname: Jackson
authors.affiliation: Department of Radiation Oncology, Georgetown University, Washington, District of Columbia.
authors.forename: Simeng
authors.initials: S
authors.lastname: Suy
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Payal D
authors.initials: PD
authors.lastname: Soni
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Jae Y
authors.initials: JY
authors.lastname: Lee
authors.affiliation: Department of Oncology, Sohag University, Sohag, Egypt.
authors.forename: Ahmed E
authors.initials: AE
authors.lastname: Abugharib
authors.affiliation: Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Zachary S
authors.initials: ZS
authors.lastname: Zumsteg
authors.affiliation: Department of Radiation Oncology, University of California-San Francisco, San Francisco, California.
authors.forename: Felix Y
authors.initials: FY
authors.lastname: Feng
authors.affiliation: Department of Radiation Oncology, Texas Oncology, Irving, Texas.
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Hamstra
authors.affiliation: Department of Radiation Oncology, Georgetown University, Washington, District of Columbia.
authors.forename: Sean P
authors.initials: SP
authors.lastname: Collins
authors.affiliation: Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Spratt
mesh_terms: D000368:Aged; D000726:Androgen Antagonists / Q000627:therapeutic use*; D003556:Cystitis / Q000453:epidemiology / Q000209:etiology; D003863:Depression / Q000453:epidemiology*; D005767:Gastrointestinal Diseases / Q000453:epidemiology*; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D016017:Odds Ratio; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000532:radiotherapy*; D011788:Quality of Life; D011832:Radiation Injuries / Q000453:epidemiology / Q000209:etiology; D016634:Radiosurgery / Q000009:adverse effects; D012042:Registries; D012307:Risk Factors; D014549:Urinary Incontinence / Q000453:epidemiology / Q000209:etiology
chemical_list: D000726:Androgen Antagonists
keywords: Expanded Prostate Cancer Index (EPIC); Patient-reported outcomes (PRO); health-related quality of life (HRQOL); prostate cancer; stereotactic body radiation (SBRT)