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Prostate size,
other neglected factors influence Prostate
Cancer Treatment satisfaction
Newswise — Men with
prostate cancer and their partners face
difficult decisions regarding treatment, and
accurate information regarding expected
outcomes can be hard to find, according to
results of a multi-center study published
Wednesday in the New England Journal of
Medicine.
Outcomes after prostate
surgery, external radiation or brachytherapy
(radioactive ‘seeds’) are highly
individualized and depend not only on age,
but also on factors that have been
previously overlooked, such as the size of
the prostate and whether a man has urinary
symptoms due to prostate enlargement before
treatment.
Previous studies
focused mostly on problems with sexuality,
bowel problems and problems with urinary
incontinence after prostate cancer
treatment, which the study confirmed as
important concerns.
But the research team
from nine hospitals, led by Martin G. Sanda,
MD, Director of the Prostate Care Center at
Beth Israel Deaconess Medical Center and
Associate Professor of Surgery at Harvard
Medical School, found that other symptoms,
such as frequent or weak urination, are
equally as important in determining overall
patient satisfaction.
While many patients and
doctors have assumed that prostate cancer
treatment only causes side effects and does
not reduce symptoms, the study found that
some men with larger prostates benefit with
improved urination after surgery.
However,
the study of 1,201 men and 625 spouses also
found that overall satisfaction with
treatment was lower among African-American
men, despite their having received care at
the same centers as their white
counterparts.
The study examined the
impact of the various forms of treatment on
many facets of quality of life, including
not only sexual function, bowel function and
urinary incontinence – but also on concerns
that are common yet have been previously
neglected by researchers, including weak or
frequent urination due to prostate
enlargement as well as a man’s “vitality” or
hormonal function.
“We didn’t presume
whether one type of side effect or another
is more important – instead, we measured a
broad range of side effects, and asked how
those mesh together and which ones actually
matter in terms of either the patient’s or
his partner’s satisfaction with the overall
cancer treatment outcome,” says Sanda,
adding the research found a greater level of
importance than previously thought in a
patient’s vitality, which includes concerns
expressed by patients and their partners
about the patient’s energy level, weight and
mood.
“When the patient and
doctor sit down, they need to be able to
take factors like the patient’s age,
prostate size, and treatment nuances into
consideration and decide what’s right. The
concept of assigning a general treatment or
non-treatment based simply on someone’s age
and cancer severity alone is no longer
valid.”
Researchers found that
hormonal therapy, when combined with
brachytherapy or with external radiation,
worsened multiple aspects of
quality-of-life, and had particularly
profound effects on men’s vitality and
sexuality. Patients receiving radioactive
seed treatment experienced problems with
weak or frequent urination which lasted
longer and had greater effect on overall
satisfaction than previously appreciated.
Some men who had their
prostates removed surgically reported
problems with urinary incontinence, in
contrast to those who experienced long-term
improvement in urinary obstruction.
Nerve-sparing techniques reduced the sexual
side effects of that surgical procedure but
did not eliminate them.
The study was the first
multi-center effort to focus on satisfaction
with overall outcome of cancer care and to
include partners in the evaluation. And the
results found that changes in quality of
life played a significant role in
determining whether patients and their
partners were satisfied.
In particular, black
patients were less satisfied with their
treatment outcome, despite having received
care and the same high-volume institutions
as other patients.
“When I speak with
black men who have undergone treatment for
prostate cancer, many express
dissatisfaction with their treatment-related
side effects,” says J. Jacques Carter, MD,
MPH, a primary care physician at BIDMC. “My
sense is that they feel they were not given
all of the options nor given a frank
discussion about the adverse effects of the
different treatment modalities.”
The study also
confirmed a commonly held belief that
treatment-related changes in quality of life
among patients had a direct effect on their
partners.
“The level of spousal
distress arising from a patient’s symptoms
after prostate cancer treatment was
associated with the partner’s level of
satisfaction with the treatment outcome,”
the study declares.
“Partners matter, and
satisfaction with overall outcome, from the
perspective of the patient and partner,
should be the bottom line in health care,”
says Sanda. “It’s the simplest thing in the
world to measure, but it’s something that
hasn’t been done very well, particularly in
cancer care.”
The study’s co-authors
were: Irving Kaplan, MD, BIDMC; Xihong Lin,
PhD, Harvard School of Public Health; Rodney
L. Dunn, MS, Howard M. Sandler, MD, Laurel
Northouse, RN, David Wood, MD, Nikhil Shah,
DO, and John T. Wei, MD, University of
Michigan; Larry Hembroff, PhD, Michigan
State University; Thomas K. Greenfield, PhD,
Public Health Institute, Emeryville, CA;
Mark S. Litwin, MD, PhD, Christopher S.
Saigal, University of California at Los
Angeles; Arul Mahadevan, MD, Eric Klein, MD,
and Jay Ciezki, MD, Cleveland Clinic; Louis
L. Pisters, MD and Deborah Kuban, MD, MD
Anderson Cancer Center; and Jeff Michalski,
MD and Adam Kibel, MD, Washington
University, St. Louis.
This study was funded
by a grant from the National Institutes of
Health.
Beth Israel Deaconess Medical Center is a
patient care, teaching and research
affiliate of Harvard Medical School, and
consistently ranks among the top four in
National Institutes of Health funding among
independent hospitals nationwide. BIDMC is
clinically affiliated with the Joslin
Diabetes Center and is a research partner of
Dana-Farber/Harvard Cancer Center. BIDMC is
the official hospital of the Boston Red Sox.
For more information, visit
www.bidmc.harvard.edu.
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