OncologyPredictors Of Patient Reported Outcomes And Cost Of Care In Younger Men With Newly Diagnosed Prostate Cancer
UroToday.com - In the online version of The Prostate, Dr. Ravishankar Jayadevappa and colleagues from the University of Pennsylvania analyzed the association between race, risk of biochemical recurrence and recovery pattern of patient reported outcomes such as satisfaction with care, HRQoL (generic and prostate-specific) and cost in younger men with newly diagnosed prostate cancer (CaP). The investigators hypothesized that younger African American men will have impaired HRQoL outcomes and will present with higher cost compared to younger Caucasian CaP patients.
The study was an observational prospective cohort design that recruited men younger than 65 years with a new diagnosis of non-metastatic CaP. Data collected included generic and prostate-specific HRQoL prior to treatment. A self-reported questionnaire was used for data on race, education, marital status, living arrangement and income. Clinical and pathologic data was chart extracted. Participants were contacted by mail at 3, 6, 12, and 24 months. Satisfaction with care was measured using the self-administered Client Satisfaction Questionnaire. Health re utilization and direct medical care cost for 3 years was obtained.
A total of 318 men (104 African American and 214 Caucasian) were recruited and 279 completed the 24-month follow-up. Caucasian men were slightly younger than African American men and were mostly college-educated with an annual income of $40,000 or more. Most patients stage T1c or T2 with a mean Gleason score of 6.3. African American men reported a significantly lower score for all generic and prostate-specific HRQoL items compared to Caucasians at baseline and at 24 months. African Americans took longer to return to baseline levels for almost all items and a higher proportion of them never returned to baseline for some of the HRQoL items. Low risk of biochemical recurrence was associated with better physical function, vitality, mental health and general health. For prostate-specific HRQoL items, low risk of BR was associated with impaired urinary function and improved bowel function and bowel bother. Caucasian men consistently reported higher satisfaction with care at 3, 6 12 and 24 month follow-up. During the pre-diagnosis phase, African Americans reported higher mean annual total cost than Caucasians. During treatment, Caucasians reported higher total annual cost.
In summary, the investigators reported that biochemical recurrence and treatment groups, but not race, are associated with poorer post-treatment outcomes.
Jayadevappa R, Chhatre S, Wein AJ, Malkowicz SB
Prostate. 2009 Apr 2. Epub ahead of print.
doi: 10.1002/pros.20955
Written by UroToday.com Contributing Editor Christopher P. Evans, MD, FACS
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