Older Age, Early Symptoms and Physical Function are Associated with the Severity of Late Symptom Clusters for Men Undergoing Radiotherapy for Prostate Cancer

A Lemanska,D.P Dearnaley,R Jena,M.R Sydes,S Faithfull

doi:10.1016/j.clon.2018.01.016

Abstract

AimsTo identify symptom clusters and predisposing factors associated with long-term symptoms and health-related quality of life after radiotherapy in men with prostate cancer. Materials and methodsPatient-reported outcomes (PROs) data from the Medical Research Council RT01 radiotherapy with neoadjuvant androgen deprivation therapy trial of 843 patients were used. PROs were collected over 5 years with the University of California, Los Angeles Prostate Cancer Index (UCLA-PCI) and the 36 item Short-Form Health Survey (SF-36). Symptom clusters were explored using hierarchical cluster analysis. The association of treatment dose, baseline patient characteristics and early symptom clusters with the change in severity of PROs over 3 years was investigated with multivariate linear mixed effects models. ResultsSeven symptom clusters of three or more symptoms were identified. The clusters were stable over time. The longitudinal profiles of symptom clusters showed the onset of acute symptoms during treatment for all symptom clusters and significant recovery by 6 months. Some clusters, such as physical health and sexual function, were adversely affected more than others by androgen deprivation therapy, and were less likely to return to pretreatment levels over time. Older age was significantly associated with decreased long-term physical function, physical health and sexual function (P < 0.001). Both baseline and acute symptom clusters were significant antecedents for impaired function and health-related quality of life at 3 years. ConclusionsMen with poorer physical function and health before or during treatment were more likely to report poorer PROs at year 3. Early assessment using PROs and lifestyle interventions should be used to identify those with higher needs and provide targeted rehabilitation and symptom management.

Highlights

Prostate cancer (PCa) survival has improved significantly over the last decade
Patterns in Patient-reported outcomes (PROs) data, reported up to 5 years after treatment by men in the Medical Research Council (MRC) RT01 clinical trial were investigated to study: (i) which PROs were associated and formed symptom clusters, to investigate what symptom clusters are experienced by men with PCa during and after radiotherapy; (ii) how symptom clusters change over time, to investigate the effect of Androgen deprivation therapy (ADT) and radiotherapy treatment on the trajectory of symptom clusters during the 5 years of follow-up; (3) the association of treatment, demographics, medical history, i.e. comorbidities, and baseline and acute symptom clusters with the change in symptom clusters over 3 years, to investigate potential risk factors contributing to late symptom clusters
We studied the trajectory of symptom clusters before, during and after radiotherapy for PCa, by analysing symptom clusters over 5 years after radiotherapy

Summary

Introduction

Prostate cancer (PCa) survival has improved significantly over the last decade. More than 84% of men survive 10 years or more in the UK [1] and the number of survivors is growing by 3% every year [2]. More than 1.1 million cases of PCa were recorded in 2012. This constitutes 8% of all cancers and 15% of cancers in men, making PCa the Author for correspondence: A.

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Discussion

Conclusion