The questionnaire was available in 19 different languages encompassing 24 countries with 2,943 answers, including an estimated 0.1% of the European patient population (Figure 1).
Figure 1. Geographic coverage of the study
The respondents’ profile is shown in Figure 2 and the treatment profile in Figure 3.
Figure 2. Respondents' profile
Figure 3. Treatment profile
The results of the EORTC-QLQ-C30 questionnaire are shown in Figure 4, demonstrating high rates of fatigue and insomnia, more in patients treated with chemotherapy (triples the reported fatigue), or radiotherapy (doubles the reported fatigue) than those treated with active surveillance or surgery.
Figure 5 shows the results of the EPIC-26 domain scores with worse scores in urinary incontinence in surgically treated patients compared to radiotherapy treated patients; and sexual function domain, with radiotherapy leading to lower sexual function scores than surgery. Men who were treated with chemotherapy had the lowest sexual functioning scores.
Figure 4. EORTC-QLQ-C30 symptom score
Figure 5. EPIC-26 domain scores
These results are significantly different than previously published results from studies reporting patient-reported outcomes after prostate cancer treatment (Figure 6).
Figure 6. The difference of results with patient-reported outcomes in the clinical environment in previously reported studies
The key messages from this study are that the data collected and the analyses that were done provide patients and physicians a “snapshot” of the impact of the various treatments based on the experience of patients. These results are not comparable to those of clinical studies using the same validated questionnaires, and further investigation in this issue is ongoing.
Other important key messages include:
- Urinary incontinence is lowest for surgical patients
- Sexual function is lowest for radiotherapy patients
- Fatigue and insomnia scores are highest for radiotherapy and chemotherapy
- Chemotherapy leads to the worst outcomes in quality of life
Dr. Deschamps concluded his presentation hoping that these results will be used to establish and disseminate realistic expectations on the effects of the different treatments for prostate cancer on future patients' quality of life.
In the next part of this session, Dr. Steven Joniau gave his interpretation of the results of the Europa Uomo Patient Reported Outcomes Study (EUPROMS) study. According to Dr. Joniau, the strengths of this study include its deliverance of real-life patient-reported outcomes. This was a patient initiative with no physicians involved. The sample was very large and had a Gaussian distribution. The follow-up was long, with six years of post-diagnosis follow-up. Additionally, all the questionnaires used were validated, and the study included patients who underwent multiple treatments.
The limitations of this study include the fact that this is a cross-sectional and not longitudinal study. There was no baseline assessment, and there might have been a possible sampling bias/response bias. Lastly, the Southern and Eastern part of Europe was under-represented.
The most important observations from this study, according to Dr. Joniau, were the following:
- Fatigue and insomnia were the most prominent reported adverse effects.
- The addition of radiotherapy, ADT and chemotherapy to the primary treatment increase fatigue and insomnia
- Urinary incontinence was highest with radical prostatectomy
- Sexual functioning was on average equally impacted by all active treatments
- Lastly, active surveillance was associated with the least impact on the quality of life sub-scores
Dr. Joniau concluded his talk stating that there are still some questions that need to be further explored. We need better insight into tumor characteristics and age/comorbidity profiles of the included patients. It is safe to assume that younger, healthier patients were more likely to undergo surgery, while older, less healthy patients were more likely to receive radiotherapy.
It would be most valuable if the interplay of age/comorbidities/additional treatment following the primary treatment be modeled. Lastly, we need to explore the effects of active interventions to improve the quality of life.
Presented by: André Deschamps, MD, Chairman, Europa Uomo, Antwerp, Belgium
Written by: Hanan Goldberg, MD, MSc, Urology Department, SUNY Upstate Medical University, Syracuse, New York, Twitter: @GoldbergHanan at the Virtual 2020 EAU Annual Meeting #EAU20, July 17-19, 2020