Editor's Commentary - Physician assessment of pretreatment functional status: A process-outcomes link

BERKELEY, CA (UroToday.com) - Dr. Karim Chamie and colleagues at UCLA report on the benefits of pretreatment functional assessment of prostate cancer (CaP) patients.

Their work appears in the April edition of the Journal of Urology. The rationale for this study is based upon the relatively similar oncologic outcomes of treatments for localized CaP but also the differences in side effects. They sought to determine whether pre-therapy physician assessment of functional status and agreement with patient reported status (a process of care measure) is associated with the outcome of improved post-treatment HRQOL.

The researchers used the CaPSURE registry database, which includes clinical, HRQOL, and economic outcomes. Patients independently completed the SF-36 and UCLA-PCI questionnaires every 6 months. Among men in the database diagnosed with localized CaP between 1995 and 2006 who were treated with radiotherapy, radical prostatectomy (RP), or brachytherapy, 2,195 were identified who had physician visits before and 1 year after treatment, and had completed at least 1 UCLA-PCI questionnaire before and 1 year after treatment. A total of 1,031 men reported impairments; 712 had one, 256 had two, and 63 had three impairments. Interestingly, only 354 of the 784 men assessed (45%) had concordant physician and patient-reported assessments. In multivariate analysis, men who were not assessed had higher odds of a decrease in 3 domains; sexual function, sexual bother, and bowel function compared with those who were assessed, and baseline status was in agreement with that of the physician. Men receiving brachytherapy or external beam radiotherapy had lower odds of a decrease in sexual and urinary domains but higher odds of a decrease in the bowel domains compared to men undergoing RP. Men who were not assessed had higher odds of a decrease in 3 domains; sexual function, sexual bother and bowel bother compared with those assessed and concordant.

In summary, they found that men who did not have physician-assessed baseline status before CaP therapy had higher odds of decline in 3 of 6 UCLA-PCI domains when compared to men who were assessed and had physician reported score in agreement with theirs.

Chamie K, Sadetsky N, Litwin MS

 

J Urol. 2011 Apr;185(4):1229-33
10.1016/j.juro.2010.11.087

PubMed Abstract
PMID: 21334026

UroToday.com Prostate Cancer Section

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