Predictors of utilities for health states in early stage prostate cancer

ArticleinThe Journal of Urology 166(3):942-6 · October 2001with6 Reads
DOI: 10.1097/00005392-200109000-00031 · Source: PubMed
Abstract
When faced with treatment choices for early stage prostate cancer, patients must balance the survival benefit of a treatment with its morbidity. Little is known about how patients balance these trade-offs. To further our understanding of patient decision making we assessed patient utilities for prostate cancer treatment related morbidities. We determined whether patient utilities were predicted by sociodemographic characteristics or baseline genitourinary function. We evaluated 401 men undergoing prostate needle biopsy for suspicion of prostate cancer at university, Veterans Affairs and public hospitals. Study design included a prospective cross-sectional cohort with correlation and multivariate analysis. Subjects were studied with 2 established health related quality of life instruments. Patient utilities were assessed with an interactive software application. On multivariate analysis utility for current general health was a significant predictor of utilities for treatment related morbidities. Surprisingly baseline urinary, sexual and bowel function scores did not correlate well with respective utilities for potential incontinence, impotence or radiation proctitis. In other words, men with good and imperfect baseline function were equally willing to risk impairment to preserve life. Men who perceived that general health was better appear to place higher value on quantity of life, while those who already are suffering from poor general health place higher value on quality of life. Ethnicity appears to modify some effects of other variables on patient preference. Utility assessment provides a quantitative tool to aid physicians in counseling patients when making treatment decisions for localized prostate cancer.
    • "We can only assume that these findings are spurious. Demographic variables appeared to have little or no effects on utility measures in other studies [22, 24, 28]. Strengths of this study are that patients resided in three geographically diverse areas of a large province in Canada and had lived with PC and the sequelae of its treatment for 2–13 years. "
    [Show abstract] [Hide abstract] ABSTRACT: Purpose: To measure quality of life (QOL) and utilities for prostate cancer (PC) patients and determine their predictors. Methods: A population-based, community-dwelling, geographically diverse sample of long-term PC survivors in Ontario, Canada, was identified from the Ontario Cancer Registry and contacted through their referring physician. Consenting patients completed questionnaires by mail: Health Utilities Index (HUI 2/3), Patient Oriented Prostate Utility Scale PORPUS-U (utility), PORPUS-P (health profile), Functional Assessment of Cancer Therapy-Prostate (FACT-P), and Prostate Cancer Index (PCI). Clinical data were obtained from chart reviews. Regression models determined the effects of a series of variables on QOL and utility. Results: We received questionnaires and reviewed charts for 585 patients (mean age 72.6, 2-13 years postdiagnosis). Mean utility scores were as follows: PORPUS-U = 0.92, HUI2 = 0.85, and HUI3 = 0.78. Mean health profile scores were as follows: PORPUS-P = 71.7, PCI sexual, urinary, and bowel function = 23.7, 79.1, and 84.6, respectively (0 = worst, 100 = best), and FACT-P = 125.1 (0 = worst, 156 = best). In multiple regression analyses, comorbidity and PCI urinary, sexual, and bowel function were significant predictors of other QOL measures. With all variables, 32-50 % of the variance in utilities was explained. Conclusions: Many variables affect global QOL of PC survivors; only prostate symptoms and comorbidity have independent effects. Our model allows estimation of the effects of multiple factors on utilities. These utilities for long-term outcomes of PC and its treatment are valuable for decision/cost-effectiveness models of PC treatment.
    Full-text · Article · Apr 2013
    • "In a time trade-off, a patient may choose between two health states: a longer lifespan in a disease state (such as metastatic prostate cancer, incontinence, erectile dysfunction) and a shorter life span in complete health [Albertsen et al. 1998; Saigal et al. 2001; Sommers et al. 2007 Sommers et al. , 2008 Stewart et al. 2005; Volk et al. 2004] . Saigal and colleagues determined that patients who had good baseline health valued quantity of life more, while those with poor general health prized quality of life more [Saigal et al. 2001] . Sommers and colleagues found, in a study of individual patient preferences, that 30% of patients had a different optimal treatment than the 'average' patient. "
    [Show abstract] [Hide abstract] ABSTRACT: Postoperative morbidity and mortality is low following radical prostatectomy (RP), though not inconsequential. Due to the natural history of the disease process, the implications of treatment on long-term oncologic control and functional outcomes are of increased significance. Structures, processes and outcomes are the three main determinants of quality of RP care and provide the framework for this review. Structures affecting quality of care include hospital and surgeon volume, hospital teaching status and patient insurance type. Process determinants of RP care have been poorly studied, by and large, but there is a developing trend toward the performance of randomized trials to assess the merits of evolving RP techniques. Finally, the direct study of RP outcomes has been particularly controversial and includes the development of quality of life measurement tools, combined outcomes measures, and the use of utilities to measure operative success based on individual patient priority.
    Full-text · Article · Apr 2012
    • "Whether such patients would have preferred to be alive even with severe adverse effects is a question that is beyond the scope of this study. Previous studies have various limitations: considering only one/ some adverse effects (Singer et al, 1991; Saigal et al, 2001; Bruner et al, 2004); assigning different severity levels to adverse effects (Saigal et al, 2001; Sculpher et al, 2004); assessing only one or two treatment options (Singer et al, 1991; Bruner et al, 2004; Sculpher et al, 2004; Jenkins et al, 2005); sampling respondents from only one treatment type (Smith et al, 2002;Bruner et al, 2004); combining bladder and bowel problems into one attribute (Chapman et al, 1999;); investigating just a few hypothetical health states (Chapman et al, 1999; Saigal et al, 2001; Bruner et al, 2004; Jenkins et al, 2005); using patients' rating of their own health states (Smith et al, 2002; Krahn et al, 2003). These factors limit the comparability of our results for relative tolerability of adverse effects with those from other studies † Median and 2.5 and 97.5 centiles based on simulated distr ibutionFigure 3 Additional months of life needed w to compensate for each persistent treatment-related adverse effect in excess of a base case of mild loss of libido with no other problems and 12 year life expectancy. "
    [Show abstract] [Hide abstract] ABSTRACT: Men diagnosed with localised prostate cancer (LPC) face difficult choices between treatment options that can cause persistent problems with sexual, urinary and bowel function. Controlled trial evidence about the survival benefits of the full range of treatment alternatives is limited, and patients' views on the survival gains that might justify these problems have not been quantified. A discrete choice experiment (DCE) was administered in a random subsample (n=357, stratified by treatment) of a population-based sample (n=1381) of men, recurrence-free 3 years after diagnosis of LPC, and 65 age-matched controls (without prostate cancer). Survival gains needed to justify persistent problems were estimated by substituting side effect and survival parameters from the DCE into an equation for compensating variation (adapted from welfare economics). Median (2.5, 97.5 centiles) survival benefits needed to justify severe erectile dysfunction and severe loss of libido were 4.0 (3.4, 4.6) and 5.0 (4.9, 5.2) months. These problems were common, particularly after androgen deprivation therapy (ADT): 40 and 41% overall (n=1381) and 88 and 78% in the ADT group (n=33). Urinary leakage (most prevalent after radical prostatectomy (n=839, mild 41%, severe 18%)) needed 4.2 (4.1, 4.3) and 27.7 (26.9, 28.5) months survival benefit, respectively. Mild bowel problems (most prevalent (30%) after external beam radiotherapy (n=106)) needed 6.2 (6.1, 6.4) months survival benefit. Emerging evidence about survival benefits can be assessed against these patient-based benchmarks. Considerable variation in trade-offs among individuals underlines the need to inform patients of long-term consequences and incorporate patient preferences into treatment decisions.
    Full-text · Article · Feb 2012
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