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Monday, 16 October 2006


Ravishankar Jayadevappa, PhD, Sumedha Chhatre, PhD, Alan J. Wein, MD, and S. Bruce Malkowicz. University of Pennsylvania, Philadelphia, PA

Purpose: To examine the predictors of return to baseline values (RBV) of patient reported outcomes (generic and prostate specific HRQoL) of localized prostate cancer (PCa) patients. Methods: In this prospective cohort study we recruited 518 newly diagnosed localized PCa patients from urology clinics of an urban academic and a VA hospital. Participants completed generic (SF-36), prostate specific (UCLA-PCI) HRQoL, and satisfaction with care (CSQ-8) surveys prior to treatment and at 3, 6, 12 and 24 months post-treatment. Two measures (anchor based and distribution based) of minimally important difference (MID) were used to compute the RBVs at 12 month follow-up. Clinical and demographic data were obtained via medical chart review. Repeated measures ANOVA was used to examine changes in generic and PCa specific HRQoL across treatments. Logistic regression models were developed to access the predictors of RBVs for generic and PCa specific HRQoL subscales. Results: Mean age of the study participants was 62.5 years (SD=8.01), 31.34% were African American and 68.66% were Caucasian. More than high school education was reported by 64.97% of the participants, 72.22% were married and 60.17% had income higher than $40,000. The range of minimally significant differences for the 14 subscales (8 generic and 6 PCa specific) was 7.4 to 19.4. Logistic regression models for predicting RBV for each of the subscales showed that radical prostatectomy was a predictor of RBV for physical function(OR=2.3, CI= 1.1 -5.1) , role physical (OR=3.1, CI=1.6-6.7), role emotional (OR=2.5, CI=1.1-6.5), urinary function (OR=0.38, CI=0.2-0.7), sexual function (OR=0.33, CI=0.2-0.6) and bowel bother (OR=2.6, CI=1.2-5.7). Being married was associated with RBV for role emotional (OR=4.6, CI=1.8-11.7), mental health (OR=2.4, CI=1.2-5.3), bowel function (OR=2.8, CI=1.4-5.8) and bowel bother (OR=4.7, CI=2.1-10.4). African American had lower odds of RBV for bodily pain (OR=0.35, CI=0.2-0.7) and urinary bother (OR=0.5, CI=0.3-0.9). The anchor based method of minimally significant difference yielded comparable results for most of the generic and PCa specific HRQoL subscales. Conclusions: Uncertainty exists at all faces of PCa care. MID can play a crucial role in patient education and clinical decision making. In absence of a well established MID for patient reported outcomes in PCa care, next logical step is to establish a valid and reliable MID.

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See more of The 28th Annual Meeting of the Society for Medical Decision Making (October 15-18, 2006)