- Email: [email protected]
EVALUATION OF PSYCHOSOCIAL CANCER DISTRESS IN MALE PATIENTS WITH UROGENITAL TUMORS
Vol. 179, No. 4, Supplement, Sunday, May 18, 2008
with SC were primarily the QOL outcomes, such as physical and mental composite scores. None of the demographic or clinicopathologic YDULDEOHVZDVVLJQL¿FDQWH[FHSW\HDURIVXUJHU\ DWPRQWKVIRU53 DW 24 months for RT). The only variable predictive of SC in all four models was FOR. Adjuvant therapy after 6 months and/or salvage therapy did not affect SC. CONCLUSIONS: Patient satisfaction with care was high for both RP and RT. Fear of cancer recurrence as well as QOL outcomes ZHUHVLJQL¿FDQWO\DVVRFLDWHGZLWKSDWLHQWVDWLVIDFWLRQZLWKFDUH Source of Funding: CaPSURE™ is supported by TAP Pharmaceutical Products (Lake Forest, IL). This research was additionally funded by National Institutes of Health/National Cancer Institute University of California—San Francisco SPORE P50 C89520.
308 INDEPENDENT PREDICTORS FOR DISSATISFACTION WITH AND REGRET OF TREATMENT CHOICE AFTER RADICAL PROSTATECTOMY Florian R Schroeck*, Tracey L Krupski, Leon Sun, David M Albala, Cary N Robertson, Thomas J Polascik, Judd W Moul. Durham, NC. INTRODUCTION AND OBJECTIVE: Patient satisfaction with treatment outcomes and regret regarding treatment decision PDNLQJDUHODUJHO\LQÀXHQFHGE\SUHRSHUDWLYHFRXQVHOLQJ:HVRXJKW to identify independent predictors for dissatisfaction and regret after radical prostatectomy (RP). METHODS: Patients who had undergone RP (perineal, retropubic (RRP), or robot-assisted laparoscopic (RALP)) were mailed cross-sectional surveys comprised of sociodemographic information, the Expanded Prostate Cancer Index Composite (EPIC), and questions regarding satisfaction and regret. Patients who stated they were less WKDQ³VDWLV¿HG´ZLWKWKHLUWUHDWPHQWRQD¿YHLWHP/LNHUWVFDOH ³H[WUHPHO\ GLVVDWLV¿HG´WR³H[WUHPHO\VDWLV¿HG´ ZHUHFDWHJRUL]HGDVGLVVDWLV¿HG Patients indicating that they wished that they could have changed the NLQGRIWUHDWPHQWWKH\UHFHLYHGPRUHWKDQ³DOLWWOHRIWKHWLPH´RQD¿YH LWHP/LNHUWVFDOH ³DOORIWKHWLPH´WR³QRQHRIWKHWLPH´ ZHUHFODVVL¿HG as being regretful. Age, race, education, income, marital status, relationship status, employment status, perioperative complications, type of procedure, year of surgery, and EPIC urinary, sexual, bowel, and hormonal domains were evaluated as independent predictors for dissatisfaction and regret in multivariate logistic regression analysis. RESULTS: 462 patients had undergone RP between 2000 and 2007 and returned a questionnaire. Return rate was 49.9%. Patients were a mean of 2.2 years (SD=1.8) status post RP. 69 patients (15%) ZHUH GLVVDWLV¿HG DQG UHJUHWWHG WKHLU WUHDWPHQW FKRLFH ,Q PXOWLYDULDWHDQDO\VLVKLJKHULQFRPH>2GGV5DWLR FRQ¿GHQFH LQWHUYDO @KDYLQJXQGHUJRQH5$/3YV553> @ DQGZRUVHXULQDU\GRPDLQVFRUH> @ZHUHLQGHSHQGHQW predictors of dissatisfaction. In terms of regret, higher income (1.88 >@ DQG5$/3YV553> @ZHUHDJDLQSUHGLFWLYH +RZHYHU$IULFDQ$PHULFDQUDFH> @\HDURIVXUJHU\> @DQGZRUVHERZHOGRPDLQVFRUH> @ZHUHDOVR independent predictors of regret. CONCLUSIONS: Social factors and quality of life were important predictors for satisfaction and regret. Patients who underwent 5$/3ZHUHPRUHOLNHO\WREHUHJUHWIXODQGGLVVDWLV¿HGSRVVLEO\EHFDXVH of high expectations from a new procedure. When counseling patients SUHRSHUDWLYHO\XURORJLVWVVKRXOGFDUHIXOO\SRUWUD\WKHULVNVDQGEHQH¿WV RIQHZWHFKQRORJLHVWRPLQLPL]HUHJUHWDQGPD[LPL]HVDWLVIDFWLRQ Source of Funding: CURED (Committee for Urologic Research, Education, and Development).
THE JOURNAL OF UROLOGY®
109
309 EFFECTS OF AGE, HEALTH-RELATED QUALITY OF LIFE, AND EDUCATION LEVEL ON MANAGEMENT AFTER BIOCHEMICAL FAILURE WITH WATCHFUL WAITING VERSUS HORMONAL THERAPY IN MEN WITH PROSTATE CANCER: RESULTS FROM THE COMPARE REGISTRY Charles L Bennett*, Oliver Sartor, David G McLeod, Susan Halabi. Chicago, IL, Boston, MA, Washington, DC, and Durham, NC. INTRODUCTION AND OBJECTIVE: Without evidence-based treatment guidelines on optimal management choices for men with prostate cancer, health-related quality-of-life (HRQOL) issues become an important consideration when discussing and selecting a management strategy. Data from the COMPARE Registry, an observational registry of SDWLHQWVZLWK36$IDLOXUHDIWHUGH¿QLWLYHORFDOWKHUDS\RISURVWDWHFDQFHU ZHUHDQDO\]HGWRHYDOXDWHWKHHIIHFWVRIDJH+542/DQGHGXFDWLRQ level on the choice of secondary management with watchful waiting (WW) or hormonal therapy (HT). METHODS: Data from HRQOL surveys on urinary, bowel, sexual function, and hormone-related problems and demographic/ PHGLFDO LQIRUPDWLRQ FROOHFWHG DW WKH HQUROOPHQW YLVLW ZHUH DQDO\]HG for 1031 men who selected WW or HT at the enrollment visit for the management of PSA failure. Statistical comparisons were made using the chi-square test. RESULTS: Of the 1031 men, 841 (82%) chose WW and 190 FKRVH +7 2I PHQ DJHG \HDUV FKRVH +7 whereas 161 (19%) of 832 men aged >65 years chose HT. The effects of HRQOL problems on the management choice after PSA failure indicated that men aged >65 years with a moderate or big urinary, ERZHO RU KRUPRQDOUHODWHG SUREOHP ZHUH VLJQL¿FDQWO\ PRUH OLNHO\ WR select HT versus WW (Table). Men aged >65 years with more than a high school education were more likely to select WW (59%) versus HT 3 )RUPHQDJHG\HDUV+542/DQGHGXFDWLRQOHYHO GLGQRWVLJQL¿FDQWO\DIIHFWWKHVHFRQGDU\PDQDJHPHQWFKRLFHEXWWKH +7VDPSOHVL]HZDVVPDOO CONCLUSIONS: These results from the COMPARE Registry suggest that among men aged >65 years HRQOL and education level are important factors in the selection of WW versus HT for the management RI 36$ IDLOXUH DIWHU LQLWLDO GH¿QLWLYH SURVWDWH FDQFHU WUHDWPHQW ,Q WKH absence of evidence-based guidelines on the optimal management of this population of men, the COMPARE Registry is a valuable source of information on factors affecting treatment decisions in a real-world, clinical-practice setting. Effects of Age and HRQOL on Management Choice After PSA Failure 65 Years >65 Years WW(n=170) HT(n=29) WW(n=671) HT(n=161) Urinary 15 (9%) 3 (10%) 62 (9%) 25 (16%)b Sexual 53 (31%) 12 (41%) 146 (22%) 39 (24%) Bowel 9 (5%) 2 (7%) 62 (11%) 23 (14%)c Hormonal 12 (7%) 4 (14%) 60 (9%) 26 (16%)d a RIPHQZLWKPRGHUDWHELJSUREOHP b3 YV:: c3 YV:: d P<0.005 vs WW
HRQOL Problema
Source of Funding:VDQR¿DYHQWLV
310 EVALUATION OF PSYCHOSOCIAL CANCER DISTRESS IN MALE PATIENTS WITH UROGENITAL TUMORS Uwe Treiber*, Birgit Marten-Mittag, Christoph Zorn, Juergen E Gschwend, Peter Herschbach. Munich, Germany. INTRODUCTION AND OBJECTIVE: The prevalence rates for psychiatric, depressive and anxiety disorders in general among cancer patients varied between 1% and 50%. Purpose of our study was to determine psychosocial stress situations in male patients with urogenital FDQFHUVE\DFDQFHUVSHFL¿FYDOLGDWHGTXHVWLRQQDLUH 46&5 METHODS: In a total of 879 unselected male patients with different cancer entities, including 196 male patients with urogenital tract (UGT) carcinoma (prostate, kidney, urothel, testis), a nationwide collection of data about psychological distress was performed by use of the “Questionnaire on Stress in Cancer Patients revised YHUVLRQ´ 46&5 +HUVFKEDFK = 0HG 3V\FKRO 7KLV questionnaire contains 23 items which are grouped in 5 homogenous VFDOHV SV\FKRVRPDWLFFRPSODLQWVIHDUVLQIRUPDWLRQGH¿FLWVHYHU\GD\
110
THE JOURNAL OF UROLOGY®
life restrictions and social strains. The period of data collection was 1/2001 to 12/2006. RESULTS: The mean age of UGT cancer pts. was 60±15.3 \HDUV RWKHUFDQFHUSWV \HDUV S 3DWLHQWVGLVWULEXWLRQ among urogenital tumor entities were: prostate cancer 45%, renal cell cancer 25%, urothelial cancer 27% and germ cell tumors 3%. The total QSC-R23 scores of both patient groups (UGT cancers: n=196 vs other cancers: n=683) were 1.22 each. In the group of pts. with UGT cancers, two items of the QSC-R23 showed the highest total scores: “having sex less frequently” (score: 2.41) and “being afraid of disease progression” (score: 2.33). The proportion of the highest response categories “strongly/very strongly distressed” within these items were 37% and 32%, respectively. Compared with other cancer pts., in the UGT cancer pts. the LWHP³KDYLQJVH[OHVVIUHTXHQWO\´VKRZHGDVLJQL¿FDQWKLJKHUVFRUH vs 2.41) with the largest difference of the mean values. Percentage of SWVLGHQWL¿HGDVWREHLQDULVNJURXSIRUSV\FKRVRFLDOGLVWUHVV KLJKHVW response categories: strongly/very strongly distressed) was 34% for UGT cancer pts. and 38% for pts. with other cancers (p=0.25). CONCLUSIONS: This retrospective analysis of unselected male patients with urogenital cancers showed that about one third of these patients belong to a risk group for psychosocial distress. The item “having sex less frequently” showed the highest score with the largest DQGVLJQL¿FDQWGLIIHUHQFHRIPHDQYDOXHV$SURVSHFWLYHVWXG\LVQRZ initiated at our institution. Implementation of routine psycho-oncological care in clinical treatment of cancer patients is mandatory, especially in Comprehensive Cancer Centers. Source of Funding: None
311 DOES NOCTURNAL INCONTINENCE AFFECT THE HEALTH RELATED QUALITY OF LIFE (HRQOL) IN PATIENTS WITH ORTHOTOPIC ILEAL NEOBLADDER? Rajinikanth Ayyathurai, Anuradha Jayathillake, Cindy T Soloway, Mark S Soloway, Murugesan Manoharan*. Miami, FL. INTRODUCTION AND OBJECTIVE: Orthotopic neobladder (NB) reconstruction is increasingly becoming the choice of urinary diversion (UD) after radical cystectomy (RC). Varying degrees of nocturnal incontinence (NI) has been reported following ileal NB reconstruction. This can be of concern to the patient, potentially affecting the HRQOL. We assessed the impact of NI on the HRQOL using a validated instrument. METHODS: The Functional Assessment of Cancer Therapy - Vanderbilt Cystectomy Index questionnaire (FACT-VCI) was used to assess the HRQOL in patients who underwent orthotopic NB following RC and had follow-up within the last 12 months. The FACT part of the questionnaire contains 27 questions that assess four aspects of HRQOL: Physical, Social, Emotional and Functional health. The VCI contains 17 questions that focused on the functional outcome of RC and UD. In addition the data on incontinence and use of pads were collected. 5HVSRQVHV ZHUH FROODWHG DQG RUJDQL]HG LQ D VWUXFWXUHG GDWDEDVH Analyses was done using SPSS software package. RESULTS: 60 patients received the questionnaire. 58% (35) responded. 91% and 9% of respondents are men and women respectively. 9 (26%) patients were fully continent. 27 (77%) patients were continent during the day. 8 (23%) had day and nighttime incontinence. The patient age and HRQOL index are shown in Table 7KHPHDQ9&,VFRUHIRUWKHFRQWLQHQWSDWLHQW $ ZDVVLJQL¿FDQWO\ higher at 53 than the patients with incontinence 44 (P=0.01). 18 (51%) patients had NI incontinence, but had good daytime continence (DC). On comparing the VCI score of these patients with those who are fully FRQWLQHQW WKHUH ZDV QR VLJQL¿FDQW GLIIHUHQFH 3 VXJJHVWLQJ that DC is the primary factor determining the HRQOL. Similarly, overall FACT health score was not statistically different among fully continent patients compared to those with night only incontinence (P=0.147). This shows that the VCI and FACT-QOL status are dictated by DC irrespective of NI. Table 1.
Vol. 179, No. 4, Supplement, Sunday, May 18, 2008
Fully Continent (A) Overall FACT score 94.2 Physical 23.5 Social 24 Emotional 21 Functional 26.5 VCI 53.5 Urinary function 32 Bowel function 18.4 Age 61.3 Follow up 34 Mean HRQOL index
Day & night Nightly incontinence P Value Incontinence (B) (C) A vs. C 77.8 17.5 21.1 20 19 38.7 21.6 14.8 64.8 30
83.9 21.4 21.9 20.3 20.2 47.1 27.7 17.0 66.6 53
0.147 0.055 0.668 0.628 0.012 0.103 0.080 0.348 0.076 0.463
CONCLUSIONS: NI is not uncommon after ileal neobladder XULQDU\GLYHUVLRQ7KH+542/VHHPVWREHGHSHQGHQWRQ'& WKH1, GRHVQRWVLJQL¿FDQWO\DIIHFWWKH+542/ Source of Funding: None
312 THE EFFECT OF SURGERY FOR STRESS URINARY INCONTINENCE ON QUALITY OF LIFE IN WOMEN ENROLLED IN A RANDOMIZED CLINICAL TRIAL COMPARING THE BURCH AND SLING PROCEDURES Philippe E Zimmern*, Chiara Ghetti, Charles W Nager, Elizabeth R Mueller, R Edward Varner, Heather J Litman, John W Kusek, Sharon Tennstedt, Stephen R Kraus. Dallas, TX, Pittsburgh, PA, San Diego, CA, Maywood, IL, Birmingham, AL, Watertown, MA, Bethesda, MD, and San Antonio, TX. INTRODUCTION AND OBJECTIVE: To describe changes LQ XULQDU\ LQFRQWLQHQFH VSHFL¿F TXDOLW\ RI OLIH 4R/ DIWHU PRQWKV in women who received either a Burch or autologous sling for stress urinary incontinence (SUI) and identify baseline factors predicting changes in QoL. METHODS: QoL of 655 women enrolled in a nationwide multi-center clinical trial comparing Burch and sling was measured at baseline and 24-months after surgery with the Incontinence Impact 4XHVWLRQQDLUH6XUJLFDOVXFFHVVZDVGH¿QHGE\DQHJDWLYHSDGWHVW no urinary incontinence on 3-day diary, a negative cough and valsalva stress test, no self-reported incontinence symptoms on the MESA Questionnaire and no re-treatment for SUI by 24-month post-surgery. We examined if change in QoL was related to each procedure and to surgical success. A stepwise least-squares regression analysis was used to examine if the following factors affected post-operative QoL: prior UI WUHDWPHQW VHOIUHSRUWHGW\SHRI8,V\PSWRPV VWUHVVDQGXUJH VH[XDO function as measured by the Prolapse/Urinary Incontinence Sexual 4XHVWLRQQDLUH V\PSWRPERWKHUPHDVXUHGZLWKWKH8URJHQLWDO'LVWUHVV ,QYHQWRU\ DQGRWKHUFOLQLFDODQGVRFLRGHPRJUDSKLFIDFWRUV RESULTS: Changes in QoL from baseline to 24 months are shown in Table 1. There was no difference in magnitude of change in QoL between the 2 procedures, but greater improvement in surgical successes. Multivariable modeling showed that QoL improvement was most strongly related to decreased symptom bother (p<0.001), followed by decrease in stress or urge symptoms (p<0.001, p=0.001 respectively), decrease in UI severity (p=0.001), prior UI treatment (p=0.002), younger age (p=0.006) and Hispanic ethnicity (p=0.011). Among sexually active women, worsening sexual dysfunction had a negative impact on QoL (<0.001). CONCLUSIONS: Two common SUI procedures have similar HIIHFWV RQ 42/ LQ ZRPHQ DIWHU VXFFHVVIXO 68, VXUJHU\ ,GHQWL¿HG predictors of postoperative improvement in QoL are relevant for preoperative patient counseling. Table 1. Baseline IIQ score and change in score at 24 months. All
Baseline Change in score at 24 mo
Burch
Mean N N (sd) 171.4 652 327 (101.3) 608
133.1 299 (109.8)
Surgical Surgical Success Failure Mean Mean N N N (sd) (sd) 169.7 166.6 325 185 334 (103.4) (102.0) Sling
Mean 173.2 (99.2)
130.3a 136.1a 309 185 (112.1) (107.7)
a p = 0.52 comparing Burch vs. sling surgical success vs. failure
160.0b 329 (103.9)
b
Mean (sd) 174.7 (101.0) 113.6b (110.9)
p<0.001 comparing
Source of Funding: NIH/NIDDK for UITN.
with SC were primarily the QOL outcomes, such as physical and mental composite scores. None of the demographic or clinicopathologic YDULDEOHVZDVVLJQL¿FDQWH[FHSW\HDURIVXUJHU\ DWPRQWKVIRU53 DW 24 months for RT). The only variable predictive of SC in all four models was FOR. Adjuvant therapy after 6 months and/or salvage therapy did not affect SC. CONCLUSIONS: Patient satisfaction with care was high for both RP and RT. Fear of cancer recurrence as well as QOL outcomes ZHUHVLJQL¿FDQWO\DVVRFLDWHGZLWKSDWLHQWVDWLVIDFWLRQZLWKFDUH Source of Funding: CaPSURE™ is supported by TAP Pharmaceutical Products (Lake Forest, IL). This research was additionally funded by National Institutes of Health/National Cancer Institute University of California—San Francisco SPORE P50 C89520.
308 INDEPENDENT PREDICTORS FOR DISSATISFACTION WITH AND REGRET OF TREATMENT CHOICE AFTER RADICAL PROSTATECTOMY Florian R Schroeck*, Tracey L Krupski, Leon Sun, David M Albala, Cary N Robertson, Thomas J Polascik, Judd W Moul. Durham, NC. INTRODUCTION AND OBJECTIVE: Patient satisfaction with treatment outcomes and regret regarding treatment decision PDNLQJDUHODUJHO\LQÀXHQFHGE\SUHRSHUDWLYHFRXQVHOLQJ:HVRXJKW to identify independent predictors for dissatisfaction and regret after radical prostatectomy (RP). METHODS: Patients who had undergone RP (perineal, retropubic (RRP), or robot-assisted laparoscopic (RALP)) were mailed cross-sectional surveys comprised of sociodemographic information, the Expanded Prostate Cancer Index Composite (EPIC), and questions regarding satisfaction and regret. Patients who stated they were less WKDQ³VDWLV¿HG´ZLWKWKHLUWUHDWPHQWRQD¿YHLWHP/LNHUWVFDOH ³H[WUHPHO\ GLVVDWLV¿HG´WR³H[WUHPHO\VDWLV¿HG´ ZHUHFDWHJRUL]HGDVGLVVDWLV¿HG Patients indicating that they wished that they could have changed the NLQGRIWUHDWPHQWWKH\UHFHLYHGPRUHWKDQ³DOLWWOHRIWKHWLPH´RQD¿YH LWHP/LNHUWVFDOH ³DOORIWKHWLPH´WR³QRQHRIWKHWLPH´ ZHUHFODVVL¿HG as being regretful. Age, race, education, income, marital status, relationship status, employment status, perioperative complications, type of procedure, year of surgery, and EPIC urinary, sexual, bowel, and hormonal domains were evaluated as independent predictors for dissatisfaction and regret in multivariate logistic regression analysis. RESULTS: 462 patients had undergone RP between 2000 and 2007 and returned a questionnaire. Return rate was 49.9%. Patients were a mean of 2.2 years (SD=1.8) status post RP. 69 patients (15%) ZHUH GLVVDWLV¿HG DQG UHJUHWWHG WKHLU WUHDWPHQW FKRLFH ,Q PXOWLYDULDWHDQDO\VLVKLJKHULQFRPH>2GGV5DWLR FRQ¿GHQFH LQWHUYDO @KDYLQJXQGHUJRQH5$/3YV553> @ DQGZRUVHXULQDU\GRPDLQVFRUH> @ZHUHLQGHSHQGHQW predictors of dissatisfaction. In terms of regret, higher income (1.88 >@ DQG5$/3YV553> @ZHUHDJDLQSUHGLFWLYH +RZHYHU$IULFDQ$PHULFDQUDFH> @\HDURIVXUJHU\> @DQGZRUVHERZHOGRPDLQVFRUH> @ZHUHDOVR independent predictors of regret. CONCLUSIONS: Social factors and quality of life were important predictors for satisfaction and regret. Patients who underwent 5$/3ZHUHPRUHOLNHO\WREHUHJUHWIXODQGGLVVDWLV¿HGSRVVLEO\EHFDXVH of high expectations from a new procedure. When counseling patients SUHRSHUDWLYHO\XURORJLVWVVKRXOGFDUHIXOO\SRUWUD\WKHULVNVDQGEHQH¿WV RIQHZWHFKQRORJLHVWRPLQLPL]HUHJUHWDQGPD[LPL]HVDWLVIDFWLRQ Source of Funding: CURED (Committee for Urologic Research, Education, and Development).
THE JOURNAL OF UROLOGY®
109
309 EFFECTS OF AGE, HEALTH-RELATED QUALITY OF LIFE, AND EDUCATION LEVEL ON MANAGEMENT AFTER BIOCHEMICAL FAILURE WITH WATCHFUL WAITING VERSUS HORMONAL THERAPY IN MEN WITH PROSTATE CANCER: RESULTS FROM THE COMPARE REGISTRY Charles L Bennett*, Oliver Sartor, David G McLeod, Susan Halabi. Chicago, IL, Boston, MA, Washington, DC, and Durham, NC. INTRODUCTION AND OBJECTIVE: Without evidence-based treatment guidelines on optimal management choices for men with prostate cancer, health-related quality-of-life (HRQOL) issues become an important consideration when discussing and selecting a management strategy. Data from the COMPARE Registry, an observational registry of SDWLHQWVZLWK36$IDLOXUHDIWHUGH¿QLWLYHORFDOWKHUDS\RISURVWDWHFDQFHU ZHUHDQDO\]HGWRHYDOXDWHWKHHIIHFWVRIDJH+542/DQGHGXFDWLRQ level on the choice of secondary management with watchful waiting (WW) or hormonal therapy (HT). METHODS: Data from HRQOL surveys on urinary, bowel, sexual function, and hormone-related problems and demographic/ PHGLFDO LQIRUPDWLRQ FROOHFWHG DW WKH HQUROOPHQW YLVLW ZHUH DQDO\]HG for 1031 men who selected WW or HT at the enrollment visit for the management of PSA failure. Statistical comparisons were made using the chi-square test. RESULTS: Of the 1031 men, 841 (82%) chose WW and 190 FKRVH +7 2I PHQ DJHG \HDUV FKRVH +7 whereas 161 (19%) of 832 men aged >65 years chose HT. The effects of HRQOL problems on the management choice after PSA failure indicated that men aged >65 years with a moderate or big urinary, ERZHO RU KRUPRQDOUHODWHG SUREOHP ZHUH VLJQL¿FDQWO\ PRUH OLNHO\ WR select HT versus WW (Table). Men aged >65 years with more than a high school education were more likely to select WW (59%) versus HT 3 )RUPHQDJHG\HDUV+542/DQGHGXFDWLRQOHYHO GLGQRWVLJQL¿FDQWO\DIIHFWWKHVHFRQGDU\PDQDJHPHQWFKRLFHEXWWKH +7VDPSOHVL]HZDVVPDOO CONCLUSIONS: These results from the COMPARE Registry suggest that among men aged >65 years HRQOL and education level are important factors in the selection of WW versus HT for the management RI 36$ IDLOXUH DIWHU LQLWLDO GH¿QLWLYH SURVWDWH FDQFHU WUHDWPHQW ,Q WKH absence of evidence-based guidelines on the optimal management of this population of men, the COMPARE Registry is a valuable source of information on factors affecting treatment decisions in a real-world, clinical-practice setting. Effects of Age and HRQOL on Management Choice After PSA Failure 65 Years >65 Years WW(n=170) HT(n=29) WW(n=671) HT(n=161) Urinary 15 (9%) 3 (10%) 62 (9%) 25 (16%)b Sexual 53 (31%) 12 (41%) 146 (22%) 39 (24%) Bowel 9 (5%) 2 (7%) 62 (11%) 23 (14%)c Hormonal 12 (7%) 4 (14%) 60 (9%) 26 (16%)d a RIPHQZLWKPRGHUDWHELJSUREOHP b3 YV:: c3 YV:: d P<0.005 vs WW
HRQOL Problema
Source of Funding:VDQR¿DYHQWLV
310 EVALUATION OF PSYCHOSOCIAL CANCER DISTRESS IN MALE PATIENTS WITH UROGENITAL TUMORS Uwe Treiber*, Birgit Marten-Mittag, Christoph Zorn, Juergen E Gschwend, Peter Herschbach. Munich, Germany. INTRODUCTION AND OBJECTIVE: The prevalence rates for psychiatric, depressive and anxiety disorders in general among cancer patients varied between 1% and 50%. Purpose of our study was to determine psychosocial stress situations in male patients with urogenital FDQFHUVE\DFDQFHUVSHFL¿FYDOLGDWHGTXHVWLRQQDLUH 46&5 METHODS: In a total of 879 unselected male patients with different cancer entities, including 196 male patients with urogenital tract (UGT) carcinoma (prostate, kidney, urothel, testis), a nationwide collection of data about psychological distress was performed by use of the “Questionnaire on Stress in Cancer Patients revised YHUVLRQ´ 46&5 +HUVFKEDFK = 0HG 3V\FKRO 7KLV questionnaire contains 23 items which are grouped in 5 homogenous VFDOHV SV\FKRVRPDWLFFRPSODLQWVIHDUVLQIRUPDWLRQGH¿FLWVHYHU\GD\
110
THE JOURNAL OF UROLOGY®
life restrictions and social strains. The period of data collection was 1/2001 to 12/2006. RESULTS: The mean age of UGT cancer pts. was 60±15.3 \HDUV RWKHUFDQFHUSWV \HDUV S 3DWLHQWVGLVWULEXWLRQ among urogenital tumor entities were: prostate cancer 45%, renal cell cancer 25%, urothelial cancer 27% and germ cell tumors 3%. The total QSC-R23 scores of both patient groups (UGT cancers: n=196 vs other cancers: n=683) were 1.22 each. In the group of pts. with UGT cancers, two items of the QSC-R23 showed the highest total scores: “having sex less frequently” (score: 2.41) and “being afraid of disease progression” (score: 2.33). The proportion of the highest response categories “strongly/very strongly distressed” within these items were 37% and 32%, respectively. Compared with other cancer pts., in the UGT cancer pts. the LWHP³KDYLQJVH[OHVVIUHTXHQWO\´VKRZHGDVLJQL¿FDQWKLJKHUVFRUH vs 2.41) with the largest difference of the mean values. Percentage of SWVLGHQWL¿HGDVWREHLQDULVNJURXSIRUSV\FKRVRFLDOGLVWUHVV KLJKHVW response categories: strongly/very strongly distressed) was 34% for UGT cancer pts. and 38% for pts. with other cancers (p=0.25). CONCLUSIONS: This retrospective analysis of unselected male patients with urogenital cancers showed that about one third of these patients belong to a risk group for psychosocial distress. The item “having sex less frequently” showed the highest score with the largest DQGVLJQL¿FDQWGLIIHUHQFHRIPHDQYDOXHV$SURVSHFWLYHVWXG\LVQRZ initiated at our institution. Implementation of routine psycho-oncological care in clinical treatment of cancer patients is mandatory, especially in Comprehensive Cancer Centers. Source of Funding: None
311 DOES NOCTURNAL INCONTINENCE AFFECT THE HEALTH RELATED QUALITY OF LIFE (HRQOL) IN PATIENTS WITH ORTHOTOPIC ILEAL NEOBLADDER? Rajinikanth Ayyathurai, Anuradha Jayathillake, Cindy T Soloway, Mark S Soloway, Murugesan Manoharan*. Miami, FL. INTRODUCTION AND OBJECTIVE: Orthotopic neobladder (NB) reconstruction is increasingly becoming the choice of urinary diversion (UD) after radical cystectomy (RC). Varying degrees of nocturnal incontinence (NI) has been reported following ileal NB reconstruction. This can be of concern to the patient, potentially affecting the HRQOL. We assessed the impact of NI on the HRQOL using a validated instrument. METHODS: The Functional Assessment of Cancer Therapy - Vanderbilt Cystectomy Index questionnaire (FACT-VCI) was used to assess the HRQOL in patients who underwent orthotopic NB following RC and had follow-up within the last 12 months. The FACT part of the questionnaire contains 27 questions that assess four aspects of HRQOL: Physical, Social, Emotional and Functional health. The VCI contains 17 questions that focused on the functional outcome of RC and UD. In addition the data on incontinence and use of pads were collected. 5HVSRQVHV ZHUH FROODWHG DQG RUJDQL]HG LQ D VWUXFWXUHG GDWDEDVH Analyses was done using SPSS software package. RESULTS: 60 patients received the questionnaire. 58% (35) responded. 91% and 9% of respondents are men and women respectively. 9 (26%) patients were fully continent. 27 (77%) patients were continent during the day. 8 (23%) had day and nighttime incontinence. The patient age and HRQOL index are shown in Table 7KHPHDQ9&,VFRUHIRUWKHFRQWLQHQWSDWLHQW $ ZDVVLJQL¿FDQWO\ higher at 53 than the patients with incontinence 44 (P=0.01). 18 (51%) patients had NI incontinence, but had good daytime continence (DC). On comparing the VCI score of these patients with those who are fully FRQWLQHQW WKHUH ZDV QR VLJQL¿FDQW GLIIHUHQFH 3 VXJJHVWLQJ that DC is the primary factor determining the HRQOL. Similarly, overall FACT health score was not statistically different among fully continent patients compared to those with night only incontinence (P=0.147). This shows that the VCI and FACT-QOL status are dictated by DC irrespective of NI. Table 1.
Vol. 179, No. 4, Supplement, Sunday, May 18, 2008
Fully Continent (A) Overall FACT score 94.2 Physical 23.5 Social 24 Emotional 21 Functional 26.5 VCI 53.5 Urinary function 32 Bowel function 18.4 Age 61.3 Follow up 34 Mean HRQOL index
Day & night Nightly incontinence P Value Incontinence (B) (C) A vs. C 77.8 17.5 21.1 20 19 38.7 21.6 14.8 64.8 30
83.9 21.4 21.9 20.3 20.2 47.1 27.7 17.0 66.6 53
0.147 0.055 0.668 0.628 0.012 0.103 0.080 0.348 0.076 0.463
CONCLUSIONS: NI is not uncommon after ileal neobladder XULQDU\GLYHUVLRQ7KH+542/VHHPVWREHGHSHQGHQWRQ'& WKH1, GRHVQRWVLJQL¿FDQWO\DIIHFWWKH+542/ Source of Funding: None
312 THE EFFECT OF SURGERY FOR STRESS URINARY INCONTINENCE ON QUALITY OF LIFE IN WOMEN ENROLLED IN A RANDOMIZED CLINICAL TRIAL COMPARING THE BURCH AND SLING PROCEDURES Philippe E Zimmern*, Chiara Ghetti, Charles W Nager, Elizabeth R Mueller, R Edward Varner, Heather J Litman, John W Kusek, Sharon Tennstedt, Stephen R Kraus. Dallas, TX, Pittsburgh, PA, San Diego, CA, Maywood, IL, Birmingham, AL, Watertown, MA, Bethesda, MD, and San Antonio, TX. INTRODUCTION AND OBJECTIVE: To describe changes LQ XULQDU\ LQFRQWLQHQFH VSHFL¿F TXDOLW\ RI OLIH 4R/ DIWHU PRQWKV in women who received either a Burch or autologous sling for stress urinary incontinence (SUI) and identify baseline factors predicting changes in QoL. METHODS: QoL of 655 women enrolled in a nationwide multi-center clinical trial comparing Burch and sling was measured at baseline and 24-months after surgery with the Incontinence Impact 4XHVWLRQQDLUH6XUJLFDOVXFFHVVZDVGH¿QHGE\DQHJDWLYHSDGWHVW no urinary incontinence on 3-day diary, a negative cough and valsalva stress test, no self-reported incontinence symptoms on the MESA Questionnaire and no re-treatment for SUI by 24-month post-surgery. We examined if change in QoL was related to each procedure and to surgical success. A stepwise least-squares regression analysis was used to examine if the following factors affected post-operative QoL: prior UI WUHDWPHQW VHOIUHSRUWHGW\SHRI8,V\PSWRPV VWUHVVDQGXUJH VH[XDO function as measured by the Prolapse/Urinary Incontinence Sexual 4XHVWLRQQDLUH V\PSWRPERWKHUPHDVXUHGZLWKWKH8URJHQLWDO'LVWUHVV ,QYHQWRU\ DQGRWKHUFOLQLFDODQGVRFLRGHPRJUDSKLFIDFWRUV RESULTS: Changes in QoL from baseline to 24 months are shown in Table 1. There was no difference in magnitude of change in QoL between the 2 procedures, but greater improvement in surgical successes. Multivariable modeling showed that QoL improvement was most strongly related to decreased symptom bother (p<0.001), followed by decrease in stress or urge symptoms (p<0.001, p=0.001 respectively), decrease in UI severity (p=0.001), prior UI treatment (p=0.002), younger age (p=0.006) and Hispanic ethnicity (p=0.011). Among sexually active women, worsening sexual dysfunction had a negative impact on QoL (<0.001). CONCLUSIONS: Two common SUI procedures have similar HIIHFWV RQ 42/ LQ ZRPHQ DIWHU VXFFHVVIXO 68, VXUJHU\ ,GHQWL¿HG predictors of postoperative improvement in QoL are relevant for preoperative patient counseling. Table 1. Baseline IIQ score and change in score at 24 months. All
Baseline Change in score at 24 mo
Burch
Mean N N (sd) 171.4 652 327 (101.3) 608
133.1 299 (109.8)
Surgical Surgical Success Failure Mean Mean N N N (sd) (sd) 169.7 166.6 325 185 334 (103.4) (102.0) Sling
Mean 173.2 (99.2)
130.3a 136.1a 309 185 (112.1) (107.7)
a p = 0.52 comparing Burch vs. sling surgical success vs. failure
160.0b 329 (103.9)
b
Mean (sd) 174.7 (101.0) 113.6b (110.9)
p<0.001 comparing
Source of Funding: NIH/NIDDK for UITN.