Long-Term Health-Related Quality of Life in Men Treated with 125I Prostate Brachytherapy for Clinically Localized Prostate Cancer

Long-Term Health-Related Quality of Life in Men Treated with 125I Prostate Brachytherapy for Clinically Localized Prostate Cancer

Proceedings of the 47th Annual ASTRO Meeting subscale 3). Cronbach’s alpha-coefficient of each subscale was 0.90 in subscale 1, 0.87 in subscale 2, a...

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Proceedings of the 47th Annual ASTRO Meeting

subscale 3). Cronbach’s alpha-coefficient of each subscale was 0.90 in subscale 1, 0.87 in subscale 2, and 0.87 in subscale 3, suggesting high internal consistency. The correlation coefficient between HADS-A score and the questionnaire about anxiety of radiotherapy score was 0.37 in subscale 1, 0.38 in subscale 2, 0.39 in subscale 3, suggesting high validity. Conclusions: We developed the questionnaire about anxiety of radiotherapy consisted of 17 items, three subscales with high internal consistency and validity. As this questionnaire was made from various primary sites, various status of patients, it can be used all type of cancer patients treated with radiotherapy. From this study, we have been studying correlational factors about anxiety of radiotherapy and methods of clinical intervention.

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Initiation of Complementary and Alternative Medical Therapies (CAM) By Cancer Patients (Pts) During Radiation Therapy (RT)

N. Vapiwala,1 R. Mick,2 A. DeNittis,1 M. Hampshire,1 J. Metz1 Radiation Oncology, University of Pennsylvania, Philadelphia, PA, 2Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, PA

1

Purpose/Objective: CAM use is prevalent both in the healthy population and among adult cancer pts. However, there are little data quantifying the initiation of CAM specifically after cancer diagnosis and during conventional cancer therapy. This study evaluated patterns of usage, reasons for utilization, and general perceptions of CAM among cancer pts undergoing RT. Materials/Methods: From 7/04 to 9/04, a piloted questionnaire assessing pt demographics and CAM use was administered on the Internet (www.oncolink.com) and in 2 oncology clinics. In total, 487 surveys were completed, of which 356 (73%) were from pts undergoing RT [142 RT only, 214 some combination of RT and chemotherapy (CT)]. RT pts were predominantly female (60%) and white (79%); about half (47%) held college or graduate degrees. The 4 most common sites of malignancy among the RT pts were breast, prostate, head and neck, and lung. The remaining 131 survey responses (27%) were from patients undergoing CT only. An exploratory analysis was performed to compare these 131 CT-only pts to the 142 RT-only pts. Results: Initiation of at least one CAM after diagnosis was reported by 171 (48%) pts undergoing RT, with a median of 2 CAM approaches per pt (range 1–7). CAM use was more common among females than males (52% vs. 42%, p⫽0.06). However, utilization did not vary based on ethnicity (49% whites vs. 44% non-whites, p⫽0.45) or education level (51.2% college graduates vs. 48.8% non-college graduates, p⫽0.15). The most commonly cited reason for CAM use after diagnosis was “general overall health” in 68 (40%) pts. Vitamin, herbal, and botanical supplements were the most popular modalities among respondents. The vast majority (88%) of CAM users expressed satisfaction with CAM as a cost effective approach. However, only 62 (36%) CAM users cited their healthcare providers (HCPs) as primary sources of information on CAM. There was a higher rate of CAM use among the 131 CT-only pts compared to the 142 RT-only pts (65% vs. 35%, p⬍0.0001), particularly of massage therapy (27% vs. 10%, p⫽0.018). There were otherwise no statistically significant differences in pt demographics or reasons for CAM use between these subgroups. Interestingly, only 16% of the 85 CT-only CAM users and 10% of the 50 RT-only CAM users reported HCPs as a primary resource for discussion of CAM. Conclusions: Approximately half (48%) of adult cancer pts initiate CAM therapy after cancer diagnosis and during RT. Also, CAM use appears to be more prevalent in pts undergoing CT-only compared to RT-only. Yet, the majority of pts do not discuss their CAM use with HCPs, even while actively receiving conventional cancer treatment(s) under their care. HCPs should be aware of their pts’ reasons for CAM use, particularly for symptom management and improved quality of life during RT and/or CT. HCPs should also be familiar with the information sources commonly used by pts, and supplement these sources with discussion of pertinent safety profiles and potential interactions with conventional therapies.

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Long-Term Health-Related Quality of Life in Men Treated with 125I Prostate Brachytherapy for Clinically Localized Prostate Cancer

J. Schaefer,1 G. Welzel,1 L. Trojan,2 K. Harrer,2 N. Eppler,1 M.S. Michel,2 P. Alken,2 F. Wenz1 Department of Radiation Oncology, Mannheim Medical Center, University of Heidelberg, Mannheim, Germany, 2 Deparment of Urology, Mannheim Medical Center, University of Heidelberg, Mannheim, Germany 1

Purpose/Objective: Prostate brachytherapy has been reported to have less morbidity for patients than radical prostatectomy or external beam irradiation. However, information regarding long-term treatment-specific quality-of-life (QoL) is scant. We evaluated the impact of permanent implant brachytherapy on general, cancer specific and symptom domains of QoL for up to 6 years using validated patient-administered quality-of-life instruments. Materials/Methods: A total of 295 men consecutively treated in a single medical center between June 1998 and December 2003 were mailed two standardized questionnaires (the EORTC prostate cancer quality of life questionnaire QLQ-PR25 and the ICS-male questionnaire) to assess health-related QoL. We subclassified two groups of patients: group 1 with patients younger than 65 years of age (n⫽45, median age 62, range 45– 64), group 2 with patients 65 years of age or older (n⫽186, median age 73, range 65– 85). The minimal follow up after treatment was 12 month (mean 50.3 months; range 12–78 months). 106 (45,9%) men have also been treated with hormonal therapy. Results: A total of 231 questionnaires were returned (78.3% response rate), 221 were suitable for analysis, 12.9% of the patient had died. 76.7% of group 1 and 73.2% of group 2 reported that they were in good, very good, or excellent health. Table 1 provides an overview of the QoL outcomes and side effects. 53.5% (group 1) and 70.7% (group 2) referred strong or moderate pollakisuria, 39.2% reported nocturia, without relevant differences between both groups, and 5.5% of patients suffered from strong or moderate dysuria (p⬎0.05). 2.3% patients reported strong stress incontinence; 24.7% reported moderate, and 22.0% strong urge incontinence. A total of 13% used pads. There was no evidence of severe rectal dysfunction. 75.6% (group 1) and 60.9% (group 2) had sex during the last four weeks. The most common problems were erectile dysfunction (48.6% vs. 75%, p⬍0.001) and decrease in ejaculation (39.4% vs. 59.6%, p⬍0.001). Whereas sexual complaints were age associated, this was not the case for urinary and bowel complaints. Most patients (95.9%) would recommend (125)I seed brachytherapy to others.

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S452

I. J. Radiation Oncology

● Biology ● Physics

Volume 63, Number 2, Supplement, 2005

Conclusions: Our data substantiate the favorable long-term QoL outcomes associated with modern brachytherapy techniques. Significant age differences were observed in all quality of life measures, with the largest occurring in sexual and urinary symptoms. Sexual function was significantly worse in patients 65 years of age and older (p ⬍0.05). Table 1: Quality of life outcomes, frequency of multi-item incontinence, bowel and sexual function scores

* Men with sexual activity over past 4 weeks.

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Radiation Associated Angiosarcoma: a Single Institution Case Series and Tissue Microarray

J.M. Herman,1 M. Amichay,1 D. Lucas,2 D. Thomas,3 J. McHugh,2 L. Baker,4 M. Ray1 Radiation Oncology, University of Michigan, Ann Arbor, MI, 2Pathology, University of Michigan, Ann Arbor, MI, 3 Internal Medicine-Hematology Oncology, University of Michigan, Ann Arbor, MI, 4Oncology, University of Michigan, Ann Arbor, MI 1

Purpose/Objective: Angiosarcomas are rare aggressive tumors of endothelial origin. They may arise sporadically or as a result of previous ionizing radiation exposure or chronic lymphedema, as first described by Stewart and Treves. Latency periods for the development of radiation-associated angiosarcoma (RAA) may be many years. It is unclear why some patients develop RAA after irradiation while others do not and the mechanisms of radiation-associated sarcogenesis remain unknown. In this report, we describe the clinical, pathologic, and treatment information on a series of RAA patients. In addition, we report preliminary immunohistochemical studies of two important tumor markers, p53 and Ki-67, on a tissue microarray composed of RAA and sporadic angiosarcoma (SA) cases. Materials/Methods: This IRB approved study identified 14 RAA and 30 SA cases seen in consultation at the University of Michigan between 1990 and 2004. Clinical, treatment, and pathological information was obtained by database and chart review. Archived pathology tissues were obtained for patients who had surgical resection at the institution. Tissue sections were reviewed, and tissue block cores were harvested for tissue microarray construction. The tissue microarray includes 8 RAA cases with 30 sporadic angiosarcoma cases, all arrayed in triplicate. Immunohistochemical analysis of p53 and Ki-67 were performed. Staining was scored by two independent pathologists. p53 staining of tumor cells was simply scored as positive or negative for nuclear staining, while Ki-67 was scored as percent nuclear staining (0 –100%). Results: Among RAA cases, mean age at the time of the primary cancer was 52.1 (16.6 –74.2), 86% were female, and 93% were Caucasian. Median dose delivered to the primary site was 61 Gy (50.4 –72 Gy). The median interval to diagnosis of RAA was 7.1 years (3.2–32.6 years). The primary malignancies of RAA patients were as follows: breast (9), cheek squamous cell (1), seminoma (1), thigh sarcoma (1), prostate cancer (1), and Hodgkin’s lymphoma (1). One breast primary patient who reported lymphedema in the axilla during and after radiation developed RAA in the axilla, typical of Stewert-Treves. Another patient who had groin dermatitis following prostate radiation developed angiosarcoma in the same location 10 years later. The remaining RAA patients reported no chronic radiation sequalae and developed RAA in the radiation field. RAA patients received chemotherapy, surgery, additional radiation therapy or a combination of these as treatment for their RAA. At the time