Adult urologyMeasuring patients’ expectations regarding health-related quality-of-life outcomes associated with prostate cancer surgery or radiotherapy
Section snippets
Material and methods
Consecutive patients visiting the multidisciplinary urologic oncology clinic during their initial consultation at a tertiary referral center were solicited, and patients who agreed and returned a baseline HRQOL survey were enrolled. Sequentially, the baseline pretreatment HRQOL scores, pretreatment expectation scores, and 1-year posttreatment scores were collected in patients undergoing radical prostatectomy or external beam radiotherapy.
The comprehensive HRQOL survey comprises the Rand Medical
Results
A total of 100 eligible patients provided written informed consent and were enrolled in the study. Of these patients, 81 returned the baseline and expectation surveys. Of the 81 patients, 24 were excluded from the analysis because they completed the expectation instrument after beginning treatment and not before treatment as required by the study design. Of the 57 remaining subjects, 50 returned the 1-year posttreatment HRQOL surveys (24 who had undergone radical prostatectomy and 26 who had
Comment
The pretreatment expectations for HRQOL outcomes 1 year after contemporary prostate cancer treatments were fulfilled for the urinary, bowel, and hormonal domains; however, patients anticipated sexual outcomes at 1 year significantly superior to their observed outcomes for both surgery and external beam radiotherapy at 1 year. In this study, the sexual domain score at 1 year was 31.5 and 35.5 for the surgery and radiotherapy groups, respectively, despite coaching the patients to improve sexual
Conclusions
HRQOL expectations are a novel tool of evaluation that may assist in, and improve, patient education to narrow the discrepancy between the anticipated outcomes and reality; thus, empowering patients to make informed treatment decisions. Ultimately, attempts by the care giving practitioner, or others, to ascertain patients’ perceptions of information with which they are provided regarding outcomes expectations may help reduce the discrepancies between patient expectations and observed realities.
Acknowledgment
To Monika Benedict, Julie Priess, and Kathy Grijalva for their expert help with data management and William Underwood, M.D., and Angela Fagerlin, Ph.D., for their support.
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Cited by (56)
Guidelines for Sexual Health Care for Prostate Cancer Patients: Recommendations of an International Panel
2022, Journal of Sexual MedicineBarriers to sexual recovery in men with prostate, bladder and colorectal cancer
2022, Urologic Oncology: Seminars and Original InvestigationsCitation Excerpt :Although men on PDE5-i have improved erectile function as measured by IIEF, their confidence in the drugs diminishes – demonstrating that excessively high expectations may lead to perceived lack of efficacy, and ultimately discontinuation of medications [25]. Symon et al. also showed that sexual bother following CaP treatment was strongly correlated with pretreatment expectations, and less so with the actual loss of sexual function [26]. It is not clear whether patients are informed that PDE5-i do not work as pro-erectile aids during the first months after prostatectomy, but may work later when erectile function improves.
Editorial Comment
2022, UrologyHard Times: Prostate Cancer Patients’ Experiences with Erectile Aids
2021, Journal of Sexual MedicineCitation Excerpt :In fact, McCarthy and McCarthy suggested that unrealistic expectations around sildenafil contribute to the development of nonsexual marriages.20 Research has shown that men who undergo PCa treatment frequently have overly optimistic expectations about sexual outcomes post-treatment and about the efficacy of EAs.21,22 Patients are rarely educated about what outcomes are reasonable to expect.
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Martin G. Sanda’s MGS effort was funded in part by National Institutes of Health grant R01-CA95662.