An “exploratory study”, published recently in BMC Urology, offers us evidence that men with prostate cancer who have less baseline fatigue and those whose dyspnea and cognitive functioning improves within 3 months of treatment have a significantly increased probability of survival.
The text of this study by Gupta et al. is available in full on the PubMed web site.
Gupta et al. set out to investigate whether changes in patients’ quality of life (QoL) could, over time, predict survival in prostate cancer patients. To do this they conducrted a retrospective analysis data from 250 prostate cancer patients treated at their institution between January 2001 and Decemebr 2009 for whom there was a minimum follow-up period of 3 months post-treatment. Specifically, they looked at QoL data at baseline and after 3 months of treatment initiation using a survey tool known as EORTC-QLQ-C30.
Here are some of the key finding from the study:
- Average (median) overall survival post-treatment was 89.1 months (i.e, nearly 7.5 years).
- Three factors appeared to be predictive of overall survival:
- The patient’s baseline level of fatigue (p = 0.001).
- Worsening of a patient’s dyspnea (every 10-point increase in dyspnea was associated with a 16 percent increase in risk of death [HR = 1.16]).
- Improvement in a patient’s cognitive function (every 10-point improvement in cognitive functioning was associated with a 24 percent decrease in risk of death [HR = 0.76]).
The authors argue that their data provides preliminary evidence to indicate that prostate cancer patients with better baseline fatigue levels and and patients whose dyspnea and cognitive functioning improves within 3 months of treatment are at a significantly decreased risk of mortality compared to the “average” patient.
Now there are a number of limitations to this study, largely because it is a retrospective analysis of accumulated data and not a prospective study. This is the core reason for why that authors describe it as a being an “exploratory study”. Having said that, it does offer some interesting insights into the value of treatment in men with low levels of fatigue and the impact of changes in dyspnea (shortness of breath) and cognitive function on long-term survival. Such data help to expand the scope of conversations between physicians and patients about the relative merits of quantity and quality of life, particularly in those patients with significant levels of comorbidity.
Another weakness of this study is that the range of patient types was high — including patients with newly diagnosed, early stage disease and those with late stage (metastatic) disease who had undergone multiple treatments, as well as patients ranging in age from 37 to 79 years. (See Table 1 in the study.)
However, the authors suggest — probably correctly — that their data “have important implications for both clinical and research practices.” As examples, they suggest that:
- Baseline QoL should be considered when planning treatment.
- Regular QoL assessments should be performed during the course of treatment.
- Interventions intended to improve specific QoL parameters should be applied when indicated.
- The utility of this approach to patient management would be validated definitively if interventions that enhance specific QoL parameters can be shown to enhance survival.