Quality of Life in Elderly Patients with Urological Malignancies


a direct relationship between alteration of QOL (both global and sexuality items) and values of serum androgen levels, particularly bioavailable testosterone. This study did not directly target elderly prostate cancer patients treated by ADT, but results indicate that FACT-P is a good tool in this setting.


The question of CRPC was addressed early (over 15 years ago) in the development of active treatments, namely chemotherapy. PROSQOLI, an index based on pragmatic indices measuring response to medical treatment in CRPC,30


All items of the LASA scales were significantly in favour of the mitoxantrone plus prednisone arm when compared with prednisone only. The trial design included a concomitant evaluation using the EORTC QLQ-C30 with a specific module other than the QLQ-PR25.53,54


Bladder Cancer Index,65 which is a robust, multidimensional measure


of bladder cancer-specific health-related QOL exploring urinary, bowel and sexual health domains. It is the first validated instrument available to assess health outcomes across a range of local treatments commonly used for bladder cancer. The current literature does not allow the conclusion that one form of urinary diversion is superior to another based on QOL outcomes. Future studies should attempt to incorporate prospective data collection, longer-term follow-up and validated disease-specific QOL instruments.66


Several studies have has not been adapted for use in elderly prostate


cancer patients. Nevertheless it has established for the first time the impact of a chemotherapeutic agent, mitoxantrone, on patients with CRPC.52


assessed the QOL of patients with infiltrating bladder cancer treated by conservative treatment.67,68


One of these studies involved the


Overall there were no significant differences in QOL changes according to treatment between the two scales. The only disadvantage of PROSQOLI was that it was relatively weak for evaluating urinary problems and family relationship; its advantage was that it was quick, simple and valid. Similar conclusions were drawn in subsequent trials testing chemotherapeutic drugs using other indexes such as the FACT-P scale.55,56


Finally, more recent trials


have limited the evaluation of QOL aspects to the measurement of pain,57,58


possibly due to the fact that overall survival impact has become the principal objective of such trials.


Quality of Life in Elderly Patients with Bladder Cancer


Few studies have been published on the QOL consequences of intravesical treatment for superficial bladder tumours. Standard questionnaires such as SF-36 have been used in only a few studies:59 the scores evaluating physical, social and role – emotional functioning decrease after the first transurethral resection and increase thereafter when transurethral resection is repeated four or more times. Other investigators have developed specific questionnaires to study the QOL outcome of these patients.60


More studies have addressed


the question of QOL consequences of radical treatments in patients with infiltrating bladder cancers using different questionnaires. The FACT questionnaire adapted for bladder cancer (FACT-BL) was used in 82 patients undergoing radical cystectomy and 177 patients receiving conservative treatment.61


There were no differences in general


QOL scores between treatment groups and between the two urinary diversion groups, but patients undergoing cystectomy had worse sexual function scores. QOL scores for patients receiving conservative treatment tended to decrease with increasing age. The SF-36 questionnaire was used to compare the QOL associated with ileal conduit and with continent orthotopic neobladder.62,63


No significant


difference was found in scale scores between treatment groups. Scale scores for role – physical functioning, social functioning and role – emotional functioning in both groups were significantly below the population norm. Patients with a neobladder who were 65 years old or older had significantly lower scores for role – physical functioning and role – emotional functioning than younger patients. Nonetheless, in elderly patients with no additional morbidity, orthotopic neobladder replacement can be superior to ileal conduit. Both types of diversion seem to result in acceptable scores for most aspects of QOL, including urinary symptoms and continence rate. These figures may be helpful in the pre-operative counselling of elderly patients with bladder cancer.64


Other clinicians have developed the 36-item EUROPEAN ONCOLOGY & HAEMATOLOGY


Quality of Life in Elderly Patients with Kidney Cancers


An interesting approach was proposed under the auspices of the Kidney Cancer Association (KCA).70


Only a few studies have addressed the question of QOL in renal cancer.69


The authors studied a


The authors conclude that assessment of the impact of the disease and of its treatment on health-related QOL may influence the choice of treatment, highlighting the importance of incorporating patient-reported outcomes in clinical trials. Only one randomised trial designed to demonstrate the activity of a targeted drug, Sorafenib,


171


composite QOL index involving demographics, medical history, the Watts Sexual Function Questionnaire (WSFQ), the SF-12 Health Survey, the Centre for Epidemiologic Studies Depression scale (CES-D) and the Revised Dyadic Adjustment Scale (RDAS). Overall, the total WSFQ scores, as well as the four domain scores (desire, arousal, orgasm and satisfaction), were similar in men and women and were lower than in female breast cancer and male hypertensive populations reported in the literature, indicating relatively worse sexual function. While most patients remained sexually active in non-distressed relationships, many reported depressive symptoms and sexual functioning was presumably worse than in comparable chronically ill populations. A recently published review explored the impact of new targeted drugs on the QOL of patients treated for advanced kidney cancer.71


concomitant use of SF-36, International Prostate Symptom Score (IPSS) and EPIC. No significant difference was found between groups according to IPSS. The QOL score of conservative treatment was lower than that of the control group of superficial bladder tumours when using SF-36, but there was no significant difference except body pain. There was a trend towards diminished physical and role – physical functioning in the conservative treatment group. The EPIC scores for urinary function, especially storage and voiding symptoms and bowel function, were significantly lower in the conservative treatment group. Multivariate analysis showed that body pain and bowel function were associated with the type of treatment. The EORTC QLQ-C30 index was also used to evaluate bladder preservation and functional quality after concurrent chemoradiotherapy for muscle-invasive bladder cancer.68


Concurrent chemoradiation therapy allowed bladder


preservation with tumour control at eight years in 67 % of the patients. QOL and quality of bladder function were satisfactory for 67 % of patients. Conversely, few results are available on the QOL of patients treated by chemotherapy for advanced or metastatic disease. The only trial involving QOL evaluation was based on the EORTC QLQ-C30 questionnaire: Vinflunine demonstrated a survival advantage in second-line treatment for advanced urothelial cancer. It did not induce a decrease in health-related QOL as compared with best supportive care. By four-month follow-up there was a positive change in the global health status score in the study arm, whereas the control arm (best supportive care) showed continuous decrements from baseline values.


Page 1  |  Page 2  |  Page 3  |  Page 4  |  Page 5  |  Page 6  |  Page 7  |  Page 8  |  Page 9  |  Page 10  |  Page 11  |  Page 12  |  Page 13  |  Page 14  |  Page 15  |  Page 16  |  Page 17  |  Page 18  |  Page 19  |  Page 20  |  Page 21  |  Page 22  |  Page 23  |  Page 24  |  Page 25  |  Page 26  |  Page 27  |  Page 28  |  Page 29  |  Page 30  |  Page 31  |  Page 32  |  Page 33  |  Page 34  |  Page 35  |  Page 36  |  Page 37  |  Page 38  |  Page 39  |  Page 40  |  Page 41  |  Page 42  |  Page 43  |  Page 44  |  Page 45  |  Page 46  |  Page 47  |  Page 48  |  Page 49  |  Page 50  |  Page 51  |  Page 52  |  Page 53  |  Page 54  |  Page 55  |  Page 56  |  Page 57  |  Page 58  |  Page 59  |  Page 60  |  Page 61  |  Page 62  |  Page 63  |  Page 64  |  Page 65  |  Page 66  |  Page 67  |  Page 68