Self-Reported Burden in Elderly Patients With Localized Prostate Cancer Treated With Stereotactic Body Radiation Therapy (SBRT)

Nima Aghdam; Abigail Pepin; Michael Carrasquilla; Colin Johnson; Malika Danner; Marilyn Ayoob; Thomas Yung; Siyuan Lei; Brian T Collins; Deepak Kumar; Simeng Suy; John Lynch; Sean P Collins

doi:10.3389/fonc.2019.01528

Self-Reported Burden in Elderly Patients With Localized Prostate Cancer Treated With Stereotactic Body Radiation Therapy (SBRT)

Front Oncol. 2020 Jan 22:9:1528. doi: 10.3389/fonc.2019.01528. eCollection 2019.

Authors

Affiliations

¹ Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, United States.
² George Washington School of Medicine and Health Sciences, Washington, DC, United States.
³ Department of Surgery, University of Southampton, Southampton, United Kingdom.
⁴ Biotechnology Research Institute, North Carolina Central University, Durham, NC, United States.
⁵ Department of Urology, Georgetown University Hospital, Washington, DC, United States.

Abstract

Purpose: Retaining quality of life in patients treated with SBRT for prostate cancer remains paramount. As such, balancing the benefits of treatment against the effects of therapy on elderly patients is essential. The EORTC QLQ-ELD14 (ELD-14) is a validated questionnaire with a domain dedicated to burden of illness and treatment in the elderly. The Expanded Prostate Cancer Index Composite (EPIC)-26 is a validated questionnaire which measures urinary, bowel, sexual, and hormonal symptoms. This study reports trends in self-reported burden in patients with prostate cancer treated with SBRT and reveals convergence of self-reported burden with treatment related side effects obtained from the EPIC-26 questionnaire. Methods: All patients ≥70 years old, with localized prostate cancer treated with SBRT ± ADT at Medstar Georgetown University Hospital from 2013 to 2018 and had completed the ELD-14 were eligible for inclusion in this cross-sectional cohort study. Percentage of responses to questions related to disease and treatment burden were counted for each category ("not at all" and "a little" vs. "quite a bit" and "very much"). Additional demographic features were derived from available medical records. A total of 111 patients (median age of 74) responded to the ELD-14 questionnaire at onset of treatment and at the 2-year mark. Responses to EPIC questionnaires at matched follow-ups were scored and correlated with the self-reported burden domain of the ELD-14 using the Spearman correlation coefficient. Results: Number of patients reporting "quite a bit" or "very much" burden from prostate cancer was 6.3% prior to treatment. This was highest at 1-month (10.8%) and decreased to 9.0% at 24 months post-SBRT (X ² = 3.836, p = 0.6986). By comparison, 3.6 and 5.4% reported "quite a bit" or "very much" burden from treatment at start of treatment and 24 months, respectively (X ² = 1.046, p = 0.9838). Patient reported treatment burden was found to converge well with individual domains of EPIC-26. Patients undergoing ADT experienced more burden than their non-ADT counterparts. Conclusions: This cross-sectional study suggests a minority of patients reported high burden from their clinically localized prostate cancer or from their SBRT treatment. Self-reported burden converged well with lower EPIC scores in multiple domains.

Keywords: SBRT; burden of disease; cyberknife; patient reported outcome (PRO); prostate cancer; quality of life.