Abstract
Background: Quality of life in prostate cancer patients with clinically localized disease has become the focus of increasing attention over the past decade. However, few instruments have been developed and validated to assess quality of life specifically in this patient population. Objective: The purpose of this investigation was to create a comprehensive, multi-scale quality of life instrument that can be tailored to the needs of the clinician/investigator in multiple settings. Design, subjects, and measures: Patients diagnosed with clinically localized prostate cancer were mailed a questionnaire consisting of new and previously validated quality of life items and ancillary scales. Data from returned questionnaires were analyzed and used to create a multi-scale instrument that assesses the effects of treatment and disease on urinary, sexual, and bowel domains, supplemented by a scale assessing anxiety over disease course/effectiveness of treatment. The instrument was then mailed to a second sample of prostate cancer patients once and then again two weeks later to assess test-retest reliability. To assess feasibility in clinical settings, the instrument was self-administered to a third patient sample during a urology clinic visit. Results: All scales exhibited good internal consistency and test-retest reliability, convergent and discriminant validity, and significant correlations with disease specific, generic health-related, and global measures of quality of life. Men with greater physiologic impairment reported more limitations in role activities and more bother. Scales were also able to differentiate patients undergoing different therapies. All scales exhibited negligible correlations with a measure of socially desirable responding. Additionally, the instrument proved feasible when used as a self-administered questionnaire in a clinical setting. Conclusions: The current instrument possesses brief multi-item scales that can be successfully self-administered in multiple settings. The instrument is flexible, relatively quick, psychometrically reliable and valid, and permits a more comprehensive assessment of patients' quality of life.
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Landis SH, Murray T, Bolden S, Wingo PA. Cancer sta-tistics, 1999. CA: A Cancer Journal for Clinicians 1999; 49: 8–31.
Albertsen PC. Urology. JAM 1996; 275: 1857–1858.
Fowler FJ Jr, Wasson J, Barry MJ, Roman A, Lu-Yao G, Wennberg J. Effect of radical prostatectomy for prostate cancer on patient quality of life: Results from a Medicare survey. Urology 1993; 45: 1007–1015.
Wasson JH, Cushman CC, Bruskewitz RC, Littenberg B, Mulley AG Jr, Wennberg JE. Prostate Disease Patient Outcome Research Team. A structured literature review of treatment for localized prostate cancer. Arch Fam Med. 1993; 2: 487–493.
Litwin MS, Hays RD, Fink A, et al. Quality of life out-comes in men treated for localized prostate cancer. JAMA 1995; 273: 129–135.
Jonler M, Messing EM, Ritter MA, Rhodes PR, Brink-mann R, Bruskewitz RC. Sequelae of definitive radiation therapy for prostate cancer localized to the pelvis. Urology 1994; 44: 876–882.
Helgason AR, Fredrikson M, Adolfsson J, Steineck G. Decreased sexual capacity after external radiation therapy for prostate cancer impairs quality of life. Int J Rad Onc Bio Phys 1995; 32: 33–39.
Herr HW. Quality of life of incontinent men after radical prostatectomy. J Urol 1994; 151: 652–654.
Fleming C, Wasson JH, Albertsen PC, Barry MJ, Wenn-berg JE. A decision analysis of alternative treatment strat-egies for clinically localized prostate cancer. JAMA 1993; 269: 2650–2658.
Chodak GW. Treatment of early stage prostate cancer: Conservative management – delayed therapy. In: DeVita VT, Hellman S, Rosenberg SA (eds), Important Advances in Oncology. Philadelphia: J.B. Lippincott Company. 1994; 241–244.
Moinpour CM. Measuring quality of life: An emerging science. Sem Oncol 1994; 21: 48–63.
Testa MA, Simonson DC. Assessment of quality of life outcomes. NEJM 1996; 334: 835–840.
Guyatt GH, Feeny DH, Patrick DL. Measuring health-related quality of life. Ann Int Med 1993; 118: 622–629.
Ware JE. The status of health assessment 1994. Ann Rev Public Health 1995; 16: 327–354.
Lim AJ, Brandon AH, Fiedler J, et al. Quality of life: Radical prostatectomy versus radiation therapy for prostate cancer. J Urol 1995; 154: 1420–1425.
Broghede G, Sullivan M. Measurement of quality of life in localized prostatic cancer patients treated with radiothera-py: Development of a prostate cancer-specific module supplementing the EORTC QLQ-C30. Qual Life Res 1996; 5: 212–222.
Pedersen KV, Carlsson P, Rahmquist M, Varenhorst E. Quality of life after radical retropubic prostatectomy for carcinoma of the prostate. Eur Urol 1993; 24: 7–11.
Talcott JA, Rieker P, Clark JA, et al. Patient-reported symptoms after primary therapy for early prostate cancer: Results of a prospective cohort study. J Clin Oncol 1998; 16: 275–283.
Nunnally JC, Bernstein IH. Psychometric theory, 3rd ed. New York: McGraw-Hill, 1994.
Ware JE, Snow KK, Kosinski M, Grandek B. SF-36 health survey manual and interpretation guide. Boston: The Health Institute, New England Medical Center, 1997.
Selby P. Measuring the quality of life of patients with cancer. In: Walker SR, Rosser RM (ed). Quality of Life Assessment: Key Issues in the 1990s. pp. 235–267 Boston: Kluwer Academic Publishers, 1993.
Paulhus D. Two-component models of socially desirable responding. J Per Soc Psych. 1984; 46: 598–609.
Crawford ED. Prostate cancer awareness week: September 22–28, 1997. CA: A Cancer Journal for Clinicians 1997; 47: 288–296.
Gill TM, Feinstein AR. A critical appraisal of the quality of life measurements. JAMA 1994; 272: 619–626.
O'Leary MP, Fowler FJ, Lenderking WR, et al. A brief male sexual functioning inventory for urology. Urol 1995; 46: 697–706.
Ware JE, Sherbourne CD. The MOS 36-item short-form survey (SF-36). Med Care 1992; 30: 473–483.
Watson D, Clark LA, Tellegen A. Development and vali-dation of brief measures of positive and negative affect: The PANAS Scales. J Per Soc Psych 1988; 54: 1063–1070.
Diener E, Emmons RA, Larsen RJ, Griffin S. The satis-faction with life scale. J Pers Assess 1985; 49: 71–75.
Brenner MH, Curbow B, Legro MW. The proximal-distal continuum of multiple health outcome measures: The case of cataract surgery. MedCare 1995; 33 (Suppl.): AS236–AS244.
Gorsuch RL. Factor analysis, 2nd edn. Hillsdale, NJ: Erl-baum, 1983.
Cronbach LJ. Coefficient alpha and the internal structure of tests. Psychometrika 1957; 3: 297–334.
Deyo RA, Diehr P, Patrick DL. Reproducibility and responsiveness of health status measures. Controlled Clinical Trials 1991; 12: 142S–158S.
Weinberger M, Oddone EZ, Samsa GP, Landsman PB. Are health-related quality-of-life measures affected by the mode of administration? J Clin Epidemiol 1996; 49: 135–140.
Kidder LH, Judd CM. Research methods in social relations. New York: Holt Rinehart Winston, 1986.
Liang MH, Larson MG, Cullen KE, Schwartz JA. Comparative measurement efficiency and sensitivity of five health status instruments for arthritis research. Arthritis and Rheumatism 1985; 28: 524–547.
Watson D, Pennebaker JW. Health complaints, stress, and distress: Exploring the central role of negative affectivity. Psych Rev 1989; 96: 234–254.
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Giesler, R.B., Miles, B.J., Cowen, M.E. et al. Assessing quality of life in men with clinically localized prostate cancer: Development of a new instrument for use in multiple settings. Qual Life Res 9, 645–665 (2000). https://doi.org/10.1023/A:1008931703884
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DOI: https://doi.org/10.1023/A:1008931703884