Scoring of treatment-related late effects in prostate cancer
Introduction
The impact of a cancer treatment on a patient's quality of life (QoL) may range from minimal to extreme. In recent years, an increasing effort has been made to measure this impact using a small number of validated schemes. This has allowed more accurate comparisons to be made between different centres and between different treatment methods.
Several characteristics of prostate cancer make the assessment of treatment-related morbidity especially important. Firstly, many patients are initially asymptomatic due to early diagnosis with prostate specific antigen (PSA) screening [14]. Secondly, there are several alternative radical treatments available, all of which have different side effects. Finally, patients may survive for a considerable period of time even in the presence of recurrent or metastatic disease [6]. Accurate and comparable reporting of treatment side effects are, therefore, essential to facilitate informed treatment decisions by both patients and clinicians.
The UCLA Prostate Cancer Index is the only validated, subjective measure of QoL outcomes in the treatment of prostate cancer [12]. In 1995 the LENT/SOMA scoring system was proposed to replace the existing scales of measurement for radiotherapy effects [15]. However, as yet, there are few publications where it has been used and none where it has been compared to the UCLA index. This study examines the subjective late effects of radiotherapy for prostate cancer on the rectum, bowel, bladder and sexual function using the UCLA and LENT/SOMA schemes in order to analyze the correlation between the scales and to highlight their strengths and weaknesses.
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Patient population
All patients who had completed radiotherapy for localized (T1–T3) prostate cancer more than 3 years previously (mean age 71 years, range 54–83 years) and who had no evidence of recurrent disease were identified from our treatment database. Of these patients 135 were randomly selected and invited to attend a clinic appointment for the study. A total of 101 patients agreed to take part. Patients then completed interviewer administered questionnaires in private with a research nurse. The
Results
Table 1, Table 2, Table 3 show the scores obtained from answering the LENT/SOMA questionnaires for rectal/bowel, urinary and sexual symptoms.
The majority of patients had no or minimal bowel dysfunction. The most common severe side effect reported was of urgency (a need to defecate as soon as the urge is felt). A total of 7% of patients recorded that they experienced urgency with every bowel motion, while 8% of patients recorded that they experienced urgency on a daily basis. Only 1% recorded
Discussion
There has been a movement towards the use of a small number of validated morbidity schemes for the reporting of side effects from prostate cancer treatments in recent years. This facilitates comparisons between different centres and different treatment methods. Measurements may be objective, where the patient and clinician count and document the number of loose bowel motions, the amount of blood loss and the number of cauterizations required, such as with the RTOG staging system [3].
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