C. Flynn

A randomized assessment of three quality-of-life questionnaires for patients with prostate cancer undergoing different radiation treatments

tients demonstrated greater fatigue, pain, and appetite loss. One year after treatment, no statistically significant differences were demonstrated in either group. CONCLUSIONS: These results provide the first description of outcomes experienced by a group of patients who have undergone BCT and radiotherapy (either EBRT or BRACHY) for stage I or II breast cancer and been followed for up to 1 year. The results do not demonstrate that patients selected to receive a shorter treatment course with BRACHY had an increase in QOL. Quantitative research such as this study cannot be generalized to a larger population, and further studies are needed. ACKNOWLEDGMENTS: Special thanks to Drs. Peter Chen, Gary Gustafson, Jannifer Stromberg, Frank Vicini, and Alvaro Martinez of the Radiation Oncology Department for their assistance and support during the enrollment of patients in this study. The authors also acknowledge Mamtha Balasubramanian for her assistance in statistical analysis.

A randomized assessment of three quality of life (QOL) questionnaires for prostate cancer patients undergoing different radiation treatment modalities

Abstract Purpose: The goal of this prospective, randomized study was to assess and compare compliance of patients diagnosed with prostate cancer to completing three different validated QOL instruments pre-treatment and six months later. Materials and Methods: Between April 2000 and April 2001, 124 patients were asked to fill out only one of three randomly selected QOL questionnaires (version A, B, C). Each addressed urinary and sexual function. One also addressed patients’ physical, social, family, emotional, and functional well being. Study patients received External Beam Radiation Therapy (EBRT) or Brachytherapy (BRACHY), according to departmental policy. Exclusion criteria included current/previous hormone therapy and prostatectomy. Patients were asked to return the questionnaire at their first treatment visit. The three tools were: A The Functional Assessment of Cancer Therapy for Prostate Patients (FACT-P), The Sexual Adjustments Questionnaire (SAQ), and The American Urological Association (AUA) Questionnaire. The Fact-P questionnaire elicits information about physical, social, family, emotional, and functional well being as they relate to prostate cancer. SAQ focuses on sexual function; the AUA on urinary symptoms. B SAQ and AUA only; identical to Version A, but does not address physical, social, family, emotional, and functional well-being. C The International Prostate Symptom Score (I-PSS) Questionnaire, which addresses urinary symptoms and Patient Sexual Function Questionnaire, which focuses on erectile function. Additionally, patients were asked to respond yes/no to four variables designed to evaluate these questionnaires: 1) ease of understanding, 2) too personal, 3)addresses concerns regarding urinary function and sexual potency and 4) willingness to complete questionnaire in six months. These variables were examined for any trends that may exist between the different questionnaires. Results: Fifteen (12%) of the 124 patients returned incomplete questionnaires due to the personal nature. When the 109 completed questionnaires were analyzed,the favorable responses of the four variables were compared. Favorable responses were received less frequently with version A when compared to version B (p=0.07) or Version C (p=0.08). Specifically, patients felt that version C addressed their concerns more effectively then version A (p= 0.03). Also, patients more frequently felt that version B was less personal when compared to versions A and C (p=0.01). When the patient responses were analyzed by treatment type, the group receiving EBRT appeared to trend toward version B. The group receiving BRACHY appeared to trend toward version C. Conclusion: Table I demonstrates that version B or C would provide a more effective QOL assessment. Patient accrual will continue to assess possible differences between B and C questionnaires. Evaluation Question Version A (n=35) Version B (n=35) Version C (n=39) 1. Easy to understand 86% yes 83% yes 95% yes 2.Too Personal 29% yes 14% yes 28% yes 3. Addresses Concerns 66% yes 77% yes 79% yes 4. Fill Out Again 80% yes 83% yes 85% yes Overall Favorable Responses 76% 82% 83%

A comparison of quality of life of early stage breast cancer patients treated by brachytherapy alone versus external beam radiation

Purpose: To prospectively assess and compare the quality of life (QOL) of patients with early stage breast cancer selected for either brachytherapy (BRACHY high or low dose rate) alone or external beam radiation therapy (EBRT) as their breast conserving therapy (BCT). We hypothesize that the shorter radiation treatment course associated with BRACHY may lead to an improvement in QOL. Methods And Materials: Between 3/97 and 3/98, 42 patients (18 in EBRT arm and 24 in BRACHY arm) with early stage breast cancer were asked to complete the European Organization for Treatment and Researchs (EORTC) Quality of Life Questionnaire (QLQ-C30 version 2.0). EBRT patients received a standard 6 1/2 week course ofexternal radiation while BRACHY patients were part of a prospective clinical trial delivering radiation to the tumor bed region over a four day period. The QLQ-C30 is composed of 5 functional scales (physical, role, emotional, cognitive and social), 3 symptom scales (fatigue, pain, nausea and vomiting), 6 single item scales (dyspnea, insomnia, appetite loss, constipation, diarrhea and financial impact) and 1 global health status (GHS)/QOL scale. Subjects were asked to complete the QLQ-C30 at the following intervals: simulation, first week of treatment, at week 7 and 3, 6, 9 and 12 months post-treatment. The mean scores of patients receiving EBRT and BRACHY with respect to functional scales, symptom/single item scales and GHS/QOL scale are reported for simulation, week i, week 7 and 3 months. T-tests for equal and unequal variances are also reported. Results: In the EBRT arm, 18/18 patients have completed the QLQ-C30 for the 3 month interval; 13/24 in the BRACHY arm to date. It is anticipated that 24/24 patients will have completed the 3 month interval by October 1998. At the time of simulation, no significant difference in functioning between the two arms were noted. At week i, EBRT patients demonstrated superior role functioning (~ = 0.0018) and social functioning (p = 0.0105). Role functioning is defined as the ability to work or perform daily activities. Social functioning is defined as activities that involve family life and social activities. At week i, patients in the BRACHY arm demonstrated a statistically significant difference for one symptom/single item (p < 0.01 for constipation). This may be due to the use of narcotics~analgesics related to the axillary node dissection/implant placement. At week 7, patients who underwent EBRT demonstrated an increase in fatigue and financial impact which approached statistical significance (0.0749 and 0.0797 respectively). At the 3 month interval, no functional, symptom/single item or GHS/QOL scales were significantly different for patients receiving either BRACHY alone or EBRT. Conclusions: With the exception of the responses at week I, at which EBRT patients demonstrated a statistically significant difference in role and social functional scales and BRACHY patients demonstrated a statistical improvement in a single item scale, there appears to be no difference in overall QOL when patients are treated by either BRACHY alone or EBRT. Further patient accrual is planned.