Findings from the EUPROMS study were reported by Mr. André Deschamps (Chairman of Europa Uomo, Antwerp, Belgium)1. This study represents the first patient-driven quality-of-life (QoL) data collection and revealed specific long-term complaints correlating with a given treatment.
Europa Uomo is an umbrella organization of European prostate cancer patient groups, which practices evidence-based patient advocacy and is active in the EAU policy making regarding patient representation. When evidence is lacking with regard to patient experience, organizations like Europa Uomo fill a critical gap in generating independent patient-reported outcomes.
In this case, the EUPROMS patient-driven QoL study included data from 2,943 men treated for prostate cancer (mean age 70 years at survey, mean age 64 years at diagnosis), from 24 countries. Participants were asked to complete a 20-minute online survey to assay QoL of patients with or who had been treated for prostate cancer. The study used validated QoL questionnaires (EPIC-26, EORTC-QLQ-C30, and EQ-5D-5L) available in 19 languages. Of the respondents, 2/3 received 1 treatment for prostate cancer, 22% received 2 treatments, 19% received 3, and 2% received 4 or more.
Fatigue and insomnia topped the complaints impacting QoL among participants. The data revealed that half of all respondents scored loss of sexual function (including the ability to have an erection or reach orgasm) as a “big” (28%) or “moderate” (22%) problem. Notably, the adverse impact of radiotherapy on sexual function was worse than that of radical prostatectomy. Alternatively, patients who underwent radical prostatectomy reported increased urinary incontinence than those undergoing radiation therapy. Radiation therapy doubled the reported fatigue compared with radical prostatectomy. Chemotherapy also led to an increase in reported fatigue. Insomnia appeared to be a function of progression of the disease rather than the treatment received, except for chemotherapy, which did cause a marked increase in reported insomnia. Active surveillance had no impact on insomnia. As anticipated, chemotherapy resulted in the worst QoL outcomes.
Mr. Deschamps concluded, “The data collected and the analysis done provide patients and healthcare professionals a snapshot on the impact of treatments based on the experiences of fellow patients. We hope that these results will be used to establish and disseminate realistic expectations on the effects of the different treatments for prostate cancer on quality of life.”
Discussant Prof. Steven Joniau (University Hospital Leuven, Belgium) complimented the strengths of this study as being the large sample size, assessment at long-term follow-up (mean 6 years post-diagnosis), and the use of validated questionnaire instruments. Weaknesses include the cross-sectional design, lack of a baseline assessment, and observational design. He continued to point out that because younger and healthier patients more likely underwent surgery and older, less healthy patients likely received radiation therapy, better insight into the baseline patient characteristics would help tease out relevant hypothesis-generating observations.
1. Deschamps A, et al. The real effect of prostate cancer treatment: EUPROMS study first patient driven quality of life study ever. 2020 European Association of Urology Virtual Congress. July 17-26, 2020. Game-changing Session 3.