Health related quality of life among prostate cancer patients on androgen deprivation therapy treated in Mulago hospital and Uganda cancer institute.

Abstract

BACKGROUND: The incidence of prostate cancer in Uganda increases by 5.2% annually. Majority of patients are diagnosed with advanced disease that is only managed with palliation using Androgen Deprivation Therapy (ADT). There is a dearth of information on ADT treatment outcomes and health related quality of life(HRQoL). The study assessed HRQoL among prostate cancer patients on ADT. OBJECTIVE: The aim of the study was to assess the health related quality of life among prostate cancer patients on androgen deprivation therapy treated in Mulago hospital and Uganda Cancer Institute. METHODS: This was a comparative cross sectional study, recruiting patients on both forms of androgen deprivation therapy (medical and surgical castration) as cases against an age matched reference group of men without prostate cancer and another group involving prostate cancer patients not on any cancer therapy. The generic HRQoL was assessed using the medical outcomes survey short form 8 (SF-8), and the cancer specific domains were assessed using the Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP). Both tools have been validated and used widely. The means and Standard deviations of patient reported outcomes per group were reported. We tested differences of HRQoL scores across groups using ANOVA. To assess which groups are statistically significant from each other, a post hoc test was performed. Clinical relevance of observed differences was assessed with differences ≥0.5 SD considered clinically relevant. Results were presented using frequency tables and bar graphs.

Results: Mean age was 70.6 ±7.4 years. and majority 66 (51%) educated above secondary level. The cases on ADT demonstrated a considerable decrease in HRQOL against control groups and the comparison was significant at 95% CI ((-26.16, -14.950 OR -20.55 with p value ˂0.001. There were generally higher HRQOL scores among the surgical castration group compared to the medical castration group. Both general and disease specific quality life scores reduced within 6 months of commencement of treatment; however there was a relative improvement thereafter with statistical significance at 95% CI (p Value 0.004 and 0.001 respectively) Conclusion There was a significant reduction in HRQOL in all domains among patients on ADT with worse scores among the medical castration group