Measuring and Predicting Prostate Cancer Related Quality of Life Changes Using EPIC for Clinical Practice

• Type of Material: Article
• Authors: Jonathan J. Chipman, Dana-Farber Cancer Institute; Martin Sanda, Emory University; Rodney L. Dunn, University of Michigan; John T. Wei, University of Michigan; Mark S. Litwin, University of California Los Angeles; Catrina M. Crociani, Beth Israel Deaconess Medical Center; Meredith M. Regan, Dana-Farber Cancer Institute; Peter Chang, Beth Israel Deaconess Medical Center
• Language: English
• Date: 2014-03-01
• Publisher: Elsevier: Journal of Urology
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2014 by AMERICAN UROLOGICAL ASSOCIATION EDUCATION AND RESEARCH, INC.
• Final Published Version (URL): http://dx.doi.org/10.1016/j.juro.2013.09.040
• Title of Journal or Parent Work: Journal of Urology, The
• ISSN: 0022-5347
• Volume: 191
• Issue: 3
• Start Page: 638
• End Page: 645
• Grant/Funding Information: This work was supported in part by a grant from the UrologyCare Foundation Research Scholars Program and Dornier Medtech titled “Measuring Prostate Cancer Patient Reported Outcomes at the Point of Care”.; National Institutes of Health (R01 CA95662, RC1 CA146596).
• Keywords: INDEX COMPOSITE; VERSION; outcome assessment (health care); prostatic neoplasms; VALIDATION; INSTRUMENT; prostate; questionnaires; quality of life; Science & Technology; SURVIVORS; Life Sciences & Biomedicine; Urology & Nephrology
• Research Categories: Health Sciences, Public Health; Health Sciences, Health Care Management

Abstract

Purpose We expanded the clinical usefulness of EPIC-CP (Expanded Prostate Cancer Index Composite for Clinical Practice) by evaluating its responsiveness to health related quality of life changes, defining the minimally important differences for an individual patient change in each domain and applying it to a sexual outcome prediction model. Materials and Methods In 1,201 subjects from a previously described multicenter longitudinal cohort we modeled the EPIC-CP domain scores of each treatment group before treatment, and at short-term and long-term followup. We considered a posttreatment domain score change from pretreatment of 0.5 SD or greater clinically significant and p ≤0.01 statistically significant. We determined the domain minimally important differences using the pooled 0.5 SD of the 2, 6, 12 and 24-month posttreatment changes from pretreatment values. We then recalibrated an EPIC-CP based nomogram model predicting 2-year post-prostatectomy functional erection from that developed using EPIC-26. Results For each health related quality of life domain EPIC-CP was sensitive to similar posttreatment health related quality of life changes with time, as was observed using EPIC-26. The EPIC-CP minimally important differences in changes in the urinary incontinence, urinary irritation/obstruction, bowel, sexual and vitality/hormonal domains were 1.0, 1.3, 1.2, 1.6 and 1.0, respectively. The EPIC-CP based sexual prediction model performed well (AUC 0.76). It showed robust agreement with its EPIC-26 based counterpart with 10% or less predicted probability differences between models in 95% of individuals and a mean ± SD difference of 0.0 ± 0.05 across all individuals. Conclusions EPIC-CP is responsive to health related quality of life changes during convalescence and it can be used to predict 2-year post-prostatectomy sexual outcomes. It can facilitate shared medical decision making and patient centered care.