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NY Prostate Cancer Conference - M. Litwin - Session 6: Documenting outcomes with patient reported questionnaires
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NY Prostate Cancer Conference - M. Litwin - Session 6: Documenting outcomes with patient reported questionnaires

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  • Again, the SF-36 scales run from 0-100 with higher scores representing better outcomes. Physical function was similar between groups.
  • Men undergoing brachytherapy had substantially worse AUASI scores that persisted, even a year after treatment.

NY Prostate Cancer Conference - M. Litwin - Session 6: Documenting outcomes with patient reported questionnaires   NY Prostate Cancer Conference - M. Litwin - Session 6: Documenting outcomes with patient reported questionnaires Presentation Transcript

    • Documenting Outcomes with
    • Patient-Reported Questionnaires
    Mark S. Litwin, MD, MPH Professor of Urology and Public Health
  • Outcomes of care
    • Mortality
    • Morbidity and complications
    • “ Objective” clinical variables (PSA)
    • Patient - centered outcomes
      • Health - related quality of life (HRQOL )
      • Patient satisfaction
      • Costs and resource utilization
  • Health - related quality of life
    • WHO definition of health (1948)
    • Health is not merely the absence of disease, but a state of complete physical, emotional, and social well-being
  • Purposes of Prostate Cancer Treatment
    • Maximize
    • Quantity of life “length”
    • Quality of Life “breadth”
  • Outcomes Research Objectives
    • To assess treatment efficacy
    • To help determine whether goals of treatment have been met
    • To inform medical decision making
    • To provide the defining issue if treatments are otherwise equivalent
  • Outcomes Measurement
    • Surveys Instruments
    • Questions Items
    • Scales Domains
    • Scoring 0 - 100
  • Outcomes Measurement
    • Psychometric properties
      • Reliability
      • Validity
      • Responsiveness
  • Quality of Life the defining issue in prostate cancer
    • General domains
      • Physical function
      • Mental health
      • Social interactions
      • Role performance
    • Disease - specific domains
      • Worry about recurrence
      • Appetite, Weight loss, etc
      • Fatigue
      • Urinary, Sexual, Bowel
    FUNCTION vs BOTHER
  • QOL Instruments for Prostate Cancer
    • General domains
    • RAND SF-36 (scored 0 - 100)
    • Physical Mental
      • Pain Social
      • General Vitality / Fatigue
    • EORTC QLQ - C30
    • Physical, Emotional, Cancer Domains
    • FACT General
    • Physical, Emotional, Cancer Domains
    • Others
  • QOL Instruments for Prostate Cancer
    • Prostate Cancer Domains
    • UCLA Prostate Cancer Index (PCI)
      • Litwin et al, JAMA 1995
    • Expanded Prostate Cancer Index Composite (EPIC)
      • Sanda et al, Urology 2000
    • EORTC QLQ - C30 Prostate Module
    • Borghede et al, Qual Life Res 1996
    • FACT - P
      • Esper et al, Urology 1997
    • Others
  • Prostate cancer QOL instruments
    • UCLA Prostate Cancer Index
    • Self – administered, written
    • 20 items
    • 6 Scales (scored 0 - 100)
      • Urinary function and bother
      • Sexual function and bother
      • Bowel function and bother
    • Used with SF – 36
    • 15-item short form
    • EPIC
    • Self – administered, written
    • 50 items
    • 6 Scales (scored 0 - 100)
      • Urinary function and bother
      • Sexual function and bother
      • Bowel function and bother
      • Hormonal
    • Used with SF – 36
    • 26-item short form
  • Doctor or patient perspective Physician vs Patient perception of QOL impairment Sonn, J Urol 2009 n = 1,366
  • Doctor or patient perspective Physician vs Patient perception of QOL impairment Sonn, J Urol 2009 n = 1,366
  • National longitudinal QOL Cohort Sanda, NEJM 2008 n = 1,201
  • UCLA longitudinal QOL cohort SF-36 Physical Composite Litwin, Cancer 2007 n = 580
  • UCLA longitudinal QOL cohort PCI Sexual Function % Return to baseline Litwin, Cancer 2007 n = 580
  • Documenting outcomes with patient-reported questionnaires
      • Principles
      • Use validated instruments
      • Rely on patient self assessment
      • Track outcomes longitudinally
      • Use general & disease – specific measures
      • Interpret outcomes in context of patient’s own baseline
  • Websites for further information on patient-reported outcomes proqolid.org outcomes.cancer.gov sf-36.org