Patient-Reported Functional Outcomes After Hypofractionated or Conventionally Fractionated Radiation for Prostate Cancer: A National Cohort Study in England

Abstract

PURPOSE The aim of the current study was to determine patient-reported functional outcomes in men with prostate cancer (PCa) undergoing moderately hypofractionated (H-RT) or conventionally fractionated radiation therapy (C-RT) in a national cohort study. PATIENDS AND METHODS All men diagnosed with PCa between April 2014 and September 2016 in the English National Health Service undergoing C-RT or H-RT were identified in the National Prostate Cancer Audit and mailed a questionnaire at least 18 months after diagnosis. We estimated differences in patient-reported urinary, bowel, sexual, and hormonal function—Expanded Prostate Cancer Index Composite short-form 26 domain scores on a 0 to 100 scale—and health-related quality of life—EQ-5D-5L on a 0 to 1 scale—using linear regression with adjustment for patient, tumor, and treatment-related factors in addition to GI and genitourinary baseline function, with higher scores representing better outcomes. RESULTS Of the 17,058 men in the cohort, 77% responded: 8,432 men received C-RT (64.2%) and 4,699 H-RT (35.8%). Men in the H-RT group were older (age ≥ 70 years: 67.5% v 60.9%), fewer men had locally advanced disease (56.5% v 71.3%), were less likely to receive androgen-deprivation therapy (79.5% v 87.8%), and slightly more men had pretreatment genitourinary procedures (24.2% v 21.2%). H-RT was associated with small increases in adjusted mean Expanded Prostate Cancer Index Composite short-form 26 sexual (3.3 points; 95% CI, 2.1 to 4.5; P < .001) and hormonal function scores (3.2 points; 95% CI, 1.8 to 4.6; P < .001). These differences failed to meet established thresholds for a clinically meaningful change. There were no statistically significant differences in urinary or bowel function and quality of life. CONCLUSION This is the first national cohort study comparing functional outcomes after H-RT and C-RT reported by patients. These real-world results further support the use of H-RT as the standard for radiation therapy in men with nonmetastatic PCa.

Evaluation of Hypofractionated Radiation Therapy Use and Patient-Reported Outcomes in Men With Nonmetastatic Prostate Cancer in Australia and New Zealand

“…These real-world results are in keeping with the Conventional or Hypofractionated High Dose Intensity Modulated Radiotherapy in Prostate Cancer (CHHiP) and Radiation Therapy Oncology Group 0415 studies that found no clinically meaningful differences in PROs between HRT and CRT. 18 , 19 The proportion of men reporting moderate or big urinary or bowel bother was less than 10% and was consistent with the CHHip study. 20 A national cohort study from England 18 also reported no differences in EPIC-26 urinary and bowel function between men receiving HRT or CRT, with mean scores in the order of 86 across the domains and consistent with the findings in this cohort study.…”

Health-related quality of life in men with localized prostate cancer treated with radiotherapy: validation of an abbreviated version of the Expanded Prostate Cancer Index Composite for Clinical Practice in Spain

“…In future, the validated Spanish EPIC-16 could be utilized in a larger-scale analysis with more longitudinal components to further assess PROs comparing different types of radiation therapies, similar to what has been recently done for EPIC-26 by Nossiter, et al [ 23 ].…”

Value-based radiotherapy: A new chapter of the ESTRO-HERO project

“…Reducing the number of radiotherapy fractions, but achieving the same health outcomes across the life cycle, would be a high value intervention given the reduction in resource costs of treatment delivery and in treatment burden with potential quicker return to previous activities. Furthermore, some hypofractionated treatments may result in reduced toxicities, which over the cancer care cycle is likely to decrease healthcare and societal costs by lower need for interventions to manage these complications, or to enable individuals to partake in work and day to day activities [23,24].…”