Self-Reported Burden in Elderly Patients With Localized Prostate Cancer Treated With Stereotactic Body Radiation Therapy (SBRT)

Abstract

Retaining quality of life in patients treated with SBRT for prostate cancer remains paramount. As such, balancing the benefits of treatment against the effects of therapy on elderly patients is essential. The EORTC QLQ-ELD14 (ELD-14) is a validated questionnaire with a domain dedicated to burden of illness and treatment in the elderly. The Expanded Prostate Cancer Index Composite (EPIC)-26 is a validated questionnaire which measures urinary, bowel, sexual, and hormonal symptoms. This study reports trends in self-reported burden in patients with prostate cancer treated with SBRT and reveals convergence of self-reported burden with treatment related side effects obtained from the EPIC-26 questionnaire. Methods: All patients ≥70 years old, with localized prostate cancer treated with SBRT ± ADT at Medstar Georgetown University Hospital from 2013 to 2018 and had completed the ELD-14 were eligible for inclusion in this cross-sectional cohort study. Percentage of responses to questions related to disease and treatment burden were counted for each category ("not at all" and "a little" vs. "quite a bit" and "very much"). Additional demographic features were derived from available medical records. A total of 111 patients (median age of 74) responded to the ELD-14 questionnaire at onset of treatment and at the 2-year mark. Responses to EPIC questionnaires at matched follow-ups were scored and correlated with the self-reported burden domain of the ELD-14 using the Spearman correlation coefficient. Results: Number of patients reporting "quite a bit" or "very much" burden from prostate cancer was 6.3% prior to treatment. This was highest at 1-month (10.8%) and decreased to 9.0% at 24 months post-SBRT (X 2 = 3.836, p = 0.6986). By comparison, 3.6 and 5.4% reported "quite a bit" or "very much" burden from treatment at start of treatment and 24 months, respectively (X 2 =1.046, p = 0.9838). Patient reported treatment burden was found to converge well with individual domains of EPIC-26. Patients undergoing ADT experienced more burden than their non-ADT counterparts. Aghdam et al. Treatment Burden From Prostate SBRT Conclusions: This cross-sectional study suggests a minority of patients reported high burden from their clinically localized prostate cancer or from their SBRT treatment. Self-reported burden converged well with lower EPIC scores in multiple domains.

Irradiation of localized prostate cancer in the elderly: A systematic literature review

“…The consistent results of these studies, most of which are getting old and use 3D, suggest a legitimate benefit in treating elderly patients with radical radiotherapy. This is even truer now, particularly with the advent of new techniques such as IMRT or stereotactic body radiation therapy (SBRT) that allow dose escalation [29] .…”

“…Nguyen et al reported the outcomes of 206 pts (MA 72.4y), with intermediate to high-risk PC treated with EBRT (70 Gy) vs EBRT + ADT (6 months) [29] . The authors showed a significant decrease in 8-year mortality with ADT (16.5% vs 41.4%) in the elderly with no/mild comorbidities but a deleterious effect in those who presented moderate/severe comorbidities [36] .…”

Protocol of a randomised, controlled trial comparing immediate curative therapy with conservative treatment in men aged ≥75 years with non‐metastatic high‐risk prostate cancer (SPCG 19/GRand‐P)

“…A recent article by Aghdam et al. [29] reported trends in self‐reported burden (ELD14) in a sample of 111 patients aged >70 years with PCa treated with stereotactic body RT between start of the treatment and 24 months. During this time period, they observed an average change of −5.6 units in a total ELD‐14 burden score (burden of treatment and illness).…”

“…It can be assumed that at the time of the evaluation at 36 months, there are negligible treatmentrelated mortality differences between the arms, and thus any missing values in HRQoL scores caused by death are equally distributed across the arms. A recent article by Aghdam et al [29] reported trends in self-reported burden (ELD14) in a sample of 111 patients aged >70 years with PCa treated with stereotactic body RT between start of the treatment and 24 months. During this time period, they observed an average change of À5.6 units in a total ELD-14 burden score (burden of treatment and illness).…”

Testosterone as a Biomarker for Quality of Life (QOL) Following Androgen Deprivation Therapy (ADT) and Stereotactic Body Radiotherapy (SBRT)

“…Treatment is well-tolerated and toxicity is low even in elderly patients [ 3 - 4 ]. Testicular scatter results in small (10%-30%) transient testosterone declines that do not impact fatigue or sexual function [ 5 - 6 ].…”