Differences in Urologist and Patient Assessments of Health Related Quality of Life in Men With Prostate Cancer: Results of the Capsure Database

PURPOSE: We determine whether urologists caring for men with prostate cancer accurately captured the nuances of quality of life, as disclosed by patients in validated, self-administered health related quality of life instruments. MATERIALS AND METHODS: We analyzed information on 2,252 patients 42 to 95 years old enrolled in CaPSURE, a large, observational cancer of the prostate strategic urological research endeavor database, in which men with all stages of prostate cancer are followed quarterly with standardized validated written surveys to assess clinical parameters, symptoms and health related quality of life. At each visit urologists recorded Karnofsky performance status rating and the presence or absence of various symptoms, such as fatigue, pain and dysfunction in the sexual, urinary and bowel domains. Within 30 days of the visit patients independently completed self-administered health related quality of life instruments, including the RAND 36-Item Health Survey and University of California, Los Angeles Prostate Cancer Index, in which scores of 80 to 100 and 0 to 79 were interpreted as absence of impairment and moderate to severe impairment, respectively. Using chi-square analysis we compared symptoms, as recorded by the urologist, with health related quality of life impairment in relevant domains, as reported by the patient. RESULTS: Significant differences (p < or = 0.002) were noted between physician and patient assessment of clinical domains, such as physical, sexual, urinary and bowel function, fatigue and bone pain. In all domains urologists underestimated patient symptoms, causing health related quality of life impairment. CONCLUSIONS: In men with early stage and advanced prostate cancer physician ratings of patient symptoms do not correlate well with patient self-assessments of health related quality of life. Hence, urologists should attempt to elucidate more completely the components of patient quality of life after the diagnosis and treatment of prostate cancer.