Quality of life of patients with prostate cancer and their spouses. The value of a data base in clinical care

BACKGROUND: Because of the dearth of information concerning the quality of life of patients with prostate cancer, a data base was established to examine the nature and extent of problems in patients' and spouses' adaptation and their interrelationships and to examine the effect of disease stage combined with treatment regimen on patients' quality of life. METHODS: One hundred seventy-two patients and 83 spouses/partners completed quality of life questionnaires in a prostate cancer health education lecture series. The measures used were the European Organization for Research and Treatment of Cancer (EORTC) Prostate Cancer Quality of Life Questionnaire, the Intrusion subscale (IS) of the Impact of Event Scale; and Selby's QL Uniscale. Fifty-five percent of patients had received medical and/or surgical hormonal therapy, 28% had received a radical prostatectomy and/or radiation therapy only, and 18% had not been placed on any treatment. RESULTS: Patients experiencing problems in adaptation were significantly more likely to have advanced stage disease; received surgical or medical hormonal therapy; and were reporting greater pain, fatigue, urinary problems, and deteriorating physical functioning. Spouses reported significantly greater psychological distress than did patients (EORTC Psychological Distress subscale, P < 0.001; IS, P < 0.001). CONCLUSIONS: A two-stage clinical evaluation is recommended, in which quality of life questionnaires would initially be used to identify patients and spouses experiencing problems in adaptation for further evaluation by a mental health professional for appropriate treatment.