The Effect of Comorbidity and Socioeconomic Status on Sexual and Urinary Function and on General Health-Related Quality of Life in Men Treated with Radical Prostatectomy for Localized Prostate Cancer

INTRODUCTION: Different treatments for localized prostate cancer (PCa) may be associated with similar overall survival but may demonstrate important differences in health-related quality of life (HRQOL). Therefore, valid interpretation of cancer control outcomes requires adjustment for HRQOL. AIM: To assess the effect of comorbidity and socioeconomic status (SES) on sexual and urinary function as well as general HRQOL in men treated with radical prostatectomy (RP) for PCa. METHODS: We sent a self-addressed mail survey, composed of the research and development short form 36-item health survey, the PCa-specific University of California at Los Angeles (UCLA) Prostate Cancer Index (PCI), as well as a battery of items addressing SES and lifetime prevalence of comorbidity, to 4,546 men treated with RP in Quebec between 1988 and 1996. MAIN OUTCOME MEASURES: The association between comorbidity, SES, and HRQOL was tested and quantified using univariable and multivariable linear regression models. RESULTS: Survey responses from 2,415 participants demonstrated that comorbidity and SES are strongly related to sexual, urinary, and general HRQOL in univariable and multivariable analyses. In multivariable models, the presence of comorbid conditions was associated with significantly worse HRQOL, as evidenced by lower scale scores by as much as 17/100 points in general domains, and by as much as 10/100 points in PCa-specific domains. Favorable SES characteristics were related to higher general (up to 9/100 points) and higher PCa-specific (up to 8/100 points) HRQOL scale scores. CONCLUSIONS: Comorbidity and SES are strongly associated with sexual, urinary and general HRQOL.