Quality of Life Research
Research into quality of life relative to chronic conditions has been an area of interest in recent years. With advances in technology, medications, procedures, and more in the healthcare field, people are receiving a higher standard of care than ever before. With these improvements has come an increase in the life expectancy for an average individual. On average, people are living an estimated six years longer than they were in the 1990’s, however, these additional years may often be riddled with chronic, debilitating conditions. The “healthy” life expectancy has also risen in recent years, but it has risen less than overall life expectancy that humans worldwide have gained.1
Although we are coming up with treatments and solutions to prolong life, the additional time gained may be filled with pain, uncomfortable or life-altering side effects, and other physical and emotional issues. While this issue may be mainly a concern for older men deciding between treating an illness at a later age, it is still pertinent to younger men battling chronic conditions.
With prostate cancer, there are often many opportunities to delay treatment if the cancer is suspected to be slow growing or to choose between several treatment options based on their impact to an individual’s overall quality of life (QoL). Impacts to QoL because of a condition or its treatment can be emotional, like depression, or physical in nature, such as loss of bladder or bowel control or sexual dysfunction, and can range in severity from minor frustrations to life-changing debilitations. Since there is such a wide range of factors involved, such as treatment options and ages of those with prostate cancer, there have been many different types of QoL studies, including the following:
Treatment options relative to their QoL impacts
Not all prostate cancer treatment options are considered equal when it comes to their side effects and long-lasting life changes. These potential life-changing issues may need to be taken into account when deciding how to treat your prostate cancer. For example, one study that looked into long-lasting QoL impacts relative to different treatment options found in general, those treated for their prostate cancer have a higher level of life-impacting sexual dysfunction when compared to those without treatment.
Further, the researchers found that different treatment options carried a higher risk of specific QoL impacts, such as radical prostatectomy being associated with adverse urinary QoL impacts, external-beam radiation being associated with adverse bowel and sexual adverse QoL impacts, and brachytherapy being associated with all three adverse impacts. Also, researchers concluded that adding hormones to these treatment options further decreased QoL.2
Treatment satisfaction as it relates to QoL
Another study investigated satisfaction with prostate cancer treatment, and found a strong association between satisfaction and higher QoL post-treatment. For example, those who had more adverse QoL impacts were found to be less satisfied with their treatment than those with fewer QoL impacts, even if the treatments in each group affected the cancer outcome similarly. The researchers concluded that health related QoL concerns, such as long term debilitating side effects post-treatment and fear of recurrence, were stronger predictors of whether or not an individual felt that their treatment was successful. These factors were even found to be stronger than any other factors, such as demographics like age, ethnicity, or education level.3
Weighing the decision to treat against QoL impacts
In some cases, prostate cancer may be found, but it is so slow growing, or non-aggressive that it could take years to become a significant problem for an individual. Although typically it makes sense to treat a cancer as soon as its been found, this isn’t always the case for prostate cancer. Even treatments that aren’t surgical or radiation-based can cause significant effects that have the potential to last long beyond the treatment window. For example, androgen deprivation therapy (hormone therapy) may be less intense than surgery or radiation, however, it still has its own significant side effects like hot flashes, psychological effects, loss of libido, impotence, and more. This is why there is a growing body of research dedicated to weighing the QoL costs of treatment against the decision to treat at all.
These investigations are especially important for older men with both aggressive and non-aggressive prostate cancer. In some cases, if an older man has prostate cancer, the time it would take for the cancer to become life threatening is longer than the individual’s remaining life expectancy. In these cases, treatment may just lead to a worse quality of life throughout the person’s remaining years. Even for those with very aggressive cancer later in life, there is a growing body of research that points towards not treating the cancer as well, since the treatment will typically decrease QoL, and will unlikely be able to cure the condition.4-6
Overall, research into QoL relative to treatment options, or making the decision whether or not to treat at all, is a growing field of research across many conditions, including prostate cancer. Your provider will be able to help predict what potential long-term side effects you are at risk for, and help you determine what treatment options are the best overall fit for your lifestyle and needs.