Trajectories of quality of life, life satisfaction, and psychological adjustment after prostate cancer

Abstract

Background: To describe trajectories of health-related quality of life (QoL), life satisfaction, and psychological adjustment for men with prostate cancer over the medium to long term and identify predictors of poorer outcomes using growth mixture models.

Methods: One-thousand sixty-four (82.4% response) men diagnosed with prostate cancer were recruited close to diagnosis and assessed over a 72-month (6-year) period with self-report assessment of health-related QoL, life satisfaction, cancer-related distress, and prostate specific antigen anxiety. Urinary, bowel, and sexual function were also assessed using validated questionnaires.

Results: Poorer physical QOL was predicted by older age, lower education, lower income, comorbidities, and receiving hormone therapy. Lower life satisfaction was related to younger age, lower income, not being partnered, and comorbidities. Poorer psychological trajectories were predicted by younger age, lower income, comorbidities, and receiving radical prostatectomy or brachytherapy. Better urinary, bowel, and sexual function were related to better global outcomes over time. Anxiety about prostate specific antigen testing was rare.

Conclusions: Distinct trajectories exist for medium- to long-term QoL, life satisfaction, and psychological adjustment after prostate cancer; with age and socioeconomic deprivation playing a differential role in men's survivorship profile and the impact of functional status on outcomes increasing over time. These results reinforce the need for an appraisal of men's life course in addition to treatment side effects when planning survivorship care after cancer.

Keywords: cancer; longitudinal; oncology; prostate; psychological distress; quality of life.

Figure 1

Trajectory patterns identified using growth mixture models: A, quality of life SF36, physical health domain (N = 928); B, quality of life SF36, mental health domain (N = 928); C, satisfaction with life (SWL) score (N = 928); D, cancer‐related distress revised impact of event scale (RIES) score (N = 934)

Figure 2

Effects from the expanded prostate cancer index composite (EPIC) urinary, bowel, and sexual functions on A, SF36 physical health, B, SF36 mental health, C, satisfaction with life (SWL), and D, revised impact of event scale (RIES): a positive value of effects means that a higher EPIC function increases the score of the outcome variable, while a negative value indicates that a higher EPIC function decreases the score of the outcome variable